Contemporary Maternal Newborn Nursing, 9th ed By Ladewig - Test Bank

Contemporary Maternal-Newborn Nursing, 9e (Ladewig et al.) Chapter 4 Conception and Fetal Development 1) The nurse is explaining the difference between meiosis and mitosis. Which statement does the nurse include? Select all that apply. 1. Meiosis is the division of a cell into two exact copies of the original cell. 2. Mitosis is the splitting of one cell into two, each with half the chromosomes of the original cell. 3. Meiosis is the process by which gametes, or the sperm and ova, are formed. 4. Mitosis occurs in most of the cells of the body. 5. Meiotic division leads to cells that halve the original genetic material. Answer: 3, 5 Explanation: 1. Meiosis creates two cells that have half of the chromosomes of the original cell. 2. Mitosis creates two cells that are exact copies of the original cell. 3. Both sperm and ova are created through meiosis. 4. Mitosis is how the majority of cells reproduce so that the new cells have the same structure and function as the original. Meiosis only occurs in gametes. 5. Meiosis creates two cells that have half of the chromosomes of the original cell. Page Ref: 42, 43 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential I: Liberal education for Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion Learning Outcome: LO 4.1-Differentiate between meiotic cellular division and mitotic cellular division. MNL LO: Analyze the components of the fertilization process. 2) The nurse has completed a presentation on reproduction. Which participants statement indicates that the teaching has been successful? 1. "A male is born with all the sperm he will ever produce." 2. "Females create new ova throughout their reproductive life." 3. "Ova separate into two unequally sized cells." 4. "Each primary spermatocyte divides into four haploid cells." Answer: 3 Explanation: 1. Males begin spermatogenesis at puberty and continue throughout their life. Each sperm divides into four haploid cells. 2. Females are born with all the ova they will ever produce. The ova begin to be formed in early fetal life. One ovum is released each month during the reproductive life of a female, from menarche to menopause. 3. Each ovum undergoes meiotic division just prior to being released from the graafian follicle. Each cell created by this meiosis has the same number of chromosomes, but the cytoplasm does not split equally. This causes a polar body to be produced along with a secondary oocyte. 4. Primary spermatocytes contain 46 chromosomes (46XY). Each primary spermatocyte undergoes meiotic division into two haploid secondary spermatocytes (22X or 22Y). Haploid cells each contain half of the genetic material of the original cell. Then each secondary spermatocyte undergoes a second meiotic division into two haploid spermatids (remaining either 22X or 22Y.) Spermatids mature into spermatozoa. Thus, a primary spermatocyte eventually becomes four haploid spermatozoa. Page Ref: 43, 44 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 4.2-Compare the processes by which ova and sperm are produced. MNL LO: Analyze the components of the fertilization process. 3) After teaching a class about the female reproductive system, the nurse asks the attendees to describe the process of meiosis. Which student response suggests successful comprehension of the material? 1. "Completion of the second meiotic division results in formation of three polar bodies and one ovum." 2. "At the time of ovulation, the first meiotic division begins." 3. "Completion of the first meiotic division produces three polar bodies and one primary oocyte." 4. "At the time of puberty, the second meiotic division begins." Answer: 1 Explanation: 1. Completion of the second meiotic division produces three polar bodies and one ovum. 2. The first meiotic division of oocytes begins before the female fetus is born. 3. Completion of the first meiotic division produces one polar body and one secondary oocyte. 4. The second meiotic division begins at the time of ovulation. Page Ref: 43 Cognitive Level: Understanding Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 4.2-Compare the processes by which ova and sperm are produced. MNL LO: Analyze the components of the fertilization process. 4) You are counseling a young woman regarding contraception. When asked if she currently uses any form of contraception, she replies, "I can't get pregnant because I don't have intercourse on the day I ovulate." Based upon her response, what information should you include in your teaching? 1. Refrain from intercourse on the day of ovulation will effectively prevent pregnancy. 2. Sperm are believed to be healthy and highly fertile for at least five days. 3. After ovulation, ova are considered fertile for about 72 to 96 hours. 4. Sperm survive 48 to 72 hours in the female reproductive tract. Answer: 4 Explanation: 1. Because sperm survive 48 to 72 hours in the female reproductive tract, avoidance of intercourse for 24 hours will not reliably prevent pregnancy from occurring. 2. Sperm are believed to be most fertile for the first 24 hours following entry into the female reproductive tract. 