The Preconception Client - LIPPINCOTT's 11th

Question 1

A client has obtained Plan B (levonorgestrel 0.75 mg, 2 tablets) as emergency contraception. After unprotected intercourse, the client calls the clinic to ask questions about taking the contraceptives. The nurse realizes the client needs further explanation when she makes which of the following responses?

1. “I can wait 3 to 4 days after intercourse to start taking these to prevent pregnancy.”
2. “My boyfriend can buy Plan B from the pharmacy if he is over 18 years old.”
3. “The birth control works by preventing ovulation or fertilization of the egg.”
4. “I may feel nauseated and have breast tenderness or a headache after using the contraceptive.”

Answer 1

1. 1. Plan B is a series of contraceptive pills similar in composition to birth control pills that have been used for the past 30 years. Plan B is the brand name for levonorgestrel 0.75 mg. Pills are most effective if taken immediately after unprotected intercourse and then again 12 hours later. Males can purchase this contraceptive as long as they are over 18 years of age. Common side effects include nausea, breast tenderness, vertigo, and stomach pain. CN: Physiological adaptation; CL: Evaluate

Question 2

2. An antenatal G 2, T 1, P 0, Ab 0, L 1 client is discussing her postpartum plans for birth control with her health care provider. In analyzing the available choices, which of the following factors has the greatest impact on her birth control options?
3. Satisfaction with prior methods.
4. Preference of sexual partner.
5. Breast- or bottle-feeding plan.
6. Desire for another child in 2 years.

Answer 2

2. 3. Birth control plans are influenced primarily by whether the mother is breast- or bottle-feeding her infant. The maternal milk supply must be well established prior to the initiation of most hormonal birth control methods. Low-dose oral contraceptives would be the exception. Use of estrogen-/ progesterone-based pills and progesterone-only pills are commonly initiated from 4 to 6 weeks postpartum because the milk supply is well established by this time. Prior experiences with birth control methods have an impact on the method chosen as do the preferences of the client’s partner; however, they are not the most influential factors. Desire to have another child in two years would make some methods, such as an IUD, less attractive but would still be secondary to the choice to breast-feed.
      CN: Pharmacological and parenteral therapies; CL: Analyze

Question 3

3. After the nurse instructs a 20-year-old nulligravid client on how to perform a breast self- examination, which of the following client statements indicates that the teaching has been successful?
4. “I should perform breast self-examination on the day my menstrual flow begins.”
5. “It’s important that I perform breast self-examination on the same day each month.”
6. “If I notice that one of my breasts is much smaller than the other, I shouldn’t worry.”
7. “If there is discharge from my nipples, I should call my health care provider.”

Answer 3

3. 4. The nurse determines that the client has understood the instructions when the client says that
      she will notify her primary health care provider if she notices discharge or bleeding because this may be symptomatic of underlying disease. Ideally, breast self-examination should be performed about 1 week after the onset of menses because hormonal influences on breast tissue are at a low ebb at this
      time. The client should perform breast self-examination on the same day each month only if she has stopped menstruating (as with menopause). The client’s breasts should mirror each other. If one breast
      is significantly larger than the other, or if there is “pitting” of breast tissue, a tumor may be present.
      CN: Reduction of risk potential; CL: Evaluate

Question 4

4. Which of the following would be important to include in the teaching plan for the client who wants more information on ovulation and fertility management?
5. The ovum survives for 96 hours after ovulation, making conception possible during this time.
6. The basal body temperature falls at least 0.2°F (0.17°C) after ovulation has occurred.
7. Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle.
8. Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus.

