OB Chapter 7
A nursing instructor is teaching about fertility and realizes a need for further instruction when a student states: "In most couples with a subfertility problem, it is the man who is subfertile." "In primary subfertility, there have been no previous conceptions." "In secondary subfertility, there has been a previous viable pregnancy." "Sterility is the inability to conceive because of a known condition, such as absence of a uterus."
"In most couples with a subfertility problem, it is the man who is subfertile." In approximately 30% of couples, the man is subfertile.
When conducting a health history with a couple who are experiencing subfertility, the nurse will include which of the following? Select all that apply. Surgical history School history Sexual history General health Medication history
Surgical history Sexual history General health Medication history
A nurse is conducting a class for a group of couples about subfertility. When describing the causes of subfertility, which cause would the nurse include as being most common? anovulation excessive exercise pelvic inflammatory disease excess body weight
anovulation
A client is being prepared for intrauterine (artificial) insemination. Which finding is the most suggestive to determine if the client is ovulating? abdominal cramps change in the cervical mucus fall in body temperature slight weight gain
change in the cervical mucus Change in the appearance and consistency of cervical mucus is an indication of ovulation. Slight weight gain and abdominal cramps are not signs used to determine ovulation. At the time of ovulation, body temperature is slightly elevated.
A male client asks the nurse to explain which structure is cut during a vasectomy. What response should the nurse give the client? the scrotum the ejaculatory ducts the vas deferens the epididymis
the vas deferens The two vas deferens or ductus deferentia are ligated and cut in the male sterilization procedure, called a vasectomy. The epididymis serves as a site for sperm to mature and be stored until ejaculation occurs. The ejaculatory ducts empty into the urethra and receive secretions from the prostate gland to make up semen. The scrotum is a sac-like structure that sits behind the penis and houses the testicles.
The nurse is assessing a male client who is concerned about his ability to produce enough sperm to have a child. He tells the nurse, "I have had some issues in my younger years." What questions would be important for the nurse to ask this client? Select all that apply. "When was the last time you had sex?" "Are you exposed to X-rays or other radioactive substances?" "Do you have a regular girlfriend?" "Have you ever had any type of trauma or surgery on or near your testicles?" "Do you use drugs or use alcohol excessively?
"Are you exposed to X-rays or other radioactive substances?" "Have you ever had any type of trauma or surgery on or near your testicles?" "Do you use drugs or use alcohol excessively? Conditions that may inhibit sperm production are trauma to the testes, surgery on or near the testicles that results in impaired testicular circulation, and endocrine imbalances, particular of the thyroid, pancreas, or pituitary glands. Drug use or excessive alcohol use and environmental factors such as exposure to X-rays or radioactive substances have also been found to negatively affect spermatogenesis. Men exposed to radioactive substances in their work environments should be provided adequate protection for the testes.
A client who is scheduled for hysteroscopy says to a nurse, "I thought I would be able to have children, but now I know that will never be possible." Which response would be most appropriate for the nurse to make? "Adoption is always an acceptable option for anyone." "I will call the health care provider to come visit with you." "Being childless is not as bad as you think it is." "The use of surrogates is more acceptable today."
"I will call the health care provider to come visit with you."
A couple is seeking guidance for their inability to conceive a child after trying for 15 months. They are morbidly obese but state they have friends with the same weight problem who have had no difficulty conceiving. What education can the nurse provide this couple to increase their chances of success? "Being this overweight is unhealthy for you and for any child that you may bring into the world. Before you consider conceiving, you should lose weight." "Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering." "If you have been trying for this long without success, something must be wrong. So we will need to run a series of tests to see what that is." "Weight has no bearing on the ability to conceive. Something else must be going on with your reproductive organs."
"Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering." Extreme obesity in a male may interfere with effective penetration and deposition of sperm, compromising the ability to conceive.
A woman trying to conceive has been prescribed metronidazole for bacterial vaginosis. What should the nurse caution this client while taking this medication? This drug is the only treatment for bacterial vaginosis and must be taken as prescribed even if pregnancy is suspected. This medication is safe for use in pregnancy. This drug can be teratogenic early in pregnancy and she should inform the health care provider if pregnancy is suspected. The medication will be continued to treat the infection. She will be monitored closely if she discovers she is pregnant.
