Chapter 4 Common Reproductive Issues

Chapter 4 Common Reproductive Issues 1. Which definition best explains the term Òsubfertility/infertilityÓ? # Failure to achieve pregnancy after 1 year of unprotected intercourse § Infertility is the failure to achieve conception after 1 year of unprotected intercourse. Because most couples have the potential to conceive but are just less able to conceive without additional help, the term subfertility is more often used today. 2. 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? # ÒYou can also test your vaginal discharge to determine if you are ovulating.Ó § 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 homeuse 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. 3. A couple in their mid-30s are at their primary care provider's office because they have been unable to conceive for 3 years. They already have one child who is 4 years of age. The care provider explains to them that they are dealing with what kind of infertility? # Secondary infertility § There are two main types of infertility: primary and secondary. A couple who has never been able to conceive has primary infertility, whereas a couple who has been able to conceive in the past but is currently unable to do so has secondary infertility. 4. The nurse is reviewing a client's electronic health record and notices that the client has recently experienced dyspareunia. The nurse knows that this is an effect of aging on the female reproductive system. What is the best description of dyspareunia that the nurse can share with the nursing student? # A woman experiences painful sexual intercourse. § Intercourse may become painful (dyspareunia) as the vaginal mucosal wall becomes thinner and vaginal secretions decrease. Female climacteric is called menopause. Osteoporosis is a condition in which bones become brittle and porous and fracture more easily. The uterus may fall (prolapse) into the vagina. 5. A client desires protection from unwanted pregnancies. However, the client does not enjoy sex when her partner wears a male condom. Also, the client experiences breast tenderness, headache, and nausea after taking oral contraceptive pills (OCPs). Which method would be the most likely choice for the couple to help them enhance their sexual experience as well as prevent any side effects? # Transdermal contraceptive § Application of transdermal contraceptive patches to the skin would most likely be the option for this couple. These patches will not hamper the sexual experience nor cause side effects such as those caused by oral contraceptive pills (OCPs). Natural membrane and polyurethane condoms are forms of male condoms, which the client does not like. Ethinyl estradiol is an oral contraceptive pill, which would most likely cause the client to experience breast tenderness, headache, and nausea. 6. The nurse is conducting a well-visit physical assessment on a 29-year-old female. The nurse determines the client is probably ovulating based on which condition of the cervical mucus? # Thin, slippery, and stretchy § The mucus at the time of ovulation is thin, slippery, and stretchy to allow for the passage of sperm into the uterus. This is called spinnbarkeit fiber. If the mucus is too thick, it will inhibit fertilization. Before ovulation, the mucus is thick and does not stretch easily. 7. 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? # 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. 8. The nurse is caring for a client requesting oral contraceptive pills (OCPs). She has multiple sexual partners. The nurse recommends condoms to the client, but the client states, "I cannot use condoms because I am allergic to latex." Which response by the nurse is appropriate? # ÒYou can still use condoms because they make latex-free condoms.Ó § Because this client has multiple partners, there is concern over the risk for sexually transmitted infections (STIs) as well as pregnancy. Condoms are the only method of contraception that protects against STIs, which is an important concern if the client is not in a monogamous relationship. The nurse would inform the client of latex-free condoms and where to purchase them first. Regardless of whether the client chooses to use latex-free condoms, the client can discuss other options for contraception with the health care provider at that time. There is no need to have the client tested for latex sensitivity. The nurse should educate the client on risks associated with multiple sexual partners; however, using therapeutic language will be most effective. 9. A nurse is helping a couple choose a contraception method that is right for them. Which is the least likely factor the nurse should consider? # The popularity of the method among the couple's friends § Important things to consider when helping a couple to choose a method that will be right for them include the following: personal values, ability to use a method correctly, whether the method will affect sexual enjoyment, financial factors, whether a couple's relationship is short-term or long-term, prior experiences with contraception, and future plans. The popularity of the method is the least likely factor the nurse should consider. 10. The nurse informs the client that a diaphragm is an example of which type of contraception? # Mechanical barrier § The diaphragm is an example of a mechanical barrier. It is a circular rubber disk placed over the cervix before intercourse. 11. 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? # No or fewer 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. 12. A young woman is newly married and is seeking advice on contraception. She is in a monogamous relationship and would like a temporary contraceptive, as she plans to have children in the future. Her husband dislikes the feel of condoms. Also, she mentions that she typically experiences dysmenorrhea and has a history of recurrent urinary tract infections. Which method should the nurse recommend? # Oral contraceptive pills (OCPs) § Oral contraceptive pills would be the best choice of those listed for this client, as it is a temporary contraceptive that also can help relieve dysmenorrhea. Postcoital douching is ineffective as a contraceptive measure as sperm may be present in cervical mucus as quickly as 90 seconds after ejaculation. Diaphragms are contraindicated for women with a history of recurrent urinary tract infections. Vasectomy is a permanent measure and thus inappropriate in this situation. 