Chp. 3 - Genetics

A newborn has been diagnosed with a disorder that occurs through an autosomal recessive inheritance pattern. The parents ask the nurse, "Which of us passed on the gene that caused the disorder?" The nurse tells them it was: 1. The female. 2. The male. 3. Neither. 4. Both.

Correct Answer: 4 Rationale 1: It is not a sex-linked disorder or an abnormal chromosome disorder. Rationale 2: It is not a sex-linked abnormality. Rationale 3: In an autosomal recessive inherited disorder, both parents are carriers of the abnormal gene. Rationale 4: In an autosomal recessive inherited disorder, both parents are carriers of the abnormal gene. It is not a sex-linked disorder or an abnormal chromosome disorder.

A nurse counsels a couple on sex-linked disorders. Both the man and the woman are carriers of the disorder. They ask the nurse how this disorder will affect any children they might have. The nurse's best response is: 1. "If you have a daughter, she will not be affected." 2. "Your son will be affected, since the father has the disorder." 3. "There is a 25% chance that your son will have the disorder, since the mother has the disorder." 4. "There is a 50% chance that your son will be a carrier only."

Correct Answer: 4 Rationale 1: There is a 50% chance that a carrier mother will pass the abnormal gene to each of her daughters, who will become carriers. Rationale 2: Fathers affected with a sex-linked disorder cannot pass the disorder to their sons, but all their daughters become carriers of the disorder. Rationale 3: Since it is sex-linked, there will be more than a 25% chance that a son would be a carrier only. Rationale 4: There is a 50% chance that a carrier mother will pass the normal gene to each of her sons, who will be unaffected.

The clinic nurse is teaching a patient about how to take the basal body temperature (BBT). Place the steps in the order that the nurse provides to the patient. Standard Text: Click and drag the options below to move them up or down. Choice 1. Choose one site for taking the temperature. Choice 2. Use the chosen site consistently. Choice 3. Take the temperature before arising. Choice 4. Immediately record the temperature. Choice 5. Shake down the thermometer.

Correct Answer: 4,1,2,5,3 Rationale 1: Using a BBT thermometer, the woman chooses one site (oral, vaginal, or rectal). Rationale 2: The chosen site must be used consistently to provide the most accurate information. Rationale 3: The temperature must be taken before any activity that will increase the temperature. Rationale 4: The result is recorded immediately on a special BBT chart, and the temperature dots for each day are connected to form a graph. Rationale 5: The thermometer is shaken down to be ready for the next day.

The couple at 12 weeks' gestation has been told that their fetus has sickle-cell disease. Which statement by the couple indicates that they are adequately coping? 1. "We knew we were both carriers of sickle cell. We shouldn't have tried to have a baby." 2. "If we had been healthier when we conceived, our baby wouldn't have this disease now." 3. "Taking vitamins before we got pregnant would have prevented this from happening." 4. "The doctor told us there was a 25% chance that our baby would have sickle disease."

Correct Answer: 4 Rationale 1: Self-blame and judgment do not indicate coping. Rationale 2: Preconception health and nutrition do not affect transmission of an autosomal recessive trait. Self-blame and judgment do not indicate coping. Rationale 3: Preconception health and nutrition do not affect transmission of an autosomal recessive trait. Rationale 4: A true statement indicates coping. When both the mother and father are carriers of an autosomal recessive disease like sickle cell, there is a 25% chance of a normal child, a 25% chance of a child with sickle-cell disease, and a 50% chance of a child with sickle-cell trait.

A patient has been diagnosed with fallopian tube obstruction and told that her best option for becoming pregnant is with in vitro fertilization. The patient asks the nurse about the procedure. The best explanation by the nurse is: 1. "During the stimulation phase of the procedure, the physician will make sure that only one egg reaches maturation." 2. "Pre-implantation genetic diagnosis will be performed on your partner's sperm to make sure that the sperm are normal." 3. "After ovarian stimulation, you will be inseminated with your partner's sperm." 4. "Any extra embryos will be preserved for you if you wish to conceive again in the future."

Correct Answer: 4 Rationale 1: The physician wants a number of eggs, and will not prevent others from maturing. Rationale 2: Pre-implantation genetic diagnosis is performed on the ova, not on the sperm. Rationale 3: The patient's tubes are blocked, so she would not have therapeutic insemination. Rationale 4: With in vitro fertilization, it is normal to save any unused embryos for future use.

