Pharmacology: Chapter 39: Introduction to the Reproductive System
The nurse is caring for a woman who went through menopause 5 years earlier. The nursing plan of care for this client includes teaching related to the importance of what dietary change? a.Increased intake of fatty foods to maintain lipid levels b.Reduced caloric intake because of lower activity levels c.Increased calcium intake to reduce calcium loss in bones d.Increased fluid intake to prevent dehydration from increased urination
Ans: C Feedback: Estrogen and progesterone levels are reduced in menopause resulting in loss of protective mechanisms provided by these hormones. The patient requires extra calcium intake to prevent osteoporosis caused by loss of calcium in the bones. Serum lipid levels rise after menopause, thus putting the woman at increased risk of heart disease so the patient should be taught to limit fat intake. Post-menopausal womens activity levels do not need to decline and they may be as active as they wish to be. No need exists for increased fluid intake secondary to menopause.
A 74 year-old male client sought care wanting to have his testosterone levels assessed. Results of testing revealed that the client's testosterone levels were below reference ranges for adult males. "What should the nurse teach the client about this finding?" a."More than likely this is a natural, age-related change in your hormone levels." b."Many men who are over 65 find that increasing their level of physical activity can increase testosterone levels." c."It's normal for testosterone production to cease between the ages of around 65 and 70." d."For many men, depression causes a drop in testosterone, while a drop in testosterone also contributes to depression."
a. "More than likely this is a natural, age-related change in your hormone levels." Response Feedback:With age, the seminiferous tubules and interstitial cells atrophy and the male climacteric or andropause, a period of lessened sexual activity and loss of testosterone effects, occurs. This is a normal, age-related change. Testosterone production normally slows, but it does not cease. There are no notable relationships between exercise and testosterone production nor depression and testosterone production.
The parents of an infant boy have been told surgery is needed because their son's testes have not descended into the scrotal sac. They ask the nurse, "What would happen if the testes remained in his lower abdomen?" What is the nurse's best response? a. "The testes need to be placed in the scrotum to protect sperm-producing cells from body heat." b. "If the testes remain in the abdomen, it would help to protect them from accidental trauma." c. "Leaving the testes in the abdomen would damage their ability to produce testosterone."d. "The risks associated with surgery are greater than the risks associated with leaving the testes in the abdomen."
a. "The testes need to be placed in the scrotum to protect sperm-producing cells from body heat." Response Feedback:During fetal development, the two testes migrate down the abdomen and descend into the scrotum outside the body where they are protected from the heat of the body to prevent injury to the sperm-producing cells. Leaving them in the abdomen would not protect them, testosterone production would not be impacted, and the risk to sperm production is far greater than surgical risks.
The nurse is caring for a client whose fallopian tubes were damaged by recurrent pelvic infections resulting in complete obstruction of both tubes. The client asks the nurse, "Why can't I get pregnant?" What is the nurse's best response? a."You can get pregnant, but the embryo, once fertilized, cannot travel to the uterus to implant and grow." b."The blockage of your fallopian tubes prevents the high levels of estrogen and progesterone needed to sustain the pregnancy." c."You cannot become pregnant because damage to your fallopian tubes causes ova to stop being released from the ovary." d."You cannot become pregnant because sperm cannot travel through the fallopian tubes to fertilize the ova released by the ovary."
a. "You can get pregnant, but the embryo, once fertilized, cannot travel to the uterus to implant and grow." Response Feedback:The sperm travels through the fallopian tube to the ova, released into the abdomen near the end of one of the fallopian tubes. With both fallopian tubes blocked, no passageway exists for sperm to reach the ova. Damage to the fallopian tubes does not impact hormone secretion or ova production. Because the ova are not fertilized, there would be no embryo to travel through the fallopian tubes to implant in the uterus.
