Test Bank for Maternity Nursing Care, 2nd Edition

Test Bank for Maternity Nursing Care, 2nd Edition

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Chapter 7: Reproduction, Sexuality, Infertility, and Family Planning

MULTIPLE CHOICE

1. In counseling a client concerning her choice of a method of contraception, the nurse should keep
all of the following in mind. What should be given the greatest consideration?
a. Cost of the various methods
b. Knowledge that oral contraceptives are almost 100 percent effective
c. Acceptability of the method for the client
d. Religious preference of the couple
ANS: C
Acceptability for the client is the greatest consideration. While cost of the various methods,
knowledge that oral contraceptives are almost 100 percent effective, and religious preference of the
couple are important factors, they are not the greatest consideration.

PTS: 1 DIF: Comprehension REF: Family Planning

2. When discussing family planning methods, the nurse should plan to

a. choose the method, based on health assessment, that would best suit the client's health
risks and needs
b. help clients to have a thorough understanding of the method they choose
c. include only the female in the discussion
d. point out all methods that have the greatest effectiveness
ANS: B
Helping the clients understand the method they choose is key to their effective use of the method
and be aware of possible adverse effects. Choosing the method should be the client’s choice. Both
partners should participate in the decision when feasible. Pointing out all methods that have the
greatest effectiveness is providing only restrictive information.

PTS: 1 DIF: Application REF: Family Planning

3. The risk of ectopic pregnancy is the greatest with the use of what contraceptive measures?
a. Combination pill c. Progesterone IUD
b. Norplant d. Tubal ligation
ANS: C
Ectopic pregnancy, as well as infection, accidental pregnancy, and expulsion of the device, are
adverse effects of the progesterone IUD. The primary risk for COCs is the risk of thrombus
formation. Ectopic pregnancy is not a risk from Norplant or tubal ligation.

PTS: 1 DIF: Knowledge REF: Pharmacological Aspects of Nursing Care

4. A 17-year-old client says she wants to use "the pill." Important baseline information that must be
collected prior to oral contraceptives being prescribed includes
a. frequency of alcohol use c. nutritional assessment
b. history of thrombophlebitis d. presence of monogamous partner
ANS: B
 Oral contraceptives increase the risk of thrombophlebitis and are contraindicated in women with a
history of thrombophlebitis. Frequency of alcohol use does not have an impact on oral
contraceptive use. Although a nutritional assessment is an important part of the assessment
process, it does not have a bearing on the use of oral contraceptives. Presence of a monogamous
partner is not a prerequisite for using oral contraceptives.

PTS: 1 DIF: Comprehension

REF: Implementation of the Choice

5. The principal contraceptive effect of combination oral contraceptives is

a. decreasing tubal motility c. inhibiting ovulation
b. inhibiting implantation d. producing thick cervical mucus
ANS: C
COCs block the surge of LH, thus preventing ovulation. Decreasing tubal motility is not an effect
of COC. Progestins make the endometrium less receptive to implantation. COCs cause the cervical
mucus to thin.

PTS: 1 DIF: Knowledge REF: Pharmacology of Oral Contraceptives

6. A client says she heard from a friend that you stop having periods once you are on "the pill." The
most appropriate response would be
a. "If your friend has missed her period, she should stop taking the pills and get a pregnancy
test as soon as possible."
b. "Missed periods can be very dangerous and may lead to the formation of precancerous
cells."
c. "The pill prevents the uterus from making much endometrial lining; that is why periods
may often be scant or skipped occasionally."
d. "The pill should cause a normal menstrual period every month. It sounds like your friend
has not been taking the pills properly."
ANS: C
The nurse’s response that "The pill prevents the uterus from making much endometrial lining; that
is why periods may often be scant or skipped occasionally." is a true statement and an appropriate
response. Option ‘a’ is incorrect because this can occur as a normal effect of oral contraceptives,
plus it is not an appropriate nursing response. Option ‘b’ is incorrect because this can occur as a
normal effect of oral contraceptives and a noncontraceptive benefit of COCs is protection against
ovarian and endometrial cancer, plus it is not an appropriate nursing response. Option ‘d’ is
incorrect because this can occur as a normal effect of oral contraceptives, and this statement is not
an appropriate nursing response.

