Chapter 09: Infertility My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 09: Infertility

Test Bank

MULTIPLE CHOICE

1. Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle?

a.

Hysterosalpingogram

b.

Endometrial biopsy

c.

Laparoscopy

d.

Follicle-stimulating hormone (FSH) level

ANS: B

Endometrial biopsy is scheduled after ovulation, during the luteal phase of the menstrual cycle.

A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing a potentially fertilized ovum out through a uterine tube into the peritoneal cavity.

Laparoscopy usually is scheduled early in the menstrual cycle.

Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.

DIF: Cognitive Level: Knowledge REF: 201

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

2. A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. The nurses most appropriate response is:

a.

This is a legitimate concern. Would you like to discuss this further before your treatment begins?

b.

No one has ever had more than triplets with Clomid.

c.

Ovulation will be monitored with ultrasound so that this will not happen.

d.

Ten percent is a very low risk, so you dont need to worry too much.

ANS: A

The incidence of multiple pregnancies with the use of these medications is higher than 25%. The clients concern is legitimate and should be discussed so that she can make an informed decision.

Stating that no one has ever had more than triplets with Clomid is inaccurate and negates the clients concerns.

Ultrasound cannot ensure that a multiple pregnancy will not occur.

Ten percent is inaccurate. Furthermore, the clients concern is discredited with a statement such as dont worry.

DIF: Cognitive Level: Application REF: 206

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. The nurses most appropriate response is:

a.

Your sperm count seems to be okay in the first semen analysis.

b.

Only marijuana cigarettes affect sperm count.

c.

Smoking can give you lung cancer, even though it has no effect on sperm.

d.

Smoking can reduce the quality of your sperm.

ANS: D

Cigarette smoking has been associated with abnormal sperm, a decreased number of sperm and chromosome damage.

Sperm counts vary from day to day and are dependent on emotional and physical status and sexual activity. Therefore, a single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility.

Marijuana use may depress the number and motility of sperm.

Smoking is indeed a causative agent for lung cancer. The use of tobacco also has detrimental effects on sperm.

DIF: Cognitive Level: Application REF: 197

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

4. A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed?

a.

Testicular biopsy

b.

Antisperm antibodies

c.

Follicle-stimulating hormone (FSH) level

d.

Examination for testicular infection

ANS: C

The woman has irregular menstrual cycles. The scenario does not indicate that she has had any testing related to this irregularity. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determination of blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of irregular menstrual cycles.

A testicular biopsy is indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells).

Antisperm antibodies are produced by a man against his own sperm. This is unlikely to be the case here because the husband has already produced children.

Examination for testicular infection would be done before semen analysis. Furthermore, infection would affect spermatogenesis.

DIF: Cognitive Level: Analysis REF: 200

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

5. A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. The nurses most appropriate response is:

a.

Tell your friends and family so that they can help you.

b.

Talk only to other friends who are infertile, because only they can help.

c.

Get involved with a support group. Ill give you some names.

d.

Start adoption proceedings immediately, because obtaining an infant is very difficult.

ANS: C

Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others experiences.

Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couples relationships with family and friends.

Limiting their interactions to other infertile couples may be a beginning point for addressing psychosocial needs, but depending on where the other couple is in their own recovery process, this may or may not be of assistance to them.

Telling the couple to start adoption proceedings immediately is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

DIF: Cognitive Level: Application REF: 203

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment

6. The nurse working with a client who has infertility concerns should be aware that leuprolide acetate (Lupron), a gonadotropin-releasing hormone (GnRH) agonist, may be prescribed for an infertile woman to treat:

a.

Anovulatory cycles

b.

Uterine fibroids

c.

Polycystic ovary disease (PCOD)

d.

Luteal phase inadequacy

ANS: B

Leuprolide acetate is used to treat endometriosis and uterine fibroids.

Anovulatory cycles are treated with Clomid, Serophene, Pergonal, or Profasi, all of which stimulate ovulation induction.

Metrodin is used to treat PCOD.

Progesterone is used to treat luteal phase inadequacy.

DIF: Cognitive Level: Knowledge REF: 205

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

7. Danazol (androgens) may be prescribed for an infertile woman if she has:

a.

Thyroid dysfunction

b.

Elevated levels of prolactin

c.

Inadequate levels of follicle-stimulating hormone (FSH)

d.

Endometriosis

ANS: D

Danazol treats endometriosis by suppressing ovarian activity and eliminating stimulation of endometrial tissue.

