Perry: Chapter 5: Infertility, Contraception and Abortions EAQ

While assessing a patient, the nurse finds that the patient's shortest and longest amount of time between menstrual periods is 25 and 28 days, respectively. The nurse teaches the patient the method to calculate the fertile period. The nurse then asks the patient which day carries the maximum chances of conception. Which response by the patient indicates effective learning? 1 2nd day 2 6th day 3 10th day 4 19th day

3 In the calendar rhythm method, the fertile period is calculated by subtracting 18 days from the shortest amount of time between menstrual periods and subtracting 11 from the longest amount of time between menstrual periods. The patient's fertile period would last from 25 - 18 = 7 days to 28 - 11 = 17 days. Therefore, on the 10th day, there would be maximum chances of conceiving. Ovulation might not happen on the second and the sixth day; therefore, chances of conception are less. The ovum may not be viable till the 19th day; therefore, conception may not happen.

The nurse is assessing a 37-year-old patient with secondary infertility. While reviewing the patient's laboratory reports, the nurse finds that the patient has a reduced ovarian reserve. Which laboratory report would the nurse have reviewed? 1 Prolactin hormone levels 2 Thyroxine hormone levels 3 Follicle-stimulating hormone levels 4 Human chorionic gonadotropin levels

3 Ovarian reserve refers to the number of viable ova that remain in the ovaries. To assess the ovarian reserve of the patient, the nurse should check the levels of follicle-stimulating hormones on the third day of menstruation. Thyroxine levels indicate the presence of thyroid dysfunction. Although prolactin levels also contribute to anovulation, the follicle-stimulating hormone (FSH) level is considered the primary assessment standard for determining ovarian reserve. Human chorionic gonadotropin hormone levels are used in determining if a patient is pregnant as they are elevated during pregnancy.

A patient is administered progestins (Depo-Provera) through the intramuscular route. What should the nurse suggest that the patient increase to prevent complications? 1 Iron intake 2 Protein intake 3 Calcium intake 4 Potassium intake

3 Patients who take progestins such as depot medroxyprogesterone acetate (Depo-Provera) may lose significant bone mineral density, which may cause osteoporosis in time. Therefore, the nurse should recommend increasing the daily calcium intake for patients who are on progestins. Iron intake is encouraged in the patients who are anemic; progestins do not cause anemia. Progestins do not affect the protein and potassium levels in the body. Therefore, the nurse need not suggest that the patient eat a diet rich in protein or potassium.

After having a discussion with a patient, the nurse finds that the patient has regular menstrual cycles every 28 days. What instructions should the nurse give to the patient to prevent conception? 1 The couple should abstain from sexual intercourse from days 6 through 19. 2 It is safe to have unprotected sexual intercourse from days 11 through 17. 3 It is safe to have unprotected sexual intercourse from days 12 through 16. 4 The couple should abstain from sexual intercourse from days 10 through 17.

4 The patient has regular menstrual cycles of 28 days. The beginning of the fertile period is estimated by subtracting 18 days from the length of the shortest cycle. The end of the fertile period is determined by subtracting 11 days from the length of the longest cycle. Therefore, according to the formula, the fertile days are from day 10 through day 17 (shortest cycle, 28 - 18 = day 10, and longest cycle, 38 - 11 = day 17). Therefore, the nurse should advise the patient to abstain from sexual intercourse between days 10 and 17. If the woman has a shortest cycle of 24 days and a longest cycle of 30 days, then the couple should abstain from sexual intercourse from days 6 through 19. As per the calculation, women who have regular cycles of 28 days should not have unprotected sexual intercourse between days 11 and 17 and days 12 through 16 because it is a fertile period.

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). The nurse instructs her that this medication is administered in which form? 1 Tablet 2 Intranasal spray 3 Vaginal suppository 4 Intramuscular injection (IM)

4 Urofollitropin is given by intramuscular injection; the dosage may vary. Intranasal spray is not the appropriate route for urofollitropin. Vaginal suppository is not the correct route for urofollitropin. Urofollitropin cannot be given by tablet; it is given only by IM injection.

A man and a woman who have not achieved a successful pregnancy are scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed? 1 Semen analysis 2 Testicular biopsy 3 Endometrial biopsy 4 Hysterosalpingogram

1 Semen analysis is usually the first test to be performed because it is least costly and noninvasive. A testicular biopsy is an invasive examination using a local anesthetic. Endometrial biopsy determines whether the endometrium is responding to ovarian stimulation. Hysterosalpingogram uses contrast medium to evaluate the structure and patency of the uterus and tubes.