This drug can be teratogenic early in pregnancy and she should inform the health care provider if pregnancy is suspected. The nurse cautions a client who is prescribed metronidazole for bacterial vaginosis to inform the health care provider if she thinks she may be pregnant. Treatment with metronidazole in pregnancy is controversial because of inconsistent evidence about risks and benefits.
A nurse should instruct a client who has secondary erectile dysfunction related to type 2 diabetes to make which lifestyle modification? reduce blood pressure lose weight reduce stress control blood sugars
control blood sugars
A nurse should instruct a client who has premenstrual syndrome (PMS) to make which of these lifestyle modifications? Walk every day, increase caffeine and salt intake, and sleep 8 to 10 hours a night. Reduce caffeine, perform cardio exercise 3 times a week, and sleep 12 hours every other night. Walk several times a week, maintain a regular sleep schedule, decrease complex carbohydrates, and avoid complex sugars. Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule.
Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule. A healthy lifestyle contributes to a general sense of well-being. Encourage regular exercise, reduction or elimination of caffeine and alcohol, and adequate and regular sleep.
A couple consults with the nurse regarding their infertility issues. The female says "I don't know what I have done so bad that God would punish me like this." What would be the most appropriate nursing diagnosis for this couple? Hopelessness related to inability to conceive Spiritual distress related to inability to conceive Powerlessness related to infertility Anticipatory grieving related to infertility
Spiritual distress related to inability to conceive The client is experiencing spiritual distress in trying to understand that the couple's infertility issue is a punishment from God. The nurse should plan interventions specifically related to education of the health problems they are experiencing so that the clients have a better understanding. In addition, the nurse should identify community resources for the client.
A 23-year-old client who is 27 weeks' pregnant arrives at her physician's office with complaints of fever, nausea, vomiting, malaise, unilateral flank pain, and costovertebral angle tenderness. Which condition would the nurse most likely suspect? bacterial vaginosis asymptomatic bacteriuria pyelonephritis urinary tract infection (UTI)
pyelonephritis The symptoms indicate acute pyelonephritis, a serious condition in a pregnant client. Asymptomatic bacteriuria doesn't cause symptoms. Bacterial vaginosis causes milky white vaginal discharge but no systemic symptoms. UTI symptoms include dysuria, urgency, frequency, and suprapubic tenderness.
A female client has been trying to conceive for 3 months. She tells the nurse, "I just know something is wrong with me." Which response by the nurse is best? "It is time to talk to your health care provider about hormone testing." "It can take up to 1 year of regular, unprotected intercourse to conceive." "The problem can be with the man, woman, or both. We will explore all possibilities." "Do you or your partner have a family history of subfertility?"
"It can take up to 1 year of regular, unprotected intercourse to conceive." The nurse would first provide accurate information by informing the client that 3 months is not an adequate time frame to indicate a problem is present. Most couples conceive within 1 year when they have regular intercourse without the use of contraceptives. There is no reason to assess for infertility issues with the female or with the couple's families. It is true that subfertility issues can be related to the man, woman, or both; however, it is not appropriate to indicate there is concern by stating "we will explore all possibilities."
A client is scheduled to start taking tadalafil for erectile dysfunction. A nurse should teach the client to observe for side effects and notify a health care provider immediately if what occurs? Orchitis Nausea Weight gain Priapism
Priapism Priapism (erection lasting longer than 4 hours) is a side effect of tadalafil that warrants notifying a health care provider immediately.
A female client had a diagnostic laparoscopy and is now reporting a sharp pain in her shoulder. What response is a priority by the nurse? The client is probably having a pulmonary embolus and should be administered anticoagulation drugs immediately. The client has possibly developed aspiration from stomach contents related to anesthesia. Some of the carbon dioxide that was used to insufflate the abdomen has likely escaped under the diaphragm and this will resolve on its own. The client may be having a myocardial infarction from the stress of the procedure and the nurse should begin cardiac protocols.
Some of the carbon dioxide that was used to insufflate the abdomen has likely escaped under the diaphragm and this will resolve on its own. Women may feel bloating of the abdomen from the infusion of CO2 after such a procedure. If some CO2 escapes under the diaphragm, there may be extremely sharp shoulder pain from pressure.
