Ladewig 8e TIF Ch07 PDF

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E
Chapter 07
Question 1
Type: MCSA
A patient who has been unable to conceive asks the nurse if it is her fault or her husband’s fault that they have not
been able to become pregnant. The best response by the nurse is:
1. “The male infertility factors are more common than female.”
2. “Female infertility issues are more common than male issues.”
3. “The testing the doctor will order will determine who is at fault.”
4. “We will know more about what is causing your infertility after some tests are done.”
Correct Answer: 4
Rationale 1: This statement is not true. Because of the complexity of ovulation and maintaining a pregnancy, it is
more likely that a female issue is causing the infertility. Regardless, using the term “at fault” is blaming and
should be avoided.
Rationale 2: Although this statement is true because of the complexity of ovulation and maintaining a pregnancy,
using the term “at fault” is blaming and should be avoided.
Rationale 3: Testing will determine what the infertility issue is, but using the term “at fault” is blaming and
should be avoided.
Rationale 4: This is a factual answer that avoids using the term “at fault.” This statement is therapeutically
worded and therefore is the best answer.
Global Rationale:
Cognitive Level: Applying

Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO01 - Compare the essential components of fertility with the possible causes of infertility.
Question 2
Type: MCSA
The patient experiencing infertility is to complete three months of documenting her basal body temperatures.
Which statement by the patient indicates a need for additional teaching?
1. “I should check my temperature with this special thermometer before I get out of bed each day.”
Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Copyright 2014 by Pearson Education, Inc.
2. “I will track my temperatures and the consistency of my cervical mucus for the next three months.”
3. “If I am ovulating, my temperature will be a smooth, even line on the graph that does not go up or down.”
4. “The point of checking my basal body temperature is to determine whether I am ovulating regularly.”
Correct Answer: 3
Rationale 1: The basal body temperature is most accurate prior to arising each day. A thermometer with larger
spaces between tenths of a degree is used to facilitate accurate recording.
Rationale 2: Taking the temperature each morning will help detect ovulation. Checking cervical mucus daily for
changes in consistency and stretchiness is another method to detect ovulation. Combining the two methods gives
better information on when ovulation is occurring than one method does alone.
Rationale 3: A flat line on the graph is a monophasic cycle indicating a lack of ovulation. An ovulating woman
will have a biphasic pattern to her basal body temperature. The temperature will drop slightly prior to ovulation,
and rise about .5–1.0°F as ovulation occurs, remaining elevated if conception occurs or dropping just prior to
onset of menses.
Rationale 4: Basal body temperatures are less predictive of when ovulation occurs, but an increase in the latter
half of the cycle indicates that ovulation has occurred.
Global Rationale:
Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: LO02 - Describe the elements of the preliminary investigation of infertility and the nurse’s
role in supporting/teaching patients during this phase.
Question 3
Type: MCSA
A 31-year-old woman with normal ovaries, a normal prolactin level, and an intact pituitary gland is undergoing
initial pharmacologic treatment of anovulation. Which medication would the nurse anticipate being prescribed for
this patient?
1. Clomiphene citrate (Clomid or Serophene)
2. Glucophage (Metformin)
3. Human menopausal gonadotropins (hMGs)
4. Bromocriptine (Parlodel)
Correct Answer: 1

