Chapter 05: Infertility, Contraception, and Abortion
Perry: Maternal Child Nursing Care, 7th Edition
MULTIPLE CHOICE
1. 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.
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. 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
OBJ: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
2. A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The
woman, 37 years, 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
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 sperms. This is unlikely to be the case here
because the man has already produced children. Examination for testicular infection would be
done before semen analysis. Infection would affect spermatogenesis.
DIF: Cognitive Level: Analysis
OBJ: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
3. 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
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a.
b.
c.
d.
―Tell your friends and family so they can help you.□
―Talk only to other friends who are infertile because only they can help.□
―Get involved with a support group. I‘ll give you some names.
―Start adoption proceedings immediately because it is very difficult to obtain an
infant.□
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
OBJ: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
4. A woman enquires about herbal alternative methods for improving fertility. Which statement
by the nurse is the most appropriate when instructing the patient 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.□
ANS: B
Herbs that a woman should avoid while trying to conceive include licorice root, yarrow,
wormwood, ephedra, fennel, golden seal, lavender, juniper, flaxseed, pennyroyal,
passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Nettle leaf, dong quai, and
vitamin E all promote fertility. Vitamin E, calcium, and magnesium may promote fertility and
conception. All supplements and herbs should be purchased from trusted sources.
DIF: Cognitive Level: Application
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
5. 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-ET is a type of assisted reproductive therapy that involves collecting eggs
from your wife‘s ovaries, fertilizing them in the laboratory 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.
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
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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 an inappropriate response.
DIF: Cognitive Level: Application
OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity
6. With regard to the assessment of female, male, and couple infertility, nurses should be aware
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 significant financial investment.
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
OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
7. In their role of implementing a plan of care for infertile couples, nurses should
a. be comfortable with their sexuality and nonjudgmental about others to counsel
their patients effectively.
b. know about such nonmedical remedies as diet, exercise, and stress management.
c. be able to direct patients to sources of information about what herbs to take that
might help and which ones to avoid.
d. do all of the above plus be knowledgeable about potential drug and surgical
remedies.
ANS: D
Nurses should be open to and ready to help with a variety of medical and nonmedical
approaches.
DIF: Cognitive Level: Comprehension
OBJ: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
8. Although remarkable developments have occurred in reproductive medicine, assisted
reproductive therapies are associated with numerous legal and ethical issues. Nurses can
provide accurate information about the risks and benefits of treatment alternatives so couples
can make informed decisions about their choice of treatment. Which issue would not need to
be addressed by an infertile couple before treatment?
a. Risks of multiple gestation.
b. Whether or how to disclose the facts of conception to offspring.
c. Freezing embryos for later use.
d. Financial ability to cover the cost of treatment.
ANS: D
Although the method of payment is important, obtaining this information is not the
responsibility of the nurse. Many states have mandated some form of insurance to assist
couples with coverage for infertility. Risk of multiple gestation is a risk of treatment of which
the couple needs to be aware. To minimize the chance of multiple gestation, 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.
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Depending on the therapy chosen, there may be a need for donor oocytes, sperm, embryos, or
a surrogate mother. 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
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OBJ: Nursing Process: Implementation
9. A woman has chosen the calendar rhythm method of conception control. During the
assessment process, it is most important that the nurse
obtain a history of menstrual cycle lengths for the past 6 months.
determine the patient‘s weight gain and loss pattern for the previous year.
examine skin pigmentation and hair texture for hormonal changes.
explore the patient‘s previous experiences with conception control.
a.
b.
c.
d.
ANS: A
The calendar rhythm 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 rhythm
method. Integumentary changes may be related to hormonal changes, but they are not
indicators for use of the calendar rhythm 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 rhythm method.
DIF: Cognitive Level: Analysis
OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
10. 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.□ The nurse‘s most appropriate response is
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
The absence of a temperature increase 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 BBT.
DIF: Cognitive Level: Application
OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
11. A married couple is discussing alternatives for pregnancy prevention and has asked about
fertility awareness methods (FAMs). The nurse‘s most appropriate reply is
―They‘re not very effective, and it‘s very likely you‘ll get pregnant.
