OB Chapt 3 Anatomy and Physiology of the Reproductive System

A woman tells you that both she and her husband like to continue sexual relations during her menstrual period. They have a monogamous relationship. She asks you if this will harm her. Which of the following would be the best response? a) "You will not be able to achieve orgasm during your menses." b) "Avoid sexual relations because orgasm may be painful for during your menses." c) "The risk of infection is too great for sexual relations during this time." d) "If this is satisfying for you and your partner, then there is no harm in it."

"If this is satisfying for you and your partner, then there is no harm in it." Correct Explanation: Sexual relations may be continued through a menstrual flow if this is satisfying for both partners. There is no danger to either party, and it is possible to achieve orgasm. p 69

The mother of a 9-year-old girl is concerned because her daughter has already begun menstruating. The daughter is of normal height for her age and weighs 150 lbs. The mother is concerned that this is not normal and asks about the factors that could be involved. Which of the following would be the best response for the nurse to give? a) "Nine is a completely normal age to begin menstruation; the age of menarche is governed completely by genetics." b) "It has become more common for girls to start their periods as early as 9; her weight may be a contributing factor." c) "Nine is an early age to begin menstruation; anorexia nervosa may be a contributing factor." d) "You are right to be concerned, as 9 is not a normal age to begin menstruation; lack of proper nutrition may be a contributing factor."

"It has become more common for girls to start their periods as early as 9; her weight may be a contributing factor." Correct Explanation: Although it is not proven, the general consensus is a girl must reach a critical weight of approximately 95 lb (43 kg) or develop a critical mass of body fat before the hypothalamus is triggered to send initial stimulation to the anterior pituitary gland to begin the formation of FSH and LH. Probably because of the combination of better nutrition and increased obesity, girls are beginning puberty at earlier ages than ever before (9 to 12 years). Nine is an early age to begin menstruation but is within the normal range. Anorexia nervosa is associated with delays or halts in menstruation, not early menstruation. The age of menarche is not governed completely by genetics; other factors are involved.

A woman experiencing menopausal symptoms asks the nurse about herbal remedies for managing her symptoms. Which response by the nurse would be most appropriate? a) "You should avoid herbal remedies and ask your physician for hormone replacement therapy." b) "Most of the information about herbal therapies is based on reports by those who have used them, not scientific studies." c) "Herbal remedies have been proven quite reliable in alleviating the symptoms of menopause." d) "Your symptoms are not severe enough to warrant any treatment or therapy."

"Most of the information about herbal therapies is based on reports by those who have used them, not scientific studies." Correct Explanation: Information about the efficacy of herbal therapies is largely anecdotal. Research to validate the efficacy, safety, and potential harmful effects of herbal therapies is lacking. Until recently, hormone replacement therapy was the mainstay of treatment, but in light of the results of the Women's Health Initiative trial, it has become controversial. Telling the woman that her symptoms are not severe enough is demeaning and inappropriate: the woman's symptoms are significant to her, regardless of what the nurse may think. p73

There is a patient in the clinic asking questions about female hygiene. She wants to know if she should douche to clean her vagina. How do you respond? a) "If you want, douching is ok." b) "Only douche if the vagina has an odor." c) "Douching can change the pH of the vagina and cause an infection." d) "You do not need to douche, the vagina is self-cleaning."

"You do not need to douche, the vagina is self-cleaning." Explanation: The vagina has an acidic environment and this should not be disturbed. It does not need to be "cleaned" with douching, and douching can change the environment and lead to vaginal infection or irritation. p65

A 12-year-old girl expresses concern to the nurse because she has not begun her period yet, whereas almost all of her friends have already begun menstruating. She asks when the nurse thinks she will begin her period. The nurse notes that the girl has grown 6 inches in the past year and a half and has developed breast buds and pubic hair in the past year. Which of the following would be the best response for the nurse to give the girl? a) "It looks like you are a late bloomer! It's difficult to say when you'll get your period; some girls start as late as age 17." b) "Most girls have already begun their period by your age. We should run a few tests to make sure you don't have a hormone problem." c) "Your body is giving a lot of signs that you will probably start your period in no more than a year, which is completely normal." d) "The age that you start your period is highly genetic; ask your mother when she began her period."

"Your body is giving a lot of signs that you will probably start your period in no more than a year, which is completely normal." Correct Explanation: There is wide variation in the time required for adolescents to move through sexual developmental stages; however, the sequential order is fairly constant. In girls, pubertal changes typically occur in the following order: growth spurt, increase in transverse diameter of the pelvis, breast development, growth of pubic hair, onset of menstruation, growth of axillary hair, and vaginal secretions. Thelarche, which is the beginning of breast development, usually starts 1 to 2 years before menstruation. Given the signs of development that this patient has already exhibited, it seems likely that she will begin her period in the coming year. Her development is completely normal, so the nurse should not tell her that she is a "late bloomer" or suggest that hormone testing is needed. Although genetics may play a role in the onset of menstruation, the age of the patient's mother when she began her period is not as accurate a predictor as are the signs of development in her own body.

