Chapter 31: Management of Fertility and Infertility My Nursing Test Banks

Chapter 31: Management of Fertility and Infertility

Test Bank

MULTIPLE CHOICE

1. The conscious decision on when to conceive or avoid pregnancy throughout the reproductive years is called

a.

Family planning

b.

Birth control

c.

Contraception

d.

Assisted reproductive therapy

ANS: A

Feedback

A

Family planning is the process of deciding when and if to have children.

B

Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children.

C

Contraception is the intentional prevention of pregnancy during sexual intercourse.

D

Assisted reproductive therapy is one of several possible treatments for infertility.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 736

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. While instructing a couple regarding birth control, the nurse should be aware that the method called natural family planning

a.

Is the same as coitus interruptus, or pulling out

b.

Uses the calendar method to align the womans cycle with the natural phases of the moon

c.

Is the only contraceptive practice acceptable to the Roman Catholic Church

d.

Relies on barrier methods during fertility phases

ANS: C

Feedback

A

Pulling out is not the same as periodic abstinence, another name for natural family planning.

B

The phases of the moon are not part of the calendar method or any method.

C

Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church.

D

Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 740

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

3. Which contraceptive method provides protection against sexually transmitted diseases?

a.

Oral contraceptives

b.

Tubal ligation

c.

Male or female condoms

d.

Intrauterine device (IUD)

ANS: C

Feedback

A

Oral contraceptives do not provide any barrier protection against sexually transmitted diseases because they work systemically.

B

A tubal ligation is considered a permanent contraceptive method but does not offer any protection against sexually transmitted diseases. The male condom is inexpensive and offers the best protection available.

C

Only the barrier methods provide some protection from sexually transmitted diseases. Because latex condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted disease.

D

IUDs are inserted in the uterus but do not block or inhibit sexually transmitted diseases.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 739

OBJ: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment

4. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurses most appropriate reply is

a.

Theyre not very effective, and its very likely youll get pregnant.

b.

They can be effective for many couples, but they require motivation.

c.

These methods have a few advantages and several health risks.

d.

You would be much safer going on the pill and not having to worry.

ANS: B

Feedback

A

Fertility awareness methods are effective if used correctly by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 25% during the first year of use.

B

FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals.

C

FAMs have no associated health risks.

D

The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the patients part.

PTS: 1 DIF: Cognitive Level: Application REF: p. 751

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

5. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurses most appropriate response is

a.

This is a highly effective method, but it has some side effects.

b.

Your current medications will reduce the effectiveness of the pill.

c.

The pill will reduce the effectiveness of your seizure medication.

d.

This is a good choice for a woman of your age and personal history.

ANS: B

Feedback

A

This is a true statement, but it is not the most appropriate response.

B

Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are taken simultaneously with anticonvulsants.

C

The anticonvulsant will reduce the effectiveness of the pill, not the other way around.

D

This statement does not teach the patient that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

PTS: 1 DIF: Cognitive Level: Application REF: p. 747

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

6. Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who

a.

Want menstrual regularity and predictability

b.

Have a history of thrombotic problems or breast cancer

c.

Have difficulty remembering to take oral contraceptives daily

d.

Are homeless or mobile and rarely receive health care

ANS: C

Feedback

A

Disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding.

B

Use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism.

C

Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year.

D

To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 744

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

7. Which woman is a safe candidate for the use of oral contraceptives?

a.

39-year-old with a history of thrombophlebitis

b.

16-year-old with a benign liver tumor

c.

20-year-old who suspects she may be pregnant

d.

43-year-old who does not smoke cigarettes

ANS: D

Feedback

A

Oral contraceptives are contraindicated with a history of thrombophlebitis.

B

Liver tumors, benign or malignant, preclude the use of oral contraceptives.

C

Pregnancy is a contraindication.

D

Heavy cigarette smoking is a contraindication.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 745

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. The role of the nurse in family planning is to

a.

Advise couples on which contraceptive to use.

b.

Educate couples on the various methods of contraception.

c.

Decide on the best method of contraception for the couple.

d.

Refer the couple to a reliable physician.

ANS: B

Feedback

A

The nurse should not advise the couple, only educate them.

B

The nurses role is to provide information to the couple so that they can make an informed decision about family planning.

