Deck 5: Infertility, contraception, and Abortion

Question 1

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 nurse's 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."

Answer 1

"Smoking can reduce the quality of your sperm."

Question 2

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 nurse's most appropriate response is:

A) "The IUD does not interfere with sex."
B) "The risk of pelvic inflammatory disease (PID) will be higher for you."
C) "The IUD will protect you from sexually transmitted infections (STIs)."
D) "Pregnancy rates are high with IUDs."

Answer 2

"The risk of pelvic inflammatory disease (PID) will be higher for you."

Question 3

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 husband and wife have arrived for their preprocedural interview.The husband asks the nurse to explain what the procedure entails.The nurse's most appropriate response is:

A) "IVF-ET is a type of assisted reproductive therapy that involves collecting eggs from your wife's ovaries, fertilizing them in the laboratory with your sperm, and transferring the embryo to her uterus."
B) "A donor embryo will be transferred into your wife's uterus."
C) "Donor sperm will be used to inseminate your wife."
D) "Don't worry about the technical stuff; that's what we are here for."

Answer 3

"IVF-ET is a type of assisted reproductive therapy that involves collecting eggs from your wife's ovaries, fertilizing them in the laboratory with your sperm, and transferring the embryo to her uterus."

Question 4

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,what contraceptive method should she and her partner avoid?

A) Cervical cap
B) Condom
C) Vaginal film
D) Vaginal sheath

Question 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 nurse's most appropriate response would be:

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."

Question 6

A woman is using the basal body temperature (BBT)method of contraception.She calls the clinic and tells the nurse,"My period is due in a few days,and my temperature has not gone up." The nurse's most appropriate response is:

A) "This probably means that you're pregnant."
B) "Don't worry; it's probably nothing."
C) "Have you been sick this month?"
D) "You probably didn't ovulate during this cycle."

Question 7

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

A) be comfortable with their sexuality and nonjudgmental about others to counsel their patients effectively.
B) know about such nonmedical remedies as diet, exercise, and stress management.
C) be able to direct patients to sources of information about what herbs to take that might help and which ones to avoid.
D) do all of the above plus be knowledgeable about potential drug and surgical remedies.

Question 8

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

A) "They're not very effective, and it's very likely you'll 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."

Question 9

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

A) "No spermicide is used with the cervical cap, so it's 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."

Question 10

A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her "fertile" time.She asks the nurse about emergency contraception.The nurse tells her that:

A) it is too late; she needed to begin treatment within 24 hours after intercourse.
B) Preven, 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.

Question 11

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.

Question 12

Although remarkable developments have occurred in reproductive medicine,assisted reproductive therapies are associated with numerous legal and ethical issues.Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment.Which issue would not need to be addressed by an infertile couple before treatment?

A) Risks of multiple gestation.
B) Whether or how to disclose the facts of conception to offspring.
C) Freezing embryos for later use.
D) Financial ability to cover the cost of treatment.

Question 13

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

A) "Tell your friends and family so 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. I'll give you some names."
D) "Start adoption proceedings immediately because it is very difficult to obtain an infant."

Question 14

A male patient asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide).The nurse's most appropriate response is:

A) "The lubricant prevents vaginal irritation."
B) "It has also been linked to an increase in the transmission of human immunodeficiency virus."
C) "The additional lubrication improves sex."
D) "Nonoxynol-9 improves penile sensitivity."

Question 15

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.

Question 16

A couple comes in for an infertility workup,having attempted to get pregnant for 2 years.The woman,37 years,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

Question 17

A woman has chosen the calendar method of conception control.During the assessment process,it is most important that the nurse:

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.

Question 18

A woman is 16 weeks pregnant and has elected to terminate her pregnancy.The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is:

A) dilation and evacuation (D&E).
B) instillation of hypertonic saline into the uterine cavity.
C) intravenous administration of Pitocin.
D) vacuum aspiration.

Question 19

A woman enquires about herbal alternative methods for improving fertility.Which statement by the nurse is the most appropriate when instructing the patient in which herbal preparations to avoid while trying to conceive?

