Chapter 22: Reproductive System

The nurse working in a prenatal clinic reviews a client's chart and notes that the primary health care provider documents that the client has a gynecoid pelvis. The nurse plans care understanding that which findings are characteristic of this type of pelvis? Select all that apply. 1. Round shape 2. Shallow depth 3. Narrow pubic arch 4. Diagonal conjugate measures 12.5 to 13 cm 5. Blunt, somewhat widely separated ischial spines

1, 4, 5 Rationale: A gynecoid pelvis is a normal female pelvis, and it is the most favorable for successful labor and birth. Characteristics of a gynecoid pelvis include a round shape, blunted ischial spines that are widely separated, a diagonal conjugate of at least 12.5 to 13 cm, a wide pelvic arch, and an adequate depth. Test-Taking Strategy: Focus on the subject, knowledge regarding pelvic types, to answer this question. Remember that the gynecoid pelvis is the normal female pelvis.

fetal circulation bypass

1. Fetal circulation bypass is present as a result of nonfunctioning lungs. 2. Bypasses must close after birth to allow for blood to flow through the lungs and liver. 3. The ductus arteriosus connects the pulmonary artery to the aorta, bypassing the lungs. 4. The ductus venosus connects the umbilical vein and the inferior vena cava, bypassing the liver. 5. The foramen ovale is the opening between the right and left atria of heart, bypassing the lungs.

cervix

1. Internal os of the cervix opens into the body of the uterine cavity. 2. The cervical canal is located between the internal cervical os and the external cervical os. 3. The external cervical os opens into the vagina.

umbilical cord

1. It contains two arteries and one vein. 2. The arteries carry deoxygenated blood and waste products from the fetus. 3. The vein carries oxygenated blood and provides oxygen and nutrients to the fetus.

vagina

1. Muscular tube that extends from the cervix to the vaginal opening in the perineum 2. Known as the birth canal 3. Passageway for menstrual blood flow, for penis during intercourse, and for the fetus

fallopian tubes

1. Muscular tubes (oviducts) lying near the ovaries and connected to the uterus 2. Tubes that propel the ova from the ovaries to the uterus

uterus

1. Muscular, pear-shaped cavity in which the fetus develops 2. Cavity from which menstruation occurs

chorion

1. Outer membrane enclosing the amniotic cavity 2. Becomes vascularized and forms the fetal part of the placenta

scrotum

1. Structures include the testes, epididymis, and vas deferens. 2. Normal temperature within the scrotum is slightly cooler than body temperature for optimum sperm production.

false pelvis

1. The shallow portion above the pelvic brim 2. Supports the abdominal viscera

implantation

1. The zygote is propelled toward the uterus and implants 6 to 8 days after ovulation. 2. The blastocyst secretes chorionic gonadotropin to ensure that the corpus luteum remains viable and secretes estrogen and progesterone for the first 2 to 3 months of gestation.

The nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse needs to tell the client that fetal circulation consists of which components? 1. Two umbilical veins and one umbilical artery 2. Two umbilical arteries and one umbilical vein 3. Arteries that carry oxygenated blood to the fetus 4. Veins that carry deoxygenated blood to the fetus

2 Rationale: Blood pumped by the fetus's heart leaves the fetus through two umbilical arteries. After the blood is oxygenated, it is then returned by one umbilical vein. The umbilical arteries carry deoxygenated blood and waste products from the fetus, and the umbilical vein carries oxygenated blood and provides oxygen and nutrients to the fetus. Test-Taking Strategy: Focus on the subject, anatomy of fetal circulation. Remember that there are three umbilical vessels within an umbilical cord (two arteries and one vein).

A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the nurse helps determine whether this method of family planning is appropriate? 1. "Have either of you ever had surgery?" 2. "Do you plan to have any other children?" 3. "Do either of you have diabetes mellitus?" 4. "Do either of you have problems with high blood pressure?"

2 Rationale: Sterilization is a method of contraception for couples who have completed their families. It would be considered a permanent end to fertility because reversal surgery is not always successful. The nurse would ask the couple about their plans for having children in the future. Options 1, 3, and 4 are unrelated to this procedure. Test-Taking Strategy: Focus on the subject, sterilization procedure. Noting the relationship between the word sterilization and the correct option will direct you to this answer.

