Maternal Child Nursing Care in Canada 1st By Perry Hockenberry Wilson – Test Bank

Maternal Child Nursing Care in Canada 1st By Perry Hockenberry Wilson – Test Bank

Chapter 07: Infertility, Contraception, and Abortion
Test Bank

MULTIPLE CHOICE

1. Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle?
a. Hysterosalpingogram
b. Endometrial biopsy
c. Laparoscopy
d. Follicle-stimulating hormone (FSH) level

ANS: B
Endometrial biopsy is scheduled after ovulation, during the luteal phase of the menstrual cycle. A hysterosalpingogram is scheduled in the early proliferative phase to avoid flushing potentially fertilized ovum out through a uterine tube into the peritoneal cavity. Laparoscopy usually is scheduled early in the menstrual cycle. Hormone analysis is performed to assess endocrine function of the hypothalamic–pituitary–ovarian axis when menstrual cycles are absent or irregular.

DIF: Cognitive Level: Knowledge REF: page 129, Table 7-1
OBJ: 3 TOP: Nursing Process: Planning MSC: CRNE: CH-30

2. 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. What is the nurse’s most appropriate response?
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, but it has no effect on sperm.”
d. “Smoking can reduce the quality of your sperm.”

ANS: D
Use of tobacco, alcohol, and marijuana may affect sperm counts. “Your sperm count seems to be okay in the first semen analysis” is inaccurate. Sperm counts vary from day to day and depend on emotional and physical status and sexual activity. Therefore, a single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility.

DIF: Cognitive Level: Application REF: page 131, Box 7-2
OBJ: 1 TOP: Nursing Process: Diagnosis MSC: CRNE: NCP-11

3. 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 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

ANS: 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. A testicular biopsy would be indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). 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. Examination for testicular infection would be done before semen analysis. Furthermore, infection would affect spermatogenesis.

DIF: Cognitive Level: Analysis REF: page 129 OBJ: 3
TOP: Nursing Process: Diagnosis MSC: CRNE: CH-8

4. 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 nurse’s most appropriate response?
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 a lengthy process.”

ANS: 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. Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couple’s relationships with family and friends. 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 help them. The statement about adoption proceedings is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

DIF: Cognitive Level: Application REF: page 131 OBJ: 2
TOP: Nursing Process: Assessment MSC: CRNE: HW-10

5. A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is most appropriate when instructing the patient about 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.”

ANS: B
Herbs that a woman should avoid while trying to conceive include licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Nettle leaf, dong quai, and vitamin E are all remedies that promote fertility. Vitamin E, calcium, and magnesium may promote fertility and conception.

DIF: Cognitive Level: Application REF: page 131 OBJ: 3
TOP: Nursing Process: Planning MSC: CRNE: NCP-10

6. 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. What is the nurse’s most appropriate response?
a. “Eggs from your wife’s ovaries are fertilized in the lab with your sperm and the embryo is transferred 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.”

ANS: A
A woman’s eggs are collected from her ovaries, fertilized in the laboratory with sperm, and transferred to her uterus after normal embryonic development has occurred. The statement “A donor embryo will be transferred into your wife’s uterus” describes therapeutic donor insemination. “Donor sperm will be used to inseminate your wife” describes the procedure for a donor embryo. “Don’t worry about the technical stuff; that’s what we are here for” discredits the patient’s need for teaching and is not the most appropriate response.

DIF: Cognitive Level: Application REF: page 134, Table 7-2
OBJ: 4 TOP: Nursing Process: Planning MSC: CRNE: HW-26

7. When working with patients who are experiencing infertility, the nurse should be aware of which of the following 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.

ANS: A
Women tend to be more stressed about infertility tests and to place more importance on having children. The prevalence of infertility is stable among the overall population, but it increases with a woman’s age, especially over age 40. Of cases with an identifiable cause, about 40% are related to female factors, 40% to male factors, and 20% to both partners. Sterility is the inability to conceive. Infertility is a state of requiring a prolonged time to conceive, or subfertility.

DIF: Cognitive Level: Comprehension REF: page 126 OBJ: 1
TOP: Nursing Process: Assessment MSC: CRNE: NCP-7

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

ANS: B
Fertility assessment and diagnosis take time, money, and commitment from the couple. Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an impact on diagnosis and assessment. Both partners are assessed systematically and simultaneously, as individuals and as a couple. Semen analysis is for men, but the postcoital test is for the couple.