3. Ova are considered fertile for about 12 to 24 hours after ovulation. 4. Sperm survive 48 to 72 hours in the female reproductive tract. Page Ref: 44, 45 Cognitive Level: Understanding Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion Learning Outcome: LO 4.3-Analyze the components of the fertilization process and how each may impact fertilization. MNL LO: Compare advantages, disadvantages, risk factors, and contraindications of contraception methods. 5) When evaluating information taught about conception and fetal development, the patient verbalizes understanding about transportation time of the zygote through the fallopian tube and into the cavity of the uterus with which statement? 1. "It will take at least three days for the egg to reach the uterus." 2. "It will take eight days for the egg to reach the uterus." 3. "It will only take 12 hours for the egg to go through the fallopian tube." 4. "It will take 18 hours for the fertilized egg to implant in the uterus." Answer: 1 Explanation: 1. It takes at least three days for the egg to reach the uterus. 2. "It will take eight days for the egg to reach the uterus" is an incorrect interpretation of the information on conception. 3. "It will only take 12 hours for the egg to go through the fallopian tube" is an incorrect interpretation of the information on conception. 4. "It will take 18 hours for the fertilized egg to implant in the uterus" is an incorrect interpretation of the information on conception. Page Ref: 46, 47 Cognitive Level: Understanding Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 4.3-Analyze the components of the fertilization process and how each may impact fertilization. MNL LO: Compare the different stages and factors influencing embryonic and fetal organ system development. 6) If only a small volume of sperm is discharged into the vagina, an insufficient quantity of enzymes might be released when sperm encounters the ovum. In that case, pregnancy would probably not result because: 1. Peristalsis of the fallopian tube would decrease, making it difficult for the ovum to enter the uterus. 2. The block to polyspermy (cortical reaction) would not occur. 3. The fertilized ovum would be unable to implant in the uterus. 4. Sperm would be unable to penetrate the zona pellucida of the ovum. Answer: 4 Explanation: 1. This is an incorrect statement. 2. This is incorrect because it is mediated by release of materials from cortical granules below the ovum's surface and not the result of low sperm count. 3. The fertilized ovum would be unable to implant in the uterus because fertilization is unlikely to occur with a low sperm count. 4. Sperm would be unable to penetrate the zona pellucida of the ovum because it takes hundreds of acrosomes (the result of the acrosome reaction) to rupture and release enough hyaluronic acid to clear the way for a single sperm to penetrate the ovum's zona pellucida successfully. Page Ref: 44, 45 Cognitive Level: Understanding Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential I: Liberal education for Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Health teaching and health promotion Learning Outcome: LO 4.3-Analyze the components of the fertilization process and how each may impact fertilization. MNL LO: Analyze the components of the fertilization process. 7) The nurse is caring for a client who is pregnant with twins. Which statement indicates the client needs additional information? 1. "Because both of my twins are boys, I know that they are identical." 2. "If my twins came from one fertilized egg that split, they are identical." 3. "If I have one boy and one girl, I will know they came from two eggs." 4. "It is rare for twins to both be within the same amniotic sac." Answer: 1 Explanation: 1. Not all same-sex twins are identical or monozygotic, because fraternal, or dizygotic, twins can be the same gender or different genders. 2. When the zygote splits, identical twins share the same genotype result. 3. The only way to have twins of different genders is if they came from two separate fertilized ova. Monozygotic twins are identical and are the same gender. 4. Monoamnionic-monochorionic twins are very rare and occur as a result of the zygote splitting seven or more days after fertilization. Page Ref: 49, 50 Cognitive Level: Understanding Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 4.5-Compare the factors and processes by which fraternal (dizygotic) and identical (monozygotic) twins are formed. MNL LO: Compare the different stages and factors influencing embryonic and fetal organ system development. 8) A pregnant client asks you to describe the differences between monozygotic and dizygotic twins. Which statement should you include in your teaching? 1. "Dizygotic twinning occurs less frequently than does monozygotic twinning." 2. "Monozygotic twins originate from division of the fertilized ovum at different stages." 3. "Dizygotic twins share one placenta and one chorion." 4. "Monozygotic twins are also referred to as 'fraternal twins." Answer: 2 Explanation: 1. Dizygotic twinning occurs more frequently than does monozygotic twinning. 