Chapter 8 - Infertility, Contraception, and Abortion

Which test used to diagnose the basis of infertility is done during the late follicular or early proliferative phase of the menstrual cycle?

a. Hysterosalpingogram

b. Endometrial biopsy

c. Laparoscopy

d. Follicle-stimulating hormone (FSH) level

a. Hysterosalpingogram

A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his partner are having getting pregnant. What information is the basis for the nurse’s response?

a. Indicating that the first sperm count seems okay

b. Informing that only marijuana cigarettes affect sperm count

c. Providing information about smoking and lung cancer and its lack of effect on sperm

d. Providing education that smoking can reduce the quality of sperm

d. Providing education that smoking can reduce the quality of sperm

A couple comes in for an infertility appointment, 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 underwent 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

c. Follicle-stimulating hormone (FSH) level

A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. What is the basis for the nurse’s response?

a. Encourage the couple to share the information with friends so they can talk more about it.

b. Suggest they only discuss their infertility problem with friends that do not have children.

c. Provide information about local support groups for infertile couples.

d. Suggest they initiate adoption proceedings immediately because it is a lengthy process.

c. Provide information about local support groups for infertile couples.

A woman inquires about herbal alternative methods for improving fertility. Which information provides the basis for the nurse’s response when instructing the patient about which herbal preparations to avoid while trying to conceive?

a. Avoid nettle leaf, dong quai, and vitamin E.

b. Avoid licorice root, lavender, fennel, sage, and thyme.

c. Avoid vitamin E, calcium, and magnesium.

d. Herbs have no bearing on fertility.

b. Avoid licorice root, lavender, fennel, sage, and thyme.

In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or unexplained infertility and for men with very low sperm counts. A couple have arrived for their preprocedural interview. The partner asks the nurse to explain what the procedure entails. What information is the basis for the nurse’s response?

a. Eggs from the woman’s ovaries are fertilized in the lab with the partner’s sperm and the embryo is transferred to her uterus.

b. A donor embryo will be transferred into your partner’s uterus.

c. Donor sperm will be used to inseminate your partner.

d. Donor eggs are used and fertilized in the lab with donor sperm.

a. Eggs from the woman’s ovaries are fertilized in the lab with the partner’s sperm and the embryo is transferred to her uterus.

When working with patients who are experiencing infertility, which should the nurse be aware of related to infertility?

a. Infertility is perceived differently by women and men.

b. Fertility has a relatively stable prevalence throughout a woman’s reproductive years.

c. Infertility is more likely the result of a physical deviation in the woman than one in the man.

d. Infertility is the same thing as sterility.

a. Infertility is perceived differently by women and men.

What should a nurse be aware of with regard to the assessment of female, male, and couple infertility?

a. The couple’s religious, cultural, and ethnic backgrounds produce emotional baggage that does not affect the clinical scientific diagnosis.

b. The investigation takes 3 to 4 months and a lot of money.

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.

b. The investigation takes 3 to 4 months and a lot of money.

What should a nurse do when implementing a plan of care for infertile couples?

a. Reserve judgement about the couple until the relationship develops.

b. Avoid discussion of lifestyle changes that may enhance fertility.

c. Promote the use of herbs that might help the couple conceive.

d. Be knowledgeable about potential medication and surgical remedies.

d. Be knowledgeable about potential medication and surgical remedies.

Which issue would need to be addressed by an infertile couple before treatment?

a. Risk of multiple gestations

b. Ways to avoid disclosing the facts of conception to offspring

c. Inability to freeze embryos for later use

d. Financial ability to cover the cost of treatment

a. Risk of multiple gestations

A woman has chosen the calendar days method of conception control. During the assessment process, what is most important for the nurse to do?

a. Obtain a history of menstrual-cycle lengths for the past 6 months.

b. Determine the patient’s weight gain and loss pattern for the previous year.

c. Examine skin pigmentation and hair texture for hormonal changes.

d. Explore the patient’s previous experiences with conception control.

a. Obtain a history of menstrual-cycle lengths for the past 6 months.

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells a nurse, “My period is due in a few days, and my temperature has not gone up.” How should the nurse respond?

a. Inform the patient that she is probably pregnant.

b. Assure the patient that this is nothing to worry about.

c. Ask the patient if she has been sick this month.

d. Explain to the patient that she probably did not ovulate during this cycle.

d. Explain to the patient that she probably did not ovulate during this cycle.

Which is correct about fertility awareness based methods (FABs)?

a. FAB methods are not very effective, and it is likely that pregnancy will result.

b. FAB methods can be effective but they require adherence to strict record keeping.

c. FAB methods have a few advantages and several health risks.

d. FAB methods are more effective than the oral contraceptive pill (OCP).

b. FAB methods can be effective but they require adherence to strict record keeping.

Why it is better to teach a patient to purchase condoms that are not lubricated with nonoxynol-9 (N-9) (a common spermicide)?

a. The lubricant prevents vaginal irritation.

b. N-9 has been linked to human immunodeficiency virus (HIV) transmission.

c. The additional lubrication improves sex.

d. Nonoxynol-9 improves penile sensitivity.

b. N-9 has been linked to human immunodeficiency virus (HIV) transmission.

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks a nurse about the combined oral contraceptive pill (COC) as a contraceptive choice. What is the basis for the nurses’ response?

a. The COC is a highly effective method, but it has some adverse effects.

b. The patient’s current medications will reduce the effectiveness of the COC.

c. The COC will reduce the effectiveness of the seizure medication.

d. The COC is a good choice for women with seizure disorders.

b. The patient’s current medications will reduce the effectiveness of the COC.

