Preview Extract
Chapter 7
1) A patient 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
Rationale 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.
Rationale 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.
Rationale 3:
Testing will determine what the infertility issue is, but using the term “at fault” is blaming
and should be avoided.
Rationale 4:
This is a factual answer that avoids using the term “at fault.” This statement is therapeutically
worded and therefore is the best answer.
2) The patient experiencing infertility is to complete three months of documenting her basal
body temperatures. Which statement by the patient 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 three
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
Rationale 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.
Rationale 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.
Rationale 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 .5–1.0°F as ovulation occurs, remaining elevated if
conception occurs or dropping just prior to onset of menses.
Rationale 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.
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 patient?
1. Clomiphene citrate (Clomid or Serophene)
2. Glucophage (Metformin)
3. Human menopausal gonadotropins (hMGs)
4. Bromocriptine (Parlodel)
Answer: 1
Rationale 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.
Rationale 2:
Oral hypoglycemic agents such as glucophage (Metformin) are used for inducing ovulation in
women with polycystic ovary disease (PCOS).
Rationale 3:
Human menopausal gonadotropins (hMGs) is a second line of therapy in women who fail to
ovulate or conceive with clomiphene citrate therapy.
Rationale 4:
Bromocriptine (Parlodel) is used to treat hyperprolactinemia accompanied by anovulation.
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
Rationale 1:
The temperature can be taken with a standard oral or rectal thermometer.
Rationale 2:
In the basal body temperature method, the woman takes her temperature every day before
starting any activity, including smoking.
Rationale 3:
In the basal body temperature method, the woman takes her temperature every day before
arising.
Rationale 4:
In the basal body temperature method, the woman takes her temperature every day for five
minutes.
5) A patient calls his urologist's office to clarify instructions about semen analysis. The nurse
should instruct the patient 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
Rationale 1:
To obtain accurate results of a semen analysis, the specimen is collected after 3 days of
abstinence.
Rationale 2:
Most lubricants also are spermicidal and should not be used unless approved by the
andrology laboratory.
Rationale 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.
Rationale 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.
6) The patient 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 patient 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:
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
Rationale 1:
The patient’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.
Rationale 2:
The patient 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.
Rationale 3:
The partner is in the anger stage of grief. Lack of acceptance would manifest as not believing
that the diagnosis is correct.
Rationale 4:
Being in the anger stage of grief is expected and normal and has no bearing on parenting
ability.
Rationale 5:
Guilt would manifest as feelings that it is his fault that pregnancy has not yet occurred. The
patient is describing anger.
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 patients?
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 patients 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
Rationale 1:
Although teaching and facilitating scheduling are important, the emotions that families deal
with during treatment for infertility must also be addressed.
Rationale 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.
Rationale 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.
Rationale 4:
This answer addresses the two main aspects of the RN working with infertile patients:
emotional support and education.
8) Which patient(s) should the nurse refer to a genetics practitioner prior to attempting
pregnancy?
1. 32-year-old woman and 29-year-old man with 3-year-old twins
2. 22-year-old woman whose sister has Tay-Sachs disease
3. 30-year-old woman whose husband has AIDS
4. 19-year-old woman whose sister has primary infertility
Answer: 2
Rationale 1:
This patient has no indication of having a genetic problem.
Rationale 2:
Tay-Sachs disease is an autosomal recessive condition; therefore, if the patient’s sister has the
disease, the patient could be a carrier for the condition.
Rationale 3:
The risk for this patient is becoming infected with HIV while attempting conception. This
couple has no indication of a genetic condition.
Rationale 4:
Primary infertility is not likely to be caused by a genetic defect that could be carried by a
sibling. This patient has no indication of a genetic condition.
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 patient 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
Rationale 1:
Down syndrome is a trisomy and most likely to occur in parents over 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.
Rationale 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.
Rationale 3:
Trisomies are three copies of a specific gene and occur most often in parents over 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.
Rationale 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% chance of inheriting
an autosomal dominant condition if one parent is affected. Males and females are equally
affected by autosomal dominant disorders.
10) A 45-year-old mother gave birth to a baby boy two 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
Rationale 1:
A single palmar crease and low-set ears are not characteristics of trisomy 13.
Rationale 2:
A single palmar crease and low-set ears are not characteristics of trisomy 18.
Rationale 3:
A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome).
Rationale 4:
Trisomy 26 is not an autosomal abnormality.
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
Rationale 1:
Fathers affected with an X-linked disorder cannot pass the disorder to their sons, but all their
daughters become carriers of the disorder.
Rationale 2:
An X-linked disorder is manifested in a male who carries the abnormal gene on his only X
chromosome.
Rationale 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.
Rationale 4:
There is a 50% chance that a carrier mother will pass the abnormal gene to each of her sons,
who will thus be affected.
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
Rationale 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.
Rationale 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.
Rationale 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.
Rationale 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.
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
Rationale 1:
Anencephaly is clearly visualized with an ultrasound and does not require genetic testing to
verify a diagnosis.
Rationale 2:
Genetic abnormalities in either parent are not related to anencephaly.
Rationale 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.
Rationale 4:
The age of either parent is not related to anencephaly.
14) A male infant was born two 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
Rationale 1:
The parents’ chromosomes do not need to be assessed in order to diagnose the infant.
Rationale 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.
Rationale 3:
The chromosome studies will be undertaken as soon as possible.
Rationale 4:
It is not necessary to wait until the breast milk has come in.
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
Rationale 1:
When a patient 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.
Rationale 2:
This response uses therapeutic communication techniques and portrays a caring attitude
towards the family. Asking if the family has questions further facilitates communication.
Rationale 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.
Rationale 4:
It is not therapeutic to ask “why” questions. In addition, although cystic fibrosis is
diagnosable prenatally, a patient 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.
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% chance that our baby would have sickle disease.”
Answer: 4
Rationale 1:
Self-blame and judgment do not indicate coping.
Rationale 2:
Preconception health does not affect transmission of an autosomal recessive trait.
Rationale 3:
Nutrition does not affect transmission of an autosomal recessive trait.
Rationale 4:
A true statement indicates coping. When both the mother and father are carriers of an
autosomal recessive disease like sickle-cell, there is a 25% chance of a normal child, a 25%
chance of a child with sickle-cell disease, and a 50% chance of a child with sickle-cell trait.
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
Rationale 1:
The nurse should act as a liaison between the family and genetic counselor.
Rationale 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.
Rationale 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.
Rationale 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.
Test Bank for Contemporary Maternal-Newborn Nursing
Patricia W Ladewig, Marcia L London, Michele Davidson
9780133429862, 9780134257020