Which female clients are likely to experience a negative impact on their reproductive cycles related to the controls of the hypothalamus? Select all that apply. a.A young adult client who has been on an extreme weight loss plan for several months b.A client who works outdoors all day in a tropical climate c.A client who is moderately obese d.A client who is undergoing treatment for major depression e.A triathlete who is training intensively for an important competition
a. A young adult client who has been on an extreme weight loss plan for several months d. A client who is undergoing treatment for major depression e. A triathlete who is training intensively for an important competition Response Feedback: In addition to stress, starvation, extreme exercise, and emotional problems are all associated with a decrease in reproductivity related to the controls of the hypothalamus. Extreme temperatures and moderate obesity have not been found to have a negative impact on the reproductive cycle relative to the hypothalamus.
When testosterone enters a cell, it reacts with what to influence messenger ribonucleic acid (mRNA) activity? a.Cytoplasmic receptor site b.Cytoplasmic reticular site c.Endoplasmic receptor site d.Endoplasmic reticular site
a. Cytoplasmic receptor site Response Feedback:Like estrogen, testosterone enters the cell and reacts with a cytoplasmic receptor site to influence mRNA activity, resulting in the production of proteins for cell structure or function.
The nurse is caring for an adolescent boy who is suspected of taking supplemental testosterone to improve his performance as a wrestler. What assessment findings would support this suspicion? Select all that apply. a.Excessive hair growth on face and body b.Enlarged muscular development c.Reduced hematocrit levels d.Growth of testes and scrotal sac e.Increased thickening of the skin
a. Excessive hair growth on face and body b. Enlarged muscular development d. Growth of testes and scrotal sac e. Increased thickening of the skin Response Feedback: Testosterone is responsible for hair growth on the body and face, muscle development, increased hematocrit levels, growth of testes and scrotal sac, and increased thickening of the skin. Hematocrit would not be affected.
The nurse working with obstetric clients understands the role of the placenta includes what? a.Hormone production b.Physical protection c.Production of glucose d.Expelling the fetus
a. Hormone production Response Feedback:The uterus is a muscular organ, which can develop a blood-filled inner lining or endometrium, which will support the development of the placenta, which provides nourishment for the developing fetus and acts as an endocrine gland producing the hormones needed to maintain the active metabolic state of the pregnancy. The amniotic sac protects the fetus. Although nutrients are sent to the growing fetus through the placenta, glucose is not produced by the placenta. The muscles in the uterus contract to expel both the fetus and the placenta.
The nurse is assessing a male client who is beginning puberty. What phenomenon should the nurse attribute to the client's increasing testosterone levels? a.Increased hematocrit b.Increased leukocyte levels c.Thinning of the cartilage and skin d.Increased insulin secretion
a. Increased hematocrit Response Feedback:Testosterone causes hematocrit to increase and causes thickening of skin and cartilage, which affects the male gait. It is not responsible for changes in leukocyte levels or insulin levels.
As a woman goes through menopause, what expected changes happen? Select all that apply. a.Increased production of gonadotropin-releasing hormone (GnRH) by the hypothalamus b.Gradual reversal of primary sex characteristics c.Loss of calcium retention in bones d.Increased serum lipid levels e.Decreased serum levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
a. Increased production of gonadotropin-releasing hormone (GnRH) by the hypothalamus c. Loss of calcium retention in bones d. Increased serum lipid levels Response Feedback: The follicles contained in the ovary become depleted over time, the ovaries no longer produce estrogen and progesterone, and menopause begins with the cessation of menses. The hypothalamus and pituitary gland produce increased levels of GnRH, FSH, and LH for a while in an attempt to stimulate the ovaries to produce estrogen and progesterone. If that does not happen, the levels of these hormones fall back within a normal range in response to their own negative feedback systems. Menopause is associated with loss of many effects of these two hormones resulting in loss of calcium in the bones, increased serum lipid levels, and maintenance of secondary sex characteristics. Primary sexual characteristics are not impacted.
The nurse is caring for an Olympic athlete who reports she has not had a menstrual period for 6 months, ever since she started training for the next Olympic tryout. The nurse suspects the root cause of this client's amenorrhea is what? a.The hypothalamus is not releasing gonadotropin-releasing hormone (GnRH) b.Absence of estrogen production c.Increased production of follicle-stimulating hormone (FSH) d.Decreased production of progesterone
a. The hypothalamus is not releasing gonadotropin-releasing hormone (GnRH) Feedback:Enormous amounts of energy are expended in reproduction, and if the body needs energy for other reasons, such as this patients tremendous energy output while training, the hypothalamus shuts down the reproductive activities, stopping the release of GnRH, which results in no FSH or luteinizing hormone (LH) release and no stimulation of the follicles. Estrogen and progesterone production are not impacted and FSH production decreases.
