Contraception and Family Planning Nursing Exam

Correct Answer A: Autosomal recessive disorder

Explanation:

Sickle cell disease follows an autosomal recessive inheritance pattern. This means that a person must inherit two copies of the mutated gene (one from each parent) to have the disease.

If both parents are carriers (each having one mutated gene and one normal gene), there is a:

25% chance the child will have the disease (inherit both mutated genes)

50% chance the child will be a carrier (inherit one mutated and one normal gene)

25% chance the child will inherit two normal genes

Because carriers typically do not show symptoms, it’s common for individuals with sickle cell disease to have no known family history of the disease, especially if previous generations were carriers who never developed symptoms.

Why the other options are incorrect:

B) Autosomal dominant disorder:

Incorrect. In autosomal dominant disorders, only one copy of the mutated gene is needed for the disease to manifest. This is not the case with sickle cell disease.

C) Mendelian inheritance disorder:

Incorrect term in this context. While sickle cell disease does follow Mendelian principles (specifically recessive inheritance), the more precise and accurate classification here is "autosomal recessive".

D) Sex-linked inheritance disorder:

Incorrect. Sickle cell disease is not linked to sex chromosomes (X or Y), so it is not a sex-linked disorder. It is located on autosomal (non-sex) chromosomes.

Correct Answer E: Menstruation

Explanation:

Menstruation is the shedding of the uterine lining that occurs when fertilization does not happen, and it does not prove ovulation by itself. While menstruation usually follows ovulation, its occurrence alone does not confirm that ovulation took place, as some menstrual cycles can be anovulatory.

Why the other options indicate ovulation:

A) BBT (Basal Body Temperature)

A sustained rise in BBT after ovulation indicates the progesterone effect and is a sign that ovulation likely occurred.

B) Pregnancy

Pregnancy confirms ovulation because fertilization requires that an ovum be released.

C) Progesterone level above 3 ng/mL

An elevated progesterone level in the luteal phase confirms ovulation as progesterone is produced by the corpus luteum after ovulation.

D) Secretory transformation of the endometrium

This histological change occurs under progesterone influence after ovulation, indicating the uterus is prepared for implantation.

Correct Answer C: Intrauterine device (IUD)

Explanation:

An IUD (either copper or hormonal) is an ideal choice for a woman seeking long-term, reversible contraception. It is over 99% effective, requires minimal maintenance, and can be easily removed when pregnancy is desired.

Why the other options are incorrect:

A) Condoms:

While effective at preventing STIs and usable on demand, condoms are not long-term and have a higher failure rate compared to IUDs.

B) Combined oral contraceptives:

These require daily adherence, making them less suitable for someone specifically seeking a long-acting method, although they are reversible.

D) Emergency contraception:

This is not a regular contraceptive method. It's intended for occasional use after unprotected sex or contraceptive failure—not for ongoing contraception

Correct Answer A: Asking the patient if she wants to discuss other options for fertility treatments

Explanation:

When a patient is emotionally vulnerable and processing the disappointment of failed fertility treatments, the nurse should first offer emotional support and provide a gentle, patient-centered approach. Asking if the patient is ready or interested in discussing other options for treatment:

Acknowledges her emotional state without ignoring the reason for the visit

Respects her autonomy and readiness to engage in further decision-making

Offers a path forward without pressuring or overwhelming her

It also allows the patient to guide the conversation, which is appropriate during emotionally difficult moments.

Why the other options are less appropriate:

B) Providing information on the adoption process:

Premature. While adoption may be a future option, bringing it up immediately after multiple failed treatments can feel insensitive or dismissive of the patient's grief and desire to conceive biologically. This discussion should be postponed until the patient has processed her emotions and expresses interest.

C) Discussing the potential rationale for why the couple is infertile:

Inappropriate timing. The patient is already emotionally distressed, and exploring reasons for infertility at this moment can feel blaming or overly clinical, rather than supportive.

D) Asking if anyone else in the family has struggled with infertility:

Not appropriate during a time of visible distress. This may feel intrusive or irrelevant to the patient's immediate emotional needs. Detailed family history should be discussed at a more emotionally stable time.

Correct Answer A: Tell me about your usual sexual habits, outside of trying to conceive.

Explanation:

Infertility treatments can place significant emotional and physical stress on a couple’s sexual relationship. By asking open-ended, nonjudgmental questions like, “Tell me about your usual sexual habits, outside of trying to conceive,” the nurse:

Normalizes the conversation about sexuality

Encourages trust and openness

Helps the couple reflect on how intimacy may have shifted from emotional connection to goal-oriented behavior

This approach is supportive and holistic, recognizing that sexual health is more than reproductive function.

Why the other options are less appropriate:

B) What sexual dysfunctions are occurring?