Answer 4

4. 3. For a client with a typical menstrual cycle of 28 days, ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. Stated another way, the menstrual period begins about 2 weeks after ovulation has occurred. Ovulation does not usually occur during the menses component of the cycle when the uterine lining is being shed. In most women, the ovum survives for about 12 to 24 hours after ovulation, during which time conception is possible. The basal body temperature rises 0.5°F to 1.0°F (0.28°C to 0.56°C) when ovulation occurs. Although some women experience some pelvic discomfort during ovulation (mittelschmerz), severe or unusual painis rare. After ovulation, the cervical mucus is thin and copious.
      CN: Health promotion and maintenance; CL: Create

Question 5

5. Which of the following instructions about activities during menstruation would the nurse include when counseling an adolescent who has just begun to menstruate?
6. Take a mild analgesic if needed for menstrual pain.
7. Avoid cold foods if menstrual pain persists.
8. Stop exercise while menstruating.
9. Avoid sexual intercourse while menstruating.

Answer 5

5. 1. The nurse should instruct the client to take a mild analgesic, such as ibuprofen, if menstrual pain or “cramps” are present. The client should also eat foods rich in iron and should continue moderate exercise during menstruation, which increases abdominal tone. Avoiding cold foods will not decrease dysmenorrhea. Sexual intercourse is not prohibited during menstruation, but the male partner should wear a condom to prevent exposure to blood.
      CN: Health promotion and maintenance; CL: Apply

Question 6

6. After conducting a class for female adolescents about human reproduction, which of the following statements indicates that the school nurse’s teaching has been effective?
7. “Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy.”
8. “I won’t become pregnant if I abstain from intercourse during the last 14 days of my menstrualcycle.”
9. “Sperms from a healthy male usually remain viable in the female reproductive tract for 96 hours.”
10. “After an ovum is fertilized by a sperm, the ovum then contains 21 pairs of chromosomes.”

Answer 6

6. 1. Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes. This is an important point to make with adolescents who may be sexually active. Many people believe that the time interval is much longer and that they can wait until after intercourse to take steps to prevent conception. Without protection, pregnancy and sexually transmitted diseases can occur. When using the abstinence or calendar method, the couple should abstain from intercourse on the days of the menstrual cycle when the woman is most likely to conceive. Using a 28-day cycle as an example, a couple should abstain from coitus 3 to 4 days before ovulation (days 10 through 14) and 3 to 4 days after ovulation (days 15 through 18). Sperm from a healthy male can remain viable for 24 to 72 hours in the female reproductive tract. If the female client ovulates after coitus, there is a possibility that fertilization can occur. Before fertilization, the ovum and sperm each contain 23 chromosomes. After fertilization, the conceptus contains 46 chromosomes unless there is a chromosomal abnormality.
      CN: Health promotion and maintenance; CL: Evaluate

Question 7

7. A 20-year-old nulligravid client expresses a desire to learn more about the symptothermal method of family planning. Which of the following would the nurse include in the teaching plan?
8. This method has a 50% failure rate during the first year of use.
9. Couples must abstain from coitus for 5 days after the menses.
10. Cervical mucus is carefully monitored for changes.
11. The male partner uses condoms for significant effectiveness.

Answer 7

7. 3. The symptothermal method is a natural method of fertility management that depends on knowing when ovulation has occurred. Because regular menstrual cycles can vary by 1 to 2 days in either direction, the symptothermal method requires daily basal body temperature assessments plus close monitoring of cervical mucus changes. The method relies on abstinence during the period of ovulation, which occurs approximately 14 days before the beginning of the next cycle. Abstinence from coitus for 5 days after menses is unnecessary because it is unlikely that ovulation will occur during this time period (days 1 through 10). Typically, the failure rate for this method is between 10% and 20%. Although a condom may increase the effectiveness of this method, most clients who choose natural methods are not interested in chemical or barrier types of family planning.
      CN: Health promotion and maintenance; CL: Create

Question 8

8. Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following?
9. Anemia.
10. Hypertension.
11. Dysmenorrhea.
12. Acne vulgaris

