London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

Chapter 7: Families with Special Reproductive Concerns Chapter 07_LO01_Q01 During the initial visit with the nurse at the fertility clinic, the client asks what effect cigarette smoking has on the ability to conceive. The nurses best response is: 1. Smoking has no effect. 2. Only if you smoke more that one pack a day will you experience difficulty. 3. After your first semen analysis, we will determine if there will be any difficulty. 4. Smoking can affect sperm motility. Correct Answer: 4 Rationale: 1. This is an incorrect response. 2. This is an incorrect response. 3. This is an incorrect response. 4. Cigarette smoking can depress sperm motility. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome: 7.1 Identify the essential components of fertility. Chapter 07_LO02_Q02 A client and her husband have contacted their physician about fertility problems. At the initial visit, the nurse instructs them on the infertility workup. Which of the following statements by the client would indicate that the instructions have been successful? 1. The first test that we need to schedule is a semen analysis. 2. We need to schedule the Huhner test first. 3. We need to schedule an appointment with the social worker in order to adopt. 4. We need to schedule an appointment with a counselor. Correct Answer: 1

London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

Rationale: 1. A semen analysis is one of the first diagnostic tests prior to doing invasive procedures. 2. The Huhner test would not be done first. 3. Scheduling to meet with a social worker would not be done after the initial visit. 4. A counselor visit is not part of the infertility workup. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome: 7.2 Describe the elements of the preliminary investigation of infertility and the nurses role in supporting/teaching clients during this phase. Chapter 07_LO03_Q03 A client calls the urologists office to receive instructions about semen analysis. The nurse instructs the client to: 1. Avoid sexual intercourse 24 hours prior to obtaining a specimen. 2. Use a latex condom to collect the specimen. 3. Expect that a repeat test might be required. 4. Expect a small sample. Correct Answer: 3 Rationale: 1. The specimen is collected after 23 days of abstinence, usually by masturbation. 2. Regular condoms should not be used, because of the spermicidal agents they contain. 3. A repeat semen analysis might be required to adequately assess the mans fertility potential. 4. A small sample is not an appropriate instruction. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome: 7.3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are done in an infertility workup. Chapter 07_LO03_Q04

London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

A client calls the fertility clinic to schedule a laparoscopy. The nurse instructs the client to: 1. Stay on bedrest 48 hours after the procedure. 2. Expect to have shoulder and arm pain. 3. Purchase a rectal tube to relieve the gas. 4. Lie on her back to relieve the gas pain. Correct Answer: 4 Rationale: 1. Normal activities can be resumed after 24 hours. 2. The client might experience shoulder and chest pain caused by gas in the abdomen. 3. Insertion of a rectal tube is not an intervention expected of the client. 4. Assuming a supine position might help to relieve discomfort caused by remaining gas. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome: 7.3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are done in an infertility workup. Chapter 00_LO03_Q05 The nurse is reviewing assessment data from several different male clients. Which one should receive information about causes of infertility? 1. Circumcised client 2. Client with a history of premature ejaculation 3. Client with a history of measles at age 12 4. Client employed as an engineer Correct Answer: 2 Rationale: 1. Circumcision, having the measles, and being an engineer do not affect fertility. 2. Premature ejaculation is a possible cause of infertility 3. Circumcision, having the measles, and being an engineer do not affect fertility.

London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

4. Circumcision, having the measles, and being an engineer do not affect fertility. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning Learning Outcome: 7.3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are done in an infertility workup. Chapter 07_LO04_Q06 An infertile couple confides in the nurse at the infertility clinic that they feel overwhelmed with the decisions facing them. Which of the following nursing strategies would be most appropriate? 1. Refer them to a marriage counselor. 2. Provide them with information and instructions throughout the diagnostic and therapeutic process. 3. Express concern and caring. 4. Inquire about the names they have chosen for their baby. Correct Answer: 2 Rationale: 1. Expressing concern, inquiring about names, and referring the couple to a counselor are not appropriate. 2. The nurse can provide comfort to couples by offering a sympathetic ear, a nonjudgmental approach, and appropriate information and instruction throughout the diagnostic and therapeutic process. 3. Expressing concern, inquiring about names, and referring the couple to a counselor are not appropriate. 4. Expressing concern, inquiring about names, and referring the couple to a counselor are not appropriate. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning

London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

Learning Outcome: 7.4 Relate the physiologic and psychologic effects of infertility on a couple to the nursing management of the couple. Chapter 06_LO05_Q07 A nurse is reviewing the basal body temperature method with a couple. Which of the following statements would indicate that the teaching has been successful? a. b. c. d. I have to go buy a special type of thermometer. I need to wait 5 minutes after smoking a cigarette before I take my temperature. I need to take my temperature before I get out of bed in the morning. I need to take my temperature for at least 2 minutes every day.

Correct Answer: 3 Rationale: 1. The temperature can be taken with a standard oral or rectal thermometer. 2. The woman takes her temperature for 5 minutes every day before arising and before starting any activity, including smoking. 3. The woman takes her temperature for 5 minutes every day before arising and before starting any activity, including smoking. 4. The woman takes her temperature for 5 minutes every day before arising and before starting any activity, including smoking. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome: 7.5 Describe the nurses role as counselor, educator, and advocate for couples during infertility evaluation and treatment. Chapter 07_LO05_Q08 The nurse is planning to teach couples factors that influence fertility. Which of the following should not be included in the teaching plan? 1. Sexual intercourse should occur four times a week. 2. Get up to urinate 1 hour after intercourse. 3. Do not douche.

London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

4. Institute stress-reduction techniques. Correct Answer: 1 Rationale: 1. Intercourse should occur 13 times per week at intervals of no less than 48 hours. 2. Urinating 1 hour after intercourse, not douching, and stress-reduction techniques should be included in the teaching plan. 3. Urinating 1 hour after intercourse, not douching, and stress-reduction techniques should be included in the teaching plan. 4. Urinating 1 hour after intercourse, not douching, and stress-reduction techniques should be included in the teaching plan. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning Learning Outcome: 7.5 Describe the nurses role as counselor, educator, and advocate for couples during infertility evaluation and treatment. Chapter 07_LO05_Q09 A male client visits the infertility clinic for the results of his comprehensive exam. The exam indicated oligospermia. The client asks the nurse which procedure would assist him and his wife to conceive. The nurses best response is: (Select all that apply.) 1. You might want to consider adoption. 2. An option you might consider is in vitro fertilization. 3. Surrogacy might be your best option. 4. Many couples utilize therapeutic husband insemination. 5. The GIFT procedure has had much success. Correct Answers: 2; 4 Rationale: 1. Adoption and surrogacy are not immediate options. 2. The in vitro fertilization procedure is used in cases in which infertility has resulted from male infertility.

London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

3. Adoption and surrogacy are not immediate options. 4. Therapeutic husband insemination is generally indicated for such seminal deficiencies as oligospermia. 5. The GIFT procedure is not an immediate option. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome: 7.5 Describe the nurses role as counselor, educator, and advocate for couples during infertility evaluation and treatment. Chapter 07_LO06_Q10 The physician has prescribed the medication Clomid (clomiphene citrate) for a client with infertility. The nurses instructions to the woman should be: 1. Have sexual intercourse every day for 1 week, starting 5 days after completion of medication. 2. Take a pregnancy test before restarting medication. 3. Contact the doctor if visual disturbances occur. 4. Discontinue the medication if hot flashes occur. Correct Answer: 3 Rationale: 1. Sexual intercourse should occur every other day. 2. If a woman does not have a period, she must be checked for the possibility of pregnancy. 3. Contact the doctor if visual disturbances occur, because the medication might have to be discontinued. 4. If hot flashes occur, relief can be obtained without discontinuing medication. Cognitive Level: Application Category of Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 7.6 Identify couples who may benefit from preconceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns.