Rationale 1: Clomiphene citrate (Clomid or Serophene) is a common first-line therapy for inducing ovulation in
women with normal ovaries, normal prolactin level, and intact pituitary gland.
Rationale 2: Oral hypoglycemic agents such as glucophage (Metformin) are used for inducing ovulation in
women with polycystic ovary disease (PCOS).
Rationale 3: Human menopausal gonadotropins (hMGs) is a second line of therapy in women who fail to ovulate
or conceive with clomiphene citrate therapy.
Rationale 4: Bromocriptine (Parlodel) is used to treat hyperprolactinemia accompanied by anovulation.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO03 - Compare the indications for the tests with the associated treatments, including
assisted reproductive technologies, that are done in an infertility workup.
Question 4
Type: MCSA
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?
1. “I have to go buy a special type of thermometer.”
2. “I need to wait five minutes after smoking a cigarette before I take my temperature.”
3. “I need to take my temperature before I get out of the bed in the morning.”
4. “I need to take my temperature for at least two minutes every day.”
Correct Answer: 3
Rationale 1: The temperature can be taken with a standard oral or rectal thermometer.
Rationale 2: In the basal body temperature method, the woman takes her temperature every day before starting
any activity, including smoking.
Rationale 3: In the basal body temperature method, the woman takes her temperature every day before arising.
Rationale 4: In the basal body temperature method, the woman takes her temperature every day for five minutes.
Global Rationale:

Client Need Sub:
Learning Outcome: LO03 - Compare the indications for the tests and associated treatments, including assisted
reproductive technologies, that are done in an infertility workup.
Question 5
Type: MCSA
A patient calls his urologist's office to clarify instructions about semen analysis. The nurse should instruct the
patient to:
1. Remain abstinent for 3 days prior to collecting the specimen.
2. Use a lubricant while obtaining the semen specimen.
3. Immediately refrigerate the specimen for a maximum of 8 hours.
4. Deliver the specimen to the laboratory within 1 hour of collection.
Correct Answer: 1
Rationale 1: To obtain accurate results of a semen analysis, the specimen is collected after 3 days of abstinence.
Rationale 2: Most lubricants also are spermicidal and should not be used unless approved by the andrology
laboratory.
Rationale 3: If the specimen is obtained at home, it needs kept at body temperature and delivered to the lab
within 1 hour so as not to impair motility.
Rationale 4: If the specimen is obtained at home, it needs to be delivered to the lab within 1 hour so as not to
impair motility.
Global Rationale:
Cognitive Level: Understanding

Client Need Sub:
Learning Outcome: LO03 - Compare the indications for the tests with the associated treatments, including
assisted reproductive technologies that are done in an infertility workup.
Question 6
Type: MCMA
The patient undergoing infertility treatment reports to the nurse that her partner is angry all of the time since
beginning treatment and is very negative in comments made about the likelihood of their achieving pregnancy.
The patient states, “I was angry and depressed, but now I am dedicated to following through with treatment and
hoping we get pregnant.” What is the best interpretation of these comments? The partner is:
Standard Text: Select all that apply.
1. Exhibiting signs of the anger stage of grieving the loss of their dreams of having children.
2. In a different stage of grief than the patient.
3. Having difficulty accepting the reality of their infertility.
4. Showing that he will not be a good parent.
5. Feeling guilty about not being able to father a child.
Correct Answer: 1,2
Rationale 1: The patient’s description of her partner correlates with the anger stage of grief. Couples often
experience the stages of grief when infertility is diagnosed because childbearing is an expected outcome in
marriage; the inability to become pregnant is the loss of the dream of parenthood.
Rationale 2: The patient is in acceptance stage of grief, while the partner is in the anger stage. It is common and
normal for families to be in different stages of the grieving process.
Rationale 3: The partner is in the anger stage of grief. Lack of acceptance would manifest as not believing that
the diagnosis is correct.
Rationale 4: Being in the anger stage of grief is expected and normal and has no bearing on parenting ability.
Rationale 5: Guilt would manifest as feelings that it is his fault that pregnancy has not yet occurred. The patient is
describing anger.
Global Rationale:

Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Diagnosis
Learning Outcome: LO04 - Explain the physiologic and psychologic effects of infertility on a couple to the
nursing care management of the couple.
Question 7
Type: MCSA
The nurse manager is interviewing nurses for a position in an infertility clinic. Which statement best indicates that
the interviewee understands the role of the nurse when working with infertile patients?
1. “My job will be teaching patients how to take their medications and scheduling tests.”
2. “Much of my duties will involve forming therapeutic relationships with patients struggling with infertility.”
3. “This position is an assistant to the physician during diagnostic testing for infertility.”
4. “I will both teach and support families struggling with emotions as they attempt to become pregnant.”
Correct Answer: 4
Rationale 1: Although teaching and facilitating scheduling are important, the emotions that families deal with
during treatment for infertility must also be addressed.
Rationale 2: Although this response addresses the emotional aspects of infertility, it does not mention providing
support or teaching, which are also major components of the job.
Rationale 3: Some assisting might be a part of this position; the role of the RN in an infertility clinic involves
much teaching and providing emotional support to infertile patients.
Rationale 4: This answer addresses the two main aspects of the RN working with infertile patients: emotional
support and education.
Global Rationale:

Client Need Sub:
Learning Outcome: LO05 - Describe the nurse’s role as counselor, educator, and advocate for couples during
infertility evaluation and treatment.
Question 8
Type: MCSA
Which patient(s) should the nurse refer to a genetics practitioner prior to attempting pregnancy?
1. 32-year-old woman and 29-year-old man with 3-year-old twins
2. 22-year-old woman whose sister has Tay-Sachs disease
3. 30-year-old woman whose husband has AIDS
4. 19-year-old woman whose sister has primary infertility
Correct Answer: 2
Rationale 1: This patient has no indication of having a genetic problem.
Rationale 2: Tay-Sachs disease is an autosomal recessive condition; therefore, if the patient’s sister has the
disease, the patient could be a carrier for the condition.
Rationale 3: The risk for this patient is becoming infected with HIV while attempting conception. This couple has
no indication of a genetic condition.

Rationale 4: Primary infertility is not likely to be caused by a genetic defect that could be carried by a sibling.
This patient has no indication of a genetic condition.
Global Rationale:

Client Need Sub:
Learning Outcome: LO06 - Identify couples who may benefit from preconceptual chromosomal analysis and
prenatal testing when providing care to couples with special reproductive concerns.
Question 9
Type: MCSA
The nurse has presented an in-service to nurses new to the maternal–child health care unit. Which statement
indicates that teaching on genetic disorders has been successful?
1. “Down syndrome is an autosomal recessive condition. If both parents carry the gene, there is a 1-in-4 chance
that a child will be affected.”
2. “Galactosemia is a sex-linked condition. Both parents must carry the gene, and more girls than boys will be
affected by this condition.”
3. “Sickle-cell disease is a trisomy; the affected patient has three copies of a gene. Trisomies are more common in
pregnancies of young women than those of older women.”
4. “Huntington’s disease is an autosomal dominant condition. Only one parent carries the gene, and males and
females are equally affected by the disease.”
Correct Answer: 4
Rationale 1: Down syndrome is a trisomy and most likely to occur in parents over age 35. Autosomal recessive
conditions are passed along to offspring when both parents carry the affected gene and pass the affected gene to
the child.
Rationale 2: Galactosemia is not a sex-linked disorder; it is an autosomal recessive disorder. Both parents must
carry the gene and pass that gene on to the child. Males and females are equally affected. Sex-linked disorders are
carried on the X chromosome; therefore, males are more likely to have the condition because they only have one
copy of the X chromosome.
Rationale 3: Trisomies are three copies of a specific gene and occur most often in parents over age 35. Sickle-cell
disease is not a trisomy; it is an autosomal recessive condition. Both parents must carry the gene; there is a 1-in-4
chance that their child will be affected.
Rationale 4: Huntington’s disease is an autosomal dominant disease, meaning that the affected person inherited
the condition from only one affected parent. A child has a 50% chance of inheriting an autosomal dominant
condition if one parent is affected. Males and females are equally affected by autosomal dominant disorders.