DIF: Cognitive Level: Application REF: page 127 OBJ: 3
TOP: Nursing Process: Assessment MSC: CRNE: CH-12

9. What should the 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 drug and surgical remedies.

ANS: D
Nurses should be open to and ready to help with a variety of pharmacological and non-pharmacological approaches. They should practice in a nonjudgemental manner at all times. When implementing a plan of care for infertile couples the nurse should engage in discussions of lifestyle changes that may enhance fertility rather than avoid discussing them. Before the nurse promotes the use of herbs it is important that the couple`s readiness for herbal remedies be assessed.

DIF: Cognitive Level: Comprehension REF: pages 131-132
OBJ: 3 TOP: Nursing Process: Implementation MSC: CRNE: CH-12

10. Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with a number of legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so that couples can make informed decisions about their choice of treatment. 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

ANS: A
The risk of multiple gestations is indeed a risk of treatment that the couple needs to be aware of. In order to minimize the chance of multiple gestations, generally only three or fewer embryos are transferred. The couple should be informed that there may be a need for multifetal reduction. Nurses can provide anticipatory guidance on this matter. Although the method of payment is important, obtaining this information is not the responsibility of the nurse. All provinces in Canada provide coverage for diagnostic testing and some medical treatment. Teaching regarding disclosure of the facts of conception should provide neutral information and not assume that the couple only wants information on how to avoid disclosure. It is possible to freeze embryos for later use. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer wants the embryos at a future time.

DIF: Cognitive Level: Application REF: page 133, Box 7-6
OBJ: 4 TOP: Nursing Process: Implementation MSC: CRNE: CH-12

11. A woman has chosen the calendar 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.

ANS: A
The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate patient understanding and compliancy, but it is not the most important aspect to assess for discussion of the calendar method.

DIF: Cognitive Level: Analysis REF: page 138 OBJ: 6
TOP: Nursing Process: Assessment MSC: CRNE: HW-13

12. 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.” What is the nurse’s most appropriate response?
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.”

ANS: D
A pattern of lower body temperature with no increase is most likely is the result of lack of ovulation. Pregnancy cannot occur without ovulation (which is being measured using the BBT method). A comment such as “Don’t worry; it’s probably nothing” discredits the patient’s concerns. Illness would most likely cause an increase in basal body temperature.

DIF: Cognitive Level: Application REF: page 139 OBJ: 6
TOP: Nursing Process: Assessment MSC: CRNE: HW-13

13. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). What is the nurse’s most appropriate response?
a. “They’re not very effective, and it’s very likely you’ll get pregnant.”
b. “They can be effective but they require adherence to strict record keeping.”
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
FAMs are effective with proper vigilance about ovulatory changes in the body and adherence to coitus intervals and strict record keeping. They are effective if used correctly by a woman with a regular menstrual cycle. FAMs have no health risks other than pregnancy. The use of birth control has associated health risks; this response disregards the patients’ question and provides false reassurance.

DIF: Cognitive Level: Application REF: page 138 OBJ: 6
TOP: Nursing Process: Planning MSC: CRNE: HW-13

14. A male patient asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). What is the nurse’s most appropriate response?
a. “The lubricant prevents vaginal irritation.”
b. “Nonoxynol-9 has been linked to HIV transmission and can cause genital herpes.”
c. “The additional lubrication improves sex.”
d. “Nonoxynol-9 improves penile sensitivity.”

ANS: B
Nonoxynol-9 does not provide protection against sexually transmitted infections; it has also been linked to an increase in the transmission of HIV and can cause genital lesions. Nonoxynol-9 may cause vaginal irritation. Nonoxynol-9 has no effect on the quality of sexual activity. Nonoxynol-9 has no effect on penile sensitivity.

