Chapter 32: Infertility My Nursing Test Banks

Chapter 32: Infertility

MULTIPLE CHOICE

1. Large amounts of leukocytes in the seminal fluid suggest:

a.

inadequate fructose.

b.

inflammation of the testes.

c.

an infection of the genital tract.

d.

an obstruction in the vas deferens.

ANS: C

The presence of large amounts of leukocytes suggests an infection. Adequate fructose must be present to supply energy for the sperm. An inflammatory process would be diagnosed by abnormal consistency or chemical composition. If an obstruction is present, the total amount of the seminal fluid would be abnormal.

PTS: 1 DIF: Cognitive Level: Understanding REF: 704

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

2. A couple who has not achieved a successful pregnancy is scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed?

a.

Semen analysis

b.

Testicular biopsy

c.

Endometrial biopsy

d.

Hysterosalpingography

ANS: A

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

PTS: 1 DIF: Cognitive Level: Understanding REF: 707

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

3. Which situation best describes secondary infertility in a couple?

a.

Never conceived

b.

Had repeated spontaneous abortions

c.

Not conceived after 1 year of unprotected intercourse

d.

Has one child but cannot conceive a second time

ANS: D

Secondary infertility occurs in couples who have conceived before but are unable to conceive again. Primary infertility occurs when a couple has never conceived or who has not conceived after 1 year of unprotected intercourse. Repeated spontaneous abortions are considered primary infertility.

PTS: 1 DIF: Cognitive Level: Understanding REF: 701

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

4. A woman undergoing evaluation of infertility states, At least when were through with all of these tests, we will know what is wrong. The nurses best response is:

a.

I know the test will identify what is wrong.

b.

Im sure that once you finish these tests, your problem will be resolved.

c.

Even with diagnostic testing, infertility remains unexplained in about 20% of couples.

d.

Once youve identified your problem, you may want to look at the option of adoption.

ANS: C

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

PTS: 1 DIF: Cognitive Level: Application REF: 702

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

5. A newly married woman states, My friend told me I would never have a baby because I had pelvic inflammatory disease when I was younger. I dont understand how that can affect whether or not I get pregnant. The nurses best response is:

a.

Your friend may be right. The disease may affect your ability to conceive.

b.

Pelvic inflammatory disease may damage the ovaries and prevent ovulation.

c.

Your friend has been misinformed. Fallopian tube damage occurs only following gonorrhea.

d.

Infection may cause scarring and obstruction of the fallopian tubes, which can prevent the fertilized egg from reaching the uterus.

ANS: D

Providing the client with accurate complete information is the best response. Pelvic inflammatory disease produces scarring and obstruction of the fallopian tube if the infection is not treated. It does not occur following gonorrhea.

PTS: 1 DIF: Cognitive Level: Application REF: 707

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

6. The procedure in which ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the womans uterus is:

a.

in vitro fertilization.

b.

tubal embryo transfer.

c.

therapeutic insemination.

d.

gamete intrafallopian transfer.

ANS: A

In vitro fertilization is a procedure used to bypass blocked or absent fallopian tubes. Tubal embryo transfer places the conceptus into the fallopian tube. Therapeutic insemination uses the partners sperm or that of a donor and places it directly into the woman. Gamete intrafallopian transfer is when the sperm and ova are placed in the fallopian tube.

PTS: 1 DIF: Cognitive Level: Understanding REF: 710

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

7. Chromosome analysis is a diagnostic test that should be offered to which couple?

a.

Never conceived

b.

Has long-standing infertility

c.

Has had repeated pregnancy losses

d.

Has a normal child but has not conceived again

ANS: C

Repeated failures to carry a pregnancy to term may indicate genetic defects in the fetus that are incompatible with life. A couple who has never conceived would not be offered chromosome analysis. Long-standing infertility is not an indicator for chromosome analysis. Secondary infertility with an existing normal child would not be an indicator for chromosome analysis.