Answer 8

8. 2. Before advising a client about oral contraceptives, the nurse needs to assess the client for signs and symptoms of hypertension. Clients who have hypertension, thrombophlebitis, obesity, or a
      family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives. In
      addition, women who smoke, are older than 40 years of age, or have a history of pulmonary disease
      should be advised to use a different method. Iron-deficiency anemia, dysmenorrhea, and acne are not
      contraindications for the use of oral contraceptives. Iron-deficiency anemia is a common disorder in young women. Oral contraceptives decrease the amount of menstrual flow and thus decrease the amount of iron lost through menses, thereby providing a beneficial effect when used by clients with anemia. Low-dose oral contraceptives to prevent ovulation may be effective in decreasing the severity of dysmenorrhea (painful menstruation). Dysmenorrhea is thought to be caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycle. Use of oral contraceptives commonly improves facial acne.CN: Reduction of risk potential; CL: Analyze

Question 9

9. After instructing a 20-year-old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which of the following as an adverse effect?
10. Weight gain.
11. Nausea.
12. Headache.
13. Ovarian cancer.

Answer 9

9. 4. The nurse determines that the client needs further instruction when the client says that one of
      the adverse effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian and endometrial cancers are reduced in women using oral contraceptives. Other adverse effects of oral
      contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most serious adverse effect is thrombophlebitis.
      CN: Pharmacological and parenteral therapies; CL: Evaluate

Question 10

10. A 22-year-old nulligravid client tells the nurse that she and her husband have been considering using condoms for family planning. Which of the following instructions should the nurse include about the use of condoms as a method for family planning?
11. Using a spermicide with the condom offers added protection against pregnancy.
12. Natural skin condoms protect against sexually transmitted diseases.
13. The typical failure rate for couples using condoms is about 25%.
14. Condom users commonly report penile gland sensitivity.

Answer 10

10. 1. The typical failure rate of a condom is approximately 12% to 14%. Adding a spermicide can decrease this potential failure rate because it offers additional protection against pregnancy. Natural skin condoms do not offer the same protection against sexually transmitted diseases caused by viruses as latex condoms do. Unlike latex condoms, natural skin (membrane) condoms do not prevent the passage of viruses. Most condom users report decreased penile gland sensitivity. However, some users do report an increased sensitivity or allergic reaction (such as a rash) to latex, necessitating the use of another method of family planning or a switch to a natural skin condom.
       CN: Health promotion and maintenance; CL: Apply

Question 11

11. Which of the following would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning?
12. Douching with an acidic solution after intercourse is recommended.
13. Diaphragms should not be used if the client develops acute cervicitis.
14. The diaphragm should be washed in a weak solution of bleach and water.
15. The diaphragm should be left in place for 2 hours after intercourse.

Answer 11

11. 2. The teaching plan should include a caution that a diaphragm should not be used if the client develops acute cervicitis, possibly aggravated by contact with the rubber of the diaphragm. Some studies have also associated diaphragm use with increased incidence of urinary tract infections. Douching after use of a diaphragm and intercourse is not recommended because pregnancy could occur. The diaphragm should be inspected and washed with mild soap and water after each use. A diaphragm should be left in place for at least 6 hours but no longer than 24 hours after intercourse. More spermicidal jelly or cream should be used if intercourse is repeated during this period.
       CN: Reduction of risk potential; CL: Create

Question 12

12. After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which of the following client statements indicates a need for further teaching?
13. “I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case.”
14. “If I get pregnant, I will have to be refitted for another diaphragm after childbirth.”
15. “Before inserting the diaphragm, I should coat the rim with contraceptive jelly.”
16. “If I gain or lose 20 lb (9.1 kg), I can still use the same diaphragm.”

Answer 12

12. 4. The client would need additional instructions when she says that she can still use the same
       diaphragm if she gains or loses 20 lb (9.1 kg). Gaining or losing more than 15 lb (6.8 kg) can change the pelvic and vaginal contours to such a degree that the diaphragm will no longer protect the client against pregnancy. The diaphragm can be used for 2 to 3 years if it is cared for and well protected in its case. The client should be refitted for another diaphragm after pregnancy and childbirth because weight changes and physiologic changes of pregnancy can alter the pelvic and vaginal contours, thus affecting the effectiveness of the diaphragm. The client should use a spermicidal jelly or cream before inserting the diaphragm.
       CN: Reduction of risk potential; CL: Evaluate

Question 13

13. A 22-year-old client tells the nurse that she and her husband are trying to conceive a baby.
    When teaching the client about reducing the incidence of neural tube defects, the nurse would
    emphasize the need for increasing the intake of which of the following foods? Select all that apply.
14. Leafy green vegetables.
15. Strawberries.
16. Beans.
17. Milk.
18. Sunflower seeds.
19. Lentils.