The nurse is collecting data from a pregnant client when the client asks the nurse about the purpose of the fallopian tubes. Which is the accurate response the nurse would make? 1. The organ of copulation 2. Where the fetus develops 3. Where fertilization occurs 4. The organ that secretes estrogen and progesterone

3 Rationale: Each fallopian tube is a hollow muscular tube that transports a mature oocyte for final maturation and fertilization. Fertilization typically occurs near the boundary between the ampulla and the isthmus of the tube. The vagina is the organ of copulation, and the fetus develops in the uterus. Estrogen is a hormone that is produced by the ovarian follicles, the corpus luteum, the adrenal cortex, and the placenta during pregnancy. Progesterone is a hormone that is secreted by the corpus luteum of the ovary, the adrenal glands, and the placenta during pregnancy. Test-Taking Strategy: Focus on the subject, anatomy and physiology of the female reproductive system, which will direct you to the correct option. Remember that fertilization occurs in the fallopian tube.

The nurse is reinforcing teaching to a pregnant woman about the physiological effects and hormonal changes that occur during pregnancy. The woman asks the nurse about the purpose of estrogen. The nurse bases the response on which purpose of estrogen? 1. It maintains the uterine lining for implantation. 2. It stimulates the metabolism of glucose and converts glucose to fat. 3. It stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation. 4. It prevents the involution of the corpus luteum and maintains the production of progesterone until the placenta is formed.

3 Rationale: Estrogen stimulates uterine development to provide an environment for the fetus and it stimulates the breasts to prepare for lactation. Progesterone maintains the uterine lining for implantation and relaxes all smooth muscle. Human placental lactogen stimulates the metabolism of glucose and converts the glucose to fat. Human chorionic gonadotropin prevents the involution of the corpus luteum and maintains the production of progesterone until the placenta is formed. Test-Taking Strategy: Focus on the subject, functions of various hormones related to pregnancy. Remember that estrogen stimulates uterine development to provide an environment for the fetus and that it stimulates the breasts to prepare for lactation.

During a prenatal visit, the nurse checks the fetal heart rate (FHR) of a client in the third trimester of pregnancy. The nurse determines that the FHR is normal if which heart rate is noted? 1. 80 beats per minute 2. 100 beats per minute 3. 150 beats per minute 4. 180 beats per minute

3 Rationale: Fetal heart rate depends on gestational age. It is normally 160 to 170 beats per minute during the first trimester, but it slows with fetal growth to 110 to 160 beats per minute near or at term. Test-Taking Strategy: Focus on the subject, the fetal heart rate in the third trimester of pregnancy. Think about the physiology associated with cardiac structures in fetal development to answer correctly.

A nursing student is assigned to a client in labor. The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. The instructor determines that the student understands the structure of the ductus venosus if the student states which about the ductus venosus? 1. Connects the pulmonary artery to the aorta 2. Is an opening between the right and left atria 3. Connects the umbilical vein to the inferior vena cava 4. Connects the umbilical artery to the inferior vena cava

3 Rationale: The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery. Test-Taking Strategy: Focus on the subject, fetal circulation. Recall the anatomy of the fetal circulation to answer this question. Remember that the ductus venosus connects the umbilical vein to the inferior vena cava.

The client asks the nurse about the purpose of the placenta. The nurse plans to respond to the client knowing which about the placenta? 1. Cushions and protects the fetus 2. Maintains the body temperature of the fetus 3. Surrounds the fetus and allows for fetal movement 4. Provides an exchange of nutrients and waste products between the mother and the fetus

4 Rationale: The placenta provides an exchange of nutrients and waste products between the mother and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus and allows for fetal movement. The amniotic fluid also maintains the body temperature of the fetus. Test-Taking Strategy: Focus on the subject, the purpose of the placenta. This knowledge is required to answer this question. Remember that the placenta provides nutrients.

The nursing instructor asks a nursing student to list the functions of the amniotic fluid. The student needs further teaching if which responses are made? Select all that apply. 1. Allows for fetal movement 2. Is a measure of kidney function 3. Surrounds, cushions, and protects the fetus 4. Maintains the body temperature of the fetus 5. Prevents large particles such as bacteria from passing to the fetus 6. Provides an exchange of nutrients and waste products between the mother and the fetus

5, 6 Rationale: The amniotic fluid surrounds, cushions, and protects the fetus. The placenta, not the amniotic fluid, prevents large particles such as bacteria from passing to the fetus, and the placenta provides an exchange of nutrients and waste products between the mother and the fetus. Amniotic fluid allows the fetus to move freely, it maintains the body temperature of the fetus, and it helps to measure kidney function, because the amount of fluid is based on the amount of urination from the fetus. Test-Taking Strategy: Note the strategic words, needs further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement regarding amniotic fluid. Think about the functions of the amniotic fluid to assist in answering correctly.