The nurse is caring for an older adult client following bilateral orchiectomy as part of testicular cancer treatment; the client asks the nurse what physical changes he can expect because of this surgery. The nurse explains that the client should expect to: a. maintain normal male characteristics. b. develop a wider and flatter pelvis. c. gradually lose his facial hair. d. take on some female characteristics.
a. maintain normal male characteristics. Response Feedback:Increased testosterone levels in boys at puberty results in thickening of the skin, a deeper voice, development of facial hair, and closure of the epiphyses. These previously established effects would be maintained by the androgens, which still remain in the body following surgical castration. Development of a wide flat pelvis and loss of facial hair are associated with estrogen's effects. An older adult male would not grow taller following surgery.
As the lining of the uterus sloughs away, clotting at the site of the separating blood vessels in the uterus is prevented by the presence of: a.plasminogen. b.fibrinolysis. c.luteinizing hormone (LH). d.follicle-stimulating hormone (FSH).
a. plasminogen. Response Feedback:High levels of plasminogen in the uterus prevent clotting of the lining as the vessels shear off. Fibrinolysis, LH, and FSH do not contribute to clot prevention.
What hormone is the first to be produced when the ovum is fertilized and implanted in the uterine wall? a.Growth hormone (GH) b.Human chorionic gonadotropin c.Prolactin d.Adrenocorticotropic hormone (ACTH)
b. Human chorionic gonadotropin Response Feedback:After the ovum is fertilized and implants itself in the uterine wall, human chorionic gonadotropin is produced by the junction of the fertilized embryo with the uterine wall. ACTH and GH are not involved with his process. The release of prolactin helps with milk production for the newborn fetus.
What hormone causes ovulation to occur? a.Adrenocorticotropic hormone (ACTH) b.Luteinizing hormone (LH) c.Prolactin d.Follicle-stimulating hormone (FSH)
b. Luteinizing hormone (LH) Response Feedback:When the circulating estrogen level rises high enough, it stimulates a massive release of LH from the anterior pituitary causing one of the developing follicles to burst and release the ovum with its stored hormones into the system. 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 stimulate follicles on the outer surface of the uterus to grow and develop and also stimulates the release of estrogen and progesterone.
The nurse is caring for a client who is on day 14 of her menstrual cycle and ovulation is thought to have just occurred. What assessment findings should the nurse attribute to this? Select all that apply. a.The client states that she had a loose bowel movement this morning. b.The client describes a sensation of abdominal fullness. c.The client states that she is hungrier than usual. d.The client describes symptoms of anxiety. e.The client reports feeling bloated.
b. The client describes a sensation of abdominal fullness. c. The client states that she is hungrier than usual. e. The client reports feeling bloated. Response Feedback: The woman experiences increased body temperature, increased appetite, breast tenderness, bloating and abdominal fullness, constipation, among other symptoms—the effects associated with progesterone, which is released into the system when the follicle ruptures. Anxiety is not expected.
What client should the nurse assess most closely to determine whether sexual activity will be safe? a.The client with benign prostatic hypertrophy b.The client with ischemic heart disease c.The client who is post-menopausal with vaginal dryness d.The client with chronic obstructive pulmonary disease (COPD)
b. The client with ischemic heart disease Response Feedback:The stimulation of the sympathetic nervous system that occurs with sexual response could be dangerous in some cardiovascular conditions if they are exacerbated by sympathetic effects, so the client with cardiovascular disease would require further assessment. Many clients with cardiovascular disease maintain a satisfactory sex life, but each requires careful assessment to determine who might be at risk. The client with benign prostatic hypertrophy can safely participate in sex if he is capable of obtaining an erection. The post-menopausal woman can use lubricants to reduce dryness and make sexual activity more comfortable. The client with COPD may have to limit physical exertion, but there is less likely to be a safety risk.