Thyroid dysfunction is not treated with danazol.

Danazol is not an appropriate treatment for a client with elevated levels of prolactin.

Inadequate levels of FSH do not respond to treatment with danazol.

DIF: Cognitive Level: Knowledge REF: 205

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

8. In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. The nurses most appropriate response is:

a.

IVF is a type of assisted reproductive therapy that involves collecting eggs from your wifes ovaries, fertilizing them in the lab with your sperm, and transferring the embryo to her uterus.

b.

A donor embryo will be transferred into your wifes uterus.

c.

Donor sperm will be used to inseminate your wife.

d.

Dont worry about the technical stuff; thats what we are here for.

ANS: A

A womans eggs are collected from her ovaries, fertilized in the laboratory with sperm, and transferred to her uterus after normal embryonic development has occurred.

Transferring a donor embryo to the womans uterus describes the procedure for a donor embryo.

Inseminating the woman with donor sperm describes therapeutic donor insemination.

Telling the client not to worry discredits the clients need for teaching and is not the most appropriate response.

DIF: Cognitive Level: Application REF: 206

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

9. With regard to the assessment of female, male, and couple infertility, nurses should be aware that:

a.

The couples religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis

b.

The investigation takes several months and can be very costly

c.

The woman is assessed first; if she is not the problem, the male partner is analyzed

d.

Semen analysis is for men; the postcoital test is for women

ANS: B

Fertility assessment and diagnosis take time, money, and commitment from the couple.

Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an effect on diagnosis and assessment.

Both partners are assessed systematically and simultaneously, as individuals and as a couple.

Semen analysis is for men, but the postcoital test is for the couple.

DIF: Cognitive Level: Application REF: 194

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

10. In their role of implementing a plan of care for infertile couples, nurses should:

a.

Be comfortable with their own sexuality and nonjudgmental about others to effectively counsel their clients

b.

Know about such nonmedical remedies as diet, exercise, and stress management

c.

Be able to direct clients to sources of information about what herbs to take that might help and which ones to avoid

d.

Do all of these plus be knowledgeable about potential drug and surgical remedies

ANS: D

Nurses should also be cognizant that a number of surgical procedures can be used for problems related to female infertility.

Nurses can help couples express and discuss their feelings as honestly as possible. The nurse must be comfortable with his or her own sexuality.

The nurse should be aware that simple changes in lifestyle may be effective in assisting the infertile couple.

Most herbal remedies have not been proven effective.

DIF: Cognitive Level: Comprehension REF: 203

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

MULTIPLE RESPONSE

1. Many factors, male and female, contribute to normal fertility. Approximately 40% of cases of infertility are related to the female partner. These alterations in physiology belong to one of five categories. Choose all that apply.

a.

Congenital or developmental factors

b.

Hormonal or ovulatory factors

c.

Tubal or peritoneal factors

d.

Uterine factors

e.

Emotional or psychologic factors

ANS: A, B, C, D

Female infertility can be attributed to alterations in any one of these systems along with possible vaginal-cervical factors.

The diagnosis and treatment of infertility require considerable emotional investment and may cause psychologic stress. However, this is not considered one of the factors associated with infertility. Feelings connected with infertility are many and complex. Resolve is an organization that provides support, advocacy, and education for both clients and health care providers.

DIF: Cognitive Level: Knowledge REF: 195

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

COMPLETION

1. The ___________________ __________ is one method used to evaluate the adequacy of coital technique, cervical mucous, sperm quality and penetration.

ANS:

Postcoital test

This test is performed within several hours after ejaculation of semen into the vagina and is used to study a number of factors affecting fertility.

DIF: Cognitive Level: Application REF: 202

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

TRUE/FALSE

1. Normally a fertile couple has approximately a 50% chance of conception each ovulatory cycle. Is this statement true or false?

ANS: F

In the healthy fertile couple, a 20% chance of conception occurs during each ovulatory cycle.

DIF: Cognitive Level: Comprehension REF: 194

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. Obesity is associated with infertility as well as poorer outcomes for assisted reproductive technologies. Is this statement true or false?

ANS: T

Women who are overweight or obese have a reduced chance of pregnancy following in vitro fertilization (IVF) and a significantly greater risk of spontaneous abortion following infertility treatment. Infertility treatment may be deferred until the body mass index (BMI) is less than 30 kg/m2, with no other risk factors.

DIF: Cognitive Level: Comprehension REF: 204

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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