Injectable progestins (DMPA) are a good contraceptive choice for which women?

a. Women who want menstrual regularity and predictability

b. Women who have a history of thrombotic problems or breast cancer

c. Women who have difficulty remembering to take oral contraceptives daily

d. Women who are homeless or mobile and rarely receive health care

c. Women who have difficulty remembering to take oral contraceptives daily

A nurse teaches a patient what is the major differences between the cervical cap and diaphragm?

a. No spermicide is used with the cervical cap, so it’s less messy.

b. The diaphragm can be left in place longer than the cervical cap 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.

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

A woman was treated recently for toxic shock syndrome (TSS). She has intercourse occasionally and uses over-the-counter protection. On the basis of her history, which contraceptive method should she and her partner avoid?

a. Cervical cap

b. Condom

c. Vaginal film

d. Vaginal sheath

a. Cervical cap

A 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 intrauterine contraception (IUC). What is the basis for the nurse’s response?

a. IUC does not interfere with sex.

b. The risk of pelvic inflammatory disease (PID) is higher with the use of IUC.

c. IUC provides protection against sexually transmitted infections (STIs).

d. Pregnancy rates are high with the use of ICU.

b. The risk of pelvic inflammatory disease (PID) is higher with the use of IUC.

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the most common technique used for elective termination of a pregnancy in the second trimester?

a. Dilation and evacuation (D&E)

b. Instillation of hypertonic saline into the uterine cavity

c. Intravenous administration of oxytocin

d. Vacuum aspiration

a. Dilation and evacuation (D&E)

A woman will be taking oral contraceptives using a 28-day pack. What should a nurse advise this woman for protection against pregnancy?

a. Limit sexual contact for one cycle after starting the pill.

b. Use condoms and foam instead of the pill for as long as she takes an antibiotic.

c. Take one pill at the same time every day.

d. Stop taking the pills and use a backup method if she misses two pills during week 1 of her cycle.

c. Take one pill at the same time every day.

A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her “fertile” time. In response to her question about emergency contraception, what is a nurse’s best response?

a. It is too late; she needed to begin treatment within 24 hours after intercourse.

b. Plan B, an emergency contraceptive method, is 98% effective at preventing pregnancy.

c. An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting.

d. The most effective approach is to use a progestin-only preparation.

c. An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting.

Which statement is true about the term contraceptive failure rate?

a. It refers to the percentage of users expected to have an accidental pregnancy over a 5-year span.

b. It refers to the minimum level that must be achieved to receive a government license.

c. It increases over time as couples become more careless.

d. It varies from couple to couple, depending on the method and the users.

d. It varies from couple to couple, depending on the method and the users.

While instructing a couple regarding birth control, what should a nurse be aware of in relation to the method called natural family planning?

a. It’s the same as coitus interruptus, or “pulling out.”

b. It involves the calendar method to align the woman’s cycle with the natural phases of the moon.

c. It involves methods that do not rely on medical devices, compounds, or medication.

d. It relies on barrier methods during fertility phases.

c. It involves methods that do not rely on medical devices, compounds, or medication.

Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)?

a. Periodic abstinence

b. Barrier methods

c. Hormonal methods

d. They all offer about the same protection

b. Barrier methods

With regard to the noncontraceptive medical effects of combined oral contraceptive pills (COCs), what should a nurse be aware of?

a. COCs can cause toxic shock syndrome if the prescription is wrong.

b. Hormonal withdrawal bleeding usually is a bit more profuse than in normal menstruation and lasts a week.

c. COCs increase the risk of endometrial and ovarian cancer.

d. The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

d. The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

What should a nurse be aware of with regard to the use of intrauterine contraception (IUC)?

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

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

c. IUC offers the same protection against sexually transmitted infections as that of the diaphragm.

d. Consent forms are not needed for IUC insertion.

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

Which statement is the most complete and accurate description of induced abortions?

a. They are performed only for maternal health.

b. They can be achieved only through surgical procedures.

c. They are mostly performed in the second trimester.

d. They can be either medically or surgically induced.

d. They can be either medically or surgically induced.

Which action should a nurse take first when meeting with a new patient to discuss contraception?

a. Obtain data about the frequency of coitus.

b. Determine the patient’s level of contraceptive knowledge.

c. Assess the patient’s willingness to touch her genitals and cervical mucus.

d. Evaluate the patient’s contraceptive life plan.

b. Determine the patient’s level of contraceptive knowledge.

Which fact would a nurse expect in an educational packet provided to a patient about tubal ligation?

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

b. This is a 100% effective form of permanent sterilization. You won’t be able to get pregnant.

c. Sterilization offers some form of protection against sexually transmitted infections (STIs).

d. Your menstrual cycle will greatly increase after your sterilization.

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

When completing discharge teaching for the patient after an induced abortion, a nurse should inform the patient to report which symptom to their health care provider?

a. Temperature of 37.8C

b. Spotting or flow on day 4

c. Abdominal tenderness when no pressure is applied

d. No return of menstrual period within 6 weeks

d. No return of menstrual period within 6 weeks

A health care provider prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. The nurse’s 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 don’t need to worry too much.”

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

A nurse is reviewing the educational packet provided to a patient about tubal ligation. What is an important fact the nurse 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 won’t be able to

get pregnant.”

c. “Sterilization offers some form of protection against sexually transmitted

infections (STIs).”

d. “Sterilization offers no protection against STIs.”

e. “Your menstrual cycle will greatly increase after your sterilization.”

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

d. “Sterilization offers no protection against STIs.”