The nurse is reviewing with a group of high school students that the hypothalamus, pituitary gland and gonads all contribute to hormonal regulation of the female reproductive system. What would be the best information for the nurse to include in the education session about the main effects of the gonadotropic hormones? 1. Stimulation of the formation of ova 2. Stimulation of the secretion of hormones from sex organs 3. Simulation of the development of secondary female sexual characteristics 4.Stimulation and functions primarily during pregnancy

1, 2, 3 Correct Explanation: The main effects of LH and FSH include stimulating the formation of ova and stimulating the secretion of hormones from sex organs. Gonadotropic hormones also stimulate the development of secondary female sexual characteristics. The ovaries begin to secrete estrogens. The estrogens include estradiol, estriol, and estrone. After puberty, the corpus luteum of the ovary produces another hormone, progesterone, which functions primarily during pregnancy. p72

The pubescent girl exhibits many changes as a result of estrogen production. Her mother asks the nurse what secondary sexual characteristics to look for in her daughter. What is the best information for the nurse to provide to the mother about secondary sexual characteristics? 1. Smaller stature 2. Lower percentage of body fat tissue 3. Wider hip structure 4. Pubic and axillary hair 5. Breast development a) 1, 2, 3, 5 b) 1, 3, 4, 5 c) 2, 3, 4, 5 d) 1, 2, 4, 5

1, 3, 4, 5 Correct Explanation: Secondary sexual characteristics of the female include a smaller stature, higher percentage of body fat tissue, wider hip structure, pubic and axillary hair, and development of breasts. p69

A client asks a nurse to review the process of menopause and the physical changes that accompany it. The client wants to know if others will know she is going through menopause. What are external indicators of menopause that the nurse should share with the client? 1. Tendency to gain weight 2. Thinning of hair 3. Loss of eyebrows 4. Dry itchy skin

2, 3, 4 Explanation: External indicators of menopause include a tendency to gain weight, thinning of hair, growth of hair on the upper lip and chin, and dry, itchy skin. p73

The vagina is a hostile environment for sperm. What characteristic of semen protects sperm from the vaginal environment? a) Secretions from seminiferous tubules b) Acidic fluid c) Alkaline fluid d) Presence of testosterone

Alkaline fluid Correct Explanation: The bulbourethral (Cowper's) glands secrete an alkaline fluid that coats the last part of the urethra during ejaculation. The alkaline fluids secreted by these glands are nutrient plasmas with several key functions, including the protection of sperm (sperm are maintained in an alkaline environment to protect them from the acidic environment of the vagina).

You are leading a seminar for parents on the changes that happen during puberty. Which of the following is an accurate list of the sequence of changes that would be experienced? a) Appearance of pubic hair, breast budding, menarche in girls b) Deepening of the voice, appearance of facial hair, appearance of pubic hair in boys c) Menarche, breast budding, appearance of pubic hair in girls d) Breast budding, appearance of pubic hair, menarche in girls

Breast budding, appearance of pubic hair, menarche in girls Correct Explanation: Secondary sexual characteristics develop in an orderly sequence with variance in the timing for individuals. Breast budding in the female is usually the first physical sign noted, and occurs between the ages of 10 and 12 years on average. Appearance of pubic hair usually occurs just before menarche, the first menstrual period. From the onset to the start of menarche is typically 2 years. Male puberty occurs simultaneously over a period of years. p 69

A nurse is caring for an adolescent girl experiencing menstruation for the first time. What are the changes that occur in the body at this stage that the nurse should share with the adolescent girl? a) Breast development b) Urinary incontinence c) Hot flashes d) Irritability and insomnia

Breast development Correct Explanation: Breast development is a change that occurs in the body of an adolescent girl. Many changes take place in the body, such as the appearance of feminine contours, development of breast tissue, appearance of unique fatty deposits, and hair in the pubic and axillary areas. Menopausal clients often experience irritability and insomnia, hot flashes, and urinary incontinence. p69

The male glans penis or glans is equitable to which structure on the female? a) Labia b) Clitoris c) Mons Pubis d) Vulva

Clitoris Correct Explanation: The female clitoris is equitable to the glans, both of these are composed of erectile tissue and are the primary organs responsible for orgasm. The vulva comprises the external female genitalia. The mons pubis is the area just above the vaginal opening. The labia are the lip like structures that are at the opening of the vagina. p74

When describing the role of the scrotum as the "climate control system" for the testes, the nurse would include a description of which of the following? a) Testes b) Cremaster muscles c) Vas deferens d) Prepuce

Cremaster muscles Correct Explanation: The cremaster muscles in the scrotal wall relax or contract to allow the testes to hang farther from the body to cool or to be pulled closed to the body for warmth or protection. The prepuce or foreskin is a circular fold of skin that extends over the glans penis unless it is removed by circumcision. The testes, located in the scrotum, produce sperm and synthesize testosterone. The vas deferens is a cordlike duct that transports sperm from the epididymis. p74

The layer of the uterus that is influenced by hormone changes in preparation for possible conception and pregnancy is: a) Myometrium b) Endometrium c) Perimetrium d) Fundus

Endometrium Correct Explanation: The endometrium is the inner layer of the uterus that builds with hormones during the month in potential preparation for pregnancy. The myometrium is the muscular layer. The perimetrium is a protective layer, and the fundus is the upper area of the uterus. p 67

The seminiferous tubules are tiny coils of tissue where spermatogenesis occurs. Where do the sperm mature? a) Prostate b) Vas Deferns c) Seminal Vesicles d) Epididymis

Epididymis Correct Explanation: A system of tiny tubes called the rete testis leads from the seminiferous tubules to the epididymis, an intricate network of coiled ducts on the posterior portion of each testis that is approximately 6 meters (20 feet) in length. It is here that sperm mature. p74

In educating a patient about the four phases of sexual response, you state that one phase of the response cycle is marked by an increase in heart rates, blood pressure, and respiration in both sexes. To which phase are you referring? a) Resolution b) Plateau c) Excitement d) Orgasm

Excitement Correct Explanation: During the excitement phase, the physiologic response of both male and females results in increase in heart rate, blood pressure, and respirations. During the plateau, the physiologic changes that occurred during excitement are maintained. In the female, the clitoris retracts and the uterus is fully elevated. In the male, the penis engorges further and the testes remain elevated. Orgasm is marked by muscular contractions. During resolution the muscle relax and blood pressure, heart rate, and breathing return to normal. p76

When describing the process of fertilization, the nurse would explain that it normally occurs in which structure? a) Cervix b) Vagina c) Endometrium d) Fallopian tube

Fallopian tube Correct Explanation: Fertilization normally occurs in the fallopian tube. Once fertilized the ovum proceeds down the uterus and attaches itself in the endometrium. The vagina and cervix are not involved in fertilization. p67