A nurse is providing health education to a client in a fertility clinic. The nurse explains possible reasons for infertility. When explaining how the ovaries are involved in conception, what will the nurse stress? a.Ova quickly degenerate and most are absorbed in the body before the age of 12. b.The ovaries at birth contain all of the ova that a woman will have. c.Ova aggregate, causing millions to be contained in a storage site called a follicle. d.Follicles produce only estrogen; the uterus produces progesterone.
b. The ovaries at birth contain all of the ova that a woman will have. Response Feedback:It would be important to explain that the woman's ova do not increase or decrease from birth to childbearing years. The nurse will stress that all the ova that a woman will have will be present at birth. The client should understand that if she does not ovulate 1 month or for several months, it is not because she has done something to her body to cause this. Ova slowly degenerate over a lifetime or they are released once a month until menopause is complete. Each ovum is contained in a storage site called a follicle, which produces the female sex hormones, estrogen, and progesterone.
A nurse is teaching a health class for girls at the local high school and explains the primary goal of sex hormones is to: a.develop the body's reproductive system. b.prepare the body for pregnancy. c.initiate the body's change into puberty. d.prepare for the emotional aspects of birth and parenting.
b. prepare the body for pregnancy. Response Feedback:Each ovum is contained in a storage site called a follicle. The follicles act as endocrine glands producing the hormones estrogen and progesterone. The primary goal of these hormones is to prepare the body for pregnancy and to maintain the pregnancy until birth of the fetus. Although secretion of these hormones develops the body's reproductive system and initiates the change into puberty, these occur to prepare the body for pregnancy, the primary goal of the hormones.
The client asks, "Why do I feel so bloated before my menstrual period begins? I am constipated, my breasts are tender, and I'm always hungry." How would the nurse best respond? a."This is the result of the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), hormones to start your period."b."This is the result of estrogen release preparing your body to release an ovum." c."These are the effects of progesterone, a hormone released to thicken your uterine lining." d."This is the result of the secretory endometrium release preparing the body for pregnancy."
c. "These are the effects of progesterone, a hormone released to thicken your uterine lining." Response Feedback:Increased body temperature, increased appetite, breast tenderness, bloating, abdominal fullness, and constipation result from the effects associated with progesterone, which is released into the system when the follicle ruptures. These symptoms are not related to FSH and LH. Estrogen may cause mild bloating and water retention, but the more significant symptoms reported by this client in conjunction with other symptoms is not caused by estrogen. Secretory endometrium causes production of glucose and other nutrients to nurture a growing embryo and does not produce the reported symptoms.
The nurse is caring for a client scheduled for removal of both testes secondary to cancer. The client voices concern that he will look like a woman if he doesn't take testosterone supplementation, which is contraindicated by testicular cancer. The nurse explains that he will maintain his masculine traits as the result of what action? a.Residual testosterone found in muscle cells b.Hormones secreted by the penis during arousal c.Androgens secreted by the adrenal glands d.Supplemental medications taken daily
c. Androgens secreted by the adrenal glands Response Feedback:The androgens released by the adrenal glands are sufficient to sustain male sexual characteristics. Androgens are very similar in structure to testosterone and are able to influence cells to maintain the changes caused by testosterone. No residual testosterone is found in muscle cells, the penis does not secrete hormones, and supplemental medications are not required.
Diagnostic testing has revealed a deficiency in a client's progesterone levels. What assessment finding is most likely to be the result of this change in endocrine function? a.Oral temperature 96.3°F (35.7°C) b.Increased appetite c.Blood glucose 60 mg/dL d.Facial flushing
c. Blood glucose 60 mg/dL Response Feedback:Progesterone has an anti-insulin effect to generate a higher blood glucose concentration to allow for rapid diffusion of glucose to the developing embryo. Conversely, low progesterone would correlate with hypoglycemia, which this client is experiencing. Body temperature and appetite are increased by progesterone. This client's temperature would be considered to be in the low-normal range and would not be considered to be exceptionally low. Facial flushing would not accompany low progesterone levels.