13. When conducting a health history with a couple who are experiencing subfertility, the nurse will include which of the following? Select all that apply. # General health # Medication history # Sexual history # Surgical history § The nurse will need to gather a thorough health history that will include information related to general health, medications, past sexual history, and surgical history. 14. A client reports that she has multiple sex partners and has a lengthy history of various pelvic infections. She would like to know if there is any temporary contraceptive method that would suit her condition. Which method should the nurse suggest for this client? # Condoms § Because the client has multiple sex partners, condoms will help offer protection against sexually transmitted infections (STIs) and are best suited for her needs. The client cannot use an IUD because of her history of various pelvic infections. Although OCPs will help the client as a means of contraception, this method is not the best choice for her because it does not offer protection against STIs. Tubal ligation is a sterilization procedure and does not suit the clientÕs purpose. 15. A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client? # ÒChecking the strings is recommended following insertion.Ó § The nurse should instruct the client to check the strings/threads regularly to make sure that the IUD is in place. Current recommendations are to check the strings monthly after insertion, but some clients may be instructed to check less frequently after the first 3 months following insertion because expulsion of the IUD is less common after that time. An IUD does not protect against STIs, and the insertion procedure may involve mild to moderate cramping pain; however, the client should not expect to have continuous cramping pain following insertion. 16. 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 § Today, a subfertility investigation usually is limited to three assessments: semen analysis, ovulation monitoring, and tubal patency. 17. A client is being prepared for intrauterine (artificial) insemination. Which finding is the most suggestive to determine if the client is ovulating? # 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. 18. The nurse is educating a class of high school students on safe sexual practices. The nurse knows the group understood the content when a group member makes which statement? # ÒAbstinence is the only way to prevent the spread of sexually transmitted infections.Ó § The nurse knows the group understood the teaching when a group member states abstinence as the only way to guarantee not spreading a sexually transmitted infection (STI). Diaphragms can only be used by female clients and are placed directly in front of the cervical opening. While condoms are effective ways to decrease the potential of pregnancy and limit the spread of STIs, abstinence is the only way to actually prevent pregnancy and STI contraction. Spermicide should be inserted into the vagina 10 to 15 minutes prior to the client having intercourse, not after. 19. The nurse is providing care to a client with abnormal uterine bleeding. Treatment with medications has been unsuccessful, and surgical intervention is being considered. The nurse identifies which technique as being the last resort? # Hysterectomy § If the client does not respond to medical therapy, surgical intervention might include dilatation and curettage (D&C), endometrial ablation, uterine artery embolization, or hysterectomy. Of these, hysterectomy is considered a last resort. 20. A couple is deciding about contraceptive measures. The male partner has decided to undergo a vasectomy. After teaching the client about this procedure, which client statement indicates the need for additional teaching? # ÒRight after surgery, my semen will be sperm-free.Ó § After vasectomy, semen no longer contains sperm. However, this is not immediate. The man must submit semen specimens for analysis 8 to 16 weeks after a vasectomy until two specimens show that no sperm is present. When the specimen shows azoospermia, the man's sterility is confirmed. A vasectomy is usually performed under local anesthesia in a urologist's office, and most men can return to work and normal activities in a day or two. 21. The school nurse is counseling a sexually active 16-year-old adolescent about the various forms of contraception. She is afraid of getting pregnant or contracting a sexually transmitted infection because her boyfriend refuses to use a condom. In answering the client's questions as to which option will be best suit her needs, which form should the nurse recommend? # Female condom § The female condom would be the best choice for this client, as it provides protection against both STIs and conception. A tubal ligation would not be recommended for a 16-year-old girl, as it is a permanent measure and she may decide to have children in the future. Neither an oral contraceptive nor coitus interruptus would provide protection against STIs. 22. A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests? # Semen analysis, ovulation monitoring, and tubal patency assessment § Only three tests are commonly used to test fertility: semen analysis in the male and ovulation monitoring and tubal patency assessment in the female. Additional testing may be performed both on the man and the woman, which may include urinalysis, serologic test for syphilis, and pelvic sonogram, but these are not the primary tests used. 23. The nurse is caring for a woman who had a dilatation and curettage (D&C) 1 hour prior. What assessment finding would alert the nurse to immediately intervene? # Pulse rate of 122 beats/min § The nurse would further assess the client for a hemorrhage when noting an elevated pulse rate. One of the risk following a D&C is vaginal hemorrhage. The client's blood pressure would be low, not high, if the client were hemorrhaging vaginally. The client's temperature is normal at 98.6¡ F (37¡ C) and is an expected finding within an hour of the procedure. Abdominal cramping is an expected finding. 