NUR114 CH4

  1. Fertility awareness methods of contraception depend on
    identifying the beginning and end of the fertile period of the menstrual cycle.
  2. mechanical barriers include
    male and female condoms, cervical caps, and diaphragms.
  3. Hormonal contraception includes
    precoital and postcoital prevention and requiresthorough patient education
  4. emergency contraceptive should be taken
    as soon possible after unprotected intercourse and no later than 120 hours afterward (or 72 depending on your source of information)
  5. Induced abortion
    is the purposeful interruption of a pregnancy before 20 weeks of gestation.
  6. common complications of elective abortion.
    Infection and excessive vaginal bleeding
  7. Infertilityaffects X of reproductive-age couples.
    10% to 15%
  8. Causes of infertility include
    decreased sperm production, ovulation disorders,and endometriosis.
  9. Assisted reproductive therapies account for
    less than 1% of all U.S. births.
  10. A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the woman in which herbal preparations to avoid while trying to conceive?

    C. “You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive.”

    Nettle leaf, dong quai, and vitamin E are all remedies that promote fertility.  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.  Vitamin E, calcium, and magnesium may promote fertility and conception.  Although most herbal remedies have not been proven clinically to promote fertility, women should avoid the following herbs while trying to conceive: licorice root, yarrow, wormwood, ephedra, fennel, golden seal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle.
  11. 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. “You probably didn’t ovulate during this cycle.”
  12. Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse would tell him to:

    A. Obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days.

    The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide.  An ejaculated sample should be obtained after a period of abstinence to get the best results.  He should avoid exposing the specimen to extremes of temperature, either heat or cold.  The specimen should be taken to the laboratory within 2 hours of ejaculation.
  13. A woman taking an oral contraceptive pill (OCP) as her birth control method of choice should notify her health care provider immediately if she notes:

    B. Swelling and pain in one of her legs.

    Breast tenderness is an expected side effect of OCPs.  Weight gain is an expected side effect of OCPs.  Leg pain and swelling (edema) may indicate thrombophlebitis and should be reported immediately.  Mood swings are a common side effect of OCPs.
  14. Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new patient to discuss contraception?

    B. Determine the woman's level of knowledge about contraception and commitment to any particular method.

    Although important, determining the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and any objections of the partner.  Determining the woman's level of knowledge about contraception and commitment to a method is the primary step of this nursing assessment; it is necessary before completing the process and moving on to a nursing diagnosis. Once the woman's level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from sexually transmitted infections, and a partner's willingness to participate.  The woman's willingness to touch her genitals and cervical mucus is a key factor for the nurse to discuss if the woman expresses interest in using one of the fertility awareness methods of contraception.  The nurse must be aware of the woman's plan regarding whether she is attempting to prevent conception, delay conception, or conceive.
  15. Nurses should be aware that infertility:

    D. Is perceived differently by women and men.

    Women tend to be more stressed about infertility tests and tend to place more importance on having children.   The prevalence of infertility is stable among the overall population, but it increases with a woman’s age, especially over age 40.  Of cases with an identifiable cause, about 40% are related to female factors, 40% to male factors, and 20% to both partners.  Sterility is the inability to conceive. Infertility is a state that requires a prolonged time to conceive, or subfertility.
  16. A 26-year-old woman is considering Depo-Provera as the form of contraception that is best for her because she does not like to worry about taking a pill every day. To assist this woman with decision making concerning this method of contraception, the nurse would tell her that Depo-Provera:

    A. Thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation.

    Depo-Provera is a progestin-only form of hormonal contraception.   Depo-Provera is administered as an intramuscular injection.  In addition to the changes in the cervical mucus, some but not all ovulatory cycles are suppressed, and formation of an endometrium capable of supporting implantation is inhibited.  The effectiveness rate is 99% or greater over 5 years. (Book failure: 3%)
  17. The nurse must evaluate a male patient's knowledge regarding the use of a condom. The nurse would recognize the need for further instruction if the patient states that he:

    A. Lubricates the condom with a spermicide containing nonoxynol-9.

    Nonoxynol-9 is no longer recommended. Recent data suggest that frequent use of nonoxynol-9 may increase human immunodeficiency virus transmission and can cause genital lesions.  Leaving an empty space at the tip of the condom is the correct instruction.  Leaving a small amount of air in the tip of the condom is the correct instruction NOT according to the book.  Removing the condom while holding the base is the correct instruction.
  18. Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with a number of 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. Financial ability to cover the cost of treatment

    • Multiple gestation is indeed 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 the matter of disclosing facts concerning conception of offspring. 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.  Although the method of payment is important, obtaining this information is not the responsibility of the nurse. It is also of note that 14 states have mandated some form of insurance to assist couples with coverage for infertility.
  19. Which statement is true about the term contraceptive failure rate?

    C. It varies from couple to couple, depending on the method and the users.

    The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only.  The contraceptive failure rate is strictly a statistical measure of likely accidental pregnancy over a couple’s first year of use.  Failure rates decline over time because users gain experience.  Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple.
  20. Infertility drugs
    • Clomiphene citrate
    • Follicle stimulating hormone (FSH)
    • Gonadotropin-releasing hormone (GnRH)
  21. Second trimester (13 weeks)
    D&E dilation and evacuation up to 20 weeks, but mostly 13-16 weeks
  22. Medical abortions
    • up to 9 weeks U.S.
    • methotrexate to 7 weeks
    • mioprostol to 8 wks
    • mifepristone to 8 wks
  23. Surgical abortions
    up to 12 weeks
  24. IUD risks
    • not for multuparas
    • PID
    • infection
    • expulsion
    • uterine perforation
  25. Day After Pill
    • Within 12/72/120 hours...
    • Causes nausea & vomiting - give antiemetic 1 hour before
    • Caution that pill may delay ovulation, pregnancy is possible days and weeks afterward, so...
  26. COC altered effectiveness
    • many medications and
    • St. John's wort
  27. COC contraindications
    Combined (estrogen and progesterone)

    • Women over 35 who smoke (more than 15 cigarettes a day)
    • Thrombolitic disorders
    • Severe HTN
  28. Cervical caps must
    remain in place at least 6 but no more than 48 hours
  29. Diaphrams
    can be inserted up to 6 hours before, but MUST remain in in for at least 6 hours after.
  30. Ovulation method
    Safe 4 days after last day of wet, clear, slippery mucus
  31. TwoDay method
    If I noted secretions today OR yesterday, no unprotected sex
  32. Standard days method
    no unprotected sex on days 8-19
  33. NFP
    Natural Family Planning - abstinance from sex during fertile period ONLY.

  34. Calendar rythhm method
    Determins fertile period AFTER recording menstrual cycles for 6 months
  35. Informed consent mnemonic?
    • B-benefits
    • R-risks
    • A-alternatives
    • I-questions (inquiries)
    • D-decision
    • E-explainations
    • D-documentation
  36. can be a highly effective, temporary method of birth control.
    Lactation amenorrhea method
Card Set
NUR114 CH4
Contraception, Abortion, and Infertility