A couple comes in and tells the nurse that they have been trying diligently to conceive for the last 3 months and are subfertile. What should the nurse explain to the couple about the definition of subfertility? Subfertility is said to exist when a pregnancy has not occurred after at least 6 months of engaging in unprotected sex. Subfertility is said to exist when a pregnancy has not occurred after at least 2 years of engaging in unprotected sex. Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected sex. Subfertility is said to exist when a pregnancy has not occurred after at least 3 months of engaging in unprotected sex.
Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected sex.
A couple comes to the clinic and informs the nurse that they have been trying to conceive for 6 months with no success. The husband states that they have sex at least 5 or 6 times per week to optimize their chance of success. What can the nurse educate the couple about the frequency of sex? The couple should have coitus only when the female partner is ovulating. The couple should consider decreasing the frequency of coitus to 2 to 3 times per week to increase the male partner's sperm count. The couple should continue to have unprotected coitus daily to improve the chance of conception. The male partner should check his sperm count each time he has coitus to ensure an adequate count.
The couple should consider decreasing the frequency of coitus to 2 to 3 times per week to increase the male partner's sperm count. Couples who engage in coitus daily, hoping to cause impregnation, may actually have more difficulty conceiving than those who space coitus to every other day. This is because too frequent coitus can lower a man's sperm count to a level below optimal fertility.
A female client is having a procedure this morning that involves radiologic examination of the fallopian tubes using a radiopaque medium. What procedure should the nurse document as being performed? a hysterosalpingography a uterine endometrial biopsy a hysteroscopy a sonohysterography
a hysterosalpingography A hysterosalpingography, a radiologic examination of the fallopian tubes using a radiopaque medium, is a frequently used technique.
A clinic nurse is interviewing a young client during a subfertility work up. When the client asks the nurse what causes infertility, the nurse informs the client that the problem can rest with the man, the woman, or both. What does the nurse tell the client are common problem areas related to the woman? Select all that apply. tubal transport impaired implantation diabetes lack of exercise ovulation
tubal transport impaired implantation ovulation
A pregnant client has been diagnosed as having a urinary tract infection (UTI). Which of the following instructions regarding control of the infection should the nurse provide the client? clean from back to front after urination Restrict the intake of salt in the diet wear cotton underwear abstain from sexual intercourse
wear cotton underwear The nurse should instruct the pregnant client with a urinary tract infection to avoid irritation of the perineal area by wearing cotton underwear instead of synthetic ones. Abstinence from sexual activity is not needed in such a case. The client should be advised to wipe from front to back after sexual intercourse and urination. For good perineal hygiene, the nurse should instruct the client to clean her perineum in a front-to-back direction, and not from a back-to-front direction. Restriction of salt intake may be necessary for the treatment of hypertension, but not urinary tract infection.
Which question would be most appropriate for a nurse to ask a client to assist in establishing a nursing diagnosis of Deficient knowledge related to measure to promote fertility? "Have you ever been diagnosed with an STI?" "How many sexual partners have you had in your life?" "How long have you not been able to get pregnant?" "How often do you and your partner engage in intercourse?"
"How often do you and your partner engage in intercourse?"
A client has been given instructions about a scheduled sonohysterosalpingogram. Which statement, if made by the client, should indicate to a nurse that the client has an adequate understanding of the instructions? "I will be put under general anesthesia for the procedure." "They will surgically implant the ovum during the procedure." "They will place a catheter in my uterus and use an ultrasound to see what the problem is." "This is just an ultrasound procedure, like they do for a baby."
"They will place a catheter in my uterus and use an ultrasound to see what the problem is." A nurse would recognize that this procedure is a sonographic procedure that includes the insertion of a contrast agent into the uterus and fallopian tubes. This procedure can be used as both diagnostic and therapeutic to break up adhesion within the fallopian tubes.
Subfertility/infertility is said to exist when a couple has failed to achieve pregnancy after how many months of unprotected sexual intercourse?
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A woman at the infertility clinic for the first time asks, "What could have caused my infertility?" After teaching the woman about possible causes, the nurse determines that the teaching was successful when the woman identifies which condition as a common cause? Select all that apply. Endometriosis History of ovarian tumor Pelvic inflammatory disease Vaginal pH of 4.2 Anovulation
Endometriosis Pelvic inflammatory disease Anovulation Common causes of female infertility include ovarian dysfunction, tubal and pelvic disorders, cervical mucus factors, and vaginal problems. A normal vaginal pH is 4-5.