What physiologic process would most directly cause spermatogenesis in an adult male client? a.Passage of more than 48 hours since ejaculation b.Synthesis and release of gonadotropin-releasing hormone (GnRH) by the hypothalamus c.Increased release of follicle-stimulating hormone (FSH) by the anterior pituitary d.Recent sexual stimulation that has not resulted in ejaculation
c. Increased release of follicle-stimulating hormone (FSH) by the anterior pituitary Response Feedback:FSH directly stimulates the seminiferous tubules to produce sperm, a process called spermatogenesis. GnRH causes FSH release, so it is an indirect influence of spermatogenesis. Absence of ejaculation causes an accumulation of sperm, but does not provide the physiologic impetus for spermatogenesis.
A 16-year-old client presents to the clinic reporting severe menstrual cramps. The client is concerned about the pain and worried that "something is wrong." The nurse explains to the client that she has cramping during her menstrual period because of what? A) An increase in the levels of estrogen and progesterone, which cause uterine contractions B) Low levels of plasminogen in the uterus that cause the shedding of the lining of the uterus C) Prostaglandins in the uterus, which stimulate uterine contractions to clamp off vessels as the lining of her uterus sheds D) An increase in progesterone and a decrease of estrogen cause the lining of the uterus to slough away
c. Prostaglandins in the uterus, which stimulate uterine contractions, clamp off vessels as the lining of her uterus sheds Feedback:Prostaglandins in the uterus stimulate uterine contractions to clamp off vessels in the lining of the uterus, which is the cause of the cramping. The decrease of estrogen and progesterone after the involution of the corpus luteum triggers the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The decreased levels of FSH and LH cause the inner lining of the uterus to slough off because the vascular system is no longer being stimulated. High, not low, levels of plasminogen in the uterus prevent clotting of the lining as the vessels shear off.
A nurse is teaching a sex education course in a local high school. What statement, made by the nurse, would be accurate regarding the human sexual response? a.Humans require endocrine stimuli during a time period called estrus for a sexual response to occur. b.Stimulation occurs with large increases in sensitivity. c.Sexual climax occurs from massive sympathetic stimulation. d.The period of recovery is initiated with parasympathetic stimulation.
c. Sexual climax occurs from massive sympathetic stimulation. Response Feedback:Stimulation in humans occurs with mild increases of sensitivity and the climax occurs from massive sympathetic stimulation. Many animals require an estrous cycle to become stimulated, but that is not true of humans. The period of recovery occurs when the sympathetic stimulation is resolved.
A client's sex glands have responded to stimulation from follicle-stimulating hormone (FSH) and luteinizing hormone (LH). What endocrine activity has directly preceded the release of FSH and LH? a.Chemoreceptors detected a deficiency in growth hormone-releasing hormone (GHRH). b.The client's hypothalamus detected a deficiency in both hormones and released them. c.The client's anterior pituitary gland was stimulated by gonadotropin-releasing hormone (GnRH). d.The client's hypothalamus responded to stimulation from prolactin-releasing hormone (PRH).
c. The client's anterior pituitary gland was stimulated by gonadotropin-releasing hormone (GnRH). Response Feedback:The male and female glands respond to luteinizing hormone (LH) and FSH, which are released from the anterior pituitary in response to stimulation from GnRH that is released from the hypothalamus. GHRH stimulates the release of the growth hormone, which targets cell growth; this hormone is uninvolved in FSH and LH synthesis or release. LH and FSH are released by the anterior pituitary, not the hypothalamus. PRH does not act on the hypothalamus, which initiates its synthesis.
The nurse is assessing a client who is known to have a low sperm count. What naturally occurring substance should the nurse identify as affecting only sperm production? a.Estrogen b.Testosterone c.Gonadotropin-releasing hormone (GnRH) d.Inhibin
Ans: D Feedback: Inhibin has been investigated for many years as a possible male birth control drug, because it is thought to affect only sperm production. Estrogen, testosterone, and GnRH have multiple effects on the body other than just sperm production.