2. Monozygotic twins originate from division of the fertilized ovum at different stages of early development. 3. Dizygotic twins each have a separate chorion and amnion. 4. Monozygotic twins are also referred to as "identical" twins. Page Ref: 49, 50 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion Learning Outcome: LO 4.5-Compare the factors and processes by which fraternal (dizygotic) and identical (monozygotic) twins are formed. MNL LO: Compare the different stages and factors influencing embryonic and fetal organ system development. 9) Which statement by a pregnant client would indicate that additional teaching was necessary? 1. "Because of their birth relationship, fraternal twins are more similar to each other than if they had been born singly." 2. "Identical twins can be the same or different sex." 3. "Congenital abnormalities are more prevalent in identical twins." 4. "Identical twins occur more frequently than fraternal twins." Answer: 3 Explanation: 1. Fraternal twins are not more similar to each other than if they had been born singly. 2. Identical or monozygotic twins have identical chromosomal structures and therefore are always the same sex. 3. Due to variations in the timing of the splitting of the embryo, congenital abnormalities such as conjoining are more common in monozygotic twins. 4. Dizygotic, or fraternal, twins occur more frequently than do monozygotic twins. Page Ref: 49, 50 Cognitive Level: Understanding Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 4.5-Compare the factors and processes by which fraternal (dizygotic) and identical (monozygotic) twins are formed. MNL LO: Compare the different stages and factors influencing embryonic and fetal organ system development. 10) The nurse is creating a poster for pregnant mothers. Which description of fetal development does the nurse include? 1. Four layers of cells form after the embryo is at the ball stage. 2. After fertilization, the cells only become larger for several weeks. 3. Most organs are formed by 8 weeks after fertilization. 4. The embryonic stage is from fertilization until 5 months. Answer: 3 Explanation: 1. Three primary germ layers form from the ball of undifferentiated cells called the blastocyst: ectoderm, mesoderm, and endoderm. 2. After fertilization, the cells reproduce by mitosis, resulting in more cells, not larger cells. 3. Most organs are formed during the embryonic stage, which lasts from the 15th day after fertilization until the end of the 8th week after fertilization. 4. The embryonic stage begins after fertilization on day 15 and ends at the completion of 8 weeks' gestation. Page Ref: 55 Cognitive Level: Application Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion Learning Outcome: LO 4.4-Summarize the processes that occur during the cellular multiplication and differentiation stages of intrauterine development and their effect on the structures that form. MNL LO: Compare options for client education of factors affecting embryonic and fetal development. 11) The nurse is presenting an early pregnancy class to a group of pregnant women. Which statement indicates a need for further education? 1. "The placenta develops and grows larger until about 20 weeks' gestation." 2. "The placenta creates hormones and enzymes that are necessary during pregnancy." 3. "The placenta ages and becomes less permeable during the last month of pregnancy." 4. "The placenta floats in the amniotic sac and filters waste products from the fetus." Answer: 4 Explanation: 1. The chorionic villi of the placenta become more differentiated with time. The placenta grows in size until about 20 weeks. After this point, the placenta thickens but does not increase in size. 2. The placenta creates glycogen, cholesterol, hormones such as human chorionic gonadotropin (hCG), and enzymes such as sulfatase and insulinase. 3. The placenta is designed to last for 40 weeks, the average length of human gestation. The permeability to nutrients and oxygen begins to decrease starting at about 36 weeks as a part of the aging of the placenta. 4. The placenta is attached to the uterine wall, and does not float in the amniotic sac. One function of the placenta is to filter metabolic waste products from the baby's blood so that they can be excreted by the mother. Page Ref: 51—53 Cognitive Level: Understanding Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 4.6-Describe the development, structure, and functions of the placenta and umbilical cord during intrauterine life (embryonic and fetal development). MNL LO: Compare the various methods of prepared childbirth education. 12) The nurse is working with a client who has experienced a fetal death in utero at 20 weeks. The client asks what her baby will look like when it is delivered. Which statement by the nurse is the best response? 1. "Your baby will be covered in fine hair called lanugo." 2. "Your child will have arm and leg buds, but not fully formed limbs." 3. "A white, cheesy substance called vernix caseosa will be on the skin." 4. "The genitals of the baby will be ambiguous." Answer: 1 Explanation: 1. Downy fine hair called lanugo covers a fetus at 20 weeks' gestation. 