Which of the following releasing hormones stimulates the release of the follicle-stimulating hormone (LH) from both male and female glands? a) Gonadotropin-releasing hormone (GnRH) b) Thyrotropin-releasing hormone (TRH) c) Prolactin-releasing hormone (PRH) d) Growth hormone-releasing hormone (GHRH)

Gonadotropin-releasing hormone (GnRH) Correct Explanation: The male and female glands respond to LH and FSH, which are released from the anterior pituitary in response to stimulation from gonadotropin-releasing hormone that is released from the hypothalamus. GHRH stimulates the release of the growth hormone, which targets cell growth. THR stimulates the thyroid stimulating hormone, which targets the thyroid gland. PRH stimulates the release of prolactin, which is necessary for milk production. p71

The nurse, while teaching a group of pregnant women about the production of breast milk, describes colostrum and compares it with mature breast milk. Which of the following would the nurse include in the comparative description? a) Limited protein content b) Its high sugar content c) High maternal antibody content d) Its low mineral content

High maternal antibody content Correct Explanation: Colostrum is rich in maternal antibodies, especially IgA, which protects the newborn against enteric pathogens. Colostrum contains more minerals and protein but less sugar and fat than mature breast milk.

A nurse caring for a 43-year-old client explains to the client that ovarian functions gradually decrease around this age. What is the implication of decreased ovarian function? a) Susceptibility to fractures b) Inability to become pregnant c) Changes in sexual response d) Increases the risk of heart disease

Inability to become pregnant Correct Explanation: Because of the decrease in ovarian functions, the client loses the ability to become pregnant. Loss of estrogen makes the client susceptible to fractures and also increases the risk of heart disease. Changes in sexual response are usually related to physical changes in the vagina. p73

The nurse is reviewing the role of the mammary glands in the reproductive process with a childbirth class. What should the nurse tell the childbirth class is the name of the ducts in the mammary glands that form a small reservoir for milk? a) Lactiferous b) Lobules c) Nipple d) Areola

Lactiferous Correct Explanation: Each breast is divided into 15 to 20 lobes of glandular tissue, covered by adipose (fat) tissue, which gives the breast its shape. The lobes are made up of lobules, which consist of milk-secreting cells in glandular alveoli. From the alveoli, small lactiferous ducts converge toward each nipple like the spokes of a wheel. Each lactiferous duct forms a small reservoir for milk. The structures of the breast include the nipple, the areola, and the areolar glands. The nipple is a circular projection containing some erectile tissue. It is surrounded by the pigmented areola. Areolar glands, which are close to the skin's surface, make the areola appear rough. p68

When teaching an adolescent about ovulation, you would include that ovulation is initiated by a surge in which of the following? a) Estrogen b) Follicle-stimulating hormone c) Progesterone d) Luteinizing hormone

Luteinizing hormone Explanation: Luteinizing hormone is released from the pituitary gland to stimulate ovulation on approximately the 14th day of a typical cycle. p72

Which of the following hormones causes ovulation to occur? a) Prolactin b) Follicle-stimulating hormone (FSH) c) Luteinizing hormone (LH) d) Adrenocorticotropic hormone (ACTH)

Luteinizing hormone (LH) Explanation: The hypothalamus releases GnRH at puberty to stimulate the anterior pituitary release of FSH and LH, thus stimulating the production and release of the sex hormones. ACTH targets the adrenal corticosteroid hormone, which helps prepare the body for the "fight or flight" response. Prolactin is responsible for milk production and FSH in combination with LH stimulates follicles on the outer surface of the uterus to grow and develop and stimulates the release of estrogen and progesterone. p72

Which of the following statements should be incorporated into the teaching plan developed to present instruction about the female menstrual cycle to nursing students? a) Menses ensues when the levels of estrogen and progesterone fall. b) Progesterone influences the growth of endometrial lining. c) The follicular phase is dominated by progesterone and testosterone. d) Estrogen is the dominant hormone during the luteal phase.

Menses ensues when the levels of estrogen and progesterone fall. Correct Explanation: Menstruation depends on the interplay of various hormones. The hypothalamus secretes gonadotropin-releasing hormone, which stimulates the pituitary gland to secrete follicle-stimulating hormone and luteinizing hormone. These hormones stimulate the ovaries to produce estrogen and progesterone, which are necessary for stimulation of the target organs (vagina, breast, uterus) in preparing for pregnancy. p72

In the female reproductive system, the hormones estrogen and progesterone are produced by the a) Bartholin's glands b) Skene's glands c) Ovaries d) Vagina

Ovaries Correct Explanation: The ovaries are two almond-shaped bodies lying on either side of the pelvic cavity. They contain ova and female hormones, specifically estrogen and progesterone.

The nurse is reviewing a client's electronic medical record and notices that the client has recently experienced dyspareunia. The nurse knows that this is an effect of aging on the female reproductive system. What is the best description of dyspareunia that the nurse can share with the nursing student who is going to see this client with the nurse? a) Uterus prolapses and falls into the vagina b) Bones become brittle and porous and fracture more easily c) Painful intercourse d) Female climacteric

Painful intercourse Correct Explanation: Intercourse may become painful (dyspareunia) as the vaginal mucosal wall becomes thinner and vaginal secretions decrease. Female climacteric is called menopause. Osteoporosis is a condition in which bones become brittle and porous and fracture more easily. The uterus may fall (prolapse) into the vagina. p56

With sexual stimulation the penis becomes erect. What is the physiologic cause of an erection? a) The fascia becomes firm b) Veins in the shaft of the penis vasoconstrict c) The corpus cavernosa vasodilates d) Penile sinuses fill up with blood

Penile sinuses fill up with blood Explanation: The sinuses within the erectile tissue fill up with blood causing an erection. p76