London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

Chapter 07_LO06_Q11 The nurse at the fertility clinic instructs a couple on the Huhner test. The nurse knows that the teaching has been effective when they state: 1. We must have sexual intercourse one day prior to the menstrual cycle. 2. This test removes the spontaneity from our sex lives. 3. The specimen is collected in a sterile cup. 4. This test counts the number of sperm my husband produces. Correct Answer: 2 Rationale: 1. The Huhner test is performed 1 or 2 days before the expected date of ovulation. 2. The focus of the postcoital exam is on the timing of intercourse. 3. The specimen is collected into a 10ml syringe. 4. The motility of the sperm is evaluated. Cognitive Level: Analysis Category of Client Need: Physiological Integrity Nursing Process: Evaluation Learning Outcome: 7.6 Identify couples who may benefit from preconceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns. Chapter 07_LO07_Q12 A newborn has been diagnosed with a disorder that occurs through an autosomal recessive inheritance pattern. The parents ask the nurse, Which of us passed on the gene that caused the disorder? The nurse tells them it was: 1. The female. 2. The male. 3. Neither. 4. Both. Correct Answer: 4

London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

Rationale: 1. In an autosomal recessive inherited disorder, both parents are carriers of the abnormal gene. It is not a sex-linked disorder or an abnormal chromosome disorder. 2. In an autosomal recessive inherited disorder, both parents are carriers of the abnormal gene. It is not a sex-linked disorder or an abnormal chromosome disorder. 3. In an autosomal recessive inherited disorder, both parents are carriers of the abnormal gene. It is not a sex-linked disorder or an abnormal chromosome disorder. 4. In an autosomal recessive inherited disorder, both parents are carriers of the abnormal gene. It is not a sex-linked disorder or an abnormal chromosome disorder. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome: 7.7 Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders. Chapter 07_LO08_Q13 The nurse is reviewing prenatal assessment data for several clients. Which one would be most likely to receive a genetic amniocentesis? 1. 25-year-old primipara 2. 40-year-old primipara 3. 30-year-old multipara 4. 28-year-old who conceived after taking fertility drugs Correct Answer: 2 Rationale: 1. The 25-year-old primipara would not be as likely as a 40-year-old primipara to receive a genetic amniocentesis. 2. Women age 35 or older are at greater risk for having children with chromosomal abnormalities, and would likely be receiving a genetic amniocentesis. 3. The 30-year-old multipara would not be as likely as a 40-year-old primipara to receive a genetic amniocentesis.

London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

4. The 28-year-old who conceived after taking fertility drugs would not be as likely as a 40-yearold primipara to receive a genetic amniocentesis. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Assessment Learning Outcome: 7.8 Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders. Chapter 07_LO09_Q14 A nurse counsels a couple on sex-linked disorders. Both are carriers of the disorder. They ask the nurse how this disorder will affect any children they might have. The nurses best response is: 1. If you have a daughter, she will not be affected. 2. Your son will be affected, since the father has the disorder. 3. There is a 25% chance that your son will have the disorder, since the mother has the disorder. 4. There is a 50% chance that your son will be a carrier only. Correct Answer: 4 Rationale: 1. There is a 50% chance that a carrier mother will pass the abnormal gene to each of her daughters, who will become carriers. 2. Fathers affected with a sex-linked disorder cannot pass the disorder to their sons, but all their daughters become carriers of the disorder. 3. There is a 50% chance that a carrier mother will pass the abnormal gene to each of her sons, who will be affected. 4. There is a 50% chance that a carrier mother will pass the normal gene to each of her sons, who will be unaffected. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation

London et al., Maternal & Child Nursing Care, 3e 2011 by Pearson Education, Inc.

Learning Outcome: 7.9 Explore the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder, and explain the nurses role in supporting the family undergoing genetic counseling. Chapter 07_LO09_Q15 A 58-year-old father and a 45-year-old mother gave birth to a baby boy 2 days ago. The nurse assesses a single palmar crease and low-set ears on the newborn. The nurse plans to counsel the couple about which of the following chromosomal abnormality? 1. Trisomy 13 2. Trisomy 18 3. Trisomy 21 4. Trisomy 26 Correct Answer: 3 Rationale: 1. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome). They are not characteristics of trisomy 13 or trisomy 18. 2. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome). They are not characteristics of trisomy 13 or trisomy 18. 3. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome). 4. Trisomy 26 is not a chromosomal abnormality. Cognitive Level: Application Category of Client Need: Psychosocial Integrity Nursing Process: Planning Learning Outcome: 7.9 Explore the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder, and explain the nurses role in supporting the family undergoing genetic counseling.