A patient and her husband have contacted their physician about fertility problems. At the initial visit, the nurse instructs them about the infertility workup. Which statement by the patient would indicate that the instructions have been successful? 1. "The first test that we need to schedule is a semen analysis." 2. "We need to schedule the Huhner test first." 3. "We need to schedule an appointment with the social worker in order to adopt." 4. "We need to schedule an appointment with a marriage counselor."

Correct Answer: 1 Rationale 1: A semen analysis is one of the first diagnostic tests, prior to doing invasive procedures. Rationale 2: The Huhner test would not be done first. Rationale 3: Scheduling to meet with a social worker would not be done immediately after the initial visit. Rationale 4: A counselor visit is not part of the infertility workup.

A couple are requesting fertility counseling. The nurse practitioner has identified the factors listed below in the woman's health history, and knows that which of them could be contributing to the couple's infertility? 1. The patient is 38 years old. 2. The patient was 13 years old when she started her menses. 3. The patient works as a dental hygienist 3 days a week. 4. The patient jogs 2 miles a day.

Correct Answer: 1 Rationale 1: As the eggs of older women age, their fertility is reduced. Rationale 2: The age of the onset of menses is not a significant factor. Rationale 3: The patient's employment as a dental hygienist does not affect fertility. Rationale 4: Strenuous exercise can affect fertility, but 2 miles of jogging daily is not enough to cause a problem.

The nurse is planning to teach couples factors that influence fertility. Which factor should not be included in the teaching plan? 1. Sexual intercourse should occur four times a week. 2. Get up to urinate 1 hour after intercourse. 3. Do not douche. 4. Institute stress-reduction techniques.

Correct Answer: 1 Rationale 1: Intercourse should occur 1-3 times per week at intervals of no less than 48 hours. Rationale 2: Urinating 1 hour after intercourse is appropriate. Rationale 3: One does not want to douche after intercourse when conception is desired. Rationale 4: Stress-reduction techniques should be included in the teaching plan

The nurse in a fertility clinic is working with a woman who has been undergoing infertility treatment with clomiphene citrate (Clomid) and menotropin (Repronex). Which statement would the nurse expect the woman to make? 1. "I feel moody so much of the time." 2. "If this doesn't work, I think my husband will leave me." 3. "This combination of medications will guarantee a pregnancy." 4. "My risk of twins or triplets is the same as the general population's."

Correct Answer: 1 Rationale 1: Moodiness is a common side effect when menotropins are used for infertility treatment. Rationale 2: Although infertility can be stressful on a marriage relationship, the nurse does not expect a marriage to end if pregnancy is not achieved. Rationale 3: There is no guarantee for any medication. Rationale 4: Multifetal pregnancies are more likely when any medication is used to stimulate fertility.

A pregnant patient asks the nurse, "What is this 'knuckle test' that is supposed to tell whether my baby has a genetic problem?" The nurse correctly explains that: 1. "The term is nuchal, and it refers to the neck. The test is a special ultrasound that measures the thickness of the back of the baby's neck." 2. "You will need to ask the physician for an explanation." 3. "It tests for Down syndrome." 4. It tests for neural tube defects."

Correct Answer: 1 Rationale 1: Nuchal translucency detects fetal chromosome anomalies, including trisomy 21, 18, and 13, and Turner's syndrome. The test measures the thickness of the tissue over the posterior of the baby's neck. Rationale 2: This is not an appropriate response. The nurse must be aware of laboratory tests performed during pregnancy to intelligently answer patients' questions. Rationale 3: The triple or quadruple screen detects increased risk for trisomy 21, or Down syndrome. Rationale 4: The triple or quadruple screen detects increased risk for neural tube defect.

The nurse working with an infertile couple has made the following diagnosis: Sexual Dysfunction related to decreased libido. Which assessment is most likely the reason for this diagnosis? 1. The couple have established a set schedule for having sexual intercourse. 2. The couple have been married for more than 10 years. 3. The couple live with his parents. 4. The couple have close friends who gave birth to a baby within the last year.

Correct Answer: 1 Rationale 1: This will often lead to sex that is not satisfying. Rationale 2: Years of marriage do not have anything to do directly with decreased libido. Rationale 3: Living with his parents does not necessarily have anything to do with decreased libido. Rationale 4: It is sometimes hard to see others have babies, but this should not contribute to decreased libido.