C

The nurse cannot decide on the best method for the couple; only they can decide which method is best for them.

D

The nurse can educate and if the couple decides on a method that requires a physician visit, the nurse can then assist the couple in selecting an appropriate physician or primary health care provider.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 737

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

9. Postcoital contraception with Ovral

a.

Requires that the first dose be taken within 72 hours of unprotected intercourse

b.

Requires that the woman take second and third doses at 24 and 36 hours after the first dose

c.

Must be taken in conjunction with an IUD insertion

d.

Is commonly associated with the side effect of menorrhagia

ANS: A

Feedback

A

Emergency contraception is most effective when used within 72 hours of intercourse but may be used with lessened effectiveness up to 120 hours later.

B

The first dose of an emergency contraception should be taken within 72 hours after coitus.

C

Insertion of the copper IUD within 5 days of intercourse may also be used and is up to 99% effective.

D

The common side effect of postcoital contraception is nausea.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 747

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

10. Informed consent concerning contraceptive use is important because some of the methods

a.

Are invasive procedures that require hospitalization

b.

Require a surgical procedure to insert

c.

May not be reliable

d.

Have potentially dangerous side effects

ANS: D

Feedback

A

The only contraceptive method that requires hospitalization is sterilization.

B

The only surgical procedure used would be for permanent sterilization.

C

Some have more effective rates, and this should be included in the teaching.

D

It is important for couples to be aware of potential side effects so they can make an informed decision about the use of contraceptives.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 741

OBJ: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment

11. Which contraceptive method is contraindicated in a woman with a history of toxic shock syndrome?

a.

Condom

b.

Spermicide

c.

Cervical cap

d.

Norplant

ANS: C

Feedback

A

The condom is worn by the man and does not stay in the vagina for prolonged periods of time.

B

Spermicides dissolve slowly, but do not stay in the vagina for prolonged periods of time.

C

The cervical cap may increase the risk of toxic shock syndrome, because it may be left in the vagina for a prolonged period.

D

Norplant is a systemic contractive that is implanted into the arm. Therefore, there is no risk for toxic shock due to devices left in the vagina for prolonged periods of time.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 738 | Table 31-1

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

12. What is important in instructing a patient in the use of spermicidal foams or gels?

a.

Insert 1 to 2 hours before intercourse.

b.

One application is effective for several hours.

c.

Avoid douching for at least 6 hours.

d.

Effectiveness is about 85%.

ANS: C

Feedback

A

Foams or gels should be inserted just before intercourse and are effective for about 1 hour.

B

Each application is effective for about 1 hour.

C

Douching within 6 hours of intercourse removes the spermicide and increases the risk of pregnancy.

D

Effectiveness is about 74% when used alone.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 749

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

13. A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurses most appropriate response is

a.

No spermicide is used with the cervical cap, so its less messy.

b.

The diaphragm can be left in place longer after intercourse.

c.

Repeated intercourse with the diaphragm is more convenient.

d.

The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide later.

ANS: D

Feedback

A

Spermicide should be used inside the cap as an additional chemical barrier.

B

The cervical cap should remain in place for 6 hours after the last act of intercourse.

C

Repeated intercourse with the cervical cap is more convenient, because no additional spermicide is needed.

D

The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. No additional spermicide is required for repeated acts of intercourse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 737 | Table 31-1

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

14. An unmarried young woman describes her sex life as active and involving many partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurses most appropriate response is

a.

The IUD does not interfere with sex.

b.

The risk of pelvic inflammatory disease will be higher for you.

c.

The IUD will protect you from sexually transmitted diseases.

d.

Pregnancy rates are high with the IUDs.

ANS: B

Feedback

A

Although this statement may be correct, it is not the most appropriate response.

B

Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted diseases (STDs) or the human immunodeficiency virus (HIV). Because this woman has multiple sex partners, she is at higher risk of developing an STD. The IUD does not protect against infection, as does a barrier method.

C

The IUD offers no protection from STDs.

D

The typical failure rate of the IUD ranges from 0.8% to 2%.

PTS: 1 DIF: Cognitive Level: Application REF: p. 737 | Table 31-1

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

15. A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by

a.

Limiting sexual contact for one cycle after starting the pill

b.

Using condoms and foam instead of the pill for as long as she takes an antibiotic

c.