The nurse is assessing a 36-year-old patient, who is planning for a second pregnancy. After reviewing the patient's medical record, the nurse provides information about the egg donation process to the patient. What would be the reason for providing this information to the patient? 1 The patient has age-related infertility. 2 The patient has congenital disorders. 3 The patient has premature ovarian failure. 4 The patient suffers from reduced fecundity.

1 The estrogen hormone levels reduce in a 36-year-old patient. This causes age-related infertility due to reduced production of ovum (egg) from the ovaries. During this condition, the nurse can guide the patient by informing her about fertilization treatments like egg donation. Fecundity means the ability to reproduce eggs. Since the patient has already had a pregnancy, the patient does not have reduced fecundity. If the patient has congenital abnormalities, then the nurse would suggest surrogate motherhood or adoption. Premature ovarian failure is observed in females who are below 30, not in a 36-year-old.

The nurse administers mifepristone (Mifeprex) to a patient in the first trimester for an abortion. The nurse then instructs the patient to return for a follow-up visit in 2 days to receive a 400 mcg dosage of misoprostol (Cytotec). How long after the last menstrual period is it safe to use these medications? 1 7 weeks 2 9 weeks 3 12 weeks 4 16 weeks

1 The patient is undergoing an abortion during the first trimester by a medical method. The nurse instructs the patient to return in 2 days to receive the dosage of misoprostol (Cytotec). According to Food and Drug Administration (FDA) guidelines, the patient must be given mifepristone (Mifeprex) on the first day of treatment. This drug can be administered up to 7 weeks after the last menstrual period. If it has been longer than 7 weeks (9, 12, or 16 weeks) since the patient's last menstrual period, the patient will need to undergo a surgical method of abortion as the fetus cannot be aborted by administering mifepristone (Mifeprex) and misoprostol (Cytotec). This method is not recommended for abortion during the second trimester.

What are the symptoms of toxic shock syndrome? Select all that apply. 1 Sore throat 2 Constipation 3 Decrease in libido 4 Arthralgia and myalgia 5 Sudden onset of high fever

1, 4, 5 Toxic shock syndrome can happen with the use of a contraceptive diaphragm. Sore throat, sudden fever, and aching muscles and joints (arthralgia and myalgia) are symptoms of toxic shock syndrome. Toxic shock syndrome causes diarrhea, not constipation. The toxic shock syndrome is unrelated to decreased libido.

The nurse is assessing a patient who is planning to conceive. While reviewing the patient's laboratory reports, the nurse notices a decrease in hypothalamic hormone levels. What should the nurse interpret from this? 1 The patient demonstrates impairment in fallopian factors. 2 The patient will not be able to successfully produce any ova. 3 The patient has a family history of fetal hemorrhagic disorders. 4 The patient has an increased risk of fetal congenital anomalies.

2 The hypothalamus secretes thyrotropin-releasing hormones, corticotrophin-releasing hormones, gonadotropin-releasing hormones, and growth hormones. Among these, gonadotropin-releasing hormones (GnRH) and thyrotropin-releasing hormones play an important role during pregnancy. The hormones stimulate the gonads to produce ova in females and sperms in males. Therefore, low hypothalamic hormones indicate that the formation of ova is affected in the patient. Impaired fallopian factors cannot be interpreted based on the low hypothalamic hormones, as it requires further evaluation. Congenital anomalies and hemorrhagic disorders are caused by genetic abnormalities in the fetus. They are not influenced by maternal hormone levels.

A patient is prescribed griseofulvin (Fulvicin P/G) for the treatment of ringworm. After reviewing the medical history of the patient, the nurse finds that the patient is taking oral contraceptives. What advice should the nurse give to the patient? 1 "Take both medications simultaneously." 2 "Use a double dose of oral contraceptive." 3 "Use other forms of contraceptive methods." 4 "Take a lower dose of griseofulvin (Fulvicin P/G)."

3 Griseofulvin (Fulvicin P/G) reduces the efficacy of oral contraceptives. Therefore, to prevent pregnancy, the nurse should advise the patient to use other contraceptive methods while taking griseofulvin (Fulvicin P/G). The patient should not take a double dose of oral contraceptives as it may cause drug overdose and may cause adverse effects in the patient. Lowering the dose of griseofulvin (Fulvicin P/G) may not eliminate the ringworm infection. Griseofulvin (Fulvicin P/G) diminishes the action of oral contraceptives. Therefore, the patient should not take oral contraceptives and griseofulvin (Fulvicin P/G) simultaneously.