Global Rationale:

Client Need Sub:
Learning Outcome: LO07 - Identify the characteristics of autosomal dominant, autosomal recessive, and X-
linked (sex-linked) recessive disorders.
Question 10
Type: MCSA
A 45-year-old mother gave birth to a baby boy two days ago. The nurse assesses a single palmar crease, poor
muscle tone, and low-set ears on the newborn. The nurse understands that these signs most likely indicate the
infant has which autosomal abnormalities?
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 not characteristics of trisomy 13.
Rationale 2: A single palmar crease and low-set ears are not characteristics of trisomy 18.
Rationale 3: A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome).
Rationale 4: Trisomy 26 is not an autosomal abnormality.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Question 11
Type: MCSA

A nurse counsels a couple regarding their concerns about an X-linked disorder. Both parents are carriers of the
disorder. They ask the nurse how this disorder will affect any children they might have. What is the nurse’s best
response?
1. “If you have a daughter, she will not be a carrier.”
2. “If you have a daughter, she will not be affected.”
3. "If you have a son, he will be a carrier."
4. "If you have a son, he will not be affected.”
Correct Answer: 2
Rationale 1: Fathers affected with an X-linked disorder cannot pass the disorder to their sons, but all their
daughters become carriers of the disorder.
Rationale 2: An X-linked disorder is manifested in a male who carries the abnormal gene on his only X
chromosome.
Rationale 3: There is no male-to-male transmission of an X-linked disorder. An X-linked disorder is manifested

in a male who carries the abnormal gene on his only X chromosome.
Rationale 4: There is a 50% chance that a carrier mother will pass the abnormal gene to each of her sons, who
will thus be affected.
Global Rationale:

Client Need Sub:
Question 12
Type: MCSA
A child with suspected Down syndrome has been born to 32-year-old parents. The parents ask the nurse how the
diagnosis will be made and if there was a way that the diagnosis could have been made during the pregnancy. The
best response by the nurse is:
1. “The baby’s genes could have been tested during pregnancy by doing an amniocentesis.”
2. “The doctor will check the baby’s genes by doing a 24-hour urine collection on your child.”
3. “Mom’s blood could have been tested during the pregnancy to check for genetic problems with the baby.”

4. “A swab of the baby’s cheek or a stool sample will be used to check your baby’s chromosomes.”
Correct Answer: 1
Rationale 1: A genetic amniocentesis is the removal of a small amount of amniotic fluid obtained by inserting a
needle through the abdominal wall into the uterus. The amniotic fluid is then processed to examine the
chromosomes.
Rationale 2: Suspected genetic conditions in newborns are diagnosed by examining the baby’s chromosomes
either from a blood sample or from a swab of the inside of the cheek.
Rationale 3: Mom’s blood would contain the mother’s chromosomes, not the baby’s. Prenatal genetic testing is
accomplished through genetic amniocentesis. A small amount of amniotic fluid is obtained by inserting a needle
through the abdominal wall into the uterus. The amniotic fluid is then processed to examine the chromosomes.
Rationale 4: Although a cheek swab can be used for genetic testing, stool samples cannot. Because part of the
answer is incorrect, the whole answer is incorrect.
Global Rationale:

Client Need Sub:
Learning Outcome: LO08 - Compare prenatal and postnatal diagnostic procedures used to determine the
presence of genetic disorders and the nursing considerations for each.
Question 13
Type: MCSA
The couple has had an ultrasound at 19 weeks’ gestation, and their fetus was found to have anencephaly. The
nurse is completing counseling for the couple on the ultrasound findings. Which statement indicates that
additional teaching is needed?
1. “We won’t know if something is wrong until the baby’s chromosomes are tested.”
2. “This problem is not caused by one of us having a genetic problem.”
3. “Our baby has an incomplete brain and might not be born alive.”
4. “Waiting until our 30s did not cause this problem to develop.”
Correct Answer: 1
Rationale 1: Anencephaly is clearly visualized with an ultrasound and does not require genetic testing to verify a
diagnosis.
Rationale 2: Genetic abnormalities in either parent are not related to anencephaly.