A young couple is having difficulty getting pregnant. The nurse is preparing the couple for the initial tests to determine their fertility. When asked by the couple why they need to start with a sperm analysis, what will be the nurse's best response? Asking the male to undergo diagnostic procedures first is the best way to assess interest in treatment of infertility. Male fertility testing is time-consuming and therefore should be initiated early. Sperm analysis is one of the easiest tests to complete. The man is found to be fertile in over 75 percent of couples with infertility problems.
Sperm analysis is one of the easiest tests to complete. Because sperm analysis is noninvasive, it is one of the easiest (and most cost-effective) tests to complete. There is no bias in male vs. female with regard to being the cause of infertility.
True or false: A nurse in a fertility clinic counsels a subfertile couple to have intercourse daily True False
false
A clinic nurse explains to a client who is undergoing an infertility workup that the patency of her fallopian tubes will be checked. Which test is currently used to do this? hysterosalpingography computed tomography scan magnetic resonance imaging uterine biopsy
hysterosalpingography Hysterosalpingography is radiologic examination with radiopaque contrast of the fallopian tubes. It is widely used to assess the patency of the fallopian tubes in women who are subfertile.
Inability to conceive can be very stressful on a couple. What is one psychological aspect of infertility? growth of intimacy couple becomes closer loss of intimacy emotional stability
loss of intimacy Intimacy, love, and support—essential components of a couple's sexual relationship—may be lost because intercourse takes on a clinical and mechanical tone.
A woman who has been trying to conceive has been diagnosed with multiple uterine fibroids (uterine myomas). What option is available for the woman to be able to conceive? appendectomy hysterectomy myomectomy salpingo-oophorectomy
myomectomy If a uterine fibroid (uterine myoma) is interfering with fertility, a myomectomy, or surgical removal of the tumor, can be scheduled. Myomectomy can be done via a hysteroscopic ambulatory procedure if the growth is small.
A couple comes to the clinic stating that they have one child who is 4 years old, but they have been trying to have another child for 1 year without success. What type of subfertility would this be considered? secondary subfertility primary subfertility erectile dysfunction sterility
secondary subfertility In secondary infertility, there has been a previous viable pregnancy, but the couple cannot conceive at present.
A female client reports difficulty becoming pregnant despite having coitus daily for the past 2 months. Which advice will the nurse recommend? "Elevate your hips on a small pillow after coitus to improve sperm motility." "You should begin considering in vitro fertilization." "Avoid having coitus every day because this may lower your partner's sperm count." "Douche immediately after coitus to push the sperm through the cervix."
"Avoid having coitus every day because this may lower your partner's sperm count." Engaging in coitus every day may actually reduce the likelihood of conceiving because too-frequent coitus can lower a man's sperm count to a suboptimal level. Elevating the client's hips on a small pillow may or may not help with conception, but it does not improve sperm motility. The client should not douche or use lubricants before or after intercourse to keep the vaginal pH unaltered. Alteration in vaginal pH could interfere with sperm motility. At this time, the nurse does not have enough information to recommend the client consider in vitro fertilization. Subfertility is not usually diagnosed unless a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus.
A nursing instructor is teaching about causes of infertility and identifies a need for further instruction when a student states which of the following? "Diet does not play a role in infertility." "Exercise can influence infertility." "A genetic abnormality may cause infertility." "An absence of ovulation may cause infertility."
"Diet does not play a role in infertility." A genetic abnormality, an absence of ovulation, body weight, and diet all can influence a client's fertility. Nutrition plays a crucial role in terms of types of food eaten, as well as how the client eats and how food is prepared. All of these can affect a client's fertility.
The nurse is conducting a health history on a couple planning to become pregnant over the next few months. Which statement by the male client most concerns the nurse? I have severe asthma and use my inhaler several times each month." "I have a degree as a chemical engineer and work at the local plant." "I consume fast food a few times each week and enjoy a few beers on the weekends." "My uncle and his wife have not been able to conceive a child."
