Care of Mother, Child, Adolescent (Well Clients)

CHAPTER 6
Nursing Care for the Family in Need of Reproductive Life Planning

Name: KARYLL C. ROMERO

Year and Section: BSN 2D

MASTERING THE INFORMATION

Activity A FILL IN THE BLANKS
Supply the missing term or the information requested.
1. A condom prevents pregnancy by collecting spermatozoa before they can be deposited in
the vagina.
2. A diaphragm is a circular rubber disk that fits over the cervix to form a barrier against the
entrance of spermatozoa.
3. A vaginal ring surrounds the cervix and continually releases a combination of estrogen
and progesterone.

Activity B MATCHING
Match the terms in Column II with definition, example, or related statement from Column I.
Place the letter corresponding to the answer in the space provided.
Column I Column II
d 1. Excision and blocking of the vas deferens to prevent a. Hypernatremia
passage of the spermatozoa
c 2. Injection required every 12 weeks for reliable b. Menstrual extraction
contraception
a 3. A result of an accidental injection of saline solution c. DMPA (depot
into a blood vessel medroxyprogesterone acetate)
b 4. Removal of the uterine lining by suction or a syringe d. Vasectomy
e 5. Contraceptive method with a 0% failure rate e. Abstinence

Activity C SHORT ANSWER

Supply the missing term or the information requested.
 1. Describe three physiologic functions that suppress ovulation when “the pill” is used as a
method of contraception.
Estrogen content of the pill suppresses follicle-stimulating hormone and luteinizing
hormone. The progesterone constituent decreases the permeability of cervical mucus,
limiting sperm mobility and access to the ova. Progesterone interferes with the tubal
transport and endometrial proliferation, making implantation unlikely. _______________
2. Describe how the “mini-pill” differs from the traditional oral contraceptive.
Differs from the traditional oral contraceptive in that it is composed of progestins only.
Ovulation occurs, but implantation will not.
_____________________________________
3. Discuss the use of intrauterine devices (IUDs), spermicides, and condoms by adolescents
as methods of reproductive life planning.
Are rarely selected as a method of contraception for adolescents because teens tend to
have variable sex partners and no prior pregnancies, both contraindications for use.
Spermicides and condoms, barrier methods, are commonly used by the adolescent
population. They are economical and require no parental consent. However, spermicides
have a failure rate of 20%. Adolescents should be cautioned carefully about the use of
condoms. They are most effective when applied before any penile-vulvar contact. The
self-lubricated type breaks less frequently. The condom should fit loosely enough to
allow the penis tip to collect the ejaculate without undue pressure. Condom efficiency is
lessened by body heat when carried for some time in pockets and wallets. The use of a
vaginally inserted spermicide further enhances the efficiency of the condom.
________________________________________

APPLYING YOUR KNOWLEDGE

Activity D CASE STUDY

Friday, April 20, marks 1 week since Mrs. Nugent gave birth to a 6-lb,7.5-oz son. She has
elected to use an oral contraceptive as her reproductive life planning method after his delivery.
The physician prescribes an oral contraceptive to be taken for 21 days. Mrs. Nugent tells the
nurse she is not clear about when to take her pills.

1. What instructions should the nurse give Mrs. Nugent on starting the use of this oral
contraceptive?
Mrs. Nugent should start the contraceptive on the Sunday closest to 2 weeks after she
gave birth. After she finishes her pill for 21 days, Mrs. Nugent should not take any pills
for 1 week and then she will restart a new month’s supply of pills on the Sunday 1 week
after she stop.
________________________________________________________________
2. How often should Mrs. Nugent take the pills, and when should she expect her menstrual
flow to begin?
 For 21 days, Mrs. Nugent should take a pill once a day. Mrs. Nugent should expect her
menstrual flow 4 days after she finishes her cycle of pills. _________________________
3. What are some suggestions that the nurse can offer Mrs. Nugent to help her remember to
take her pill?
The nurse can suggest to use a calendar or an alarm clock when Mrs. Nugent needed to
take a pill. _______________________________________________________________

Activity E CASE STUDY 2

Mrs. Jordan brings her 16-year-old daughter Tammy to the physician’s office. Tammy
experienced menarche 2 months ago, and Mrs. Jordan suspects she is sexually active. Mrs.
Jordan is requesting an oral contraceptive as a method for reproductive life planning for her
daughter.

