Infertility

Question 1

Which sexually transmitted disease can result in infertility in women?

Answer 1

Pelvic inflammatory disease or PID, is an infection of the female reproductive organs. PID is one of the most serious complications of certain sexually transmitted diseases in women. PID can cause irreversible damage to the uterus, ovaries, Fallopian tubes, or other parts of the female reproductive system, and is the primary preventable cause of infertility in women.

Question 2

If a couple is infertile, this means the couple…

Answer 2

Could not conceive after 12 months of unprotected sex
Infertility is defined as the inability to conceive after 12 months of regular unprotected intercourse.

Question 3

A patient with infertility asks the nurse what is causing her to have irregular cycles leading to her diagnosis of PCOS. What is the nurse’s best response?
a.“PCOS is caused by damage to the female reproductive tract by pathogens.” ob.“Increased levels of progesterone with PCOS cause the sperm to be unable to penetrate cervical mucus.”
oc.“PCOS causes your body to have menstrual cycles in which ovulation does not occur.” od.“PCOS is a state in which there is a lack of estrogen that interferes with the menstrual cycle.

Answer 3

c.“PCOS causes your body to have menstrual cycles in which ovulation does not occur

Question 4

A patient has been prescribed clomiphene citrate therapy by her doctor. The patient asks the nurse, “How does my new medicine work?” What is the nurse’s best response to convey the mechanism of action of clomiphene citrate therapy to this patient?
oa.“This medication works by stimulating the ovaries, increasing the chance of ovulation.” ob.“This medication increases circulating progesterone levels.”
oc.“This medication usually does not work on the first cycle.”
od.“This medication helps the ovaries form multiple follicles.”

Answer 4

“This medication works by stimulating the ovaries, increasing the chance of ovulation.”

Question 5

.A patient at the STI clinic asks why he is not prescribed antibiotics. He has been diagnosed with HSV-2. The nurse’s best response is based on what knowledge? (Select all that apply.)
oa.Antibiotics will not lessen the symptoms of HSV.
ob.HSV can be cured with antiviral medications only.
oc.Antibiotics are used to successfully treat viral infections.
od.HSV symptoms may be relieved with palliative antiviral medications.
oe.Antibiotics combined with antiviral medications are the best treatment for HSV-2 infections.

Answer 5

oa.Antibiotics will not lessen the symptoms of HSV.
od.HSV symptoms may be relieved with palliative antiviral medications.

Question 6

.The nurse is reviewing risk factors for STIs with a patient. Which behavior has the least risk for acquiring an STI?
oa.Abstinence
ob.Use of a male condom
oc.Sexual relations within a mutually monogamous relationship
od.Sexual relations with a previous IV substance user

Answer 6

oa.Abstinence

Question 7

The nurse prepares a class for high school students. What best describes why ulcerative STIs increase an individual’s risk for HIV infection?
oa.Ulcerative STIs decrease the amount of lubrication.
ob.STIs are commonly associated with other high-risk behaviors.
oc.STIs are only found in individuals with multiple sexual partners.
od.A break in the skin increases the transmission of pathogens.

Answer 7

od.A break in the skin increases the transmission of pathogens.

Question 8

.The nurse is meeting with a couple during the early phase of treatment for primary infertility. Which content would be appropriate to include in a generic teaching plan to be personalized for this couple? (Select all that apply.)
oa.Ways to alleviate feelings of low self-esteem related to infertility
ob.Sexual techniques that enhance fertilization
oc.Recommended avoidance of guaifenesin od.Necessity of repetitive treatment regimens before successful conception
oe.Infertility is 100% curable

Answer 8

oa.Ways to alleviate feelings of low self-esteem related to infertility
ob.Sexual techniques that enhance fertilization
od.Necessity of repetitive treatment regimens before successful conception