―They can be effective for many couples, but they require motivation.
―These methods have a few advantages and several health risks.
―You would be much safer going on the pill and not having to worry.□
a.
b.
c.
d.
ANS: B
FAMs are effective with proper vigilance about ovulatory changes in the body and adherence
to coitus intervals. They are effective if used correctly by a woman with a regular menstrual
cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs have no
associated health risks. The use of birth control has associated health risks. In addition, taking
a pill daily requires compliance on the patient‘s part.
DIF: Cognitive Level: Application
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
12. A male patient asks the nurse why it is better to purchase condoms that are not lubricated with
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a. ―The lubricant prevents vaginal irritation.
b. ―It has also been linked to an increase in the transmission of human
immunodeficiency virus.□
c. ―The additional lubrication improves sex.□
d. ―Nonoxynol-9 improves penile sensitivity.□
ANS: B
The statement ―Nonoxynol-9 does not provide protection against sexually transmitted
infections, as originally thought; it has also been linked to an increase in the transmission of
human immunodeficiency virus and can cause genital lesions is true. Nonoxynol-9 may
cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on
penile sensitivity.
DIF: Cognitive Level: Application
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
13. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks
the nurse about the pill as a contraceptive choice. The nurse‘s most appropriate response
would be
a. ―This is a highly effective method, but it has some side 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
Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are
taken simultaneously with anticonvulsants. The statement ―Your current medications will
reduce the effectiveness of the pill is true, but it is not the most appropriate response. The
anticonvulsant will reduce the effectiveness of the pill, not the other way around. The
statement ―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
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
14. Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who
a. want menstrual regularity and predictability.
b. have a history of thrombotic problems or breast cancer.
c. have difficulty remembering to take oral contraceptives daily.
d. 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. 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
OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
15. A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse
what the major differences are between the cervical cap and the diaphragm. The nurse‘s most
appropriate response is
a. ―No spermicide is used with the cervical cap, so it‘s less messy.□
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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
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
16. 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, what
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
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
17. 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). The nurse‘s most appropriate response is
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 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 human immunodeficiency virus. Because this woman has multiple sex partners, she is
at higher risk of developing a 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 over 5 years of use is 1.1%.
DIF: Cognitive Level: Application
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
18. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows
that the most common technique used for medical termination of a pregnancy in the second
trimester is
a. dilation and evacuation (D&E).
b. instillation of hypertonic saline into the uterine cavity.
c. intravenous administration of Pitocin.
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ANS: A
The most common technique for medical termination of a pregnancy in the second trimester is
D&E. It is usually performed between 13 and 16 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 Pitocin is used to induce labor in a woman with a
third-trimester fetal demise. Vacuum aspiration is used for abortions in the first trimester.
DIF: Cognitive Level: Comprehension
OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
19. A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this
woman to protect against pregnancy by
limiting sexual contact for one cycle after starting the pill.
using condoms and foam instead of the pill for as long as she takes an antibiotic.
taking one pill at the same time every day.
throwing away the pack and using a backup method if she misses two pills during
Week 1 of her cycle.
a.
b.
c.
d.
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 take two pills a day for 2 days, finish the
package, and use a backup method the next 7 consecutive days.
DIF: Cognitive Level: Application
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
20. A woman had unprotected intercourse 36 hours ago and is concerned that she may become
pregnant because it is her ―fertile time. She asks the nurse about emergency contraception.
The nurse tells her that
a. it is too late; she needed to begin treatment within 24 hours after intercourse.
b. Preven, 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 side 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 72 hours of unprotected intercourse to prevent pregnancy.
Postcoital contraceptive use is 74% to 90% 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
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
21. 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
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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
OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
22. While instructing a couple regarding birth control, the nurse should be aware that the method
called natural family planning
a. is the same as coitus interruptus, or ―pulling out.
b. uses the calendar method to align the woman‘s cycle with the natural phases of the
moon.
c. is the only contraceptive practice acceptable to the Roman Catholic Church.
d. relies on barrier methods during fertility phases.