You are responsible for educating nervous parents about their newborn son's circumcision. In describing the procedure, which part of the penis do you tell them will be removed? a) Rugae b) Tunica albuginea c) Corpus spongiosum d) Prepuce

Prepuce Correct Explanation: The foreskin, which covers the glans of the penis, is called the prepuce and parents may elect to have an infant male circumcised, removal of the prepuse. The Tunica albuginea is connective tissue found inside the penile shaft. The corpus spongiosum is erectile tissue that runs the full length of the penis. Rugae are folds that allow for stretching during an erection. p74

The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of nursing students. What would be the best response by a nursing student about the function of the OVARIES? a) Receives the fertilized ovum and provides housing and nourishment for a fetus b) Receives sperm, provides an exit for menstrual flow, and serves as the birth canal c) Small erectile structure that responds to sexual stimulation d) Produces female gametes or ova and secretes female sex hormones

Produces female gametes or ova and secretes female sex hormones Correct Explanation: The ovaries' functions are to produce female gametes or ova and secrete female sex hormones. The uterus's functions are to receive the fertilized ovum and provide housing and nourishment for a fetus. The vagina's functions are to receive sperm, provide an exit for menstrual flow, and serve as the birth canal. The clitoris is a small erectile structure that responds to sexual stimulation. p68

The nurse is reviewing with a group of high school students that the hypothalamus, pituitary gland, and gonads all contribute to hormonal regulation of the female reproductive system. Based on this information, what is the specific hormone that functions primarily during pregnancy? a) Progesterone b) Estrone c) Estriol d) Estradiol

Progesterone Correct Explanation: After puberty, the corpus luteum of the ovary produces another hormone, progesterone, which functions primarily during pregnancy. The ovaries begin to secrete estrogens. The estrogens include estradiol, estriol, and estrone. p73

After ovulation the ovary forms a yellow body called the corpus luteum out of the empty egg follicle. What does the corpus luteum produce? a) Lutenizing hormone b) Progesterone c) Androgen d) Follicle stimulating hormone

Progesterone Correct Explanation: In addition to producing estrogen, the corpus luteum secretes a hormone called progesterone. p71

The nurse describes the components of semen, stating that most of the volume of semen is provided by the seminal vesicles and the: a) Bulbourethral glands b) Prostate gland c) Vas deferens d) Penile mucous glands

Prostate gland Explanation: The seminal vesicles and the prostate gland produce fluid that nourishes the sperm and provide most of the volume of semen. Other fluid that makes up semen comes from the vas deferens and from the mucous glands in the head of the penis. The bulbourethral glands secrete a mucus-like fluid that lubricates the head of the penis in preparation for sexual intercourse. p76

After explaining the function of the seminal vesicles to a class, the instructor determines the need for additional teaching when the students identify which of the following as a function? a) Aid for sperm to reach the ovum b) Nourishment of the sperm c) Prevent sperm destruction by female antibodies d) Reduce sperm motility

Reduce sperm motility Correct Explanation: The seminal vesicles are a pair of glands that produce fluid with various substances that function to (1) nourish sperm, (2) enhance sperm motility by enzymatically liquefying ejaculated semen (3) stimulate contraction of the uterus to help the sperm reach the ovum, and (4) resist sperm destruction by female antibodies. p75

Male and female reproductive systems are complementary; for example, male testes and female ovaries; male scrotum and female labia majora; and male glans penis and female clitoris. What part of the female system is homologous to the spermatic cord in the male? a) Uterosacral ligaments b) Round ligaments c) Cardinal ligaments d) Broad ligament

Round ligaments Correct Explanation: Round ligaments and spermatic cord are both fibromuscular bands that assist in holding specific reproductive structures in place in the male and female. Cardinal ligaments anchor the walls of the cervix and vagina to the lateral pelvic walls. The uterosacral ligaments anchor the lower posterior portion of the uterus to the sacrum. The broad ligament is a sheet of peritoneum that attaches the lower sides of the uterus to the sidewalls of the pelvis. p65

The uterine cycle refers to changes that occur in the endometrial lining of the uterus. In which phase of this cycle does the corpus luteum begin to produce progesterone? a) Ischemic b) Proliferative c) Secretory d) Menstrual

Secretory Correct Explanation: After ovulation, the corpus luteum begins to produce progesterone; this hormone causes the uterine lining to become rich in nutrients in preparation for pregnancy. During the menstrual phase of the uterine cycle, the uterine lining is shed because of low levels of progesterone and estrogen. When estrogen levels are high enough, the endometrium begins to regenerate. Estrogen stimulates blood vessels to develop. The blood vessels, in turn, bring nutrients and oxygen to the uterine lining, which begins to grow and become thicker. The proliferative phase ends with ovulation on day 14. Without estrogen and progesterone to maintain the blood vessel network, the uterine lining becomes ischemic. p72

Hormonal regulation of reproductive functions in both the male and the female are complicated processes. In the male where are the male sex hormones produced? a) Cowper's glands b) Bulbourethral glands c) Testes d) Seminal vesicles

Testes Correct Explanation: The testes serve two important functions: production of male sex hormones, androgens, and formation and maturation of spermatozoa. p74

The increase in thickness of the endometrial layer during the first half of the menstrual cycle is controlled by: a) The dropping level of LH b) The level of the FSH c) The increasing level of Estrogen d) The increasing level of the HcG

The increasing level of Estrogen Correct Explanation: Estrogen levels increase after menstruation. These levels promote a thickening of the endometrial tissue. FSH and LH are responsible for ovarian changes. HcG is the hormone present during pregnancy. p 70

When teaching a couple trying to conceive about the changes in cervical mucous near the time of ovulation, you should advise them: a) The mucous is thin related to the reduced progesterone levels b) The mucous is thick and tacky related to the reduced estrogen levels c) The mucous is thin and copious related to the elevated estrogen levels d) The mucous is scant due to the elevated progesterone levels

The mucous is thin and copious related to the elevated estrogen levels Correct Explanation: The estrogen levels are elevated at this time. These levels are responsible for the thinning and copious nature of the cervical mucus. Progesterone is not a factor at this time. p72

When reviewing normal menstruation with an early adolescent, you would teach that during the second half of a typical menstrual cycle, the endometrium of the uterus becomes a) Thin and transparent, due to follicle-stimulating hormone. b) Thick and purple-hued, due to estrogen stimulation. c) Thin and transparent, due to progesterone stimulation. d) Thick and purple-hued, due to progesterone stimulation.