2. Limb buds have developed by 35-days postfertilization. At 20 weeks, the fetus will have well developed well differentiated arms and legs. 3. Vernix caseosa forms at about 24 weeks. This fetus is only 20 weeks and will not have vernix. 4. The genitals are apparent by 12 weeks after fertilization. At 20 weeks' gestation, the fetus would have specifically male or female genitals. Page Ref: 55, 56 Cognitive Level: Application Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion Learning Outcome: LO 4.7-Contrast the significant changes in growth and development of the fetus at 4, 6, 12, 16, 20, 24, 28, 36, and 40 weeks' gestation. MNL LO: Implement specific nursing interventions related to caring for families experiencing perinatal loss. 13) At her first prenatal visit, the client states, "I'm five weeks' pregnant now and I would like to hear my baby's heartbeat today." How should the nurse respond? 1. Prepare to assist with auscultation of the fetal heartbeat using a fetoscope. 2. Explain to the client that the fetal heart does not begin to beat until approximately 7 weeks' gestation. 3. Anticipate that the client will be scheduled for Doppler ultrasound. 4. Explain to the client that the fetal heartbeat is not yet detectable at 5 weeks' gestation. Answer: 4 Explanation: 1. Fetal heart tones can be identified through use of a fetoscope at approximately 20 weeks' gestation. 2. The fetal heart begins to beat by 4 weeks' gestation. 3. Generally, fetal heart tones cannot be heard until approximately 8 weeks' gestation by ultrasound Doppler device. 4. While the tubular heart begins to form during the third week, fetal heart tones generally are not be detectable until at least 7 weeks' gestation. Page Ref: 55, 56 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion Learning Outcome: LO 4.7-Contrast the significant changes in growth and development of the fetus at 4, 6, 12, 16, 20, 24, 28, 36, and 40 weeks' gestation. MNL LO: Compare the different stages and factors influencing embryonic and fetal organ system development. 14) The client, at 18 weeks' gestation, thinks she might have been exposed to a toxin at work that could affect fetal development. The client asks the nurse what organs might be affected at this point in pregnancy. The best response of the nurse is: 1. "The brain is developing now and could be affected." 2. "Because you are in the second trimester, there is no danger." 3. "The internal organs like the heart and lungs could be impacted." 4. "Its best to not worry about possible problems with your baby." Answer: 1 Explanation: 1. Maximum brain growth and myelination are occurring at this point in fetal development. 2. Although the greatest danger from teratogens is during the embryonic stage (the first 8 weeks of pregnancy), the fetus at 20 weeks is still vulnerable to exposure to teratogens. 3. The heart, lungs, and other internal organs form during the embryonic state, or the first 8 weeks of pregnancy. During their formation is when they are most likely to be affected by a teratogen. 4. Avoid telling patients to not worry. Doing so indicates to the patient that you don't care about their concerns and will end effective communication. Page Ref: 56 Cognitive Level: Analyzing Client Need&Sub: Psychosocial Integrity Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion Learning Outcome: LO 4.8-Identify the factors that influence congenital malformations of the various organ systems. MNL LO: Compare the different stages and factors influencing embryonic and fetal organ system development. 15) The nurse is preparing a preconception information class. Information about causes of fetal organ malformation in the first trimester will be presented. What prenatal influences on the intrauterine environment should be included in the instruction? Select all that apply. 1. The use of saunas or hot tubs 2. The use of drugs 3. The quality of the sperm or ovum 4. Maternal nutrition 5. Age of the mother at conception Answer: 1, 2, 4 Explanation: 1. The use of saunas or hot tubs is associated with maternal hyperthermia and neural tube defects. 2. Many drugs can have teratogenic effects. 3. The quality of the sperm or ovum can affect fertility but not organ formation. 4. Maternal nutrition, if deficient, can cause damage to the fetus. Vitamins and folic acid taken prior to and during the pregnancy can have beneficial effects. 5. A maternal age of 35 or older is associated with genetic defects that occur at conception, not with first-semester organ malformation. Page Ref: 46, 60—61 Cognitive Level: Analyzing Client Need&Sub: Physiological Integrity Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion Learning Outcome: LO 4.8-Identify the factors that influence congenital malformations of the various organ systems. MNL LO: Relate various factors to their effect on pregnancy outcomes. 16) A woman at 20 weeks' gestation finds that her blood type is O. She tells the nurse that her boyfriends blood type is AB, and asks what blood type her child will have. Which blood types should the nurse tell the woman her child may have? Select all that apply. 