The nurse is collecting data for the first time from a pregnant adolescent who reports consuming small amounts of alcohol on a daily basis. On the basis of the information provided, what would the nurse do?

Adolescent pregnancies are considered high risk because of the immaturity of the reproductive system and the high-risk behaviors that some adolescents engage in. The nurse would provide information to the adolescent regarding the risks associated with drug and alcohol consumption during pregnancy. The nurse would explain to the adolescent that large particles such as bacteria cannot pass through the placenta, but nutrients, drugs, antibodies, and viruses can pass through; therefore, measures must be taken to minimize exposure to substances that can cross the placental barrier and affect the health of the fetus. Follow-up regarding this high-risk behavior is also necessary.

week 16

Fetus is 11.5-13.5 cm in length. Fetus is 100 g. Active movements are present. Fetal skin is transparent. Lanugo hair begins to develop. Skeletal ossification occurs.

week 20

Fetus is 16-18.5 cm in length. Fetus is 300 g. Lanugo covers the entire body. Fetus has nails. Muscles are developed. Enamel and dentin are depositing. Heartbeat is detected by regular (nonelectronic) fetoscope. Gender can be determined about 18 to 20 weeks.

week 24

Fetus is 23 cm in length. Fetus is 600 g. Hair on head is well formed. Skin is reddish and wrinkled. Reflex hand grasp functions. Vernix caseosa covers entire body. Fetus has ability to hear.

secretory phase

The secretory phase lasts about 12 days and follows ovulation. This phase is initiated in response to the increase in LH level. The Graafian follicle is replaced by the corpus luteum. The corpus luteum secretes progesterone and estrogen. Progesterone prepares the endometrium for pregnancy if a fertilized ovum is implanted.

android pelvis

a. Heart-shaped or angulated b. Resembles a male pelvis c. Not favorable for labor and birth d. Narrow pelvic planes can cause slow descent and midpelvic arrest

gynecoid pelvis

a. Normal female pelvis b. Transversely rounded or blunt -most favorable for successful labor and birth. If cephalopelvic disproportion (CPD) exists, the normal labor process will be delayed and most likely result in a cesarean delivery

anthropoid pelvis

a. Oval shape b. The outlet is adequate, with a normal or moderately narrow pubic arch.

FHR

depends on gestational age: FHR is 160 to 170 beats per minute during the first trimester, but slows with fetal growth to 110 to 160 beats per minute near or at term

preembryonic period

first 2 weeks after conception

transverse diameter

largest of the pelvic inlet diameters; located at right angles to the true conjugate

fertilization

occurs in the ampulla of the fallopian (uterine) tube when sperm and ova unite

placenta

provides for exchange of nutrients and waste products between the fetus and the mother. 2. Begins to form at implantation; structure is complete by week 12. 3. It produces hormones to maintain pregnancy and assumes full responsibility for the production of these hormones by the twelfth week of gestation. 4. In the third trimester, transfer of maternal immunoglobulin provides the fetus with passive immunity to certain diseases for the first few months after birth. 5. By week 10 and 12, genetic testing can be done via chorionic villus sampling (CVS).

amnion

1. Encloses the amniotic cavity 2. Inner cell membrane that forms around the second week of embryonic development 3. Forms a fluid-filled sac that surrounds the embryo and later the fetus

ovaries

1. Form and expel ova 2. Secrete estrogen and progesterone

prostate gland

1. Secretes a milky alkaline fluid 2. Enhances sperm movement and neutralizes acidic vaginal secretions

penis

1. Structures include the body or shaft, glans penis, and urethra. 2. Primary functions include pathway for urination and it is the organ for intercourse.

fetal period

9 weeks to birth

week 1

Blastocyst is free-floating.

week 5

Embryo is 0.4-0.5 cm in length. Embryo is 0.4 g. Double heart chambers are visible. Heart is beating. Limb buds form.

weeks 2-3

Embryo is 1.5-2 mm in length. Lung buds appear. Blood circulation begins. Heart is tubular and begins to beat. Neural plate becomes brain and spinal cord.

week 12

Fetus is 6-9 cm in length. Fetus is 19 g. Face is well formed Limbs are long and slender. Kidneys begin to form urine. Spontaneous movements occur. Heartbeat is detected by Doppler transducer between 10 and 12 weeks.

oblique diameter

Not clinically measurable

menstrual phase

The menstrual phase consists of 4-6 days of bleeding as the endometrium breaks down because of the decreased levels of estrogen and progesterone. The level of FSH increases, enabling the beginning of a new cycle.

ovarian hormones

released by the anterior pituitary gland, include follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

The nursing student is asked to describe the size of the uterus in a nonpregnant client. Which response indicates an understanding of the anatomy of this structure? 1. "The uterus weighs about 2 ounces." 2. "The uterus weighs about 2.2 pounds." 3. "The uterus has a capacity of about 50 milliliters." 4. "The uterus is round in shape and weighs approximately 1000 grams."