The nurse is teaching an infertile couple about the causes of infertility. The nurse tells them that infertility can be caused by: Select all that apply. 1. Immunological responses. 2. Congenital anomalies. 3. Patent fallopian tubes. 4. Hypothyroidism. 5. Favorable cervical mucus.

Correct Answer: 1,2,4 Rationale 1: Immunological responses, such as antisperm antibodies, can cause infertility. Rationale 2: Congenital anomalies, such as a septate uterus, can cause infertility. Rationale 3: Patent tubes are not a cause of infertility. Patent tubes are needed for the ova to travel from the ovary to the uterus. Rationale 4: Hypothyroidism is a cause of infertility. Rationale 5: Favorable cervical mucus is not a cause of infertility. Cervical mucus must be favorable for the sperm to survive and travel up the fallopian tube.

The nurse is talking with a couple who have been trying to get pregnant for 5 years. They are now at the fertility clinic seeking help. The nurse assesses their emotional responses as part of the workup. Which response would the nurse expect to hear? Select all that apply. 1. Anger at others who have babies 2. Feelings of failure because they cannot make a baby 3. Sexual excitement because they want so desperately to conceive a baby 4. Sadness because of the perceived loss of being a parent 5. Guilt on the part of one partner because he or she is not able to give the other a baby

Correct Answer: 1,2,4,5 Rationale 1: Infertile couples often express anger at others who have babies. Rationale 2: Feelings of failure are common. Rationale 3: They are more likely to have an aversion to sex because of the intrusive nature of scheduling sex. Rationale 4: Sadness is a common feeling. Rationale 5: Guilt is often expressed by one or both partners.

The nurse in the OB-GYN clinic counsels a couple that in autosomal dominant inheritance, which of the following occur? Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. An affected individual might have an affected parent. 2. The affected individual has a 75% chance of passing on the abnormality. 3. Males and females are equally affected by the gene. 4. A father can pass the defective gene to a son. 5. There are no variances in the genetic pattern for autosomal dominant disorders.

Correct Answer: 1,3,4 Rationale 1: null Rationale 2: An affected individual has a 50% chance of passing on the abnormal gene. Rationale 3: Males and females are equally affected in autosomal dominant disorders. Rationale 4: In autosomal dominant disorders, the father can pass the defective gene to a son. Rationale 5: Autosomal dominant inherited disorders have varying degrees of presentation-e.g., a child can have a more severe form than the parent does.

The nurse is planning a group session for parents who are beginning infertility evaluation. Which statement should be included in this session? Select all that apply. 1. "Infertility can be stressful for a marriage." 2. "The doctor will be able to tell why you have not conceived." 3. "Your insurance will pay for the infertility treatments." 4. "Keep communicating with one another through this process." 5. "Taking a vacation usually results in pregnancy."

Correct Answer: 1,4 Rationale 1: Infertility is often stressful on a marriage as a result of the need to schedule intercourse, the need to pay for treatments, and the societal expectation to have children. Rationale 2: Although fertility usually can be explained, there is a chance that a couple's infertility cannot be explained despite extensive treatments. Rationale 3: Insurance often does not pay for infertility treatment. Rationale 4: Communication is important to help cope with stress. A nurse should always encourage patients to ask questions. Rationale 5: A common myth is that taking a vacation or just relaxing will result in conception.

The clinic nurse assesses a newborn who is not progressing as expected. Genetic tests are ordered. The nurse explains to the parents that the laboratory tests to be done include: Select all that apply. 1. Chromosome analysis. 2. Complete blood count. 3. Phenylketonuria. 4. Enzyme assay. 5. Antibody titers.

Correct Answer: 1,4,5 Rationale 1: Laboratory analysis includes chromosome analysis. Rationale 2: Laboratory analysis for a gentic disorder will not specifically call for a complete blood count. Rationale 3: A test for phenylketonuria would have been completed at the time of birth. Rationale 4: Laboratory analysis includes enzyme assay for inborn errors of metabolism. Rationale 5: Laboratory analysis includes antibody titers for infectious teratogens.

A couple who have sought fertility counseling have been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which condition occurs? 1. The vas deferens is ligated. 2. The testes are overheated. 3. The prostate gland is enlarged. 4. The flagella are segmented.

Correct Answer: 2 Rationale 1: A ligation of the vas deferens is a vasectomy, and the sperm cannot migrate. Rationale 2: High temperatures harm the development of the sperm. Rationale 3: The prostate has nothing to do with development of the sperm. Rationale 4: The flagella are normally divided into a middle segment and an end segment.