Thick and purple-hued, due to progesterone stimulation. Explanation: Progesterone is released following ovulation and thus is the dominating hormone of the second half of the menstrual cycle; its effect is to increase endometrium growth. Progesterone stimulates a growth of tissue, not a thinning of it. FSH and estrogen are found in the earlier stages of menstruation, not in the second half. p72

Dyspareunia is pain during coitus. a) False b) True

True

There are two major functions of the reproductive system, continuation of the species and sexual pleasure. In the male the reproductive system has a third function. What is this third function? a) Elimination of solid wastes b) Stimulation of sexual maturation c) Urinary elimination d) Production of sex hormones

Urinary elimination Correct Explanation: However, some of the structures in the reproductive tract serve dual purposes. Most often these alternate functions have to do with urinary elimination, because the urinary and reproductive systems are closely connected. p74

A client confused about terminology, asks the nurse to define the term conception. Which statement would the nurse include in the response? a) The moment at which a woman experiences an orgasm b) The period during which a woman is most fertile c) When one sperm penetrates one ovum to form a zygote d) The development of the human embryo

When one sperm penetrates one ovum to form a zygote Correct Explanation: Conception occurs when one sperm penetrates one ovum to form a zygote. It does not refer to the development of the human embryo, to orgasm, or to the period during which a woman is most fertile. p69-70

When reviewing normal menstruation with an early adolescent, you would teach that during the second half of a typical menstrual cycle, the endometrium of the uterus becomes a) corkscrew-like, because of progesterone stimulation. b) thin and transparent, because of progesterone stimulation. c) thick and purple-hued, because of estrogen stimulation. d) twisted and ragged, because of follicle-stimulating hormone.

corkscrew-like, because of progesterone stimulation. Explanation: Progesterone is released following ovulation and thus is the dominating hormone of the second half of the menstrual cycle; its effect is to increase endometrium growth.

As a result of loss of estrogen, postmenopausal women have decreased vaginal lubrication. What may occur as a result? a) painful menses b) painful intercourse c) excess fatigue d) frequent urination

painful intercourse Correct Explanation: During sexual activity, the walls of the vagina secrete a thin watery material, necessary for the comfortable placement and movement of the penis in the vagina during intercourse. Decreased lubrication often results in painful intercourse. p73

A client is worried about her 14-year-old daughter's recent interest, and possible participation, in sexual activities. Which response by the nurse would be most appropriate? a) "Send your daughter to a professional or a religious counselor immediately." b) "Try to curb your daughter's dating and socializing activities." c) "Urge your daughter to delay sexual gratification until she has reached maturity." d) "I can help you and your daughter develop strategies that will be in her best interests."

"I can help you and your daughter develop strategies that will be in her best interests." Correct Explanation: The nurse should help the client's daughter identify information necessary to make an informed decision about sexual activity. Advising or forcing the teenager to delay sexual gratification or referring her to a religious counselor is not a realistic course of action and may lead to rebellion. p68-69

A group of students are reviewing material in preparation for a test on the male and female breasts. The students demonstrate understanding of the material when they identify which of the following? a) A primary function of the female breast is to produce milk. b) The breasts contain a limited supply of blood vessels. c) Progesterone is primarily responsible for the growth of breast tissue. d) Striated muscle in the nipples contract causing them to become erect.

A primary function of the female breast is to produce milk. Correct Explanation: A primary function of the female breast is to produce milk, a process called lactation. The breasts contain an abundant supply of blood vessels and lymphatics. Estrogen is the hormone primarily responsible for the growth and development of breast tissue. Smooth muscle in the nipples contracts, causing them to become erect when cold, touched, or sexually stimulated. (p68)

A school nurse who is teaching a health course at the local high school is presenting information on human development and sexuality. When talking about the role of hormones in sexual development, which hormone does the nurse teach the class is the most important for developing and maintaining the female reproductive organs? a) Progesterone b) Androgens c) Estrogen d) Follicle-stimulating hormone

Estrogen Correct Explanation: Progesterone is the most important hormone for conditioning the endometrium in preparation for implantation of the fertilized ovum. Estrogens are responsible for developing and maintaining the female reproductive organs. Androgens, secreted by the ovaries in small amounts, are involved in the early development of the follicle and affect the female libido. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete estrogen. p73

The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of nursing students. What would be the best response by a nursing student about the function of the uterus? a) Receives the fertilized ovum and provides housing and nourishment for a fetus b) Small erectile structure that responds to sexual stimulation c) Receives sperm, provides an exit for menstrual flow, and serves as the birth canal d) Produces female gametes or ova and secretes female sex hormones

All the ova a female will ever have are present at birth Correct Explanation: It is believed that all the ova a female will ever have are present at birth. The human ovum consists of protoplasm enclosed within a two-layered cell wall. The outer layer is the zona pellucida; the inner layer is the vitelline membrane. The ovum cell contains a large nucleus, within which is a nucleolus called the germinal spot. The ovum is larger than the sperm cell, and it is the only human cell normally visible to the naked eye p70

The nurse is reviewing the structure and function of various organs in the female reproductive system. Which information should the nurse include about the ovum in the review with the client? a) Contains a small nucleus, within which is a nucleolus called the germinal spot b) Consists of protoplasm enclosed within a three-layered cell wall c) Ovum is smaller than the sperm cell d) All the ova a female will ever have are present at birth