1. O 2. A 3. B 4. OA 5. AB Answer: 2, 3 Explanation: 1. Type O is recessive so it will not be the child's blood type. 2. The child could be Type A. 3. The child could be Type B. 4. Type OA is a fictitious blood type. 5. Because the mother is Type O, the child cannot be AB. Page Ref: 53, 56 Cognitive Level: Application Client Need&Sub: Safe and Effective Care Environment | Management of Care Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 4.7-Contrast the significant changes in growth and development of the fetus at 4, 6, 12, 16, 20, 24, 28, 36, and 40 weeks' gestation. MNL LO: Relate various factors to their effect on pregnancy outcomes. 17) A woman had a genetic evaluation and it is discovered that she carries on autosomal dominant gene for Huntington's disease, while her husbands history is ordinary. Which family members should be referred for genetic counseling? Select all that apply. 1. The woman's brothers 2. The woman's sisters 3. The woman's parents 4. The woman's husband 5. The woman's children Answer: 1, 2, 3, 5 Explanation: 1. The woman's brothers would have a 50 percent probability of having the gene. 2. The woman's sisters would have a 50 percent probability of having the gene. 3. One of the parents has the gene; manifestation of the disease has not happened yet. 4. The husbands history is unremarkable. 5. The woman's children have a 50 percent probability of having the gene. Page Ref: 42—44 Cognitive Level: Application Client Need&Sub: Safe and Effective Care Environment | Management of Care Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care Learning Outcome: LO 4.8-Identify the factors that influence congenital malformations of the various organ systems. MNL LO: Contrast the various genetic inheritance patterns. Contemporary Maternal-Newborn Nursing, 9e (Ladewig et al.) Chapter 7 Families with Special Reproductive Concerns 1) A client 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." Answer: 4 Explanation: 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. 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. 3. Testing will determine what the infertility issue is, but using the term "at fault" is blaming and should be avoided. 4. This is a factual answer that avoids using the term "at fault." This statement is therapeutically worded and therefore is the best answer. Page Ref: 115 Cognitive Level: Application Client Need&Sub: Psychosocial Integrity Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion Learning Outcome: LO 7.1-Compare the essential components of fertility with the possible causes of infertility. MNL LO: Explain infertility and its associated risk factors. 2) The client experiencing infertility is to complete three months of documenting her basal body temperatures. Which statement by the client indicates a need for additional teaching? 1. "I should check my temperature with this special thermometer before I get out of bed each day." 2. "I will track my temperatures and the consistency of my cervical mucus for the next 3 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." Answer: 3 Explanation: 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. 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. 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 to 1.0°F as ovulation occurs, remaining elevated if conception occurs or dropping just prior to onset of menses. 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. Page Ref: 116, 117 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 7.2-Describe the elements of the preliminary investigation of infertility and the nurse's role in supporting/teaching patients during this phase. MNL LO: Recognize the various strategies for managing infertility. 3) 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 client? 1. Clomiphene citrate (Clomid or Serophene) 2. Glucophage (Metformin) 3. Human menopausal gonadotropins (hMGs) 4. Bromocriptine (Parlodel) Answer: 1 Explanation: 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. 2. Oral hypoglycemic agents such as glucophage (Metformin) are used for inducing ovulation in women with polycystic ovary disease (PCOS). 3. hMGs is a second line of therapy in women who fail to ovulate or conceive with clomiphene citrate therapy. 4. Bromocriptine (Parlodel) is used to treat hyperprolactinemia accompanied by anovulation. Page Ref: 114, 115 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Quality of practice Learning Outcome: LO 7.3-Compare the indications for the tests with the associated treatments, including assisted reproductive technologies that are done in an infertility workup. MNL LO: Examine the assessment process for male and female infertility. 4) 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." Answer: 3 Explanation: 1. The temperature can be taken with a standard oral or rectal thermometer. 2. In the basal body temperature method, the woman takes her temperature every day before starting any activity, including smoking. 3. In the basal body temperature method, the woman takes her temperature every day before arising. 