"I have a degree as a chemical engineer and work at the local plant." The client works around chemicals that could cause infertility issues. The nurse should further question the client as to what types of chemicals he is exposed to and what type of precautions are taken to protect him. Eating fast food and occasionally consuming alcohol are not risk factors for infertility. The client does not state a direct family member having issues with conception. An uncle is not concerning; however, a brother would be of concern. The client's asthma status should be monitored; however, this is not an issue regarding fertility.
The nurse is caring for a couple who are trying to get pregnant and have not been able to for over a year. The nurse explains to the couple that diagnostic testing usually begins on the male partner, as these tests are easier. The couple asks what kind of problems a man can have that can cause infertility. What should be the nurse's response? "Men can have increased prolactin levels that decrease sperm viability." "Men can have problems that increase the temperature around their testicles, which decreases the quality of their semen." "Men may not have enough estrogen and FSH in their bodies to maintain testicular function." "Men may ejaculate into the bladder instead of the vagina."
"Men can have problems that increase the temperature around their testicles, which decreases the quality of their semen." Men may be affected by varicoceles, varicose veins around the testicle, which decrease semen quality by increasing testicular temperature. Retrograde ejaculation or ejaculation into the bladder is assessed by urinalysis after ejaculation. Blood tests for male partners may include measuring testosterone; FSH and LH (both of which are involved in maintaining testicular function); and prolactin levels.
A couple went through subfertility testing and was told that everything looks normal. After 4 months, the couple still has not conceived. The couple comes to the clinic stressed and depressed, unsure of their next option. One spouse tells the nurse that they seem to argue all the time now and does not know if all this is worth it. How will the nurse respond? "I worry about your stress level. You need to relax more and it will happen." "Perhaps a support group will help you both work through this stress." "It does seem like you should briefly focus on something else to regain perspective." "I know this is stressful. Let me know how I can help you."
"Perhaps a support group will help you both work through this stress." Fertility does not always instantaneously result in pregnancy, which can cause stress and depression. Participation in a support group may allow a couple to work through the stress that fertility testing places on their lives. A support group provides a therapeutic environment. There is nothing that a nurse can do to change the circumstances that are causing the stress, although, the nurse's statement is a caring gesture. Stating that relaxation or focusing on something else will allow the couple to conceive is not accurate.
A nurse is instructing a client on the use of home-use ovulation determination kits. What is most appropriate for the nurse to tell the client? "You will need a prescription for these kits." "These are not reliable; you should just monitor your temperature." "The results of the kit will have to be sent in to the clinic on a daily basis." "The kit will help determine when your body is preparing for ovulation."
"The kit will help determine when your body is preparing for ovulation."
A 38-year-old client wishes to discontinue use of birth control pills and attempt to conceive. The client says to the nurse, "I know a lot of women who have waited later to have children and became pregnant easily." How will the nurse respond? "The age of a woman does not matter when trying to conceive, but you have been on birth control for a long time, thus it may take you longer." "Women in their late 30s who use oral contraceptive pills may face a delay in conception, as the body takes a few months to be able to conceive." "You should be off of oral contraceptive pills for at least 1 year before trying, and then you may or may not be able to become pregnant." "As soon as you stop taking the pill, you should be able to conceive. There are no age-related problems with you becoming pregnant."
"Women in their late 30s who use oral contraceptive pills may face a delay in conception, as the body takes a few months to be able to conceive." Age impacts the ability to conceive. The chance of subfertility increases with age. Because of this gradual decline in fertility, women who defer pregnancy to their late 30s are apt to have more difficulty conceiving than their younger counterparts. Clients using oral, injectable, or implanted hormones for contraception may have difficulty becoming pregnant for several months after discontinuing these medications, because it takes that long for the body to restore normal functioning.
A 25-year-old having a yearly check-up informs the nurse that she has stopped taking oral contraceptive pills (OCPs) because she and her husband want to start a family. She states, "I know I will get pregnant right away because my mother was very fertile." What is the nurse's best response? "Women who used oral birth control pills may have difficulty becoming pregnant for several months after discontinuing them." "It seems that everybody is different when it comes to getting pregnant." "The chance of subfertility increases with age, especially after the age of 20." "Based on your history, you probably won't experience a problem getting pregnant."
"Women who used oral birth control pills may have difficulty becoming pregnant for several months after discontinuing them."