Rationale 3: Anencephaly is a condition in which the skull does not cover the brain completely, and the brain
consists mostly of brainstem with little other brain development.
Rationale 4: The age of either parent is not related to anencephaly.
Global Rationale:

Client Need Sub:
Question 14
Type: MCSA
A male infant was born two days ago, and the nurse assessed the infant as having single palmar crease, poor
muscle tone, and low-set ears. Genetic testing of the infant has been ordered by the physician. Which statement
should the nurse include when explaining this plan to the parents?
1. “We will draw blood from both of you to check for abnormal genes.”
2. “Your son will have his chromosomes sampled and then studied.”
3. “When your son is 2 years old, he will need a blood test.”
4. “After your breast milk is in, we will draw blood from your son.”
Correct Answer: 2
Rationale 1: The parents’ chromosomes do not need to be assessed in order to diagnose the infant.
Rationale 2: A single palmar crease, poor muscle tone, and low-set ears could indicate trisomy 18. This diagnosis
is confirmed by chromosomal analysis of the infant, using either a buccal smear or a blood specimen.
Rationale 3: The chromosome studies will be undertaken as soon as possible.
Rationale 4: It is not necessary to wait until the breast milk has come in.
Global Rationale:

Client Need Sub:

Question 15
Type: MCSA
The family of a 3-day-old child has just been informed that their child has cystic fibrosis. Which statement to the
family should the nurse make?
1. “I can see that you are adjusting well. I’ll leave you alone for a while.”
2. “This must be difficult news for you. What questions do you have?”
3. “Do you have family members or clergy you would like me to call?”
4. “Why didn’t you have an amniocentesis during your pregnancy?”
Correct Answer: 2
Rationale 1: When a patient is given bad news, the grieving process begins. The family is grieving the loss of a
normal child. This family is most likely in the shock/disbelief stage of grief.
Rationale 2: This response uses therapeutic communication techniques and portrays a caring attitude towards the
family. Asking if the family has questions further facilitates communication.
Rationale 3: Although it is good to have supportive family members or a clergy person called if the family
desires, it is better for the nurse to take the initiative and establish therapeutic communication and to portray
caring.
Rationale 4: It is not therapeutic to ask “why” questions. In addition, although cystic fibrosis is diagnosable
prenatally, a patient opposed to abortion often will not seek prenatal diagnosis, because the pregnancy would not
be terminated if the child were affected by a chromosomal abnormality.
Global Rationale:

Client Need Sub:
Learning Outcome: LO09 - Examine the emotional impact on a couple undergoing genetic testing or coping
with the birth of a baby with a genetic disorder.
Question 16
Type: MCSA
The couple at 12 weeks’ gestation has been told that their fetus has sickle-cell disease. Which statement by the
couple indicates that they are adequately coping?
1. “We knew we were both carriers of sickle cell. We shouldn’t have tried to have a baby.”

2. “If we had been healthier when we conceived, our baby wouldn’t have this disease now.”
3. “Taking vitamins before we got pregnant would have prevented this from happening.”
4. “The doctor told us there was a 25% chance that our baby would have sickle disease.”
Correct Answer: 4
Rationale 1: Self-blame and judgment do not indicate coping.
Rationale 2: Preconception health does not affect transmission of an autosomal recessive trait.
Rationale 3: Nutrition does not affect transmission of an autosomal recessive trait.
Rationale 4: A true statement indicates coping. When both the mother and father are carriers of an autosomal
recessive disease like sickle-cell, there is a 25% chance of a normal child, a 25% chance of a child with sickle-cell
disease, and a 50% chance of a child with sickle-cell trait.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO09 - Examine the emotional impact on a couple undergoing genetic testing or coping
with the birth of a baby with a genetic disorder.
Question 17
Type: MCSA
The parents of a child with cystic fibrosis are attending genetic counseling. After their initial visit, they ask the
nurse what will happen next. How should the nurse respond?
1. "Your genetic counseling is a medical matter that can only be discussed with your physician."
2. “You will have one more appointment with your genetic counselor and that will conclude your genetic
counseling."
3. "You will receive a letter from your primary care physician that explains the results of your genetic counseling
session.”
4. "You will have a follow-up visit with your genetic counselor and you will receive additional information at that
time."
Correct Answer: 4
Rationale 1: The nurse should act as a liaison between the family and genetic counselor.