4. In the basal body temperature method, the woman takes her temperature every day for five minutes. Page Ref: 116. 117 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 7.3-Compare the indications for the tests with the associated treatments, including assisted reproductive technologies that are done in an infertility workup. MNL LO: Recognize the various strategies for managing infertility. 5) A client calls his urologist's office to clarify instructions about semen analysis. The nurse should instruct the client 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. Answer: 1 Explanation: 1. To obtain accurate results of a semen analysis, the specimen is collected after 3 days of abstinence. 2. Most lubricants also are spermicidal and should not be used unless approved by the andrology laboratory. 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. 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. Page Ref: 118, 119 Cognitive Level: Understanding Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Quality of practice Learning Outcome: LO 7.3-Compare the indications for the tests with the associated treatments, including assisted reproductive technologies that are done in an infertility workup. MNL LO: Recognize the various strategies for managing infertility. 6) The client 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 client 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 (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. Answer: 1, 2 Explanation: 1. The client'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. 2. The client 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. 3. The partner is in the anger stage of grief. Lack of acceptance would manifest as not believing that the diagnosis is correct. 4. Being in the anger stage of grief is expected and normal and has no bearing on parenting ability. 5. Guilt would manifest as feelings that it is his fault that pregnancy has not yet occurred. The client is describing anger. Page Ref: 123, 124 Cognitive Level: Analyzing Client Need&Sub: Psychosocial Integrity Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Diagnosis/Quality of practice Learning Outcome: LO 7.4-Explain the physiologic and psychologic effects of infertility on a couple in relation to the nursing management of the couple. MNL LO: Implement the nurse's role in caring for and supporting couples who experience infertility. 7) 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 clients? 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 clients 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." Answer: 4 Explanation: 1. Although teaching and facilitating scheduling are important, the emotions that families deal with during treatment for infertility must also be addressed. 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. 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. 4. This answer addresses the two main aspects of the RN working with infertile clients: emotional support and education. Page Ref: 123, 124 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Quality Improvement | AACN Essential Competencies: Essential V: Healthcare Policy, Finance, and Regulatory Environments | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Quality of practice Learning Outcome: LO 7.5-Describe the nurse's role as counselor, educator, and advocate for couples during infertility evaluation and treatment. MNL LO: Implement the nurse's role in caring for and supporting couples who experience infertility. 8) Which client(s) should the nurse refer to a genetics practitioner prior to attempting pregnancy? 1. A 32-year-old woman and a 29-year-old man with 3-year-old twins. 2. A 22-year-old woman whose sister has Tay-Sachs disease. 3. A 30-year-old woman whose husband has AIDS. 4. A 19-year-old woman whose sister has primary infertility. Answer: 2 Explanation: 1. This client has no indication of having a genetic problem. 2. Tay-Sachs disease is an autosomal recessive condition; therefore, if the client's sister has the disease, the client could be a carrier for the condition. 3. The risk for this patient is becoming infected with HIV while attempting conception. This couple has no indication of a genetic condition. 4. Primary infertility is not likely to be caused by a genetic defect that could be carried by a sibling. This client has no indication of a genetic condition. Page Ref: 128 Cognitive Level: Application Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care Learning Outcome: LO 7.6-Identify couples who may benefit from pre-conceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns. MNL LO: Recognize the various strategies for managing infertility. 9) 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 client 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." Answer: 4 Explanation: 1. Down syndrome is a trisomy and most likely to occur in parents older than 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. 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. 3. Trisomies are three copies of a specific gene and occur most often in parents older than 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. 