A client states she has purchased home-use ovulation strips to help her know when she is ovulating. Which response by the nurse is most appropriate? "These strips are often not reliable and end up being a waste of money." "I am sure these strips will help you become pregnant faster." "It is a lot more accurate if you come to the clinic routinely to get tested." "You can also test your vaginal discharge to determine if you are ovulating."
"You can also test your vaginal discharge to determine if you are ovulating." The appropriate statement for the nurse to make is regarding testing vaginal or cervical discharge (spinnbarkeit test). This testing and basal body temperature monitoring are free methods clients can use at home to test for ovulation. The home-use ovulation kit monitors luteinizing hormone (LH) levels in a urine sample. The home-use kit monitors for a surge in LH that would indicate ovulation is getting ready to occur. They are typically effective; however, they can be expensive to use repeatedly. Although being tested in the clinic would be most accurate, this is not feasible for most clients financially nor easy to fit into daily schedules. The nurse would not provide false assurance that usage will lead to a quick pregnancy as other factors could be present.
In teaching a fertility class, what is the most appropriate method for the nurse to explain self-ovulation monitoring that promotes conception? Immediately following the menses At the midpoint between menses cycles 14 days before the next menses is expected 14 days after the beginning of the last menses
14 days before the next menses is expected The nurse should explain the ovulation occurs approximately 14 days before the next menses and that this is the best time for intercourse to promote conception.
A couple who has not conceived after 6 years of not using birth control are being seen in the infertility clinic. In assessing the client's psychosocial response to infertility, which might the nurse expect to find? Select all that apply. Excitement at the possibility of conceiving Anger toward others who have conceived Guilt related to the lack of conception Fear of the possible outcome of the testing Sexual stimulation and excitement
Anger toward others who have conceived Guilt related to the lack of conception Fear of the possible outcome of the testing
The experienced nurse working in a fertility clinic identifies concerns of clients when they have to schedule sexual relations. Which nursing suggestion would be most helpful to a couple to help prevent further stress on their relationship? Take up new individual hobbies. Begin a new activity together. Avoid talking about the overall cost of fertility treatment. Try to relax and enjoy it.
Begin a new activity together. Suggesting that a couple combine involvement with fertility planning and ongoing activities or that they begin a new activity together at the same time as beginning fertility testing is a way of helping to reduce the feeling that their entire existence revolves around the fertility issues. It also may help to increase intimacy by helping to compensate for any decreased enjoyment that comes from "scheduled" sexual relations. Telling the couple to relax and enjoy it or take up a hobby is inappropriate and does not address the concern. There is no information that the cost of working with a fertility clinic is an issue.
A client asks the nurse, "What would be the best way to get pregnant." The nurse would incorporate which of the following in the response? Conception is more likely when intercourse occurs within 72 hours of ovulation. The timing of intercourse and conception affects the sex of the pregnancy. Conception is more likely in the presence of orgasm. Conception is more likely if the sperm has just been ejaculated.
Conception is more likely when intercourse occurs within 72 hours of ovulation. Conception is more likely when sexual intercourse occurs within 72 hours of ovulation. There is no evidence that age of sperm in the ejaculate affects its viability or that the timing of intercourse affects the sex of the pregnancy. Studies have also shown that conception is more likely in the absence of orgasm.
A 31-year-old client is preparing to undergo a second round of in vitro fertilization (IVF). In the first round of IVF the client had 5 viable embryos and 2 were implanted; this pregnancy resulted in a spontaneous abortion (miscarriage) at 6 weeks. The client asks if the remaining 3 embryos can be implanted in the second round. How should the nurse respond to this request? Because you were able to get pregnant with the first round of IVF, we recommend only one embryo be implanted with this round. Guidelines for clients your age are that only 1 to 2 embryos should be implanted to avoid risks of complications from a multiple gestation. If we implant 2 embryos again that leaves one for a third round of IVF if needed. You will need to ask your health care provider for special permission to increase the number to 3 embryos.
Guidelines for clients your age are that only 1 to 2 embryos should be implanted to avoid risks of complications from a multiple gestation. For clients younger than age 35, guidelines recommend only implanting 1 to 2 embryos to avoid the risks associated with higher order multiple gestation. The client should be provided with this information to understand the risks and potential outcomes of the IVF procedures. This advice is not based upon the client's previous cycle of IVF and spontaneous abortion (miscarriage), nor is it based upon the number of embryos remaining and potential future cycles.