Rationale 2: After a follow-up visit, the family may return to the genetic counselor to ask questions and express
concerns, especially if the couple is considering having more children, or if siblings want information about their
affected brother or sister.
Rationale 3: Upon completion of genetic counseling, the genetic counselor sends the parent(s) and their certified
nurse–midwife or physician a letter detailing the contents of the sessions.
Rationale 4: After the initial genetic counseling session, a follow-up visit is scheduled in order for the genetic
counselor to provide the parents with all available information and offer additional counseling.
Global Rationale:

Client Need Sub:
Learning Outcome: LO10 - Explain the nurse’s role in supporting the family undergoing genetic counseling.


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Ladewig, Contemporary Maternal-Newborn Nursing, 8/E

1. “The male infertility factors are more common than female.”

2. “Female infertility issues are more common than male issues.”

Cognitive Level: Applying

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Analyzing

1. Clomiphene citrate (Clomid or Serophene)

3. Human menopausal gonadotropins (hMGs)

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Rationale 4: Bromocriptine (Parlodel) is used to treat hyperprolactinemia accompanied by anovulation.

Cognitive Level: Analyzing

1. “I have to go buy a special type of thermometer.”

4. “I need to take my temperature for at least two minutes every day.”

Cognitive Level: Analyzing

1. Remain abstinent for 3 days prior to collecting the specimen.

2. Use a lubricant while obtaining the semen specimen.

3. Immediately refrigerate the specimen for a maximum of 8 hours.

4. Deliver the specimen to the laboratory within 1 hour of collection.

Cognitive Level: Understanding

2. In a different stage of grief than the patient.

3. Having difficulty accepting the reality of their infertility.

4. Showing that he will not be a good parent.

5. Feeling guilty about not being able to father a child.

Correct Answer: 1,2

Cognitive Level: Analyzing

Cognitive Level: Analyzing

1. 32-year-old woman and 29-year-old man with 3-year-old twins

2. 22-year-old woman whose sister has Tay-Sachs disease

3. 30-year-old woman whose husband has AIDS

4. 19-year-old woman whose sister has primary infertility

Rationale 1: This patient has no indication of having a genetic problem.

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Applying

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Applying

Rationale 4: Trisomy 26 is not an autosomal abnormality.

Cognitive Level: Applying

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

1. “If you have a daughter, she will not be a carrier.”

2. “If you have a daughter, she will not be affected.”

3. "If you have a son, he will be a carrier."

4. "If you have a son, he will not be affected.”

Rationale 3: There is no male-to-male transmission of an X-linked disorder. An X-linked disorder is manifested

Cognitive Level: Analyzing

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Analyzing

2. “This problem is not caused by one of us having a genetic problem.”

Rationale 2: Genetic abnormalities in either parent are not related to anencephaly.

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Rationale 4: The age of either parent is not related to anencephaly.

Cognitive Level: Analyzing

3. “When your son is 2 years old, he will need a blood test.”

Rationale 3: The chromosome studies will be undertaken as soon as possible.

Cognitive Level: Applying

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

4. “Why didn’t you have an amniocentesis during your pregnancy?”

Cognitive Level: Applying

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Rationale 1: Self-blame and judgment do not indicate coping.

Rationale 3: Nutrition does not affect transmission of an autosomal recessive trait.

Cognitive Level: Applying

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Analyzing