PTS: 1 DIF: Application REF: Noncontraceptive Benefits

7. A client asks what the difference is between birth control pills and birth control shots. An accurate
response would be
a. "The shots, called Depo-Provera, are basically the same as the pills, but the shots are
easier because you only have to take them every 3 months."
b. "The shots, called Depo-Provera, have been shown to be more effective than the pills."
c. "The shots, called Depo-Provera, have no serious side effects."
d. "The shots, called Depo-Provera, have only progesterone in them, but they still work by
preventing eggs from being released."
ANS: D
 The most accurate response by the nurse would be to say, "The shots, called Depo-Provera, have
only progesterone in them, but they still work by preventing eggs from being released." All other
options are false statements.

PTS: 1 DIF: Application REF: InjecTable Methods

8. Which information would be most important to provide to a client who desires Depo-Provera
(DMPA) for contraception?
a. Amenorrhea seldom occurs with the use of DMPA.
b. Menstrual changes are a common side effect of DMPA.
c. DMPA provides protection against STDs.
d. DMPA injections must be administered every month.
ANS: B
Menstrual changes are very common for the duration of the use of DMPA. Heavy and irregular
bleeding, not amenorrhea, are common adverse effects of DMPA. DMPA injections are
administered every 3 months.

PTS: 1 DIF: Application REF: InjecTable Methods: Side Effects

9. A sexually active teen comes to the clinic for family planning. She admits to having more than one
sexual partner and has been treated for STDs. Which contraceptive method would be
contraindicated?
a. IUD c. Diaphragm
b. Depo-Provera d. Oral contraceptives
ANS: A
The IUD is contraindicated in clients with multiple partners. Depo-Provera, the diaphragm, and
oral contraceptives are not contraindicated in clients with multiple partners.

PTS: 1 DIF: Comprehension

REF: Intrauterine Methods: Contraindications

10. Which information is correct regarding the IUD's mechanism of action?

a. It works as an abortifacient that prevents implantation of the fertilized egg.
b. It changes the pH of vaginal secretions, creating a hostile environment for sperm.
c. It interferes with the transport of sperm from the cervix to the fallopian tubes.
d. It creates an inflammatory response in the fallopian tubes, thus preventing conception.
ANS: C
The IUD’s mechanism of action is to interfere with sperm capacitation.

PTS: 1 DIF: Knowledge REF: Intrauterine Methods: Mechanisms of Action

11. Which directions would be most important for the nurse to provide regarding taking combined oral
contraceptives?
a. Dosages of oral contraceptives are standardized and interchangeable.
b. The pill can be started anytime during the menstrual cycle and be effective.
c. If more than one pill is missed, throw away the pack and start a new one on the Sunday
following the first day of the menses.
d. The pill is more effective if taken at the same time every day.
ANS: D
 Taking the pill at the same time every day increases its contraceptive success rate. There are three
basic types of COCs; the dosages vary according to the prescriber and the client’s needs. The pill
should be started on the Sunday after the first day of the woman’s menses. If more than one pill is
missed, the woman should use a backup contraceptive plan with the pill for the next 7 days.

PTS: 1 DIF: Comprehension

REF: Client Education: Oral Contraceptives

12. Combined oral contraceptives would always be contraindicated in which client?

a. A 20-year-old woman with nonvascular headaches
b. A 13-year-old teen with a history of STDs
c. A 37-year-old woman who smokes cigarettes
d. A 35-year-old woman who has multiple sexual partners.
ANS: C
Cigarette smoking increases the risk of thrombophlebitis associated with COC. Nonvascular
headaches, a history of STDs, and multiple sexual partners are not contraindications for the use of
COC.