PTS: 1 DIF: Cognitive Level: Understanding REF: 709

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

8. A woman who is undergoing infertility testing states, My husband wont discuss this with me. I dont think he cares about or wants a baby. The nurses best response is:

a.

You should confront him about this.

b.

He probably doesnt understand your concern.

c.

Men are sometimes less eager to have children.

d.

It may be harder for him to express his feelings.

ANS: D

Men often internalize their feelings, which may appear to women as lack of concern or interest. Suggesting that the woman confront her husband suggests that the woman is at fault and not communicating with her husband. He probably doesnt understand your concern does not explain to the woman why her husband wont discuss the problem; it passes judgment on the husband. Men are sometimes less eager to have children does not allow the woman to express her feelings; it offers the nurses opinion, which is not appropriate.

PTS: 1 DIF: Cognitive Level: Application REF: 712

OBJ: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity

9. Which of the following medical conditions could possible affect a womans fertility status?

a.

Past medical history of asthma during childhood that is presently under control with the use of an inhaler

b.

Recently diagnosed with PCOS

c.

Past surgical history of removal of external polyps on labial tissue

d.

History of frequent sinus headaches that is seasonal in nature treated with over-the-counter medication

ANS: B

PCOS (polycystic ovarian syndrome) is associated with infertility issues related to syndrome presentationhormonal abnormalities, obesity, and dyslipidemia. The use of inhaler therapy for the treatment of asthma should not affect the clients fertility status. Removal of external polyps on the labia should not affect the clients fertility. A history of sinus headaches should not affect the clients fertility.

PTS: 1 DIF: Cognitive Level: Analysis REF: 704

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

10. A client has been diagnosed with an incompetent cervix. What treatment option will be incorporated into the plan of care?

a.

Bed rest throughout the pregnancy

b.

Wait and see approach to determine if the client goes into preterm labor

c.

Preparation for cerclage procedure at 32 weeks gestation

d.

More frequent ultrasounds to assess progression of pregnancy

ANS: D

An incompetent cervix would place the client in a high-risk category, and more frequent ultrasound monitoring would be included. Although bed rest may be ordered, there is conflicting evidence about the merits of this intervention. However, it is unlikely that it would be ordered for the duration of the pregnancy. An incompetent cervix is a clinical abnormality, so the standard of care requires appropriate surgical intervention. A cerclage procedure is typically done much earlier in the pregnancy period.

PTS: 1 DIF: Cognitive Level: Analysis REF: 705

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Physiologic Integrity/Physiologic Adaptations

MULTIPLE RESPONSE

11. Which factors would contribute to abnormalities of the fallopian tube associated with the development of infertility? (Select all that apply.)

a.

History of conization of the cervix

b.

History of pelvic surgical procedures

c.

Incompetent cervix

d.

Past treatments of STD with follow-up test of cure

e.

Endometriosis

ANS: B, D, E

Surgical procedures related to the cervix, along with an incompetent cervix, would not affect the fallopian tubes in terms of infertility. It would affect fertility issues related to the cervix as a result of potential scarring (conization) and an inability to maintain the pregnancy in the presence of an incompetent cervix. A history of pelvic surgical procedures could result in the development of pelvic adhesions, which would affect the fallopian tube. Also, the presence of STDs, even with effective treatment, along with the clinical diagnosis, would affect the fallopian tube and possibly result in infertility.

PTS: 1 DIF: Cognitive Level: Analysis REF: 708

OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Physiologic Integrity/Reduction of Risk Potential

12. Which adverse reactions are associated with the administration of clomiphene citrate (Clomid)? (Select all that apply.)

a.

Abdominal bloating

b.

Diarrhea

c.

Oliguria

d.

Nausea and vomiting

e.

Abnormal uterine bleeding

ANS: A, D, E

Some adverse reactions associated with Clomid are abdominal distension, frequent urination, nausea and vomiting, and abnormal uterine bleeding. Diarrhea is not a common presentation.

PTS: 1 DIF: Cognitive Level: Application REF: 708

OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Physiologic Integrity/Pharmacologic and Parenteral Therapies

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