ANS: C
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.
Natural family planning is the only contraceptive practice acceptable to the Roman Catholic
Church. ―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.
DIF: Cognitive Level: Comprehension
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
23. 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
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
24. With regard to the noncontraceptive medical effects of combined oral contraceptive pills
(COCs), nurses should be aware that
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
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The effectiveness of COCs can be altered by some over-the-counter medications and herbal
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
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
25. With regard to the use of intrauterine devices (IUDs), nurses should be aware that
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 (STIs) as
the diaphragm.
d. consent forms are not needed for IUD insertion.
ANS: B
The woman has up to 5 days to insert the IUD after unprotected sex. Return to fertility is
immediate after removal of the IUD. IUDs offer no protection for STIs. A consent form is
required for insertion, as is a negative pregnancy test.
DIF: Cognitive Level: Comprehension
OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
26. Which of the following statements is the most complete and accurate description of medical
abortions?
a. They are performed only for maternal health.
b. They can be achieved through surgical procedures or with drugs.
c. They are mostly performed in the second trimester.
d. They can be either elective or therapeutic.
ANS: D
Medical abortions are performed through the use of medications (rather than surgical
procedures). They are mostly done in the first trimester, and they can be either elective (the
woman‘s choice) or therapeutic (for reasons of maternal or fetal health).
DIF: Cognitive Level: Comprehension
OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
27. Postcoital contraception with Ella
a. requires that the first dose be taken within 72 hours of unprotected intercourse.
b. requires that the woman take second and third doses at 24 and 36 hours after the
first dose.
c. must be taken in conjunction with an IUD insertion.
d. is commonly associated with the side effect of menorrhagia.
ANS: A
Emergency contraception is most effective when used within 72 hours of intercourse;
however, it may be used with lessened effectiveness 120 hours later. Insertion of the copper
IUD within 5 days of intercourse may also be used and is up to 99% effective. The most
common side effect of postcoital contraception is nausea.
DIF: Cognitive Level: Comprehension
OBJ: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
28. Informed consent concerning contraceptive use is important because some of the methods
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a. are invasive procedures that require hospitalization.
b. require a surgical procedure to insert.
d. have potentially dangerous side effects.
ANS: D
To make an informed decision about the use of contraceptives, it is important for couples to
be aware of potential side effects. The only contraceptive method that is a surgical procedure
and requires hospitalization is sterilization. Some methods have greater efficacy than others,
and this should be included in the teaching.
DIF: Cognitive Level: Comprehension
OBJ: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
29. A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing
infertility. She is very concerned about the risk of multiple births. The nurse‘s most
appropriate response is
a. ―This is a legitimate concern. Would you like to discuss this further before your
treatment begins?
b. ―No one has ever had more than triplets with Clomid.
c. ―Ovulation will be monitored with ultrasound so that this 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 significantly
increased. The patient‘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 is inaccurate and
negates the patient‘s concerns. Ultrasound cannot ensure that a multiple pregnancy will not
occur. The percentage quoted in this statement is inaccurate. The comment ―don‘t worry
discredits the patient‘s concern.
DIF: Cognitive Level: Application
OBJ: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. You (the nurse) are reviewing the educational packet provided to a patient about tubal
ligation. What is an important fact you should point out? (Select all that apply.)
a. ―It is highly unlikely that you will become pregnant after the procedure.□
b. ―This is an effective form of 100% permanent sterilization. You won‘t be able to
get pregnant.□
c. ―Sterilization offers some form of protection against sexually transmitted
infections (STIs).□
d. ―Sterilization offers no protection against STIs.□
e. ―Your menstrual cycle will greatly increase after your sterilization.
ANS: A, D
A woman is unlikely to become pregnant after tubal ligation, although it is not 100%
effective. Sterilization offers no protection against STIs. The menstrual cycle typically
remains the same after a tubal ligation.
DIF: Cognitive Level: Application
OBJ: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
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