PTS: 1 DIF: Comprehension

REF: Box 7-4: Contraindications to the Use of Combined Oral Contraceptives

13. Which drug reduces the efficacy of combined oral contraceptives?

a. Dilantin c. Tetracycline
b. Penicillin d. Prednisone
ANS: A
Phenytoin reduces the efficacy of COC. Penicillin, Tetracycline, and Prednisone do not impact on
the efficacy of COC.

PTS: 1 DIF: Knowledge REF: Nursing Alert: COC Contraindications

14. The use of the minipill is indicated for clients with which condition?
a. Diabetes c. Liver tumor
b. Premenstrual syndrome d. Breast cancer
ANS: A
The minipill is indicated for clients with chronic medical conditions such as diabetes.

PTS: 1 DIF: Comprehension REF: Benefits and Risks

15. The most common side effect after insertion of the IUD is
a. irregular menses c. decreased libido
b. cramping and bleeding d. vaginal infections
ANS: B
Bleeding and cramping are the two most common side effects encountered after insertion of the
IUD.

PTS: 1 DIF: Knowledge REF: Side Effects

16. Following the insertion of a Paragard IUD, the nurse should counsel the client to
a. have the device replaced every year
b. douche with a Betadine solution for 3 days
c. use a backup method for the first month
 d. notify the physician if the tails cannot be felt
ANS: D
If the tail string is not felt in the vagina, the woman should notify her health care provider
immediately. Paragard is approved for 10 years of use before replacement. Douching will cause
severe drying of the vaginal mucosa.

PTS: 1 DIF: Knowledge REF: Intrauterine Methods: Benefits and Risks

17. The client using a diaphragm for contraception should be advised to

a. keep the device in place for 1 hour after intercourse
b. apply a petroleum-based product to assist with insertion
c. have the device refitted if there is a substantial weight gain
d. clean the device with water and pat with cornstarch to aid drying
ANS: C
Diaphragms should fit snugly and, if there is a substantial weight gain, it could affect the fit and
consequently the effectiveness of the diaphragm. The diaphragm should be in place for 6 hours
after intercourse. When vaginal lubricants are used for intercourse, they should be water-based.
Petroleum-based products increase the risk of disintegration of the latex of the diaphragm. The
diaphragm should be washed with a mild soap and water and allowed to air dry.

PTS: 1 DIF: Application REF: Diaphragm-Mechanism of Action

18. Which statement is correct regarding the use of the cervical cap?
a. It does not need to be fitted by a physician.
b. It must be removed within 24 hours.
c. It does not require the use of a spermicide.
d. It may affect Pap smear results.
ANS: D
Cervical erosion is an adverse effect of the cervical cap and can affect the outcome of the woman’s
Pap smear. The cervical cap must be fitted to the woman by a health care professional and it may
be left in place for 36 to 48 hours after intercourse. A spermicidal gel is placed in the dome of the
cap and left in place until the cervical cap is removed.

PTS: 1 DIF: Knowledge REF: Cervical Cap: Side Effect

19. Before initiating DMPA injection, it is most important that the nurse
a. inquire about a history of drug allergic reactions
b. obtain a urine hCG
c. check the client's Pap smear results
d. take the client's vital signs
ANS: A
Hypersensitivity to DMPA may occur and should be assessed for prior to administering DMPA.
Obtaining a urine hCG, checking the client’s Pap smear results, and taking the client’s vital signs
are not necessary interventions with the use of DMPA.

PTS: 1 DIF: Comprehension

REF: InjecTable Methods: Contraindications

20. Which statement is true regarding the birth control patch?

a. Contraindications for use are the same as for the pill.
b. It has to be removed and reapplied monthly.
 c. It is effective in preventing STDs.
d. It has the same degree of effectiveness regardless of the client's body weight.
ANS: A
Because the birth control patch contains the same hormones as COCs, the contraindications for use
are the same. The patch is replaced weekly for 3 weeks each month. Like COCs, the patch is not
effective in preventing STDs. Evidence indicates that a higher dose for the patch may be necessary
for women weighing over 250 pounds.

