Chapter 03: Reproductive Anatomy and Physiology
A postpartum patient who has had a vaginal birth asks the nurse, "I was wondering if my cervix will return to its previous shape before I had the baby?" Which is the best response by the nurse? a. The cervix will now have a slit-like shape.
ANS: A After vaginal birth, the external os has an irregular slit-like shape and may have tags of scar tissue. The external os of a childless woman is round and smooth
Which hormonal effect is noted during the menstrual cycle? a. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion rise during the ovulatory phase.
ANS: A Levels of LH and FSH rise dramatically during the ovulatory phase and are known as the LH surge prior to ovulation. A positive feedback mechanism occurs with regard to the menstrual cycle. The anterior pituitary gland secretes LH. Estrogen secretion minimizes FSH secretion.
The nurse is reviewing normal female development with a mother of a 10-year-old daughter. The mother states, "I noticed that my daughter developed breast buds about a year ago. When do you think she will start her menstrual cycle?" What is the nurse's best response? a. "In about a year."
ANS: A Menarche occurs about 2 to 2.5 years after breast development. Asking the mother if her daughter knows what to expect is a vague response that does not answer the mother's question.
The nurse is describing the size and shape of the nonpregnant uterus to a patient. Which is an accurate description? a. The nonpregnant uterus is the size and shape of a pear.
ANS: A The nonpregnant uterus is about 7.5 5 2.5 cm, which is close to the size and shape of a pear. A cantaloupe would be too large and is the wrong shape for the uterus. A grapefruit is too large for the nonpregnant uterus, the uterus is larger at the upper end and tapers down. An orange may be the appropriate size, but it is not the appropriate shape.
A young female patient comes to the health unit at school to discuss her irregular periods. In providing education regarding the female reproductive cycle, the nurse describes the regular and recurrent changes related to the ovaries and the uterine endometrium. Although this is generally referred to as the menstrual cycle, the ovarian cycle includes which phases? (Select all that apply.) a. Follicular b. Ovulatory c. Luteal
ANS: A, B, C The follicular phase is the period during which the ovum matures. It begins on day 1 and ends around day 14. The ovulatory phase occurs near the middle of the cycle, about 2 days before ovulation. After ovulation and under the influence of the luteinizing hormone, the luteal phase corresponds with the last 12 days of the menstrual cycle. The proliferative and secretory phases are part of the endometrial cycle. The proliferative phase takes place during the first half of the ovarian cycle when the ovum matures. The secretory phase occurs during the second half of the cycle when the uterus is prepared to accept the fertilized ovum. These are followed by the menstrual phase if fertilization does not occur.
A female patient who has gone through puberty and started menstruating without any problems has developed cessation of periods after 2 years of normal cycles. Which finding would indicate a possible cause for this occurrence? b. Overproduction of androgenic hormones
ANS: B An overproduction of androgenic hormones may cause the development of secondary amenorrhea. This patient has progressed through puberty, which would indicate that there is no problem with the development of secondary sexual characteristics. If the patient had a positive pregnancy test, then menstruation would stop. These signs and symptoms indicate the occurrence of secondary amenorrhea.
The clinic nurse is reviewing breastfeeding with a pregnant patient. Which hormone will the nurse explain is responsible for milk production after the birth of the placenta. b. Prolactin
ANS: B During pregnancy, high levels of estrogen and progesterone produced by the placenta stimulate growth of the alveoli and ductal system to prepare them for lactation. Prolactin secretion by the anterior pituitary gland stimulates milk production during pregnancy, however, this effect is inhibited by estrogen and progesterone produced by the placenta. Inhibiting effects of estrogen and progesterone stop when the placenta is expelled after birth, and active milk production occurs in response to the infant's suckling while breastfeeding. Pitocin is the hormone that causes the let-down reflex during breastfeeding.
If a woman's menstrual cycle began on June 2, on which date should ovulation mostly likely have occurred? b. June 16
ANS: B June 16 would be 18 days into the cycle, ovulation should have occurred at this point. June 10 would just be 8 days into the cycle and too early for ovulation. Ovulation occurs about 12 to 14 days after the beginning of the next menstrual period in a 28-day cycle, ovulation normally occurs about 14 days before the beginning of the next period. June 29 is at the end of the cycle. July 5 would be 27 days into the cycle and about time for the next period.