Answer 13

13.1,2,3,5,6. The pregnancy requirement for folic acid is 600 mcg/day. Major sources of folic acid include leafy green vegetables, strawberries and oranges, beans, particularly black and kidney beans, sunflower seeds, and lentils. Milk and fats contain no folic acid.
CN: Health promotion and maintenance; CL: Apply

Question 14

14. A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan?
15. “Another method of contraception is needed until the sperm count is 0.”
16. “Vasectomy is easily reversed if children are desired in the future.”
17. “Vasectomy is contraindicated in males with prior history of cardiac disease.”
18. “Vasectomy requires only a yearly follow-up once the procedure is completed.”

Answer 14

14. 1. Another method of contraception is needed until all sperm has been cleared from the body. The number of ejaculates for this to occur varies with the individual and laboratory analysis is required to determine when that has been accomplished. Vasectomy is considered a permanent sterilization procedure and requires microsurgery for anastomosis of the vas deferens to be completed. Studies have shown that there is no connection between cardiac disease in males andvasectomy. There is no need for follow-up after verification that there is no sperm in the system.
       CN: Physiological adaptation; CL: Create

Question 15

15. A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which of the following client statements indicates effective teaching?
16. “My fallopian tubes will be tied off through a small abdominal incision.”
17. “Reversal of a tubal ligation is easily done, with a pregnancy success rate of 80%.”
18. “After this procedure, I must abstain from intercourse for at least 3 weeks.”
19. “Both of my ovaries will be removed during the tubal ligation procedure.”

Answer 15

15. 1. Tubal ligation, a female sterilization procedure, involves ligation (tying off) or cauterization of the fallopian tubes through a small abdominal incision (laparotomy). Reversal of a tubal ligation is not easily done, and the pregnancy success rate after reversal is about 30%. After a tubal ligation, the client may engage in intercourse 2 to 3 days after the procedure. The ovaries are not generally removed during a tubal ligation. An oophorectomy involves removal of one or both ovaries.
       CN: Health promotion and maintenance; CL: Evaluate

Question 16

16. A 23-year-old nulliparous client visiting the clinic for a routine examination tells the nurse that she desires to use the basal body temperature method for family planning. The nurse should instruct the client to do which of the following?
17. Check the cervical mucus to see if it is thick and sparse.
18. Take her temperature at the same time every morning before getting out of bed.
19. Document ovulation when her temperature decreases at least 1°F (0.56°C).
20. Avoid coitus for 10 days after a slight rise in temperature.

Answer 16

16. 2. The basal body temperature method requires that the client take her temperature each morning before getting out of bed, preferably at the same time each day before eating or any other activity. Just before the day of ovulation, the temperature falls by 0.5°F (0.28°C). At the time of ovulation, the temperature rises 0.4°F to 0.8°F (0.22°C to 0.44°C) because of increased progesterone secretion in response to the luteinizing hormone. The temperature remains higher for the rest of the
       menstrual cycle. The client should keep a diary of about 6 months of menstrual cycles to calculate
       “safe” days. There is no mucus for the first 3 or 4 days after menses, and then thick, sticky mucus begins to appear. As estrogen increases, the mucus changes to clear, slippery, and stretchy. This condition, termed spinnbarkeit, is present during ovulation. After ovulation, the mucus decreases in amount and becomes thick and sticky again until menses. Because the ovum typically survives about 24 hours and sperm can survive up to 72 hours, couples must avoid coitus when the cervical mucus is copious and for about 3 to 4 days before and after ovulation to avoid a pregnancy.
       CN: Health promotion and maintenance; CL: Apply

Question 17

17. A couple visiting the infertility clinic for the first time states that they have been trying to conceive for the past 2 years without success. After a history and physical examination of both partners, the nurse determines that an appropriate outcome for the couple would be to accomplish which of the following by the end of this visit?
18. Choose an appropriate infertility treatment method.
19. Acknowledge that only 50% of infertile couples achieve a pregnancy.
20. Discuss alternative methods of having a family, such as adoption.
21. Describe each of the potential causes and possible treatment modalities.