PTS: 1 DIF: Knowledge REF: Dermatologic Methods

21. Which physical sign is an indicator that ovulation has occurred?

a. Decrease in the basal body temperature of 0.1 degrees Fahrenheit
b. Cervical mucous threads are 1 to 2 centimeters long
c. Thick, white cervical mucus
d. Occurrence of mittelschmerz
ANS: D
Mittelschmerz is lower abdominal pain that occurs for some woman at the time of ovulation. The
basal body temperature increases prior to ovulation and decreases 0.2 degrees F. after ovulation.
Cervical mucous threads increase to 12 to 24 centimeters and become thin, clear, and copious
when ovulation occurs. Cervical mucus becomes thin and clear when ovulation occurs.

PTS: 1 DIF: Comprehension REF: Ovulation

22. Which sperm count is abnormal?

a. 25 million per mL, 50 percent motility, 4 mL volume
b. 45 million per mL, 40 percent motility, 3 mL volume
c. 140 million per mL, 20 percent motility, 3 mL volume
d. 60 million per mL, 50 percent motility, 2 mL volume
ANS: C
This result indicates decreased sperm motility, which should be 25 percent to 50 percent.

PTS: 1 DIF: Comprehension

REF: Table 7-1: Normal Semen Analysis

23. What does the nurse anticipate to be the initial step in the evaluation of male infertility?
a. Testicular biopsy c. Semen analysis
b. Endocrine profiles d. Postcoital test
ANS: C
Semen analysis is a noninvasive diagnostic tool used to determine the most common cause of male
infertility, a decrease in the functioning of the sperm. Testicular biopsy is an invasive procedure
used to diagnose testicular cancer and is seldom a cause of infertility. Endocrine profiles and
postcoital test are not appropriate first steps in diagnosing infertility.

PTS: 1 DIF: Knowledge REF: Male Factors

24. The most common reason for female infertility is a problem with
a. ovulation c. sexual dysfunction
b. tubal or pelvic problems d. uterine defects
ANS: B
 Tubal or pelvic problems are responsible for 30 percent of female infertility. Sexual dysfunction is
not considered a factor for female infertility. Uterine defects are one cause of female infertility, but
they are not the most common cause. Failures to ovulate account for 10 to 15 percent.

PTS: 1 DIF: Knowledge REF: Female Factors

25. Which factor can adversely affect sperm count?

a. Malformation of the urethra c. Chronic febrile illnesses
b. Erectile dysfunction d. Poor nutrition
ANS: C
Increased scrotal heat negatively impacts on the sperm count. Sperm counts are based on testicular
and hormonal function. Erectile dysfunction will affect fertility, but not the sperm count. Poor
nutrition may affect physical activity, but is not directly related to the sperm count.

PTS: 1 DIF: Comprehension REF: Male Factors

26. What would be the most likely infertility treatment for a woman with an obstruction of her
fallopian tubes?
a. Artificial insemination
b. Hormonal therapy
c. GIFT (gamete intra-fallopian transfer)
d. IVF (in vitro fertilization)
ANS: D
In vitro fertilization is most appropriate when the tubes are absent or blocked. Neither artificial
insemination nor hormonal therapy affect the fallopian tubes’s ability to allow passage of the ovum
for fertilization. GIFT requires at least one fallopian tube to be open.

PTS: 1 DIF: Comprehension

REF: Assisted Reproductive Technology

27. The nurse explains to a client that the major purpose of the postcoital test is to evaluate the
a. tubal patency c. cervical structure
b. adequacy of cervical mucus d. tubal motility
ANS: B
Postcoital testing is used to evaluate cervical mucus to determine adequacy of mucus and the
ability of the sperm to travel within it. Tubal patency is evaluated using hysterosalpingography,
ultrasonography, or laparoscopy. Cervical structure is evaluated through vaginal examination, and
tubal motility can be determined by hysterosalpingography.