Question 9

Answer: b. Between 10% and 15% of couples who wish to have children are unable to conceive.
5. Answer: a. One year is an average time for impregnation to occur.
6. Answer: d. Working at a desk job can elevate scrotal temperature and reduce sperm productivity and motility
7. Answer: b. Sperm should be kept at body temperature following collection for best results.
8. Answer: b. A normal sperm count is over 20 million per mL. The number of sperm does not give information on mobility or amount of semen.
9. Answer: b. With sterility, unlike subfertility, there is a documented reason for not conceiving.
10. Answer: c. Trans fats are associated with subfertility. Whole milk and exercise increase fertility.
11. Answer: c. Because a hysterosalpingogram involves x-ray examination, it is important that it be scheduled when a pregnancy could not be present.
12. Answer: b. When carbon dioxide is infused into the uterus and then fallopian tubes, it may escape under the diaphragm, cause pressure on nerves, and cause sharp pain post procedure.
13. Answer: a. Clomid is an estrogen agonist that acts to stimulate ovulation through initiation of FSH and LH from the pituitary.
14. Answer: Answer: d. Scarring and inflammation of the fallopian tubes is a common consequence of pelvic inflammatory disease.
15. Answer: d. In vitro fertilization is transfer of a fertilized ovum into the uterus. It is helpful if a male partner has a low sperm count or fallopian tubes do not allow passage of the ova or sperm
16. Answer: A. In vitro fertilization is an expensive procedure and in some centers the failure rate is as high as 70%.

Question 10

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

Answer 10

B
(Endometrial biopsy is scheduled after ovulation, during the luteal phase of the menstrual cycle.

Question 11

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 11

D

(Use of tobacco, alcohol, and marijuana may affect sperm counts.

Question 12

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 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

Answer 12

C

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.”

Answer 13

C

(Venting negative feelings may unburden the couple.

Question 14

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

Answer 14

B

Question 15

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 is a type of assisted reproductive therapy that involves collecting eggs from your wife’s ovaries, fertilizing them in the lab 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 15

A

Question 16

The nurse is teaching a couple about fertility during the female reproductive cycle. The couple
asks the nurse, “When is the most fertile time for intercourse?” What is the best response by the
nurse?
a. During the luteal phase.
b. 3-4 days before and after ovulation.
c. During the follicular phase.
d. 12-24 hours before and after ovulation.

Answer 16

3-4 days before and after ovulation.

Rationale: Based on serial BBT charts, the clinician might recommend sexual intercourse every
other day beginning 3-4 days prior to and continuing until 2-3 days after the expected time of ovulation.

Question 17

A nurse is reviewing a basal body temperature chart with a couple. Which change would
indicate probable ovulation?
a. Decrease in temperature followed by an increase for several days.
b. Steadily increasing temperature over 7 days.
c. Increase in temperature followed by a decrease for several days.
d. Decrease in temperature that remains until menses begins.

Answer 17

Decrease in temperature followed by an increase for several days.

Rationale: As ovulation approaches, production of estrogen increases, and at its peak can cause a
slight drop, then a rise, in the basal temperature.

Question 18

A nurse is working with four clients desiring in vitro fertilization (IVF). Which clients would
be good candidates for IVF? Select all that apply.
a. The client with tubal blockage.
b. The client whose husband has a very low sperm count.
c. The client with immunological infertility.
d. The client with absence of a uterus.

Answer 18

The client with tubal blockage.
The client whose husband has a very low sperm count.

Rationale: The in vitro fertilization (IVF) procedure is selectively used in cases in which
infertility has resulted from tubal factors; mucus abnormalities; male infertility; unexplained
infertility; male and female immunologic infertility; and cervical factors. In IVF, a woman’s
eggs are collected from her ovaries, fertilized in the laboratory, and placed into her uterus after
normal embryo development has begun

Question 19

Which disorder has lower-than-expected levels of alpha-fetoprotein (AFP).
a. Multiple gestation.
b. Anencephaly.
c. Down syndrome.
d. Open neural tube defects.

Answer 19

Down syndrome.

Rationale: The maternal serum AFP (MSAFP) level is elevated in cases of infants with open
neural tube defects, anencephaly, omphalocele, and gastroschisis; fetal death; vaginal bleeding;
or multiple gestations. Down syndrome causes lower-than-expected levels.

Question 20

A married woman presents to the infertility clinic. She reports an inability to get pregnant
again. She has no children, and a history of two ectopic pregnancies. The nurse can anticipate
which test or workup to be ordered for this client?
a. Endometrial biopsy.
b. Huhner test.
c. Hysterosalpingography.
d. Basal body temperature recording.

Answer 20

Hysterosalpingography.

Rationale: Ectopic pregnancies can cause scarring in the fallopian tubes, thereby causing an
obstruction between the ovaries and the uterus. Hysterosalpingography is the test to determine
tubal patency and uterine structure.