Answer 17

17. 4. By the end of the first visit, the couple should be able to identify potential causes and treatment modalities for infertility. If their evaluation shows that a treatment or procedure may help them to conceive, the couple must then decide how to proceed, considering all of the various treatments before selecting one. Treatments can be difficult, painful, or risky. The first visit is not the appropriate time to decide on a treatment plan because the couple needs time to adjust to the diagnosis of infertility, a crisis for most couples. Although the couple may be in a hurry for definitive therapy, a thorough assessment of both partners is necessary before a treatment plan can be initiated. The success rate for achieving a pregnancy depends on both the cause and the effectiveness of the treatment, and in some cases it may be only as high as 30%. The couple may desire information about alternatives to treatment, but insufficient data are available to suggest that a specific treatment modality may not be successful. Suggesting that the couple consider adoption at this time may inappropriately imply that the couple has no other choice. If a specific therapy may result in a
       pregnancy, the couple should have time to consider their options. After a thorough evaluation, adoption may be considered by the couple as an alternative to the costly, time-consuming, and sometimes painful treatments for infertility.
       CN: Health promotion and maintenance; CL: Analyze

Question 18

18. A client is scheduled to have in vitro fertilization (IVF) as an infertility treatment. Which of the following client statements about IVF indicates that the client understands this procedure?
19. “IVF requires supplemental estrogen to enhance the implantation process.”
20. “The pregnancy rate with IVF is higher than that with gamete intrafallopian transfer.”
21. “IVF involves bypassing the blocked or absent fallopian tubes.”
22. “Both ova and sperm are instilled into the open end of a fallopian tube.”

Answer 18

18. 3. The client’s understanding of the procedure is demonstrated by the statement describing IVF as a technique that involves bypassing the blocked or absent fallopian tubes. The primary health care
       provider removes the ova by laparoscope- or ultrasound-guided transvaginal retrieval and mixes
       them with prepared sperm from the woman’s partner or a donor. Two days later, up to four embryos are returned to the uterus to increase the likelihood of a successful pregnancy. Supplementalprogesterone, not estrogen, is given to enhance the implantation process. Gamete intrafallopian transfer (GIFT) and tubal embryo transfer have a higher pregnancy rate than IVF. However, these procedures cannot be used for clients who have blocked or absent fallopian tubes because the fertilized ova are placed into the fallopian tubes, subsequently entering the uterus naturally for
       implantation. In IVF, fertilization of the ova by the sperm occurs outside the client’s body. In GIFT,
       both ova and sperm are implanted into the fallopian tubes and allowed to fertilize within the woman’s
       body.
       CN: Reduction of risk potential; CL: Evaluate

Question 19

19. A 20-year-old primigravid client tells the nurse that her mother had a friend who died from hemorrhage about 10 years ago during a vaginal birth. Which of the following responses would be most helpful?
20. “Today’s modern technology has resulted in a low maternal mortality rate.”
21. “Don’t concern yourself with things that happened in the past.”
22. “In North America, mothers seldom die in childbirth.”
23. “What is it that concerns you about pregnancy, labor, and childbirth?”