A 45-year-old client and her spouse are present in the clinic. Results of fertility testing indicate that the client has damage to her fallopian tubes. Which would be the most appropriate infertility option for this client? In vitro fertilization Ovulation stimulation Gamete intrafallopian transfer Surrogate mother
In vitro fertilization This client has damage to her fallopian tubes, so any procedure would need to bypass this structure. In vitro fertilization fertilizes an ovum and then inserts it into a women's uterus.
A young woman is having trouble conceiving and has come to the office for fertility testing. She states that she has irregular and unpredictable menstrual cycles. On blood testing, it is found that her ovaries are producing excess testosterone, which is lowering her follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Which of the following is the most likely cause of her subfertility? tubal transport problems stenotic cervical os endometriosis anovulation
anovulation Anovulation is the absence of ovulation or release of ova from the ovary. The most frequent cause for anovulation is naturally occurring variations in ovulatory patterns or polycystic ovary syndrome, a condition in which the ovaries produce excess testosterone lowering FSH and LH levels, which then causes irregular and unpredictable menstrual cycles. Based on the woman's symptoms and test results, anovulation is the most likely cause of her subfertility. The other conditions listed would not have the same symptoms and test results.
A female client who comes to the clinic for a visit is diagnosed with Turner syndrome. The nurse would expect the client to experience which of the following? development of respiratory distress syndrome in her infant development of cystic fibrosis in male offspring compromised or absent fertility maternal tubal problems
compromised or absent fertility A woman with Turner syndrome, a genetic condition in which one of the two sex chromosomes is completely or partially absent, will have compromised or absent fertility. Cystic fibrosis in males is a genetic condition, but the male child will not develop cystic fibrosis due to his mother's Turner syndrome. The woman's child is not susceptible to respiratory distress syndrome due to the client's genetic disorder. Preterm babies are at increased risk for respiratory distress syndrome. Turner syndrome will not cause tubal problems in the client. Tubal problems are caused by ascending pelvic infections, inflammation from an intrauterine device, surgical adhesions, or previous ectopic pregnancy.
A 40-year-old female client with a chronic pelvic infection expresses her desire to conceive post-treatment. When discussing this with the client the nurse keeps in mind that the client is at increased risk for which of the following? gestational diabetes ectopic pregnancy decreased menses symptoms of menopause
ectopic pregnancy Chronic pelvic infection increases the risk for narrowed or blocked fallopian tubes. It decreases the possibility of fertility or increases the risk of ectopic pregnancy. Only in case of a premature ovarian failure will the client experience symptoms of menopause earlier than expected. A client with hyperthyroidism will experience decreased or absent menses. The client with chronic pelvic infection is not susceptible to gestational diabetes. Clients with multiple gestations are more susceptible to gestational diabetes.
A male client visits a fertility clinic after one year of attempting unsuccessfully to impregnate his wife. What is a risk factor associated with male infertility? morphology of sperm within normal limits sperm density about 20 million/ml no or few sperm cells produced 2 to 5 ml of semen ejaculated
no or few sperm cells produced Azoospermia or oligospermia (no or few sperm cells produced) is a risk factor affecting male infertility. Normally, the volume of semen ejaculated needs to be about 2-5 ml, with a density of sperm at about 20 million/ml. In addition to the number of sperm, the motility (movement), viability, and morphology (shape) of the sperm must be within normal limits.
A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What assessments does the nurse anticipate will be performed for this couple? Select all that apply. semen analysis ovulation monitoring tubal patency fertility drugs in vitro fertilization counseling
semen analysis ovulation monitoring tubal patency Today, a subfertility investigation usually is limited to three assessments: semen analysis, ovulation monitoring, and tubal patency.
A couple has come to the infertility clinic because they have been unable to get pregnant even though they have been trying for over a year. Diagnostic tests are planned for the woman to ascertain if ovulation is regular and whether her endometrium is adequately supported for implantation. What test would the nurse expect to have ordered for this woman? serum progesterone ovulation list oocyte viability test urine testosterone
serum progesterone Diagnostic studies performed to determine if ovulation is regular and whether the progestational endometrium is adequate for implantation may include a serum progesterone level and an ovulation index.