1. What permanent damage may occur if use of the oral contraceptive begins before the
cycle is regulated?
Need for menstrual cycles to be established for at least 2 years; possible suppression of
pituitary-regulating activity if started too early; early closure of epiphyses and halting of
growth if started too early. __________________________________________________
2. Explain the relationship between oral contraception and the potential for alteration in
skeletal growth with adolescent girls.
Estrogen content of pills leading to closure of epiphyses of long bones; subsequent
halting of growth and preadolescent growth spurt.
______________________________________

Activity F CASE STUDY 3

Mrs. Patterson, age 40 years, married, and the mother of three children, is visiting the health care
center to electively terminate her pregnancy at 8 weeks of gestation. She visits the community
health care facility to be counseled on the procedure. As she is being examined, she asks you if
terminating her pregnancy would reflect negatively on her as a patient.

1. What are some very important guidelines that you must remember when responding to
Mrs. Patterson?
Teach Mrs. Patterson the signs and symptoms of complications and offer contraceptive
counseling so that she can avoid a repeat procedure.
______________________________
2. Mrs. Patterson is administered a laminaria for dilation of the cervix. Why would Mrs.
Patterson be routinely placed on antibiotic therapy with this procedure?
This procedure can help Mrs. Patterson prevent infection. Also, because this procedure
will give Mrs. Patterson an intense pain and needed some antibiotic therapy to lessen the
pain she will feel before the procedure. ________________________________________
 Activity G CRITICAL INQUIRY EXERCISES

1. Prepare a nursing care plan to provide health education and counseling for a patient who
will be undergoing an elective tubal ligation. Focus on the future implication of the
procedure.

2. Prepare a teaching plan for an adolescent who is pregnant and has expressed a desire to
learn about contraceptives. The plan should address safe sex and a suitable method of
reproductive life planning.
Time Objectives Content Methods and Evaluation Method
Allowed Materials
(Day)
1 hour The learner will: The teacher will Chalkboard and 1. Check for
30 1. Describe common discuss: chalk with the completion of
minutes methods of  Different following four notes
reproductive life methods of questions written 2. Questioning on
contraception on it: different
planning and the
 Natural 1. Does the methods of
advantages, method contraceptives.
Family
disadvantages, and Planning prevent
risk factors  Barrier pregnancy?
associated with each. Methods 2. Does the
2. Understand why  Hormonal method
effective Methods prevent
 Surgical STIs and
contraception is
Methods HIV?
needed. 3. How
effective is
the method?
4. What are
the possible
side
effects?
Activity H CRITICAL EXPLORATION

1. Use the teaching plan that you constructed for the above exercise to teach a teen group in
a community health care setting about safer sex and reproductive life planning.
2. Survey the Internet for condoms that are self-lubricated and treated with nonoxynol-9.
Are there potential problems with the spermicide’s use? Present your findings when
counseling the adolescent in a clinical setting.

PRACTICING FOR NCLEX

Activity I MULTIPLE-CHOICE QUESTIONS

Circle the letter that corresponds to the best answer for each question.

1. A woman is scheduled for a tubal ligation involving the use of carbon dioxide to raise the
abdominal wall. You identify this a
a. culdoscopy
b. laparoscopy
c. hysterectomy
d. minilaparotomy
2. You are teaching a woman about using oral contraceptives. You would instruct the
woman to take the first pill on which day of the week after the start of menstrual flow?
a. Sunday
b. Monday
c. Wednesday
d. Saturday
3. When counseling an adolescent girl who express a desire to begin using the oral
contraceptive method of reproductive life planning, you would determine that oral
contraceptives would be an appropriate choice if the adolescent has been experiencing
menses for at least how long?
a. 1 year
b. 2 years
c. 3 years
d. 4. years
4. A woman is receiving depot medroxyprogesterone acetate (DMPA) for contraception
demonstrates understanding of this agent when she identifies which of the following as a
possible side effect?
a. Thrombophlebitis
 b. Weight gain
c. Weight loss
d. Permanent infertility

Activity J ALTERNATE FORMAT QUESTIONS

Multiple-Answer Multiple-Choice Questions

Circle the letter (s) corresponding to the appropriate answer (s). Select all that apply.

