A 34-year-old female patient complains of lack of conception ...

[Beheh]

A 34-year-old female patient complains of lack of conception after unprotected sexual intercourse for 1 year. The patient has been keeping track of basal body temperature to plot ovulation. Pelvic examination is normal.
 
  The clinician should ask the patient if which of the following laboratory test(s) have been done:
  A. TSH
  B. FSH
  C. LH
  D. All of the above

Question 2

To assess muscle tone, the clinician should:
 
  A. Palpate the patient's muscle as the muscle is passively stretched
  B. Examine how the patient performs active range of motion
  C. Palpate the muscles comparing side to side
  D. A and C

[johnharpe]

Answer to Question 1

ANS: D
The work-up for infertility is complex and will need to be referred to a gynecologist specializing in infertility. The causes are numerous but generally fall into the categories of anovulation, implantation failure, hormonal failure, chromosomal abnormalities, or low sperm count in the male partner. Preliminary tests that can be initiated by the nurse practitioner include the following: pelvic examination to ensure that the cervix is open and that there are no uterine abnormalities, basal body temperature charts to plot monthly ovulation and menstrual patterns, and laboratory testing that includes TSH, FSH, LH, and estradiol.

Answer to Question 2

ANS: D
To assess muscle tone, passively stretch the muscle, ask the patient to relax, and then palpate the muscle, comparing side to side. Alternatively, assessment of muscle tone can be combined with a determination of the patient's resistance to passive movement. Tense patients, those with increased muscle tone, will have increased resistance to passive movements. Flaccid or hypotonic muscles do not have any palpable tension. A spastic muscle has increased resistance, which may vary as the limb is moved, as in cogwheeling, such as that found in patients with parkinsonism. Resistance with both flexion and extension is called lead-pipe rigidity, as is sometimes seen in parkinsonism.