Chapter 3: Genetics, Conception, Fetal Development, and Reproductive Technology by Durham and Chapman

During prenatal class, the childbirth educator describes the two membranes that envelop the fetus. The __________ contains the amniotic fluid, and the __________ is the thick, outer membrane.

amnion; chorion The embryonic membranes (chorion and amnion) are early protective structures that begin to form at the time of implantation. The thick chorion, or outer membrane, forms first. It develops from the trophoblast and encloses the amnion, embryo, and yolk sac. The amnion arises from the ectoderm during early embryonic development. The amnion is a thin, protective structure that contains the amniotic fluid. With embryonic growth, the amnion expands and comes into contact with the chorion. The two fetal membranes are slightly adherent and form the amniotic sac.

3. The fetal circulatory structure that connects the pulmonary artery with the descending aorta is known as which of the following?

Ductus arteriosus

Which of the following statements by a pregnant woman indicates she needs additional teaching on ways to reduce risks to her unborn child from the potential effects of exposure to toxoplasmosis?

"I will wear a mask when cleaning my cat's litter box." Correct. Pregnant women and women who are attempting pregnancy should avoid contact with cat feces. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef and lamb is ingested. Wearing a mask will not decrease the risk through ingestion of the parasite.

An ultrasound of a fetus' heart shows that "normal fetal circulation is occurring." Which of the following statements is consistent with the finding?

A right to left shunt is seen between the atria. This is correct. The foramen ovale is a duct between the atria. In fetal circulation, there is a right to left shunt through the duct.

During preconception counseling, the clinic nurse explains that the time period when the fetus is most vulnerable to the effects of teratogens occurs from:

2 to 8 weeks The period of organogenesis lasts from approximately the second until the eighth week of gestation during which time the embryo undergoes rapid growth and differentiation. During organogenesis, the embryo is extremely vulnerable to teratogens such as medications, alcohol, tobacco, caffeine, illegal drugs, radiation, heavy metals, and maternal (TORCH) infections. Structural fetal defects are most likely to occur during this period because exposure to teratogens either before or during a critical period of development of an organ can cause a malformation.

. __________ __________ __________ is when sperm and oocytes are mixed outside the woman's body and then placed into the fallopian tube via laparoscopy.

Gamete intrafallopian transfer Gamete intrafallopian transfer, also referred to as GIFT, is used when there is a history of failed infertility treatment for anovulation, or unexplained infertility, or low sperm count.

A nurse is teaching a woman about her menstrual cycle. The nurse states that __________ is the most important change that happens during the secretory phase of the menstrual cycle.

Proliferation of the endometrium The proliferation of the endometrium occurs during the secretory phase of the menstrual cycle.

The clinic nurse knows that the part of the endometrial cycle occurring from ovulation to just prior to menses is known as the:

Secretory phase The secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. (SEX PRIOR TO MENSES)

The nurse takes the history of a client, G2 P1, at her first prenatal visit. The client is referred to a genetic counselor, due to her previous child having a diagnosis of __________.

Sickle cell anemia Sickle cell anemia is an autosomal recessive illness. This client needs to be seen by a genetic counselor.

A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication?

Stimulate release of FSH and LH Clomiphene Citrate stimulates release of FSH and LH.

A major fetal development characteristic at 16 weeks' gestation is:

Teeth begin to form

A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis?

The couple has established a set schedule for their sexual encounters. Couples who "schedule" intercourse often complain that their sexual relationship is unsatisfying.

A couple who has sought infertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur?

The testes are overheated. Spermatogenesis occurs in the testes. High temperatures harm the development of the sperm.

Karen, a 26-year-old woman, has come for preconception counseling and asks about caring for her cat as she has heard that she "should not touch the cat during pregnancy." The clinic nurse's best response is:

Toxoplasmosis is a concern during pregnancy, so it is important to have someone else change the cat's litter pan and also to avoid consuming uncooked meat. Women need to be aware that Toxoplasma gondii, a single-celled parasite, is responsible for the infection toxoplasmosis. The majority of individuals who become infected with toxoplasmosis are asymptomatic, although when present, symptoms are described as "flu like" and include glandular pain and enlargement and myalgia. Severe toxoplasmosis infection may cause damage to the fetal brain, eyes, or other organs. Toxoplasmosis is usually acquired by consuming raw or poorly cooked meat that has been contaminated with T. gondii. Toxoplasmosis may also be acquired through close contact with feces from an infected animal (usually cats) or soil that has been contaminated with T. gondii.

True/False: The perinatal nurse explains to the student nurse that in the fetal circulation, the lowest level of oxygen concentration is found in the umbilical arteries.

True The highest oxygen concentration (PO2 = 30-35 mm Hg) is found in the blood returning from the placenta via the umbilical vein; the lowest oxygen concentration occurs in blood shunted to the placenta where reoxygenation takes place. The blood with the highest oxygen content is delivered to the fetal heart, head, neck, and upper limbs, and the blood with the lowest oxygen content is shunted toward the placenta.

A couple who has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? (Select all that apply.)

-Anger at others who have babies. -Feelings of failure because they cannot make a baby. -Guilt on the part of one partner because he or she is unable to give the other a baby. a. Infertile couples often feel anger toward couples who have babies. b. Infertile couples often express feelings of personal failure. d. Guilt is often expressed by the couple.