Which response by the nurse is most appropriate when a woman asks, "What contraceptive do you think I should use?" 1 "Your health care provider will know what is best for you." 2 "The male condom is probably the easiest for you to use." 3 "I can discuss the various methods so you can decide what is best for you." 4 "Because you are younger than 40, you should use oral contraceptives."

3 The nurse should provide the woman with all the necessary information to make an informed decision but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her.

The nurse is assessing a couple for infertility problems. After reviewing the patient's history and laboratory results, the nurse finds that the patient is being treated with clomiphene (Milophene). However, there has not been an increase in the sperm count. What else could be added to the prescription that would help the patient to increase the sperm count? 1 Bromocriptine (Parlodel) 2 Progesterone (Prometrium) 3 Intracytoplasmic sperm injection (ICSI) 4 Depot medroxyprogesterone acetate (DMPA)

3 The patient may require intracytoplasmic sperm injection (ICSI). This treatment is preferred for treating patients who have a low sperm count or reduced spermatogenesis. In this process, one sperm cell is selected and injected directly into the egg to achieve fertilization. Bromocriptine (Parlodel) is used to reduce excess prolactin levels. Progesterone (Prometrium) is used for the treatment of endometriosis. Progestin (DMPA) injections are used to impair fertility by inhibiting ovulation. These medications are not prescribed for infertility problems in males.

A 26-year-old woman is considering Depo-Provera as the contraception that is best for her because she does not like to worry about taking a pill every day. To assist this woman with decision making concerning this method of contraception, what should the nurse tell her about Depo-Provera? 1 It is a combination of progesterone and estrogen. 2 It is a small adhesive hormonal birth control patch that is applied weekly. 3 It has an effectiveness rate in preventing pregnancy of 96% when used correctly. 4 It thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation.

4 In addition to the changes in the cervical mucus, some but not all ovulatory cycles are suppressed, and formation of an endometrium capable of supporting implantation is inhibited. Depo-Provera is a progestin-only form of hormonal contraception. Depo-Provera is administered as an intramuscular injection. The effectiveness rate is 99% or greater over 5 years.

On interacting with a patient, the nurse finds that the patient uses lubricants that contain nonoxynol-9 (N-9) at least twice a day. The nurse instructs the patient to not use N-9. What is the reason for giving such advice to the patient? 1 Because frequent use of this medication reduces bone mineral density and causes osteoporosis 2 Because frequent use of this medication can cause a significant decrease in the patient's libido 3 Because frequent use of this medication raises the patient's risk of sexually transmitted infections 4 Because frequent use of this medication increases the patient's progesterone and estrogen levels

3 Nonoxynol-9 is a surfactant and is used as a lubricant. This chemical has spermicidal properties and reduces the mobility of sperm. This chemical attacks the flagella and body of the sperm, thereby preventing the sperm from reaching the cervical os. Frequent use of nonoxynol-9 places the patient at a higher risk for sexually transmitted infections as it decreases immunity and can cause lesions in the anus. Nonoxynol-9 does not decrease libido and does not increase progesterone or estrogen levels. Nonoxynol-9 does not decrease bone mineral density. Depot medroxyprogesterone acetate, used as a contraceptive, decreases bone mineral density in females and increases the risk of osteoporosis.

A woman undergoing evaluation of infertility states, "At least when we're through with all of these tests, we will know what is wrong." What is the nurse's best response? 1 "I know the test will identify what is wrong." 2 "I'm sure that once you finish these tests your problem will be resolved." 3 "Even with diagnostic testing, infertility remains unexplained in about 20% of couples." 4 "Once you've identified your problem, you may want to look at the option of adoption."

3 Problems with infertility must be approached realistically. Nurses should not make judgments or give false reassurance. Providing accurate information to the couple is the best response. The nurse should not make statements indicating that problems will be resolved, because this gives a false impression. The tests are not always definitive, so the nurse should not give false reassurance. The nurse should not offer her opinion but instead should state the facts.

When using the basal body temperature method of family planning, what should the woman know? 1 She will remain fertile for five days after ovulation. 2 She should take her temperature each night before going to bed. 3 Her temperature will increase about 0.4° to 0.8° F after ovulation. 4 Her temperature is normally lower during the second half of her cycle.

3 The basal body temperature will increase about 0.4° to 0.8° F when ovulation occurs. The woman is fertile for up to 18 days. She should take her temperature upon rising in the morning. A woman's temperature is usually higher in the second half of her cycle.