A woman who has had multiple miscarriages is advised to go through genetic testing. The patient asks the nurse the rationale for this recommendation. The nurse will explain that: 1. The woman's pedigree might exhibit a problem carrying a fetus to term. 2. The majority of miscarriages are caused by genetic defects. 3. A woman's chromosomal pattern determines her fertility. 4. There is a genetic marker that detects the presence of an incompetent cervix.

Correct Answer: 2 Rationale 1: A pedigree does not show a woman's ability to carry a fetus to term. Rationale 2: Most miscarriages are related to genetic defects. Rationale 3: Fertility is determined by many factors. Rationale 4: There is no genetic marker for incompetent cervix.

The nurse is reviewing assessment data from several different male patients. Which one should receive information about causes of infertility? 1. Circumcised patient 2. Patient with a history of premature ejaculation 3. Patient with a history of measles at age 12 4. Patient employed as an engineer

Correct Answer: 2 Rationale 1: Circumcision does not affect fertility. Rationale 2: Premature ejaculation is a possible cause of infertility. Rationale 3: Having the measles does not affect fertility. Rationale 4: Being an engineer does not affect fertility.

An infertile couple confide in the nurse at the infertility clinic that they feel overwhelmed with the decisions facing them. Which nursing strategy would be most appropriate? 1. Refer them to a marriage counselor. 2. Provide them with information and instructions throughout the diagnostic and therapeutic process. 3. Express concern and caring. 4. Inquire about the names they have chosen for their baby.

Correct Answer: 2 Rationale 1: Referral to a counselor at this time is not appropriate. Rationale 2: The nurse can provide comfort to couples by offering a sympathetic ear, a nonjudgmental approach, and appropriate information and instruction throughout the diagnostic and therapeutic processes. Rationale 3: Expressing concern is fine, but they will also require a lot of information in order to make an informed decision. Rationale 4: Inquiring about names for a baby is certainly not appropriate at this time.

The nurse at the fertility clinic instructs a couple on the Huhner test. The nurse knows that the teaching has been effective when they state: 1. "We must have sexual intercourse 1 day prior to the menstrual cycle." 2. "This test removes the spontaneity from our sex lives." 3. "The specimen is collected in a sterile cup." 4. "This test counts the number of sperm my husband produces."

Correct Answer: 2 Rationale 1: The Huhner test is performed 1 or 2 days before the expected date of ovulation. Rationale 2: The focus of the postcoital exam is on the timing of intercourse. Rationale 3: The specimen is collected into a 10 ml syringe. Rationale 4: The motility, not the quantity, of the sperm is evaluated.

A patient is to receive fetility drugs prior to in vitro fertilization. The expected action of this medication is: 1. Prolonging of the luteal phase. 2. Stimulation of ovulation. 3. Suppression of menstruation. 4. Promotion of cervical mucus production.

Correct Answer: 2 Rationale 1: The luteal phase occurs after ovulation. Rationale 2: Fertility drugs are administered to infertile women to increase follicular growth and maturation of the follicles, and to stimulate ovulation. Rationale 3: Fertility drugs do not suppress menstruation. Rationale 4: Fertility drugs do not promote the production of cervical mucus.

A male patient visits the infertility clinic for the results of his comprehensive exam. The exam indicated oligospermia. The patient asks the nurse which procedure would assist him and his wife to conceive. The nurse's best response is: Select all that apply. 1. "You might want to consider adoption." 2. "An option you might consider is in vitro fertilization." 3. "Surrogacy might be your best option." 4. "Many couples utilize therapeutic husband insemination." 5. "The GIFT procedure has had much success."

Correct Answer: 2,4 Rationale 1: Adoption is not necessarily an immediate option. Rationale 2: The in vitro fertilization procedure is used in cases in which infertility has resulted from male infertility. Rationale 3: Surrogacy is not necessarily an immediate option. Rationale 4: Therapeutic husband insemination is generally indicated for such seminal deficiencies as oligospermia. Rationale 5: The GIFT procedure is not an immediate option.

A couple is at the clinic for preconceptual counseling. Both parents are 40 years old. The nurse knows that the education session has been successful when the wife states: Select all that apply. 1. "We are at low risk for having a baby with Down syndrome." 2. "Our children are more likely to have genetic defects." 3. "Children born to parents this age have sex-linked disorders." 4. "The tests for genetic defects can be done early in pregnancy." 5. "It will be almost impossible for us to conceive a child."