Taking one pill at the same time every day

d.

Throwing away the pack and using a backup method if she misses two pills during week 1 of her cycle

ANS: C

Feedback

A

If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or abortion, another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur.

B

No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users.

C

To maintain adequate hormone levels for contraception and to enhance compliance, patients should take oral contraceptives at the same time each day.

D

If the patient misses two pills during week 1, she should take two pills a day for 2 days and finish the package and use a backup method the next 7 consecutive days.

PTS: 1 DIF: Cognitive Level: Application REF: p. 746 | Box 31-1

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

16. With regard to the use of intrauterine devices (IUDs), nurses should be aware that

a.

Return to fertility can take several weeks after the device is removed.

b.

IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse.

c.

IUDs offer the same protection against sexually transmitted diseases as the diaphragm.

d.

Consent forms are not needed for IUD insertion.

ANS: B

Feedback

A

Return to fertility is immediate after removal of the IUD.

B

The woman has up to 5 days to insert the IUD after unprotected sex.

C

IUDs offer no protection for sexually transmitted diseases.

D

A consent form is required for insertion, as is a negative pregnancy test.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 737 | Table 31-1

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

17. 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

Feedback

A

The incidence of multiple pregnancies with the use of these medications is increased. The patients concern is legitimate and should be discussed so that she can make an informed decision.

B

This statement is inaccurate and negates the patients concerns.

C

Ultrasound cannot ensure that a multiple pregnancy will not occur.

D

The percentage quoted in this statement is inaccurate. Furthermore, the patients concern is discredited with a statement such as Dont worry.

PTS: 1 DIF: Cognitive Level: Application REF: p. 760

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

18. 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.

FSH level

d.

Examination for testicular infection

ANS: C

Feedback

A

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

B

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.

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.

D

Examination for testicular infection should be done before semen analysis. Furthermore, infection affects spermatogenesis.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 758

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance

19. 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

Feedback

A

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.

B

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.

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.

D

This statement is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

PTS: 1 DIF: Cognitive Level: Application REF: p. 767

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

20. 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 pre-procedural 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

Feedback

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.

B

This statement describes therapeutic donor insemination.

C

This statement describes the procedure for a donor embryo.

D

This statement discredits the patients need for teaching and is not the most appropriate response.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 761-762

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

21. 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 is lengthy 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

Feedback

A

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

B

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

C

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

D

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

PTS: 1 DIF: Cognitive Level: Application REF: p. 763

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. You (the nurse) are reviewing the educational packet provided to a patient about tubal ligation. What is an important fact you should point out? Select all that apply.

a.

It is highly unlikely that you will become pregnant after the procedure.

b.

This is an effective form of 100% permanent sterilization. You wont be able to get pregnant.

c.

Sterilization offers some form of protection against sexually transmitted diseases.

d.

Sterilization offers no protection against sexually transmitted diseases.

e.

Your menstrual cycle will greatly increase after your sterilization.

ANS: A, D

Feedback

Correct

A woman is unlikely to become pregnant after tubal ligation. Sterilization offers no protection against STDs.

Incorrect

Tubal ligation is not 100% effective. Tubal ligation does not offer any protection against STDs. Typically, the menstrual cycle remains the same after a tubal ligation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 737 | Table 31-1

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

TRUE/FALSE

1. Three million unintended pregnancies occur each year in the United States. A Healthy People 2020 goal is to increase the number of intended pregnancies to 70%. Is this statement true or false?

ANS: F

A Healthy People 2020 goal is to increase the number of pregnancies that are intended to 56% from a baseline of 51%. Unintended pregnancies are those that are unwanted or occur in women who want to become pregnant, but not until a later date. These pregnancies may result in economic hardship, health problems, or interference with educational or career plans. Many of these occur in women who are using contraceptives incorrectly. The nurse plays a vital role as counselor and educator.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 736

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance

2. Conception in the first cycle of treatment for infertility has a success rate of 15% to 25%, falling as subsequent attempts are made. Is this statement true or false?

ANS: T

Only 3% of couples conceive in the 12th cycle of treatment. Couples are often in a hurry for definitive therapy; however, a thorough assessment of the problem is essential for effective and financially sound treatment.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 757

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance

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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 759 | Table 31-5

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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