DIF: Cognitive Level: Application REF: page 142 OBJ: 6
TOP: Nursing Process: Planning MSC: CRNE: HW-13

15. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurse’s most appropriate response?
a. “This is a highly effective method, but it has some adverse 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
“Your current medications will reduce the effectiveness of the pill” is a true statement. It is not highly effective for her because the liver metabolizes oral contraceptives and their effectiveness is reduced when they are taken simultaneously with anticonvulsants. The anticonvulsant will reduce the effectiveness of the pill, not the other way around. “This is a good choice for a woman of your age and personal history” does not teach the patient that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

DIF: Cognitive Level: Application REF: page 148 OBJ: 5
TOP: Nursing Process: Planning MSC: CRNE: CH-44

16. Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for which of the following 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

ANS: C
Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives, with the requirement of only four injections a year; therefore, women who have difficulty remembering to take a daily pill will find this method attractive. Disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. Use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. 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.

DIF: Cognitive Level: Comprehension REF: pages 149-150
OBJ: 5 TOP: Nursing Process: Assessment MSC: CRNE: HW-13

17. 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. What is the nurse’s most appropriate response?
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.”

ANS: 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. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient, because no additional spermicide is needed.

DIF: Cognitive Level: Application REF: page 144 OBJ: 5
TOP: Nursing Process: Planning MSC: CRNE: HW-13

18. 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

ANS: A
Women with a history of TSS should not use a cervical cap. Condoms, vaginal films, and vaginal sheaths are not contraindicated for a woman with a history of TSS.

DIF: Cognitive Level: Comprehension REF: page 144 OBJ: 5
TOP: Nursing Process: Planning MSC: CRNE: HW-13

19. 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). What is the nurse’s most appropriate response?
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 the IUDs.”

ANS: B
Disadvantages of IUDs include an increased risk of PID in the first 20 days after insertion and the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against STIs or the human immunodeficiency virus. Because this woman has multiple sex partners, she is at higher risk of developing an STI. The IUD does not protect against infection, as does a barrier method. Although the statement “The IUD does not interfere with sex” may be correct, it is not the most appropriate response. The IUD offers no protection from STIs. The typical failure rate of the IUD ranges from 0.8 to 2%.

DIF: Cognitive Level: Application REF: page 150 OBJ: 5
TOP: Nursing Process: Planning MSC: CRNE: HW-13

20. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the most common technique used for medical 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

ANS: A
The most common technique for medical termination of a pregnancy in the second trimester is D&E. It is usually performed between 14 and 18 weeks. Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use. Intravenous administration of oxytocin is used to induce labour in a woman with a third-trimester fetal demise. Vacuum aspiration is used for abortions in the first trimester.

DIF: Cognitive Level: Comprehension REF: page 154 OBJ: 7
TOP: Nursing Process: Implementation MSC: CRNE: CH-8

21. A woman will be taking oral contraceptives using a 28-day pack. What should the 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.

ANS: C
To maintain adequate hormone levels for contraception and to enhance compliance, patients should take oral contraceptives at the same time each day. 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. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormone levels in oral contraceptive users. If the patient misses two pills during week 1, she should continue to take one pill a day, finish the package, and use a backup method the next 7 consecutive days.

DIF: Cognitive Level: Application REF: page 149, Figure 7-12
OBJ: 6 TOP: Nursing Process: Planning MSC: CRNE: HW-13

22. 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 should the nurse tell her?
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.

ANS: C
To minimize the adverse effect of nausea that occurs with high doses of estrogen and progestin, the woman can take an over-the-counter antiemetic 1 hour before each dose. Emergency contraception is used within 5 days of unprotected intercourse to prevent pregnancy. Postcoital contraceptive use is 75 to 89% effective at preventing pregnancy. Oral emergency contraceptive regimens may include progestin-only and estrogen-progestin pills. Women with contraindications to estrogen use should use progestin-only pills.

DIF: Cognitive Level: Analysis REF: page 150 OBJ: 7
TOP: Nursing Process: Planning MSC: CRNE: CH-44

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.

ANS: D
Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.

DIF: Cognitive Level: Knowledge REF: page 135 OBJ: 5
TOP: Nursing Process: Assessment MSC: CRNE: HW-13

24. While instructing a couple regarding birth control, what should the 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. Is the only contraceptive practice acceptable to Catholic-centred organizations.
d. It relies on barrier methods during fertility phases.

ANS: C
Natural family planning is the only contraceptive practice acceptable to Catholic-centred organizations. “Pulling out” is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method. 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.