Correct Answer: 2,4 Rationale 1: When a mother will be 35 years or older at the time of delivery, there is an increased risk of trisomy 21 (Down syndrome). Rationale 2: When a mother will be 35 years or older at the time of delivery, there is an increased risk of genetic defects. Rationale 3: Sex-linked disorders are not related to the age of either parent. Rationale 4: Genetic testing such as amniocentesis and chorionic villus sampling are done in the first trimester. Rationale 5: Fertility decreases somewhat after age 35, but age over 35 does not mean that conception is impossible.

A 58-year-old father and a 45-year-old mother gave birth to a baby boy 2 days ago. The nurse assesses a single palmar crease and low-set ears on the newborn. The nurse plans to counsel the couple about which chromosomal abnormality? 1. Trisomy 13 2. Trisomy 18 3. Trisomy 21 4. Trisomy 26

Correct Answer: 3 Rationale 1: A single palmar crease and low-set ears are not characteristic of trisomy 13. Rationale 2: A single palmar crease and low-set ears are not characteristics of trisomy 18. Rationale 3: A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome). Rationale 4: Trisomy 26 is not a chromosomal abnormality.

The nurse is reviewing preconception questionnaires in charts. Which couple are the most likely candidates for preconceptual genetic counseling? 1. Wife is 30 years old, husband is 31 years old. 2. Wife and husband are both 29 years old, first baby for husband, wife has a normal 4-year-old. 3. Wife's family has a history of hemophilia. 4. Single 32-year-old woman is using donor sperm.

Correct Answer: 3 Rationale 1: An age under 35 is not a risk factor for genetic abnormalities. Rationale 2: An age under 35 is not a risk factor for genetic abnormalities. Rationale 3: Hemophilia is a sex-linked disorder; therefore, the couple with hemophilia in the wife's family is at risk for hemophilia in male offspring. Rationale 4: Sperm donors are screened for genetic disorders, and men with a possible genetic problem are not accepted for sperm donation.

Question 35 Type: MCSA The couple has had an ultrasound at 19 weeks' gestation, and their fetus was found to have anencephaly. The nurse is completing counseling for the couple on the ultrasound findings. Which statement indicates that additional teaching is needed? 1. "Our baby has an incomplete brain, and might not be born alive." 2. "This problem is not caused by one of us having a genetic problem." 3. "We won't know whether something is wrong until the baby's chromosomes are tested." 4. "Waiting until our 30s did not cause this problem to develop."

Correct Answer: 3 Rationale 1: Anencephaly is a condition in which the skull does not cover the brain completely, and the brain consists mostly of brain stem with little other brain development. Rationale 2: Folic acid deficiency is a contributing factor, but genetic abnormalities in either parent are not related to anencephaly. Rationale 3: Anencephaly is clearly visualized with ultrasound, and does not require genetic testing to verify a diagnosis. Rationale 4: The parents' ages are not related to anencephaly.

The physician has prescribed the medication clomiphene citrate (Clomid) for a patient with infertility. The nurse's instructions to the woman should be: 1. "Have sexual intercourse every day for 1 week, starting 5 days after completion of medication." 2. "Take a pregnancy test before restarting medication." 3. "Contact the doctor if visual disturbances occur." 4. "Discontinue the medication if hot flashes occur."

Correct Answer: 3 Rationale 1: Sexual intercourse should occur every other day. Rationale 2: Only if a woman does not have a period must she be checked for the possibility of pregnancy. Rationale 3: The patient should contact the doctor if visual disturbances occur, and the medication might have to be discontinued. Rationale 4: If hot flashes occur, relief can be obtained without discontinuing medication.

A patient calls the urologist's office to receive instructions about semen analysis. The nurse instructs the patient to: 1. Avoid sexual intercourse 24 hours prior to obtaining a specimen. 2. Use a latex condom to collect the specimen. 3. Expect that a repeat test might be required. 4. Expect a small sample.

Correct Answer: 3 Rationale 1: The specimen is collected after 2-3 days of abstinence, usually by masturbation. Rationale 2: Regular condoms should not be used, because of the spermicidal agents they contain. Rationale 3: A repeat semen analysis might be required to adequately assess the man's fertility potential. Rationale 4: A small sample is not an appropriate instruction.

A couple are seeking advice regarding what they can do to increase the chances of becoming pregnant. What recommendation can the nurse give to the couple? 1. The couple could use vaginal lubricants during intercourse. 2. The couple should delay having intercourse until the day of ovulation. 3. The woman should refrain from douching. 4. The woman should be on top during intercourse.