Answer 19

19. 4. The client is verbalizing concerns about death during childbirth, thus providing the nurse with an opportunity to gather additional data. Asking the client about these concerns would be most helpful to determine the client’s knowledge base and to provide the nurse with the opportunity to answer any questions and clarify any misconceptions. Although the maternal mortality rate is low in the United States and Canada, maternal deaths do occur, even with modern technology. Leading causes of maternal mortality in the United States and Canada include embolism, pregnancy-induced hypertension, hemorrhage, ectopic pregnancy, and infection. Telling the client not to concern herself about what has happened in the past is not useful. It only serves to discount the client’s concerns and block further therapeutic communication. Also, postponing or ignoring the client’s need for a discussion about complications of pregnancy may further increase the client’s anxiety.
       CN: Health promotion and maintenance; CL: Apply

Question 20

20. A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which of the following statements would the nurse expect to include in the client’s teaching plan?
21. About midway through the menstrual cycle, cervical mucus is thick and sticky.
22. During ovulation, the cervix remains dry without any mucus production.
23. As ovulation approaches, cervical mucus is abundant and clear.
24. Cervical mucus disappears immediately after ovulation, resuming with menses.

Answer 20

20. 3. As ovulation approaches, cervical mucus is abundant and clear, resembling raw egg white. Ovulation generally occurs 14 days (±2 days) before the beginning of menses. During the luteal phase of the cycle, which occurs after ovulation, the cervical mucus is thick and sticky, making it difficult for sperm to pass. Changes in the cervical mucus are related to the influences of estrogen and progesterone. Cervical mucus is always present.
       CN: Health promotion and maintenance; CL: Create

Question 21

21. When instructing a client about the proper use of condoms for pregnancy prevention, which of the following instructions would be included to ensure maximum effectiveness?
22. Place the condom over the erect penis before coitus.
23. Withdraw the condom after coitus when the penis is flaccid.
24. Ensure that the condom is pulled tightly over the penis before coitus.
25. Obtain a prescription for a condom with nonoxynol 9.

Answer 21

21. 1. To ensure maximum effectiveness, the condom should always be placed over the erect penis before coitus. Some couples find condom use objectionable because foreplay may have to be interrupted to apply the condom. The penis, covered by the condom, should be withdrawn before the penis becomes flaccid. Otherwise sperm may escape from the condom, providing an opportunity for possible fertilization. Rather than having the condom pulled tightly over the penis before coitus, space should be left at the tip of the penis to allow the condom to hold the sperm. The client does not need a prescription for a condom with nonoxynol 9 because these are sold over the counter.
       CN: Reduction of risk potential; CL: Apply

Question 22

22. A multigravid client will be using
    medroxyprogesterone acetate (Depo-Provera) as a family planning method. After the nurse instructs the client about this method, which of the following client
    statements indicates effective teaching?
23. “This method of family planning requires monthly injections.”
24. “I should have my first injection during my menstrual cycle.”
25. “One possible adverse effect is absence of a menstrual period.”
26. “This drug will be given by subcutaneous injections.”

Answer 22

22. 3. With medroxyprogesterone acetate, irregular menstrual cycles and amenorrhea are common
       adverse effects. Other adverse effects include weight gain, breakthrough bleeding, headaches, and
       depression. This method requires deep intramuscular injections every 3 months. The first injection should occur within 5 days after menses.
       CN: Reduction of risk potential; CL: Evaluate

Question 23

23. Which of the following instructions should the nurse include in the teaching plan for a 30-year-old multiparous client who will be using an intrauterine device (IUD) for family planning?
24. Amenorrhea is a common adverse effect of IUDs.
25. The client needs to use additional protection for conception.
26. IUDs are more costly than other forms of contraception.
27. Severe cramping may occur when the IUD is inserted.

Answer 23

23. 4. Severe cramping and pain may occur as the device is passed through the internal cervical os. The insertion of the device is generally done when the client is having her menses, because it is unlikely that she is pregnant at that time. Common adverse effects of IUDs are heavy menstrual bleeding and subsequent anemia, not amenorrhea. Uterine infection or ectopic pregnancy may occur.The IUD has an effectiveness rate of 98%. Therefore, additional protection is not necessary to prevent pregnancy. IUDs generally are less costly than other forms of contraception because they do not require additional expense. Only one insertion is necessary, in comparison to daily doses of oral contraceptives or the need for spermicides in conjunction with diaphragm use.
       CN: Reduction of risk potential; CL: Apply

Question 24

24. After instructing a 40-year-old woman about osteoporosis after menopause, the nurse determines that the client needs further instruction when the client states which of the following?
25. “A standard serving of yogurt is the equivalent of one glass of milk.”
26. “Women who do not eat dairy products should consider calcium supplements.”
27. “Women of African descent are at the greatest risk for osteoporosis.”
28. “Estrogen therapy at menopause can reduce the risk of osteoporosis.”