All the ova a female will ever have are present at birth Explanation: It is believed that all the ova a female will ever have are present at birth. The human ovum consists of protoplasm enclosed within a two-layered cell wall. The outer layer is the zona pellucida; the inner layer is the vitelline membrane. The ovum cell contains a large nucleus, within which is a nucleolus called the germinal spot. The ovum is larger than the sperm cell, and it is the only human cell normally visible to the naked eye. p 70

A woman is expecting to give birth to a boy soon and is debating about whether to have him circumcised. Which of the following would be the best response for the nurse to give her? a) Circumcision is recommended by the American Academy of Pediatrics because it improves fertility later in life b) Circumcision is not recommended by the American Academy of Pediatrics because it increases the risk of HIV infection c) Circumcision is recommended by the American Academy of Pediatrics because it allows for better hygiene d) Circumcision is not recommended by the American Academy of Pediatrics because it is extremely painful to the infant

Circumcision is recommended by the American Academy of Pediatrics because it allows for better hygiene Correct Explanation: Although controversial to some, the American Academy of Pediatrics recommends male circumcision be done in consultation with parents for all male infants as the practice's advantages outweigh its risks. Its advantages allow for better hygiene as well as protection from HIV, STIs, and penile cancer.

A woman tells you she has difficulty achieving orgasm. Orgasm in females results mainly from which of the following? a) Sensory arousal b) Uterine stimulation c) Penile penetration d) Clitoral stimulation

Clitoral stimulation Correct Explanation: The clitoris is thought to be the main stimulus for initiating orgasm in women. p65

The hormone that is responsible for the onset of menstruation is: a) Luteinizing hormone b) Decrease in progesterone c) Increase in estrogen d) Follicle-stimulating hormone

Decrease in progesterone Correct Explanation: A decrease in progesterone during the menstrual phase is the hormone responsible for the shedding of the uterine lining resulting in menstruation. Increases in estrogen, LH, and FSH occur leading up to menstruation, but are not responsible for the onset. p73

When describing the process of fertilization, the nurse would explain that it normally occurs in which structure? a) Endometrium b) Cervix c) Vagina d) Fallopian tube

Fallopian tube Correct Explanation: Fertilization normally occurs in the fallopian tube. Once fertilized the ovum proceeds down the uterus and attaches itself in the endometrium. The vagina and cervix are not involved in fertilization. p67

A transvestite is someone who believes that he or she is of the opposite gender as his or her biological sex. a) True b) False

False Correct Explanation: A transvestite is a form of fetishism in which an individual dresses in the clothes of the opposite sex. A transsexual or transgender person is an individual who, although of one biologic gender, feels as if he or she is of the opposite gender.

After teaching a health education class on the female reproductive cycle, the nurse determines that the teaching was effective when the group identifies which phase as belonging to the ovarian cycle? a) Secretory phase b) Proliferative phase c) Ischemic phase d) Follicular phase

Follicular phase Correct Explanation: The ovarian cycle consists of the follicular phase, ovulation, and the luteal phase. The proliferative, secretory, and ischemic phases occur in the endometrial cycle. p70

The nurse describes a half-moon-shaped area behind the vaginal opening, identifying this structure as the: a) Introitus b) Prepuce c) Hymen d) Fourchette

Fourchette Correct Explanation: The fourchette is to the half-moon-shaped area behind the vaginal opening. The introitus is the opening to the vagina. The hymen is the tough, elastic, perforated, mucosa-covered tissue across the vaginal introitus. The prepuce is the hood-like covering over the clitoris. p65

A young woman is trying to get pregnant. She asks the nurse to recommend a practical way that she can tell the point in her monthly cycle when she will have the best odds of getting pregnant. Which of the following would be the best recommendation for the nurse to give her? a) Have sex when the cervical mucus is thick and scant b) Have sex when fernlike patterns appear on a microscope slide of cervical mucus c) Have sex when the cervical mucus is thin, stretchy, and copious d) Have sex immediately after menstruation has ended

Have sex when the cervical mucus is thin, stretchy, and copious Correct Explanation: Women can analyze cervical mucus changes to help plan coitus so it coincides with ovulation if they want to increase their chance of becoming pregnant or plan to avoid coitus at the time of ovulation to prevent pregnancy by analyzing how thick or thin is cervical mucus. At the beginning of each cycle, when estrogen secretion from the ovary is low, cervical mucus is thick and scant. Sperm survival in this type of mucus is poor. At the time of ovulation, when the estrogen level has risen to a high point, cervical mucus becomes thin, stretchy (Spinnbarkeit), and copious. Sperm penetration and survival in this thin mucus are both excellent. Fernlike patterns on a microscope slide of cervical mucus do indicate ovulation, but this method is not nearly as practical as examining the consistency of the cervical mucus. The beginning of the cycle, just after the end of menstruation, is before ovulation, and thus not the best time to have coitus if the goal is conception.

The vagina is at risk for infection because of its location and because it opens to the outside of the body. What is a protective mechanism of the vagina to keep from becoming infected? a) Normal vaginal pH is acidic (4 to 5), which protects from infection b) Produces its own natural antibiotics c) Normal vaginal flora act as phagocytes of invading bacteria d) Maintains an alkaline pH of 7 to 8, which destroys invading bacteria

Normal vaginal pH is acidic (4 to 5), which protects from infection Explanation: Normally, the vagina maintains an acidic pH of 4 to 5, which protects the vagina from infection. (p 65)

In the menstrual cycle, every month the female reproductive system generates an ovum. When the ovum is not fertilized, production of which of the following leads to menstruation? a) Follicle stimulating hormone by the anterior pituitary. b) Another ovum which begins immediately. c) Progesterone by the corpus luteum beginning to decrease. d) Estrogen by the corpus luteum begins to decrease.