1 Rationale: Before conception, the uterus is a small, pear-shaped organ that is contained entirely in the pelvic cavity. Before pregnancy, the uterus weighs approximately 60 g (2 oz) and it has a capacity of about 10 mL (⅓oz). At the end of pregnancy, the uterus weighs approximately 1000 g (2.2 lb) and it has a capacity that is sufficient for the fetus, the placenta, and the amniotic fluid. Test-Taking Strategy: Focus on the subject, size of the uterus, and note the word, nonpregnant. Visualizing each of the items identified in the options will direct you to the correct answer.

amniotic fluid

1. Consists of 800 to 1200 mL by the end of pregnancy 2. Surrounds, cushions, and protects the fetus and allows for fetal movement 3. Maintains the body temperature of the fetus 4. Contains fetal urine and is a measure of fetal kidney function 5. The fetus modifies the amniotic fluid through the processes of swallowing, urinating, and moving the fluid through the respiratory tract.

true pelvis

1. Lies below the pelvic brim 2. Consists of the pelvic inlet, the mid pelvis, and the pelvic outlet

embryonic period

Beginning day 15 through approximately week 8 after conception

diagonal conjugate

Distance from the lower margin of the symphysis pubis to the sacral promontory

posterior sagittal diameter

Distance from the point where the anteroposterior and transverse diameters cross each other to the middle of the sacral promontory

True conjugate or conjugate vera

Distance from the upper margin of the symphysis pubis to the sacral promontory

week 8

Embryo is 3 cm in length. Embryo is 2 g. Eyelids begin to fuse. Circulatory system through umbilical cord is well established. Every organ system is present.

obstetrical conjugate

Extends from the sacral promontory to the top of the symphysis pubis. It is the smallest front-to-back distance through which the fetal head must pass in moving through the pelvic inlet.

week 28

Fetus is 27 cm in length. Fetus is 1100 g. Limbs are well flexed. Brain is developing rapidly. Eyelids open and close. Lungs are developed sufficiently to provide gas exchange (lecithin forming). If born, neonate can breathe at this time.

week 32

Fetus is 31 cm in length. Fetus is 1800-2100 g. Bones are fully developed. Subcutaneous fat has collected. The L/S (lecithin-to-sphingomyelin) ratio is 1.2:1.

week 36

The fetus is 35 cm in length. The fetus is 2200-2900 g. The skin is pink and the body is rounded. The skin is less wrinkled. Lanugo is disappearing. The L/S ratio is higher than 2:1.

week 40

The fetus is 40 cm in length. The fetus is 3200+ g. The skin is pinkish and smooth. Lanugo present on upper arms and shoulders. Vernix caseosa decreases. Fingernails extend beyond fingertips. Sole (plantar) creases run down to the heel. The testes are in the scrotum. The labia majora are well developed.

Preovulatory Phase

The hypothalamus releases gonadotropin-releasing hormone through the portal system to the anterior pituitary system. Secretion of follicle-stimulating hormone (FSH) by the anterior lobe of the pituitary gland stimulates growth of follicles. Most follicles die, leaving one to mature into a large Graafian follicle. Estrogen produced by the follicle stimulates increased secretions of luteinizing hormone (LH) by the anterior lobe of the pituitary gland. The follicle ruptures and releases an ovum into the peritoneal cavity.

luteal phase

The luteal phase begins with ovulation. Body temperature drops and then rises by 0.5°F-1°F around the time of ovulation. Corpus luteum is formed from follicle cells that remain in the ovary following ovulation. Corpus luteum secretes estrogen and progesterone during the remaining 14 days of the cycle. Corpus luteum degenerates if the ovum is not fertilized, and secretion of estrogen and progesterone declines. The decline of estrogen and progesterone stimulates the anterior pituitary to secrete more FSH and LH, initiating a new reproductive cycle.

proliferative phase

The proliferative phase lasts about 9 days. Estrogen stimulates proliferation and growth of the endometrium. As estrogen increases, it suppresses secretion of FSH and increases secretion of LH. Secretion of LH stimulates ovulation and the development of the corpus luteum. Ovulation occurs between days 12 and 16. The estrogen level is high and the progesterone level is low.

platypelloid pelvis

a. Flat shape with an oval inlet b. Wide transverse diameter, but short anteroposterior diameter, making labor and vaginal birth difficult