The nurse is explaining the function of the male's cremaster muscle to a group of nursing students. Which statement accurately describes the function of the cremaster muscle? b. Aids in temperature control of the testicles
ANS: B One cremaster muscle is attached to each testicle. Its function is to bring the testicle closer to the body to warm it or allow it to fall away from the body to cool it, thus promoting normal sperm production. Seminal fluid assists with transporting sperm. The urinary meatus aids in controlling the excretion of urine. Entrapment of the blood in the penis is a result of the spongy tissue.
Which statement with regard to reproductive anatomy and physiology is inaccurate? b. Puberty symptoms are more prominent in males than females.
ANS: B Puberty symptoms are less prominent in developing males than females. The other statements are correct.
Which characteristic best describes the levator ani? b. Collection of three pairs of muscles
ANS: B The levator ani is a collection of three pairs of muscles that support internal pelvic structures and resist increases in intraabdominal pressure. The fallopian tube divisions are the interstitial portion, isthmus, ampulla, and infundibulum. The linea terminalis is the imaginary line that divides the false from the true pelvis. The basin-shaped structure at the lower end of the spine is the bony pelvis.
The middle school nurse is reviewing the phases of the endometrial cycle with a group of female students. Which statement by a student will the nurse need to correct? b. "The expulsion phase occurs when the ovum is discharged from the ovary."
ANS: B The menstrual cycle has only three phases: proliferative, secretory, and menstrual. Occurrences of each of the three phases have been described. There is no expulsion phase in the menstrual cycle.
The school nurse is conducting health education classes for a group of adolescent girls. Select the actions of the estrogen hormone that the nurse should include in the lessons. (Select all that apply.) b. Relaxes pelvic ligaments during pregnancy c. Stimulates the endometrium before ovulation d. Stimulates growth of uterus during pregnancy
ANS: B, C, D The hormone estrogen relaxes pelvic ligaments during pregnancy, stimulates the endometrium before ovulation, and stimulates the growth of the uterus during pregnancy. Oxytocin stimulates contractions during pregnancy and stimulates the let-down reflex during breastfeeding.
The school nurse is conducting health education classes for a group of adolescents. Which statement best describes a secondary sexual characteristic? c. Female breast development
ANS: C A secondary sexual characteristic is one not directly related to reproduction, such as development of the characteristic female body form. Maturation of ova is directly related to reproduction and is a primary sexual characteristic. Production of sperm is directly related to reproduction and is a primary sexual characteristic. Secretion of hormones is directly related to reproduction and is a primary sexual characteristic.
A patient states, "My breasts are so small. I don't think I will be able to breastfeed my baby." Which is the nurse's best response? c. "All women have about the same amount of glandular tissue necessary to secrete milk."
ANS: C All women have 15 to 20 lobes arranged around and behind the nipple and areola. These lobes, not the size of the breast, are responsible for milk production. The size of the breasts does not ensure success or failure in breastfeeding. Supplementation decreases the production of breast milk by decreasing stimulation. Stimulation of the breast, not the size of the breast, brings about milk production. Increased levels of estrogen decrease the production of milk by affecting prolactin.
Which 16-year-old female patient is most likely to experience secondary amenorrhea? c. 5 ft 7 in, 96 lb
ANS: C Due to her height and low body weight, this adolescent is at risk of developing secondary amenorrhea. Secondary amenorrhea occurs in women who are thin and have a low percentage of body fat. Fat is necessary to make the sex hormones that stimulate ovulation and menstruation. The other patients are of sufficient height and weight to promote sex hormone production.
A newly pregnant patient asks the nurse, "What is a false pelvis?" Which statement by the nurse will best explain this anatomy to the patient. c. It provides support for the internal organs and the upper part of the body.
ANS: C The linea terminalis, also called the pelvic brim or iliopectineal line, is an imaginary line that divides the upper, or false, pelvis from the lower, or true, pelvis. The false pelvis provides support for the internal organs and upper part of the body. The false pelvis is the upper portion, not the total anterior portion. The lower portion of the pelvis is the true pelvis, which is most important during childbirth because it has the narrowest portion through which the fetus will pass during childbirth.
On speculum examination of the cervix, it is found to be round and smooth. These findings suggest that the patient c. is nulliparous.
ANS: C These findings indicate that the patient has never been pregnant, and she would be classified as nulliparous. The other findings indicate that the patient is a multipara, has had vaginal deliveries, or is a gravida 1, para 0. These all refer to a patient with a positive history of pregnancy.