Which contraceptive method is contraindicated in a woman with a history of toxic shock syndrome? 1 Condom 2 Spermicide 3 Cervical cap 4 Oral contraceptives

3 The cervical cap may increase the risk of toxic shock syndrome because it may be left in the vagina for a prolonged period. A condom is not contraindicated with a history of toxic shock syndrome. Spermicide is not contraindicated with a history of toxic shock syndrome. Oral contraceptives are not contraindicated with a history of toxic shock syndrome.

After reviewing the laboratory results of a patient, the nurse finds that the levels of follicle-stimulating hormone (FSH) are less than 10. What should the nurse interpret from the laboratory report? 1 The patient has spinnbarkeit present in the cervix. 2 The progesterone levels are markedly decreased. 3 The patient has adequate ovarian follicles in reserve. 4 Pregnancy is impossible with the patient's own eggs.

3 The laboratory reports of the patient suggest that the level of FSH is less than 10. It implies that the patient has adequate ovarian follicles on reserve. Spinnbarkeit is a condition found during the ovulation stage. During this stage, the mucus becomes thick and abundant. Based on the levels of follicle-stimulating hormone, the nurse cannot conclude that the patient has low levels of progesterone. The nurse should suggest a serum progesterone test to the patient to measure level of progesterone. High FSH levels (greater than 20) indicate that pregnancy will not occur with the woman's own eggs.

What should discharge instructions after tubal ligation include? Select all that apply. 1 Expecting heavier menstrual periods 2 Using two forms of birth control to prevent pregnancy 3 Using condoms to prevent sexually transmitted infections 4 Being prepared for significant mood swings due to hormonal influences 5 Not expecting change in sexual functioning but possibly enjoying sex more because of no need to be concerned about pregnancy

3, 5 Patient teaching regarding what to expect after tubal ligation includes: You should expect no change in hormones and their influence. Your menstrual period will be about the same as before the sterilization. You may feel pain at ovulation. The ovum disintegrates within the abdominal cavity. It is highly unlikely that you will become pregnant. You should not have a change in sexual functioning; you may enjoy sexual relations more because you will not be concerned about becoming pregnant. Sterilization offers no protection against sexually transmitted infections. Therefore, you may need to use condoms.

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the woman in which herbal preparations to avoid while trying to conceive? 1 "Herbs have no bearing on fertility." 2 "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." 3 "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." 4 "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive."

4 Nettle leaf, dong quai, and vitamin E promote fertility. Vitamin E, calcium, and magnesium may promote fertility and conception. Although most herbal remedies have not been proven clinically to promote fertility, women should avoid the following herbs while trying to conceive: licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle.

A male patient asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). What is the nurse's most appropriate response? 1 "The lubricant prevents vaginal irritation." 2 "The additional lubrication improves sex." 3 "Nonoxynol-9 improves penile sensitivity." 4 "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions."

4 Nonoxynol-9 does not provide protection against sexually transmitted infections. Nonoxynol-9 may cause vaginal irritation. Nonoxynol-9 has no effect on the quality of sexual activity. Nonoxynol-9 has no effect on penile sensitivity.

The nurse is teaching the nursing student about semen analysis. Which statement by the student indicates the need for further teaching? 1 "The patient should be instructed to masturbate to obtain the semen sample." 2 "The test must be performed within 2 hours of collecting the semen sample." 3 "A spermicide-free plastic sheath must be used to collect the semen sample." 4 "A cold environment or low temperature is suitable for storing the semen sample."

4 Semen samples should not be kept in a cold environment or at low temperatures as it reduces the sperm motility. For collecting the semen sample, the patient should be instructed to masturbate, as it stimulates the impulse. For accurate estimation of sperm count, the test should be performed within 2 hours after collecting the semen sample. This helps to prevent deterioration of the sample. To keep the sperm alive, semen samples should be collected in plastic sheaths that are free from any spermicidal agent.

What is the role of the nurse in initial family planning? 1 Decide on the best method for the couple. 2 Advise couples on which contraceptive to use. 3 Refer the couple to a reliable health care provider. 4 Educate couples on the various methods of contraception.

4 The nurse's role is to provide information to the couple so that they can make an informed decision about family planning. The nurse can help the couple initially; they do not need to be sent to a health care provider unless it is warranted. The nurse's role is to educate, not to decide for the couple which is the best method. The nurse's role is to educate, not to advise couples on which contraceptive to use.