Correct Answer: 3 Rationale 1: Vaginal lubricants can alter the pH of the reproductive system and adversely affect the couple's chances of becoming pregnant. Rationale 2: This is not good advice, as fertilization can take place anywhere from day 7 to 17 during a 28-30-day cycle. Rationale 3: This is the correct answer, as douching can wash the sperm out and change the pH of the vagina to make it hostile to sperm. Rationale 4: The male superior position with the female remaining recumbent for at least 20-30 minutes after intercourse maximizes the number of sperm reaching the cervix.

A nurse working with couples undergoing genetic testing recognizes which of the following as nursing responsibilities? Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. Allowing the family to interact with the genetic counselor without interference 2. Giving information about support groups when asked 3. Identifying families at risk for genetic problems 4. Aiding families in coping with the crisis 5. Ensuring continuity of nursing care to the family

Correct Answer: 3,4,5 Rationale 1: The nurse should assist the couple by acting as their liaison with the genetic counselor. Rationale 2: The nurse should provide information about support groups without being asked. Rationale 3: The nurse has a responsibility to identify families at risk for genetic problems. Rationale 4: The nurse should aid families in coping. Rationale 5: The nurse needs to ensure continuity of care to the family.

The OB-GYN nurse is assessing a pregnant patient, and recognizes genetic amniocentesis will be indicated. The nurse makes this conclusion because the indications for genetic amniocentesis are: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. Maternal age under 35. 2. Ultrasound visualization at 8 weeks. 3. One child with a chromosome abnormality. 4. A family history of neural tube defects. 5. Both parents with an abnormal chromosome.

Correct Answer: 3,4,5 Rationale 1: Women 35 or older are at greater risk for having children with chromosome abnormalities. Rationale 2: Genetic ultrasound would be done at 10-13 weeks and 18-20 weeks. Rationale 3: Parents who have a child with a chromosomal anomaly have an increased chance of having a second child with the abnormality. Rationale 4: Family history of neural tube defects is an indication for genetic amniocentesis. Rationale 5: If both parents carry an autosomal recessive disease, they have a 25% chance with each pregnancy that the fetus will be affected.

During the initial visit with the nurse at the fertility clinic, the patient asks what effect cigarette smoking has on the ability to conceive. The nurse's best response is: 1. "Smoking has no effect." 2. "Only if you smoke more than one pack a day will you experience difficulty." 3. "After your first semen analysis, we will determine whether there will be any difficulty." 4. "Smoking can affect sperm motility."

Correct Answer: 4 Rationale 1: Cigarette smoking in females can delay time to conception and increase the risk of spontaneous abortion, early labor, and low birth weight. Rationale 2: Any amount of smoking can affect fertility, fetal growth, and time of labor. Rationale 3: In the male, the quantity and quality of male sperm can be affected. A semen analysis is not necessary to know that smoking impacts sperm. Rationale 4: Cigarette smoking can depress sperm motility.

A nurse working in an infertility clinic should include which information in her discussions with the patients? 1. It is important to know the statistics surrounding couples who never learn why they are infertile. 2. Couples should understand the legal controversy concerning artificial insemination. 3. Couples should seek marriage counseling before undergoing fertility treatments. 4. Couples should discuss therapeutic insemination and in vitro fertilization as alternatives.

Correct Answer: 4 Rationale 1: Most couples find the causes of their infertility, so learning the statistics surrounding the small number who never learn the cause is not important information. Rationale 2: There might be ethical issues surrounding artificial insemination, but there are no legal controversies. Rationale 3: Marriage counseling is not needed for all couples before infertility treatments. Rationale 4: This is the correct answer. This information should be presented to patients so that they are aware of all the alternatives and can make an informed decision.

A patient scheduled a laparoscopy. After the procedure, the nurse instructs the patient to: 1. Stay on bed rest for 48 hours. 2. Expect to have shoulder and arm pain. 3. Purchase a rectal tube to relieve the gas. 4. Lie on her back to relieve the gas pain after the procedure.

Correct Answer: 4 Rationale 1: Normal activities can be resumed 24 hours after a laparoscopy. Rationale 2: The patient might experience shoulder and chest pain caused by gas in the abdomen, but no arm pain. Rationale 3: Insertion of a rectal tube is not an intervention expected of the patient. Rationale 4: Assuming a supine position might help to relieve discomfort caused by remaining gas.