1. After teaching a group of young women about the possible side effects of oral
contraceptives, you determine that the teaching has been successful when the group
identifies which of the following?
a. Nausea
b. Weight loss
c. Headache
d. Breast tenderness
e. Alternating cycles
2. When the pill is used for contraception, which of the following occur to suppress
ovulation?
a. Suppression of follicle-stimulating hormone
b. Interference with progesterone secretion
c. Increase in amount of cervical mucus
d. Decrease in cervical mucus permeability
e. Suppression of luteinizing hormone
3. A woman who is 16 weeks pregnant comes to clinic for an elective termination of
pregnancy. Which of the following methods would be appropriate for this woman?
a. Menstrual extraction
b. Dilation and curettage
c. Dilation and vacuum extraction
d. Saline induction
e. Hysterotomy
 Care of Mother, Child, Adolescent (Well Clients)
CHAPTER 7
The Nursing Role in Genetic Assessment and Counseling

Name: KARYLL C. ROMERO

Year and Section: BSN 2D

MASTERING THE INFORMATION

Activity A FILL IN THE BLANKS
Supply the missing term or the information requested.
1. Health professionals have a legal and ethical obligation to share genetic information with
the involved couple and no one else.
2. Genetic counseling will inform a couple about the genetic disorder and the chances that
their child might inherit it.
3. A person’s genotype refers to his or her actual gene composition.

Activity B MATCHING
Match the terms in Column II with definition, example, or related statement from Column I.
Place the letter corresponding to the answer in the space provided.
Column I Column II
d_ 1. Expression of genetic material allowing a. Genetic disorder
identification whether chromosomal material has
come from the male or female parent
h_ 2. Principles of genetic inheritance, whether b. Chromosomes
diseased or healthy.
f_ 3. A woman agreeing to undergo artificial c. Phenotype
insemination by the male partner’s sperm and to bear
a child for the couple
b_ 4. Material of heredity, strands of genes in the d. Imprinting
nucleus of the body cells.
g_ 5. When paired with other genes, these genes are e. Homozygous
always expressed
a_ 6. Abnormality which can be passed from one f. Surrogate
generation to the next
i_ 7. Visual inspection of the chromosome pattern g. Dominant gene
 e_ 8. Having two like genes for a trait, one from each h. Mendelian laws
donor
c_ 9. One’s outward appearance or expression of i. Karyotyping
genes

Activity C SHORT ANSWER

Supply the missing term or the information requested.
1. Discuss the merits of genetic testing for a couple at risk for having a child with an
incurable genetic disease.
Genetic testing allows the couple to make informed choices about future reproduction. __
2. Differentiate between the chance of inheriting a disease if both parents are heterozygous
for the trait and the disease is autosomal dominantly inherited, and the chance of
inheritance if the disease is autosomal recessively inherited.
If the disease is dominantly inherited, two out of four children could inherit the disease; if
the disease is recessively inherited, one out of four children could inherit the disease.
____
3. Discuss two of the four main purposes of genetic counseling.
Provide concrete, accurate information about the process of inheritance and inherited
disorders; reassure people who are concerned that their children will inherit a disorder
that the disorder will not occur; allow people who are affected by inherited disorders to
make informed choices about future reproduction; offer support to people who are
affected by genetic illness.
___________________________________________________________
4. Discuss why genetic counseling might be ineffective after the diagnosis of the pregnancy
or immediately after the birth of a child with a defect.
The couple would most likely not be ready for or amenable to counseling. At this point,
they are probably experiencing disbelief, shock, and/or grief.
_______________________