The clinic nurse recognizes that pregnant women who are in particular need of support are those who (select all that apply):

-Are awaiting genetic testing results -Are trying to conceal this pregnancy as long as possible A second pregnancy is not an indication of a woman in need of additional support. A support system may be lacking for women who are trying to conceal a pregnancy or for women who are trying to keep the news of their pregnancy from relatives or friends until results from genetic tests are known. These individuals may need additional support from their nurses and other health-care providers, as they are placed in a powerless situation while awaiting results and face a pregnancy that may be in jeopardy.

A woman seeks care at an infertility clinic. Which of the following tests may this woman undergo to determine what, if any, infertility problem she may have? (Select all that apply.)

-Endometrial biopsy -Hysterosalpingogram -Serum FSH analysis b. Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium's response to progesterone. c. Hysterosalpingogram is used to determine if fallopian tubes are patent. d. Serum FSH levels are used to assess ovarian function.

The ovarian cycle includes which of the following phases? (Select all that apply.)

-Follicular phase -Ovulatory phase -Luteal phase Follicular phase, ovulatory phase, and luteal phase are part of the ovarian cycle. Secretory and menstrual phases are part of the endometrial cycle.

Which of the following places a couple at higher risk for conceiving a child with a genetic abnormality? (Select all that apply.)

-Maternal age over 35 years -Partner who has a genetic disorder Fertility decreases after 35 years. A partner contributes half of the chromosomal makeup, and genetic disorders can be inherited. Maternal diabetes can have an effect on the fetus/neonate, such as causing complications such as macrosomia and hypoglycemia, but these are not genetic disorders. Paternal heart disease can place the neonate at risk for heart disease later in life, but this is not referred to as a genetic disorder, such as is trisomy 21 and hemophilia.

A couple is undergoing an infertility workup. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? (Select all that apply.)

-The man rides a bike to and from work each day. -The man takes a calcium channel blocker for the treatment of hypertension. The daily riding of a bike can be the cause of prolonged heat exposure to the testicles. Prolonged heat exposure is a gonadotoxin. A number of medications, such as calcium channel blockers, can have an effect on sperm production. Coffee has not been associated with low sperm counts. Prostatitis or other infections within the last 3 months may have an effect on the sperm analysis. This man's episode of prostatitis was 12 months prior.

A clinic nurse explains to the pregnant woman that the amount of amniotic fluid present at 24 weeks' gestation is approximately:

800 mL Amniotic fluid first appears at about 3 weeks. There are approximately 30 mL of amniotic fluid present at 10 weeks' gestation, and this amount increases to approximately 800 mL at 24 weeks' gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term.

The nurse is interviewing a gravid woman during the first prenatal visit. The woman confides to the nurse that she lives with a number of pets. The nurse should advise the woman to be especially careful to refrain from coming in contact with the stool of which of the pets?

Cat The patient should refrain from coming in direct contact with cat feces. Cats often harbor toxoplasmosis, a teratogenic illness.

Information provided by the nurse that addresses the function of the amniotic fluid is that the amniotic fluid helps the fetus to maintain a normal body temperature and also:

Cushions the fetus from mechanical injury Amniotic fluid cushions the fetus from mechanical injury.

A diagnostic test commonly used to assess problems of the fallopian tubes is:

Hysterosalpingogram Correct. Hysterosalpingogram provides information on the endocervical canal, uterine cavity, and fallopian tubes.

A woman at 40 weeks' gestation has a diagnosis of oligohydramnios. Which of the following statements related to oligohydramnios is correct?

It indicates that there is a 50% reduction of amniotic fluid. Correct. Oligohydramnios refers to a decreased amount of amniotic fluid of less than 500 mL at term or 50% reduction of normal amounts.

The color of a person's hair is an example of which of the following?

Phenotype Correct. Phenotype refers to how genes are outwardly expressed, such as eye color, hair color, and height.

The perinatal nurse is teaching nursing students about fetal circulation and explains that fetal blood flows through the superior vena cava into the right __________ via the __________.

atrium; foramen ovale Blood flows through the vein from the placenta to the fetus. Most of the blood bypasses the liver and then enters the inferior vena cava by way of the ductus venosus, a vascular channel that connects the umbilical vein to the inferior vena cava. The blood then empties into the right atrium, passes through the foramen ovale (an opening in the septum between the right and left atrium) into the left atrium, and then moves into the right ventricle and on into the aorta. From the aorta, blood travels to the head, upper extremities, and lower extremities.

The perinatal nurse explains to the student nurse that the growing embryo is called a __________ beginning at 8 weeks of gestational age.

fetus Major organs are being formed (organogenesis) during the first weeks following fertilization. During this time, the developing organism is called an embryo. By the end of 8 weeks, the embryo has sufficiently developed to be called a fetus.

After birth, the perinatal nurse explains to the new mother that __________ is the hormone responsible for stimulating milk production.

prolactin Following birth and delivery of the placenta, there is an abrupt decrease in estrogen. This event triggers an increased secretion of prolactin (the hormone that stimulates milk production) by the anterior pituitary gland. The posterior pituitary and hypothalamus play a role in the production and secretion of oxytocin, a hormone that causes release of milk from the alveoli.

The perinatal nurse defines a __________ as any substance that adversely affects the growth and development of the embryo/fetus.

teratogen Teratogens (drugs, radiation, and infectious agents that can cause development of abnormal structures in an embryo) and a variety of internal and external developmental events may cause structural and functional defects.