24. A nurse supervisor observes a nurse massage a clientÕs injection site after giving a dose of depot medroxyprogesterone acetate (Depo-Provera). What is the priority response by the nurse supervisor? # Remind the nurse that this injection should absorb slowly. § The medication should absorb slowly from the muscle, so the nurse supervisor should remind the nurse not to rub the injection site following administration. 25. A woman is diagnosed with primary dysmenorrhea and is prescribed ibuprofen as part of her treatment plan. When teaching the woman about using this medication, which instruction would be important for the nurse to emphasize? # ÒStart taking the medication when you first get your period.Ó § When taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, for dysmenorrhea, it is important for the woman to start therapy prophylactically and use sufficient doses to maximally suppress prostaglandin production. NSAIDs should be taken with food to prevent gastrointestinal upset. They should not be taken with aspirin because doing so can increase the risk of bleeding, which would be noted with black stools. 26. 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? # ÒThey will place a catheter in my uterus and use an ultrasound to see what the problem is.Ó § 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. 27. A woman uses a diaphragm for contraception. The nurse would instruct her to return to the clinic to have her diaphragm fit checked after which occurrence? # A weight gain of 10 lb (4.5 kg) § A substantial weight gain or weight loss of 10 pounds (4.5 kilograms) or more may shift the relationship of pelvic organs enough that the diaphragm no longer fits correctly. 28. Which description best explains the hysterosalpingogram procedure? # Radiograph of the uterus and fallopian tubes following introduction of a radiopaque medium through the cervix § Hysterosalpingogram is a procedure to document the patency of the fallopian tubes through the use of a radiopaque medium. 29. A client's subfertility has been attributed to intrauterine adhesions. When talking with the client about treating this condition, which treatment will the nurse describe? # Myomectomy § Uterine fibroids and intrauterine adhesions as the cause of subfertility will be treated with a myomectomy. Clomiphene would be used to treat problems with anovulation. If the problem of subfertility appears to be a luteal phase defect, this can be corrected by progesterone vaginal suppositories. A dilatation and curettage (D&C) is linked to tightening or obstruction of the cervical os as a cause of subfertility. 30. The nurse in a primary care clinic and a client have come to see the primary care provider because the client is getting married and wants to have a prenuptial gynecologic examination. After the exam, the nurse asks about the woman's plan to have a family. The woman responds, "Why do I have to plan for a family?" What would be the nurse's best response? # The couple can control the time between births when they plan their family. § Women and couples can avoid unwanted pregnancies, bring about wanted births, and control the intervals between births with family planning. 31. A client expresses interest in having an intrauterine device (IUD) placed for contraception. Which finding noted in the health history would indicate to the nurse that this would not be an appropriate contraceptive option? # Bicornuate uterus § The client has an abnormally shaped uterus, which could be a contraindication for the use of an IUD due to increased risk for uterine wall perforation. All other findings would not contraindicate the device. 32. Which laboratory result would be most important for a nurse to monitor for a client who has recently started letrozole? # FSH § The nurse will need to monitor FSH levels in the client taking letrozole to increase ovulation. 33. The nurse working in a free health clinic assesses a 17-year-old client interested in contraceptives. Which statement by the client would indicate that female or male condoms would be the appropriate recommendation? # ÒLast year I was diagnosed with HPV.Ó § The client has already contracted HPV; to prevent further spread of itÑor contracting other STIsÑthe nurse should recommend the client use male or female condoms. 34. A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client? # ÒChecking the strings is recommended following insertion.Ó § The nurse should instruct the client to check the strings/threads regularly to make sure that the IUD is in place. Current recommendations are to check the strings monthly after insertion, but some clients may be instructed to check less frequently after the first 3 months following insertion because expulsion of the IUD is less common after that time. An IUD does not protect against STIs, and the insertion procedure may involve mild to moderate cramping pain; however, the client should not expect to have continuous cramping pain following insertion. 35. A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about? # Overstimulation of the ovary resulting in potential multiple births § Therapy with clomiphene citrate may be used to stimulate ovulation. Administration of either clomiphene citrate or gonadotropins may overstimulate an ovary, causing multiple ova to come to maturity and possibly resulting in multiple births. The nurse should counsel women who receive these agents that this is a possibility. None of the other answers is a common effect of clomiphene citrate use. 36. A couple has chosen fertility awareness as their method of contraception. The nurse explains that the unsafe period for them during the menstrual cycle would be at which time? # Three days before and three days after ovulation § Typically, the unsafe period during the menstrual cycle is approximately 3 days before and 3 days after ovulation. An ovum is released from the ovary 14 days before the next menstrual period. 37. 38. 39. 40. V V V V