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Maternity and Womens Health Care 11th Edition by Deitra Leonard Lowdermilk -Test Bank

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  • ISBN-10 ‏ : ‎ 0323377408
  • ISBN-13 ‏ : ‎ 978-0323377409

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Maternity and Womens Health Care 11th Edition by Deitra Leonard Lowdermilk -Test Bank

Chapter 09: Infertility
Lowdermilk: Maternity & Women’s Health Care, 11th Edition

MULTIPLE CHOICE

1. Which test is performed around the time of ovulation to diagnose the basis of infertility?
a. Hysterosalpingogram
b. Ultrasonography
c. Laparoscopy
d. Follicle-stimulating hormone (FSH) level

ANS: B
Ultrasonography is performed around the time of ovulation to assess pelvic structures for abnormalities, to verify follicular development, and to assess the thickness of the endometrium. A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing a potentially fertilized ovum out through a uterine tube into the peritoneal cavity. Laparoscopy is usually 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: Understand REF: p. 201 TOP: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

2. An infertility specialist prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple pregnancies. What is the nurse’s most appropriate response?
a. “This is a legitimate concern. Would you like to discuss further the chances of multiple pregnancies before your treatment begins?”
b. “No one has ever had more than triplets with Clomid.”
c. “Ovulation will be monitored with ultrasound to ensure that multiple pregnancies will not happen.”
d. “Ten percent is a very low risk, so you don’t need to worry too much.”

ANS: A
The incidence of multiple pregnancies with the use of these medications is higher than 25%. The client’s concern is legitimate and should be discussed so that she can make an informed decision. Stating that no one has ever had more than triplets with Clomid is inaccurate and negates the client’s concerns. Ultrasound cannot ensure that a multiple pregnancy will not occur, and 10% is inaccurate. Furthermore, the client’s concern is discredited with a statement such as, “…don’t worry.”

DIF: Cognitive Level: Apply REF: p. 208 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance

3. 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. Which guidance should the nurse provide?
a. “Your sperm count seems to be okay in the first semen analysis.”
b. “Only marijuana cigarettes affect sperm count.”
c. “Although smoking has no effect on sperm count, it can give you lung cancer.”
d. “Smoking can reduce the quality of your sperm.”

ANS: D
Cigarette smoking has detrimental effects on sperm and has been associated with abnormal sperm, a decreased number of sperm, and chromosomal damage. The nurse may suggest a smoking cessation program to increase the fertility of the male partner. Sperm counts vary from day to day and are dependent 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. Marijuana use may depress the number and motility of sperm. Smoking is indeed a causative agent for lung cancer.

DIF: Cognitive Level: Apply REF: p. 199 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance

4. A couple comes in for an infertility workup, having attempted to achieve pregnancy for 2 years. The woman, 37 years of age, 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 testing is needed?
a. Testicular biopsy
b. Antisperm antibodies
c. FSH level
d. Examination for testicular infection

ANS: C
This scenario does not indicate that the woman has had any testing related to her irregular menstrual cycles. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determining the blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of the woman’s irregular menstrual cycles. A testicular biopsy is indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). Although unlikely to be the case because the husband has already produced children, antisperm antibodies may be produced by the man against his own sperm. Examination for testicular infection would be performed before semen analysis. Furthermore, infection would affect spermatogenesis.

DIF: Cognitive Level: Analyze REF: p. 201 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance

5. A couple is attempting 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 that 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 adopting an infant can be very difficult.”

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. However, depending on where the other couple is in their own recovery process, limiting their interactions may not be of assistance to them. Telling the couple to start adoption proceedings immediately is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

DIF: Cognitive Level: Apply REF: p. 204
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

6. The nurse working with clients who have infertility concerns should be aware of the use of leuprolide acetate (Lupron) as a gonadotropin-releasing hormone (GnRH) agonist. For which condition would this medication be prescribed?
a. Anovulatory cycles
b. Uterine fibroids
c. Polycystic ovary disease (PCOD)
d. Luteal phase inadequacy

ANS: B
Leuprolide acetate is used to treat endometriosis and uterine fibroids. Anovulatory cycles are treated with Clomid, Serophene, Pergonal, or Profasi, all of which stimulate ovulation induction. Metrodin is used to treat PCOD. Progesterone is used to treat luteal phase inadequacy.

DIF: Cognitive Level: Remember REF: p. 206
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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