APPLYING YOUR KNOWLEDGE

Activity D CASE STUDY
Belle and Bennie Johnson, both 32 years old, have been married for 1 year and want to have a
baby. Belle has come for a complete physical and states she is concerned that she is too old for a
healthy pregnancy. While doing the history, you discover Belle has a brother with Duchene
muscular dystrophy.
1. What is the significance of X-linked Inheritance in determining the chances that Belle
will have a baby with DMD if Belle is a carrier?
 Female who inherit the affected gene will be heterozygous, and because a normal gene is
also present, the expression of the disease will be blocked. There is a 50% chance that if
her child is a male, the baby will manifest the disease and 50% if her baby will be a
female, the child will carry the disease
gene.___________________________________________
2. If Belle gives birth to a child with DMD, what nursing actions would be appropriate to
help Bennie and Belle in planning for the future needs of their family and the child?
Would it be appropriate for you to approach family members, explain the genetic defect,
and encourage them to support the couple? Why or why not?
Belle and Bennie should do a regular check-ups and tests for their future baby. There’s no
cure for DMD, but there are medicines and other therapies that can ease their child’s
symptoms, protect their muscles, and keep their heart and lungs healthy.; it’s appropriate to
approach their family members so that they can ensure the safety of their baby and will know
what to do in the
future.__________________________________________________________________

Activity E CRITICAL INQUIRY EXERCISE

1. Write a brief statement of your opinion regarding the use of amniocentesis to determine if
a fetus is without defects and if the couple should continue or terminate the pregnancy.
Amniocentesis (also referred to as an amniotic fluid test or, informally, an "amnio") is a
medical procedure used primarily in prenatal diagnosis of chromosomal abnormalities
and fetal infections as well as for sex determination. This procedure will help the parents
decide if they will continue their pregnancy or not.
_____________________________________
2. How might testing to determine the gender of an infant become an ethical dilemma?
What are your thoughts regarding the use of modern technology to determine the gender
of a child when a gender-specific disorder is possible? When no disorder is likely?
because – like selective abortion after prenatal diagnosis – it amounts to a form
of selective reproduction, in which only children are allowed to be born who are not
affected by the disorders their parents were at risk of transmitting; Technologies really
can lessen our works and helps as a lot. This advancement is really useful specially in
determining the gender of a baby, or if the baby has a disorder. This modern technology
can help us healthcare workers to determine the impossible.
_________________________________

Activity F CRITICAL EXPLORATION

Attend a genetic counselling session and write a short report on the content discussed and
reactions noted from the couple.
PRACTICING FOR NCLEX
Activity G MULTIPLE-CHOICE QUESTIONS
Circle the letter that corresponds to the best answer for each question.
1. If "large feet" is a recessive trait and one parent is heterozygous for the trait and the other
parent is homozygous for the trait, what are the chances that a child of this union will
have large feet?
a. 25% (one in four)
b. 50% (two in four)
c. 75% (three in four)
d. 100% (four in four)
2. Which of the following individuals must be heterozygous for the recessive disease trait?
a. Adam, who has no symptoms of the disease but has a child with the disease
b. Barbara, who displays no symptoms and has no children with the disease
c. Peter, who has no symptoms of the disease and has an affected child
d. Wendy, who has symptoms of the disease but has no affected child
3. Which of the following couples would benefit most from referral for immediate genetic
counseling?
a. Tom, age 50 years, and Alice, age 42 years, who have just discovered they are going
to have a baby
b. Jim and Melissa, who have just had an infant with cystic fibrosis
c. John and Jean, who want to have a baby but only want a male child
d. Pete, who has hemophilia, and DeeDee, married for a year and want to have a child.
4. What role would be most appropriate for the nurse involved with genetic counseling?
a. Assess the options available to a couple and select the best ones to present for the
couple to choose from.
b. Inform the couple of the procedures they may undergo in genetic screening and in
genetic counseling.
c. Instruct parents on the need for an immediate abortion if both parents have the trait
for dominant disease.
d. Limit the information provided to the couple about the genetic defect to avoid
influencing their decision.
5. To determine if a disorder occurred by chance or is carried by family members, a nurse
should collect which of the following data?
a. A history of the couple’s sexual pattern during the time of conception
b. As complete a family history of infant deaths or abnormalities as possible
c. A prenatal history of nausea and reports of back pain in the last trimester
d. Physical assessment of the infant’s eye and hair color
 6. Nursing measures that may be implemented when preparing a woman for amniocentesis
should include which of the following?
a. Determining that the woman is in her fifth to eight weeks of pregnancy
b. Discussing the 10% risk of possible spontaneous miscarriage
c. Supporting her as she is beginning to accept the pregnancy and bond with the fetus