A) "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant."
B) "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive."
C) "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile."
D) "Herbs have no bearing on fertility."

Question 20

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

A) the couple's religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis.
B) the investigation takes 3 to 4 months and a significant financial investment.
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.

Question 21

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.

Question 22

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.

Question 23

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.

Question 24

MATCHING
Evaluation for infertility should be offered to couples who have failed to become pregnant after 1 year of regular intercourse or after 6 months if the woman is older than 35 years. Impaired fertility in women may be the result of numerous factors. Careful identification of the cause of infertility assists in determining the correct treatment plan. The nurse who chooses to work in the specialty of infertility must have an excellent understanding of these factors and causes. Match each factor affecting female infertility with the likely cause.

Isoimmunization

A)Ovarian
B)Tubal/peritoneal
C)Uterine
D)Vaginal/cervical
E)Other factors

Question 25

Which of the following statements is the most complete and accurate description of medical abortions?

A) They are performed only for maternal health.
B) They can be achieved through surgical procedures or with drugs.
C) They are mostly performed in the second trimester.
D) They can be either elective or therapeutic.

Question 26

With regard to the noncontraceptive medical effects of combined oral contraceptive pills (COCs),nurses should be aware that:

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.

Question 27

MATCHING
Evaluation for infertility should be offered to couples who have failed to become pregnant after 1 year of regular intercourse or after 6 months if the woman is older than 35 years. Impaired fertility in women may be the result of numerous factors. Careful identification of the cause of infertility assists in determining the correct treatment plan. The nurse who chooses to work in the specialty of infertility must have an excellent understanding of these factors and causes. Match each factor affecting female infertility with the likely cause.

Thyroid dysfunction or obesity

A)Ovarian
B)Tubal/peritoneal
C)Uterine
D)Vaginal/cervical
E)Other factors

Question 28

Practice of the calendar rhythm method is based on the number of days in each menstrual cycle.The fertile period is determined after monitoring each cycle for 6 months.The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest.If the woman's cycles vary in length from 24 to 30 days,what would her fertile period be?
________ to _________

Question 29

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 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."

Question 30

Postcoital contraception with Ella:

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.

Question 31

MATCHING
Evaluation for infertility should be offered to couples who have failed to become pregnant after 1 year of regular intercourse or after 6 months if the woman is older than 35 years. Impaired fertility in women may be the result of numerous factors. Careful identification of the cause of infertility assists in determining the correct treatment plan. The nurse who chooses to work in the specialty of infertility must have an excellent understanding of these factors and causes. Match each factor affecting female infertility with the likely cause.

Endometrial or myometrial tumors

A)Ovarian
B)Tubal/peritoneal
C)Uterine
D)Vaginal/cervical
E)Other factors

Question 32

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 woman's 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.

Question 33

A physician 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."

Question 34

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 infections (STIs) as the diaphragm.
D) consent forms are not needed for IUD insertion.

Question 35

MATCHING
Evaluation for infertility should be offered to couples who have failed to become pregnant after 1 year of regular intercourse or after 6 months if the woman is older than 35 years. Impaired fertility in women may be the result of numerous factors. Careful identification of the cause of infertility assists in determining the correct treatment plan. The nurse who chooses to work in the specialty of infertility must have an excellent understanding of these factors and causes. Match each factor affecting female infertility with the likely cause.

Endometriosis

A)Ovarian
B)Tubal/peritoneal
C)Uterine
D)Vaginal/cervical
E)Other factors

Question 36

MATCHING
Evaluation for infertility should be offered to couples who have failed to become pregnant after 1 year of regular intercourse or after 6 months if the woman is older than 35 years. Impaired fertility in women may be the result of numerous factors. Careful identification of the cause of infertility assists in determining the correct treatment plan. The nurse who chooses to work in the specialty of infertility must have an excellent understanding of these factors and causes. Match each factor affecting female infertility with the likely cause.

Anorexia

A)Ovarian
B)Tubal/peritoneal
C)Uterine
D)Vaginal/cervical
E)Other factors