DIF: Cognitive Level: Comprehension REF: pages 137-138
OBJ: 5 TOP: Nursing Process: Planning MSC: CRNE: NCP-5

25. Which of the following contraceptive methods is least effective?
a. Standard days method
b. Periodic abstinence
c. Postovulation
d. Coitus interruptus

ANS: A
The method involving standard days variation on the calendar is the least effective natural birth control method. Periodic abstinence is not the least effective natural birth control method. The postovulation method is not the least effective natural birth control method. Coitus interruptus is not the least effective natural birth control method.

DIF: Cognitive Level: Knowledge REF: page 138 OBJ: 5
TOP: Nursing Process: Implementation MSC: CRNE: HW-13

26. 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.

ANS: B
Barrier methods such as condoms best protect against STIs and HIV. Periodic abstinence and hormonal methods (“the pill”) offer no protection against STIs or HIV.

DIF: Cognitive Level: Application REF: page 142 OBJ: 5
TOP: Nursing Process: Planning MSC: CRNE: HW-12

27. With regard to the noncontraceptive medical effects of combined oral contraceptive pills (COCs), what should the 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.

ANS: D
The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements as well as by prescription drugs. Toxic shock syndrome can occur in some diaphragm users, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.

DIF: Cognitive Level: Comprehension REF: page 148 OBJ: 6
TOP: Nursing Process: Planning MSC: CRNE: CH-44

28. What should nurses be aware of with regard to the use of intrauterine devices (IUDs)?
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 as that of the diaphragm.
d. Consent forms are not needed for IUD insertion.

ANS: B
The woman has up to 7 days to insert the IUD after unprotected sex. Return to fertility is immediate after removal of the IUD. IUDs offer no protection against sexually transmitted infections. A consent form is required for insertion, as is a negative pregnancy test.

DIF: Cognitive Level: Comprehension REF: page 150 OBJ: 8
TOP: Nursing Process: Assessment MSC: CRNE: HW-13

29. 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.

ANS: D
Abortions can be either medically or surgically induced. They are mostly done in the first trimester. They can be induced for reasons of maternal or fetal health.

DIF: Cognitive Level: Comprehension REF: pages 153-154
OBJ: 7 TOP: Nursing Process: Assessment MSC: CRNE: CH-8

30. Nurses, certified nurse-midwives, and other advanced-practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman’s social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new patient to discuss contraception?
a. Obtain data about the frequency of coitus.
b. Determine the woman’s level of contraceptive knowledge.
c. Assess the woman’s willingness to touch her genitals and cervical mucus.
d. Evaluate the woman’s contraceptive life plan.

ANS: B
Determining the woman’s level of contraceptive knowledge is the primary step of this nursing assessment and is necessary before completing the process and moving on to a nursing diagnosis. Once the patient’s level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from sexually transmitted infections, and a partner’s willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should take when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and partner’s objections (if any). Assessing the woman’s willingness to touch herself is a key factor for the nurse to discuss should the patient express interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the patient’s plan regarding whether she is attempting to prevent conception, delay conception, or conceive; however, but this evaluation is not the nurse’s initial step.

DIF: Cognitive Level: Analysis REF: page 136, Nursing Process: Contraception
OBJ: 6 TOP: Nursing Process: Assessment MSC: CRNE: CH-13

31. The nurse is reviewing the educational packet provided to a patient about tubal ligation. What is an important fact he or she should point out?
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.”

ANS: A
A woman is unlikely to become pregnant after tubal ligation, although it is not 100% effective. It does not offer any protection against STIs. Sterilization offers no protection against STIs. Typically, the menstrual cycle remains the same after a tubal ligation.

DIF: Cognitive Level: Application REF: page 152, Patient Teaching
OBJ: 5 TOP: Nursing Process: Implementation MSC: CRNE: NCP-14

32. When completing discharge teaching for the patient after an induced abortion, the nurse should inform the patient to report which of the following immediately to her 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

ANS: D
Part of discharge teaching includes informing the woman that if she has no return of menstrual period within 6 weeks she should contact her health care provider. A temperature greater than 38C should be reported, not one below that value. Abdominal tenderness is expected unless it is felt when pressure is applied. Spotting or flow on day 4 is normal; teaching includes having the patient report bleeding greater than two saturated pads in 2 hours or heavy bleeding that lasts a few days.

DIF: Cognitive Level: Application REF: page 154, Box 7-11
OBJ: 8 TOP: Nursing Process: Implementation MSC: CRNE: CH-14