Answer 24

24. 3. Small-boned, fair-skinned women of northern European descent are at the greatest risk for
       osteoporosis, not women of African descent. One standard serving of yogurt is the equivalent of one
       glass of milk. Women who do not eat dairy products, such as women who are lactose intolerant, should consider using calcium supplements. Inadequate lifetime intake of calcium is a major risk factor for osteoporosis. Estrogen therapy, or some of the newer medications that are not estrogen based, can greatly reduce the incidence of osteoporosis.
       CN: Reduction of risk potential; CL: Evaluate

Question 25

25. When developing a teaching plan for an 18-year-old client who asks about treatments for sexually transmitted diseases, the nurse should explain that:
26. Acyclovir (Zovirax) can be used to cure herpes genitalis.2. Chlamydia trachomatis infections are usually treated with penicillin.
27. Ceftriaxone sodium (Rocephin) may be used to treat Neisseria gonorrhoeae infections.
28. Metronidazole (Flagyl) is used to treat condylomata acuminata.

Answer 25

25. 3. Ceftriaxone sodium (Rocephin) may be used to treat N. gonorrhoeae infections and is commonly combined with doxycycline hyclate (Vibramycin). Both the client and her partner should be treated if gonorrhea is present. Acyclovir (Zovirax) can be used to treat herpes genitalis; however, the drug does not cure the disease. C. trachomatis infections are usually treated with antibiotics such as doxycycline or azithromycin (Zithromax). Metronidazole (Flagyl) is used to treat trichomoniasis vaginitis, not condylomata acuminata (genital warts).
       CN: Pharmacological and parenteral therapies; CL: Create

Question 26

26. A couple is visiting the clinic because they have been unable to conceive a baby after 3 years of frequent coitus. After discussing the various causes of male infertility, the nurse determines that the male partner needs further instruction when he states which of the following as a cause?
27. Seminal fluid with an alkaline pH.
28. Frequent exposure to heat sources.
29. Abnormal hormonal stimulation.
30. Immunologic factors.

Answer 26

26. 1. The client needs further instruction when he says that one cause of male infertility is decreased sperm count due to seminal fluid that has an alkaline pH. A slightly alkaline pH is necessary to protect the sperm from the acidic secretions of the vagina and is a normal finding. An alkaline pH is not associated with decreased sperm count. However, seminal fluid that is abnormal in amount, consistency, or chemical composition suggests obstruction, inflammation, or infection, which can decrease sperm production. The typical number of sperm produced during ejaculation is 400 million. Frequent exposure to heat sources, such as saunas and hot tubs, can decrease sperm
       production, as can abnormal hormonal stimulation. Immunologic factors produced by the man against
       his own sperm (autoantibodies) or by the woman can cause the sperm to clump or be unable to
       penetrate the ovum, thus contributing to infertility.
       CN: Health promotion and maintenance; CL: Evaluate

Question 27

27. A 24-year-old woman is being assessed for a malformation of the uterus. The figure below
    indicates which of the following uterine malformations?
28. Septate uterus.
29. Bicornuate uterus.
30. Double uterus.
31. Uterus didelphys.

Answer 27

27.2. A bicornuate uterus has a “Y” shape and appears to be a double uterus but in fact has only one cervix. A septate uterus contains a septum that extends from the fundus to the cervix, thus dividing the uterus into two separate compartments. A double uterus has two uteri, each of which has a cervix. A uterus didelphys occurs when both uteri of a double uterus are fully formed.
CN: Physiological adaptation; CL: Apply