Progesterone by the corpus luteum beginning to decrease. Correct Explanation: If the ovum is not fertilized, the production of progesterone by the corpus luteum begins to decrease and it changes from a yellow to a white spot on the ovary (corpus albicans). Without the high level of progesterone, the endometrium degenerates and sheds, a process referred to as menstruation. The corpus luteum does not produce estrogen. The production of another ovum is not the factor that causes endometrium degeneration. Production of follicle stimulating hormone by the anterior pituitary initiates ovulation. p71

Put the following phases of the menstrual cycle in correct order: Menses phase Proliferative phase Secretory phase Ischemic phase

Proliferative phase Secretory phase Ischemic phase Menses phase Correct Explanation: The menstrual cycle consists of four phases: 1) Proliferative phase (also known as the estrogenic, follicular, or postmenstrual phase), in which the ovary begins to produce estrogen and the endometrium begins to proliferate and thicken; 2) secretory phase (also known as the progestational, luteal, premenstrual, or secretory phase), in which progesterone forms in the corpus luteum and causes the glands of the uterine endometrium to become corkscrew or twisted in appearance and dilated with quantities of glycogen; 3) ischemic phase, in which the ovary begins to regress, production of progesterone decreases, and the endometrium of the uterus begins to degenerate; and 4) menses phase, in which a mixture of blood from ruptured capillaries, mucin, fragments of endometrial tissue, and the ovum flow from the vagina.

The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of high school students. What would be the best response by a high school student about the function of the VAGINA? a) Produces female gametes or ova and secretes female sex hormones b) Receives sperm, provides an exit for menstrual flow, and serves as the birth canal c) Small erectile structure that responds to sexual stimulation d) Receives the fertilized ovum and provides housing and nourishment for a fetus

Receives sperm, provides an exit for menstrual flow, and serves as the birth canal Explanation: The vagina's functions are to receive sperm, provide an exit for menstrual flow, and serve as the birth canal. The ovaries' functions are to produce female gametes or ova and secrete female sex hormones. The uterus's functions are to receive the fertilized ovum and provide housing and nourishment for a fetus. The clitoris is a small erectile structure that responds to sexual stimulation. p65

The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of nursing students. What would be the best response by a nursing student about the function of the UTERUS? a) Produces female gametes or ova and secretes female sex hormones b) Receives sperm, provides an exit for menstrual flow, and serves as the birth canal c) Small erectile structure that responds to sexual stimulation d) Receives the fertilized ovum and provides housing and nourishment for a fetus

Receives the fertilized ovum and provides housing and nourishment for a fetus Explanation: The uterus's functions are to receive the fertilized ovum and provide housing and nourishment for a fetus. The ovaries' functions are to produce female gametes or ova and secrete female sex hormones. The vagina's functions are to receive sperm, provide an exit for menstrual flow, and serve as the birth canal. The clitoris is a small erectile structure that responds to sexual stimulation. p 49

A nurse is teaching a sex education class and is discussing sexual response. She describes a 30-minute period during which external and internal genital organs return to an unaroused state. This phase of sexual response is known as which of the following? a) Excitement b) Plateau c) Resolution d) Orgasm

Resolution Correct Explanation: Resolution, the fourth and final phase of sexual response, is a 30-minute period during which the external and internal genital organs return to an unaroused state. Excitement, the first phase, occurs with physical and psychological stimulation (sight, sound, emotion, or thought) that causes parasympathetic nerve stimulation. The plateau stage, which is the second phase, is reached just before orgasm. Orgasm, the third phase, occurs when stimulation proceeds through the plateau stage to a point at which a vigorous contraction of muscles in the pelvic area expels or dissipates blood and fluid from the area of congestion.

After teaching a class on the female reproductive system, the nurse determines that the teaching was successful when the class identifies which of the following as a primary function of the ovaries? a) Secretion of mucus that supplies lubrication for intercourse b) Carrying the ovum to the endometrium c) Location for implantation of a fertilized ovum d) Secretion of estrogen and progesterone

Secretion of estrogen and progesterone Correct Explanation: The ovaries have two primary functions: development and release of the ovum and secretion of estrogen and progesterone. The fallopian tubes are responsible for conveying the ovum from the ovary to the uterus and sperm from the uterus toward the ovary. The Bartholin's glands when stimulated secrete mucus that supplies lubrication for intercourse. The uterus is the site of implantation of a fertilized ovum. p68

The nurse asks the class to identify the location of sperm production. The class is correct when they identify the:

Seminiferous tubules Correct Explanation: Sperm is produced in the seminiferous tubules of the testes. The vas deferens transports sperm from the epididymis. The seminal vesicles produce nutrient seminal fluid. The spermatic cord is formed by the vas deferens, blood vessels, and nerves to act as a passageway for sperm. p74

The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of high school students. What would be the best response by a high school student about the function of the clitoris? a) Receives the fertilized ovum and provides housing and nourishment for a fetus b) Receives sperm, provides an exit for menstrual flow, and serves as the birth canal c) Small erectile structure that responds to sexual stimulation d) Produces female gametes or ova and secretes female sex hormones

Small erectile structure that responds to sexual stimulation Correct Explanation: The clitoris is a small erectile structure that responds to sexual stimulation. The ovaries' functions are to produce female gametes or ova and secrete female sex hormones. The uterus's functions are to receive the fertilized ovum and provide housing and nourishment for a fetus. The vagina's functions are to receive sperm, provide an exit for menstrual flow, and serve as the birth canal. p64

A 16-year-old girl confides in a nurse that she recently had sex for the first time and is concerned because she noticed some blood coming from her vagina afterward. She said that her period had been over for 2 weeks at the time. Which of the following should the nurse explain as the most likely cause of the bleeding? a) An HIV infection b) Tearing of the hymen during sexual intercourse c) An irregular period due to a hormone imbalance d) An injury to the vagina due to sexual intercourse

Tearing of the hymen during sexual intercourse Correct Explanation: The hymen is a tough but elastic semicircle of tissue that covers the opening to the vagina during childhood. It is often torn during the time of first sexual intercourse. It is less likely that the blood is a result of an irregular period or an injury to the vagina, as there is no evidence for either in the scenario. Also, bleeding is not a sign of an HIV infection.