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 percent chance of inheriting an autosomal dominant condition if one parent is affected. Males and females are equally affected by autosomal dominant disorders. Page Ref: 127 Cognitive Level: Application Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Quality Improvement | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 7.7-Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders. MNL LO: Contrast the various genetic inheritance patterns. 10) A 45-year-old mother gave birth to a baby boy 2 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 Answer: 3 Explanation: 1. A single palmar crease and low-set ears are not characteristics of trisomy 13. 2. A single palmar crease and low-set ears are not characteristics of trisomy 18. 3. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome). 4. Trisomy 26 is not an autosomal abnormality. Page Ref: 126 Cognitive Level: Application Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Assessment/Quality of practice Learning Outcome: LO 7.7-Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders. MNL LO: Contrast the various genetic inheritance patterns. 11) 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." Answer: 2 Explanation: 1. Fathers affected with an X-linked disorder cannot pass the disorder to their sons, but all their daughters become carriers of the disorder. 2. An X-linked disorder is manifested in a male who carries the abnormal gene on his only X chromosome. 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. 4. There is a 50 percent chance that a carrier mother will pass the abnormal gene to each of her sons, who will thus be affected. Page Ref: 127 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion Learning Outcome: LO 7.7-Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders. MNL LO: Examine the role of the nurse and the process involved in genetic counseling. 12) 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." Answer: 1 Explanation: 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. 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. 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. 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. Page Ref: 126 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 7.8-Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders and the nursing considerations for each. MNL LO: Examine the role of the nurse and the process involved in genetic counseling. 13) 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." Answer: 1 Explanation: 1. Anencephaly is clearly visualized with an ultrasound and does not require genetic testing to verify a diagnosis. 2. Genetic abnormalities in either parent are not related to anencephaly. 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. 4. The age of either parent is not related to anencephaly. Page Ref: 126 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion Learning Outcome: LO 7.8-Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders and the nursing considerations for each. MNL LO: Examine the role of the nurse and the process involved in genetic counseling. 14) A male infant was born 2 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." Answer: 2 Explanation: 1. The parents' chromosomes do not need to be assessed in order to diagnose the infant. 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. 3. The chromosome studies will be undertaken as soon as possible. 4. It is not necessary to wait until the breast milk has come in. Page Ref: 126, 127 Cognitive Level: Application Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion Learning Outcome: LO 7.8-Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders and the nursing considerations for each. MNL LO: Examine the role of the nurse and the process involved in genetic counseling. 15) 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?" Answer: 2 Explanation: 1. When a client 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. 2. This response uses therapeutic communication techniques and portrays a caring attitude towards the family. Asking if the family has questions further facilitates communication. 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. 4. It is not therapeutic to ask "why" questions. In addition, although cystic fibrosis is diagnosable prenatally, a client 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. Page Ref: 128 Cognitive Level: Application Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication Learning Outcome: LO 7.9-Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder. MNL LO: Examine the role of the nurse and the process involved in genetic counseling. 16) 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 percent chance that our baby would have sickle cell disease." Answer: 4 Explanation: 1. Self-blame and judgment do not indicate coping. 2. Preconception health does not affect transmission of an autosomal recessive trait. 3. Nutrition does not affect transmission of an autosomal recessive trait. 