PTS: 1 DIF: Knowledge REF: Table 7-2: Tools Used to Assess Fertility

28. The nurse instructs an infertility client on how to determine if she is ovulating by using the basal
body temperature method. Which statement should be included in the teaching session?
a. Temperature rises slightly (0.2 degrees Fahrenheit) about 24 to 36 hours before ovulation.
b. The basal body temperature should be taken each morning within 1 hour after arising.
c. The most fertile time is 3 to 4 days before and 1 to 2 days after ovulation.
d. Begin charting the temperature on the first day the menses ceases.
ANS: C
The nurse should include the fact that the most fertile time is 3 to 4 days before and 1 to 2 days
after ovulation. Although the other statements are true, they do not determine if the client is
ovulating.
 PTS: 1 DIF: Comprehension
REF: Table 7-2: Tools Used to Assess Infertility

29. Which phase of female sexual response is shorter when compared to male sexual response?
a. Excitement phase c. Resolution phase
b. Orgasmic phase d. Plateau phase
ANS: C
The male experiences a longer resolution phase than the woman. Although physiologic responses
differ between men and women, there is not necessarily a difference in the duration of the
excitement, orgasmic, or plateau phases.

PTS: 1 DIF: Comprehension REF: Human Sexual Response

30. You are working in a Pediatric Clinic at the local hospital. You have performed a complete
physical on four children. Referral is indicated in which situation?
a. Secondary sex characteristics present, no menses, age 15
b. No secondary sex characteristics, age 12
c. Secondary sex characteristics present, age 11
d. No secondary sex characteristics, age 14
ANS: D
The lack of secondary sex characteristics in a 14-year-old should prompt the parents to have the
child evaluated by a health care provider. Menstruation may not occur until age 16 or 17. Age 11 is
considered prepubescent age and lack of secondary sex characteristics is not viewed as abnormal
until the age of 14. The presence of secondary sex characteristics would be of concern in a child
under the age of 8.

PTS: 1 DIF: Application REF: Physical Assessment and Diagnostic Tools

31. What is the primary factor in the initiation of menses?

a. Height
b. Age of the girl's mother at menarche
c. Body weight
d. Age
ANS: C
Current information supports the importance of body weight in determining the time of menarche.
Moderately overweight girls begin menstruation earlier than do those of normal weight. Girls with
very low body fat, such as those having anorexia, and girls who participate in strenuous athletics
may have delayed menarche. While age is a factor, it is not the most significant factor. Height is
not a factor for initiation of menses.

PTS: 1 DIF: Knowledge REF: Female Reproductive Function

32. Which contraceptive method can be used by a client with mild controlled hypertension?
a. Combined oral contraceptives c. Patch
b. Vaginal ring d. IUD
ANS: D
Rather than a chemical/drug contraceptive, the IUD is a mechanical contraceptive, so it would not
aggravate hypertension unless a complication occurred. COCs can aggravate hypertension.
Because the vaginal ring contains doses similar to COCs, hypertension can be aggravated with its
use. The patch contains similar doses to the COCs, so hypertension can be aggravated with its use.
 PTS: 1 DIF: Comprehension
REF: Box 7-4: Contraindications to the Use of Combined Oral Contraceptives

MULTIPLE RESPONSE

1. You have just completed teaching a class on combined oral contraceptives (COC) to a group of
women. You decide to give a quiz asking the women to name the different types of COCs. Which
responses would indicate that further teaching is needed? (Select all that apply.)
a. Monophasic d. Multiphasic
b. Biphasic e. Seasonal
c. Triphasic f. Biseasonal
ANS: C, F
Further teaching is needed if the women responded triphasic or biseasonal. The four types of
combined oral contraceptives include monophasic, biphasic, multiphasic, and seasonal.