Activity H ALTERNATE FORMAT QUESTIONS

Multiple-Answer Multiple-Choice Questions

Circle the letter (s) corresponding to the appropriate answer (s). Select all that apply.

1. Couples who undergo genetic counseling and are informed that they have a genetic
abnormality in the family and might have a child with a genetic defect may experience
which of the following behaviors?
a. Loss of self-esteem
b. Blame
c. embarrassment;
d. joy
e. anger
f. depression
2. After teaching a class on various types of genetic disorders, the instructor determines that
the class has understood the information when they identify which of the following as
examples of autosomal recessive disorders?
a. Marfan syndrome
b. Huntington disease
c. Tay-Sachs disease
d. Cystic fibrosis
e. hemophilia
3. Which of the following would be important for the nurse to keep in mind when caring for
a couple undergoing genetic testing, counseling, and therapy?
a. The couple is mandated to participate in screening
b. Signed informed consent is necessary or any genetic screening procedure
c. Results are provided to the couple after several validations for accuracy
d. The couple are the only ones to whom the results are given
e. The couple is strongly encouraged to undergo an abortion for a defect
 Care of Mother, Child, Adolescent (Well Clients)
CHAPTER 8
Nursing Care of the Family Having Difficulty Conceiving a Child

Name: KARYLL C. ROMERO

Year and Section: BSN 2D

Activity A FILL IN THE BLANKS

Supply the missing term or the information requested.

1. A uterine endometrial biopsy may result in symptoms of bleeding and clot passage after
the procedure.
2. A woman who is allergic to iodine and is scheduled for a hysterosalpingography is
considered to be at risk for an allergic reaction.
3. Undescended tests, also called cryptorchidism may lead to lowered sperm production.

Activity B MATCHING
Match the terms in Column II with definition, example, or related statement from Column I.
Place the letter corresponding to the answer in the space provided.
Column I Column II
_e_ 1. The inability to conceive a child or sustain a a. Anovulation
pregnancy to childbirth.
_h_ 2. The production of sperm cells. b. Hysterosalpingography
_f_ 3. Introduction of a thin hollow, lighted tube c. Basal body temperature
through the abdomen to examine the ovaries and
uterus.
_c_ 4. A test for ovulation involving monitoring a d. Endometriosis
monthly graph to determine when ovulation occurs.
_i_ 5. The inability to conceive because of a known e. Infertility
condition
_J_ 6. Enlargement of a testicular vein may result in f. Laparoscopy
subfertility due to venous congestion.
_a_ 7. Absence of ovulation, inadequate or faulty g. Secondary subfertility
ova expulsion
 _b_ 8. Radiographic examination of the fallopian h. Spermatogenesis
tubes using a radiopaque medium to evaluate tubal
patency.
_g_ 9. The couple cannot conceive a child at i. Sterility
present but has had a previous viable pregnancy.
_d_ 10. Implantation of uterine nodules to locations j. Varicocele
outside the uterus.

Activity C SHORT ANSWER

Supply the missing term or the information requested.
1. Depending on a couple's motivations for fertility testing, their reaction to study results
may vary from relief to grief for children never to be born.
2. A surrogate mother is a woman who agrees to be impregnated by a man's sperm and carry
the child for him and his partner.
3. When vaginal pH is acidic, sperm motility is limited or destroyed.
4. Therapeutic insemination is the instillation of sperm into the uterus to aid conception.
5. In vitro fertilization involves exposing an egg to sperm outside the woman's body and
transferring the embryo.