4. A true statement indicates coping. When both the mother and father are carriers of an autosomal recessive disease like sickle cell disease, there is a 25 percent chance of a normal child, a 25 percent chance of a child with sickle-cell disease, and a 50 percent chance of a child with sickle-cell trait. Page Ref: 128 Cognitive Level: Application Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Assessment/Communication Learning Outcome: LO 7.9-Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder. MNL LO: Contrast the various genetic inheritance patterns. 17) 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." Answer: 4 Explanation: 1. The nurse should act as a liaison between the family and genetic counselor. 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. 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. 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. Page Ref: 128 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Communication Learning Outcome: LO 7.10-Explain the nurse's role in supporting the family undergoing genetic counseling. MNL LO: Examine the role of the nurse and the process involved in genetic counseling. 18) The nurse is planning a group session for parents who are beginning infertility evaluation. Which statement should be included in this session? Select all that apply. 1. "Infertility can be stressful for a marriage." 2. "The doctor will be able to tell why you have not conceived." 3. "Your insurance will pay for the infertility treatments." 4. "Keep communicating with one another through this process." 5. "Taking a vacation usually results in pregnancy." Answer: 1, 4 Explanation: 1. Infertility is often stressful on a marriage, as a result of the need to schedule intercourse and pay for treatments and the societal expectation to have children. 2. Some infertility cannot be explained, despite extensive treatments. 3. Insurance often does not pay for infertility treatment. 4. Communication is important to help cope with stress. A nurse should always encourage clients to ask questions. 5. A common myth is that taking a vacation or just relaxing will result in conception. Page Ref: 97 Cognitive Level: Application Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion Learning Outcome: LO 7.5-Describe the nurse's role as counselor, educator, and advocate for couples during infertility evaluation and treatment. MNL LO: Explain infertility and its associated risk factors. 19) A woman has had her initial infertility work-up and labs. In the next step, the nurse teaches the woman about basal body temperature (BBT) method. The nurse should explain that certain situations can disturb body temperature, which situations should the nurse instruct the client regarding? 1. Eating 2. Jet lag 3. Voiding 4. Waterbed use 5. Shift work Answer: 2, 4, 5 Explanation: 1. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work. 2. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work. 3. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work. 4. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work. 5. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work. Page Ref: 142 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Health teaching and health promotion Learning Outcome: LO 7.5-Describe the nurse's role as counselor, educator, and advocate for couples during infertility evaluation and treatment. MNL LO: Recognize the various strategies for managing infertility. 20) The first-line therapy to induce ovulation in women with normal ovaries, normal prolactin level and an intact pituitary is Clomiphene citrate. The nurse also teaches about what side effects? 1. Dryness/loss of hair 2. Hot flashes 3. Visual disturbances 4. Weight gain 5. Hair growth Answer: 1, 2, 3 Explanation: 1. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort. 2. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort. 3. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort. 4. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort. 5. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort. Page Ref: 148 Cognitive Level: Analyzing Client Need&Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Health teaching and health promotion Learning Outcome: LO 7.5-Describe the nurse's role as counselor, educator, and advocate for couples during infertility evaluation and treatment. MNL LO: Recognize the various strategies for managing infertility. Contemporary Maternal-Newborn Nursing, 9e (Ladewig et al.) Chapter 11 Maternal Nutrition 1) The prenatal clinic nurse is caring for a 15-year-old primiparous client at 8 weeks' gestation. The client is 64 inches tall and weighs 115 pounds. The client asks the nurse why she is supposed to gain so much weight. What is the best response by the nurse? 1. "Gaining 25 to 35 pounds is recommended for healthy fetal growth." 2. "It's what your certified nurse-midwife recommended for you." 3. "Inadequate weight gain delays lactation after delivery." 4. "Weight gain is important to assure that you get enough vitamins." Answer: 3 Explanation: 1. For an appropriate weight woman, 25 to 35 pounds of weight gain is recommended for optimal fetal growth and development. 2. Although this statement might be true, the patient has asked a "why" question that sh