A 13-year-old boy has begun showing signs of puberty, including appearance of axillary and facial hair, as well as a change in his voice. He asks the nurse what exactly is causing these changes in his body. The nurse should mention which of the following as the primary hormone responsible for these changes? a) Testosterone b) Estrogen c) Luteinizing hormone d) Follicle-stimulating hormone

Testosterone Correct Explanation: The level of the primary androgenic hormone, testosterone, is low in males until puberty (between ages 12 and 14 years) when it rises to influence pubertal changes in the testes, scrotum, penis, prostate, and seminal vesicles; the appearance of male pubic, axillary, and facial hair; laryngeal enlargement with its accompanying voice change; maturation of spermatozoa; and closure of growth plates in long bones (termed adrenarche). Estrogen, luteinizing hormone, and follicle-stimulating hormone are not the primary hormone associated with secondary sex changes in males

An instructor is preparing a teaching plan for a group of students about reproductive structures and sexual arousal. Which female reproductive structure would the instructor include? a) The mons pubis b) Labia minora c) Labia majora d) The clitoris

The clitoris Correct Explanation: At the superior junction of the labia, there is a fleshy protrusion of tissue called the clitoris. The clitoris is an erectile tissue that enlarges and becomes sensitive when stimulated by the penis or touching that accompanies sexual foreplay. p65

The anatomy professor is teaching about the female reproductive system to a class of pre-nursing students. One young lady asks "Where is the opening to the vagina?" The best answer the professor can give is a) The introitus is between the labia majora and by the paraurethral glands b) The opening to the vagina is in what is called the vestibule, which is located between the labia minora c) The opening to the vagina is by the Bartholin glands d) Between where you pee and where you poop

The opening to the vagina is in what is called the vestibule, which is located between the labia minora Correct Explanation: The vestibule is the area between the labia minora. The urethral meatus (opening to the urethra), paraurethral (Skene's) glands, vaginal opening or introitus, and Bartholin glands are located within the vestibule. (p 65)

A 50-year-old woman confides in the nurse that, since beginning menopause, her sex life has suffered. When the nurse asks what the problem is, the client responds that her libido has decreased significantly; she just is not as interested in sex as she had been before. Which of the following should the nurse recommend the client to address this concern? a) KY jelly b) Progesterone administration c) Vaginal ring that dispenses low-dose estrogen d) Kegel exercises

Vaginal ring that dispenses low-dose estrogen Explanation: Low-dose estrogen or testosterone can be prescribed to increase sexual libido. Women who notice excessive vaginal dryness can be advised to use a lubricating jelly such as KY jelly prior to sexual relations. Practicing Kegel exercises can help strengthen bladder supports and reduce urinary incontinence. Progesterone administration is not indicated for increasing libido.

The nurse is describing the three phases of the uterine cycle with a client. What occurs during the secretory phase of the uterine cycle that the nurse should include in a teaching session with the client? a) Withdrawal of hormones causes the endometrial cells to change, and menstruation begins b) Maturation of an ovum c) If fertilization does not occur, the corpus luteum degenerates and hormonal levels fall. d) While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth

While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth Correct Explanation: While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth during the proliferative phase. If fertilization does not occur, the corpus luteum degenerates and hormonal levels fall during the secretory phase. Withdrawal of hormones causes the endometrial cells to change, and menstruation begins. Maturation of an ovum occurs during the ovarian cycle; growth of the lining (endometrium) of the uterus occurs during the uterine cycle. Together, these cycles are known as the menstrual cycle. p 72

The nurse is describing the three phases of the uterine cycle with a client. What occurs during the proliferative phase of the uterine cycle that the nurse should include in a teaching session with the client? a) If fertilization does not occur, the corpus luteum degenerates and hormonal levels fall b) While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth c) Maturation of an ovum d) Withdrawal of hormones causes the endometrial cells to change, and menstruation begins

While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth Correct Explanation: While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth during the proliferative phase. If fertilization does not occur, the corpus luteum degenerates and hormonal levels fall during the secretory phase. Withdrawal of hormones causes the endometrial cells to change, and menstruation begins. Maturation of an ovum occurs during the ovarian cycle; growth of the lining (endometrium) of the uterus occurs during the uterine cycle. Together, these cycles are known as the menstrual cycle. p72

Following reproductive-tract surgery, assessment of urinary status is important because the a) ureters pass in front of the uterus. b) bladder and the cervix surfaces touch. c) ureters pass just behind the uterine arteries. d) bladder is supplied by the uterine arteries.

ureters pass just behind the uterine arteries. Explanation: The proximity of the ureters to the fallopian tubes can cause them to be injured during uterine or fallopian tube surgery p65

A male client in the hospital receives a visit from his current partner, another male. The client identifies himself as a male and was born with male genitalia. The nurse recognizes that the client could be which of the following sexual orientations? (Select all that apply.) a) Heterosexual b) Bisexual c) Homosexual d) Transgender

• Bisexual • Homosexual Correct Explanation: His current partner being a male indicates that this client could be either a homosexual or a bisexual, but not a heterosexual. Because he identifies himself as a male and is biologically male, he is not transgender.

When describing the external female reproductive organs, which of the following would the nurse include? Select all that apply. a) Vestibule b) Fallopian tubes c) Perineum d) Labia majora e) Clitoris f) Vagina

• Perineum • Labia majora • Vestibule • Clitoris Explanation: The external female reproductive organs include the mons pubis, labia majora, labia minora, clitoris, vestibule, and perineum. The vagina and fallopian tubes are internal female reproductive organs. p64