This is too direct and clinical, and may make the patient feel defensive or embarrassed. It labels the issue as a dysfunction without first exploring their experience.

C) Can you explain back to me the cause of the infertility?

This tests knowledge rather than promotes sexual or emotional support. It may make the couple feel blamed or inadequate and does not address their sexual well-being.

D) What efforts have you put into improving sexual function?

This may come across as accusatory or critical, implying the couple hasn’t done enough. It also puts responsibility on the patient without first understanding their experience.

Correct Answer C: After the first post-insertion menses (usually 1 month)

Explanation:

A routine follow-up visit is recommended about 3 to 6 weeks (or after the first menstrual cycle) following IUD insertion. This visit allows the healthcare provider to check that the IUD is still in place, assess for any complications (such as expulsion or infection), and ensure the client is adapting well to the method.

Why the other options are incorrect:

A) Not necessary:

Incorrect. Although routine monthly checks are not needed, one follow-up visit shortly after insertion is recommended to ensure proper placement.

B) Only by complaints:

Incorrect. While complaints should prompt an earlier visit, a scheduled follow-up is still advised to confirm correct positioning, especially since early expulsion may occur without symptoms.

D) Every month:

Incorrect. Monthly follow-up is not required and is not standard practice unless problems arise.

Correct Answer A: History of treatment for pelvic inflammatory disease (PID)

Explanation:

Pelvic Inflammatory Disease (PID) is a significant risk factor for infertility in women. It can lead to scarring and damage to the fallopian tubes, which may result in tubal factor infertility, ectopic pregnancy, or chronic pelvic pain. Because the couple has been trying to conceive for over a year without success, a history of PID requires further evaluation, such as imaging (e.g., hysterosalpingography) or referral to a fertility specialist.

Why the other options are less concerning:

B) History of sinusitis:

Sinusitis is unrelated to reproductive health and does not affect fertility. It is not a factor that would interfere with conception or the reproductive organs.

C) History of treatment for asthma:

While asthma should be well-controlled during pregnancy, it does not typically impact fertility. As long as the asthma is managed properly, it is not a barrier to conception.

D) History of breast augmentation:

Cosmetic breast augmentation does not affect fertility. It may be relevant during prenatal care or breastfeeding discussions but is not associated with difficulty conceiving.

Correct Answer A: Both the statement and the explanation are true and a causal relationship exists between them

Explanation:

Natural family planning (behavioral methods)—such as the calendar method, cervical mucus tracking, and basal body temperature—are more prone to failure compared to hormonal or barrier methods. This is primarily because:

Ovulation timing can vary, and couples may misinterpret fertile signs or fail to detect early ovulation.

External factors like stress, illness, travel, or weight changes can cause irregular menstrual cycles, making ovulation unpredictable and increasing the likelihood of unprotected sex during the fertile window.

Therefore, the increased failure rate is directly caused by these limitations.

Why the other options are incorrect:

B) Both true, no causal link:

Incorrect. The explanation clearly contributes to the higher failure rate, so a causal relationship does exist.

C) Statement true, explanation false:

Incorrect. The explanation accurately identifies the causes of the high failure rate.

D) Statement false, explanation true:

Incorrect. The statement is factually correct.

E) Both false:

Incorrect. Both the statement and explanation are true and linked.

Correct Answer A: To ensure pregnancy, assisted reproductive technology (ART) is the best option.

Explanation:

While assisted reproductive technology (ART), such as IVF or ICSI (intracytoplasmic sperm injection), may be an option, it is not necessarily the best or only first-line approach in all cases of oligospermia. Many cases can be addressed through lifestyle changes, medical therapy, or less invasive procedures such as therapeutic husband insemination (THI) or intrauterine insemination (IUI) depending on sperm count and motility. The blanket statement that ART is "the best option" reflects a limited understanding and may signal that the patient needs more information about the spectrum of fertility treatments available.

Why the other options are correct statements:

B) Avoid wearing tight-fitting underwear or 'skinny' jeans.

Correct. Tight clothing can increase scrotal temperature, which may negatively affect sperm production. Avoiding heat exposure and tight clothing is a valid lifestyle recommendation for men with oligospermia.

C) Therapeutic husband insemination (THI) is one option that involves mechanically depositing semen into the cervix or uterus.

Correct. THI is a valid and less invasive fertility treatment that may be used in cases of mild male infertility, such as oligospermia. It can help improve the chances of conception when timed with ovulation.

D)  In most cases of in vitro fertilization, eggs are retrieved through a transvaginal ultrasound guided procedure.

Correct. This is an accurate description of how eggs are retrieved in IVF. The procedure is performed using a transvaginal ultrasound probe with a needle to aspirate mature follicles.