PTS: 1 DIF: Analysis REF: Combined Oral Contraceptives

2. When teaching a client about COCs, the nurse would be sure to tell the client that which of the
following drugs interact with COCs to reduce their efficacy? (Select all that apply.)
a. Erythromycin d. Tylenol
b. Tegretol e. Topamax
c. Dilantin f. Fluvicin
ANS: B, C, E, F
Medications that interact with COCs to reduce their efficacy include Tegretol, Fluvicin,
Phenobarbital, Dilantin, Mycobutin, Rifadin, and Topamax. Erythromycin and Tylenol are not
included.

PTS: 1 DIF: Application REF: Nursing Alert: COC Contraindications

3. You are assessing a client for possible cardiovascular side effects of COCs related to hormone
dosage. Your assessment would most likely reveal which of the following? (Select all that apply.)
a. Capillary fragility d. Telangiectasis
b. Increased breast size e. Dizziness
c. Hypermenorrhea f. Deep vein thrombosis
ANS: A, D, F
The cardiovascular side effects of COCs related to hormone dosage include estrogen excess,
capillary fragility, cerebrovascular accident, deep vein thrombosis, telangiectasis, and
thromboembolic disease. Increased breast size and hypermenorrhea are reproductive side effects,
and dizziness is a premenstrual side effect.

PTS: 1 DIF: Application

REF: Table 7-5: Side Effects of Combined Oral Contraceptives Related to Hormones and Dosage

4. You are counseling a 32-year-old woman who has been unable to get pregnant. The woman asks
you what are the female factors that can affect fertility. Your response would include which of the
following? (Select all that apply.)
a. Problems of ovulation d. Tubal structural problems
b. Structural problems of the vagina e. Structural problems of the uterus
c. Structural problems of the cervix f. Structural problems of the pelvis
 ANS: A, B, C, D, E
Your most appropriate response is that factors that affect fertility in the female include problems of
ovulation, structural problems of the vagina and cervix; tubal structural problems, and structural
problems of the uterus. While structural problems of the pelvis may complicate delivery, this
problem does not interfere with the fertility of the woman.

PTS: 1 DIF: Application REF: Factors Affecting Fertility-Female Factors

5. You are teaching a group of young men about the factors that can affect sperm count. At the end of
class, you review the material. What factor if identified by one of the men would indicate that
further clarification is needed? (Select all that apply.)
a. Infrequent ejaculation d. Marijuana use
b. Wearing loose-fitting clothing e. Overuse of hot tubs
c. Overuse of saunas f. Excessive cold showers
ANS: A, B, F
Further clarification is needed if one of the men responded infrequent ejaculation, wearing
loose-fitting clothing, or excessive cold showers. The factors that interfere with sperm count
include frequent ejaculations, wearing tight-fitting clothing, overuse of saunas and hot tubs, and
marijuana use.

PTS: 1 DIF: Analysis REF: Client Education: Sperm Count

COMPLETION

1. The onset of menses is called ____________________.

ANS: menarche

PTS: 1 DIF: Knowledge REF: Female Reproductive Function

2. The onset of puberty before age 8 is called ____________________ puberty.

ANS: precocious

PTS: 1 DIF: Knowledge REF: Female Reproductive Function

3. Menses starts ____________________ days after ovulation.

ANS:
14
Fourteen

PTS: 1 DIF: Comprehension REF: Endometrial Activity

4. The ovum is fertile for ____________________ hours after ovulation.

ANS:
24
Twenty-four

PTS: 1 DIF: Knowledge REF: Male Reproductive Function

Test Bank for Maternity Nursing Care, 2nd Edition

5. Sperm live for approximately ____________________ to ____________________ days.

ANS:
2, 3
Two, three

PTS: 1 DIF: Knowledge REF: Male Reproductive Function

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