The nurse is talking with a woman about menopause when the woman turns to her husband and says, "You're so lucky not to have to go through anything like this!" What is the nurse's best response? a. "Men go through something called andropause when less testosterone is produced." b. "Men are fortunate to maintain the same hormone levels throughout their life." c. "With age, sexual function declines but that is not due to hormonal changes in men." d. "The ability to obtain and maintain an erection will decline with age."
a. "Men go through something called andropause when less testosterone is produced." Response Feedback:With age, the seminiferous tubules and interstitial cells atrophy and the male climacteric or andropause, a period of lessened sexual activity and loss of testosterone effects, occurs. This indicates a decline in hormone levels in men similar to what women experience. Sexual function and the ability to obtain and maintain an erection do not occur in all men, but usually is most often seen in those with problems such as hypertension, diabetes, and heart disease. Healthy men who make healthy lifestyle choices can maintain sexual activity well into their senior years.
The nurse is assessing a client who has recently become pregnant. What hormone activity is most likely to maintain the pregnancy until birth of the fetus? a.High levels of estrogen for the first trimester, gradually declining throughout pregnancy b.Temporary cessation of gonadotropin-releasing hormone (GnRH) c.High levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) d.High levels of estrogen and progesterone throughout pregnancy
d. High levels of estrogen and progesterone throughout pregnancy Response Feedback:In a pregnant woman, both estrogen and progesterone hormones have specific functions. High levels of both hormones are needed for the maintenance of pregnancy. Pregnancy is not maintained through the actions of GnRH, FSH, or LH.
The nurse expects the level of what substance to increase to stimulate uterine contraction and the onset of labor? a.Follicle-stimulating hormone (FSH) b.Progesterone c.Estrogen d.Prostaglandins
d. Prostaglandins Response Feedback:Local prostaglandins are released stimulating the uterus to contract and the onset of labor begins. High levels of estrogen and progesterone support the uterus and block uterine contractions. FSH is not responsible for the onset of labor.
A client is in the first 14 days of her menstrual cycle and the increased levels of estrogen have thinned the client's cervical mucosa. What nursing diagnosis best applies to this stage of the client's menstrual cycle? a.Risk for imbalanced body temperature b.Risk for urge incontinence c.Risk for deficient fluid volume d.Risk for infection
d. Risk for infection Response Feedback:During the first 14 days of the menstrual cycle, the woman's cervical mucosa become thin, creating a risk for infection. Water retention can cause fluid volume excess, not deficit. Disruptions in urinary function or thermoregulation are not typical.
A school nurse works with many preadolescent and adolescent female clients. Which client would most likely have delays in developing and maintaining the female reproductive organs? a.A client who has low levels of estrogen b.A client with higher-than-average levels of progesterone c.A client whose blood work reveals the presence of androgens d.A client whose levels of follicle-stimulating hormone are slightly below norms
a. A client who has low levels of estrogen Response Feedback:Estrogens are responsible for developing and maintaining the female reproductive organs; a deficiency could affect growth and development. Progesterone is the most important hormone for conditioning the endometrium in preparation for implantation of the fertilized ovum. Androgens, secreted by the ovaries in small amounts, are involved in the early development of the follicle and affect the female libido, so their presence is expected. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete estrogen; a slight decrease would not likely have a major effect.
The nurse reviews the female client's laboratory results and finds the level of gonadotropin-releasing hormone (GnRH) has increased significantly since the previous day. When assessing this client, what will the nurse expect to find? a.The client is pregnant. b.The client's menses have begun. c.The client is ovulating. d.The client is preparing to give birth.
Ans: B Response Feedback: The dropping levels of estrogen and progesterone trigger the release of gonadotropin-releasing hormone (GnRH) and then follicle-stimulating hormone (FSH) and luteinizing hormone (LH) again, along with the start of another menstrual cycle. Lowered hormone levels cause the inner lining of the uterus to slough off because it is no longer stimulated by the hormones, demonstrated by the beginning of menses. The client is not pregnant or ovulating at the start of another menstrual cycle nor is she preparing for birth of the baby.
The nurse is teaching students about sexual health and explains that the effects of arousal include what? Select all that apply. a. Increased heart rate b. Decreased blood pressure c. Sweating d. Pupil constriction e. Increased blood glucose levels
a. Increased heart rate c. Sweating e. Increased blood glucose levels