APPLYING YOUR KNOWLEDGE

Activity D CASE STUDY

Marilyn and Palo Jaketes have been married for 3 years. For the past year, they have had
unprotected sex an average of three or four times per week in an effort to conceive. They have
come to the clinic for assessment and counseling.

1. How might the ages of Mr. and Mrs. Jaketes affect their infertility evaluation and
possible solutions for subfertility?
The chance of subfertility increases with age. Women who defer pregnancy to their late
30’s are apt to have more difficulty conceiving than their counterparts; the possible
solutions for subfertility are intrauterine insemination and in vitro fertilization.
_________
2. What cultural beliefs might impact the Jaketes when discussing measures to facilitate
fertility? How might cultural beliefs affect their choice of alternatives to childbirth?
Their natural family planning; some people might judge them for their choices and
options.

Activity E CRITICAL INQUIRY EXERCISE

 1. Prepare a teaching plan for an infertile couple that outlines various options.
Time Objectives Content Methods and Evaluation Method
Allowed Materials
(Day)
3 hours The learner will: The teacher will Power Point Ask what are the
1. Understan discuss: Presentation about different reproductive
d the 1. The different the different techniques.
different reproductive reproductive
procedure techniques for the techniques and
s to help infertile couple: chart about the
them in a. Therapeutic reproductive
getting Insemination organs of human.
pregnant. b. In Vitro
2. Get to Fertilization
choose c. Gamete
what Intrafallopian
procedure Transfer
they can d. Zygote
get for Intrafallopian
them to Transfer
get e. Surrogate
pregnant. Embryo
Transfer
f. Preimplantati
on Genetic
Diagnosis

2. When might adoption be an acceptable option for a couple?

When a married couple seeks to adopt a child,  it needs to give its consent for adoption
and should be stable marriage for at least two years.
_________________________________

Activity F CRITICAL EXPLORATION

Explore the facilities in your city to which you might refer clients with conception difficulties
(e.g., sperm or egg banks, clinics, and adoption agencies.)

Activity G MULTIPLE-CHOICE QUESTIONS

Circle the letter that corresponds to the best answer for each question.
 1. Which of the following is true about fertility studies?
a. Fertility studies should be undertaken more quickly with younger women.
b. If a couple is very anxious, studies should not be delayed regardless of the couple's
age.
c. Initial testing involves primarily the partner who is suspected of being infertile.
d. Women under 30 years of age should be referred for evaluation after 6 months of
subfertility.
2. Diane has been told she has blocked fallopian tubes. Which of the following fertility
options should the nurse help her to explore?
a. Hormonal therapy
b. Therapeutic Insemination
c. In vitro fertilization
d. Gamete intrafallopian transfer
3. Which of the following suggestions would be most appropriate to give to a couple to aid
conception?
a. Having coitus everyday will increase chances for fertility
b. Douching should be done before coitus to promote sperm mobility
c. Male-superior position is best because it places sperm near the cervix
d. The woman should ambulate immediately after coitus to mobilize the egg toward
sperm

Activity H ALTERNATE FORMAT QUESTIONS

Multiple-Answer Multiple-Choice Questions

Circle the letter (s) corresponding to the appropriate answer (s). Select all that apply.

1. Which of the following would be most appropriate to include when teaching a man to
increase his sperm count?
a. Increase frequency of coitus
b. Wear clothing that does not restrict or overheat the scrotum
c. Avoid frequent use of hot baths
d. Increase alcohol intake
e. Increase sport activities
2. When discussing the benefits associated with childless living with a couple who is
subfertile, which of the following would the nurse include?
a. Career growth
b. Pursuit of hobbies
c. Antisocial behaviors
d. Personal contributions to society
e. Continuance of education
3. Which of the following tests might be used to assess the patency of a woman's fallopian
tubes?
a. Hysterosalpingography
b. Basal body temperature monitoring
c. Antisperm antibody testing
d. Sonohysterography
e. Endometrial biopsy
f. Hysteroscopy