Genetics and Conception (Sherpath Wk 3)

Place the structures in the order that fetal blood flows through them from the inferior vena cava. Foramen ovale Ductus venosus Right atrium Aorta Left ventricle Left atrium

Ductus venosus Right Atrium Foramen Ovale Left Atrium Left Ventricle Aorta

Which physiologic change in fetal circulation is triggered by clamping of the umbilical cord after birth? First breath Foramen ovale closure Ductus venosus constriction Ductus arteriosus constriction

Ductus venosus constriction

Three phases of implantation

Entry of the zygote into the uterus Implantation in the decidua Maintenance of the decidua in the secretory phase

A woman says, "My husband and I will be trying to have a baby soon." Which statement by the woman demonstrates an understanding of the growth that occurs during the embryonic period? "If I eat more, then the baby's structures will grow larger." "By week 8, all organs are formed, but none are functioning." "All of the major organs for my baby are formed in 8 weeks." "In the beginning, the fetal brain and heart are the only organs that grow rapidly."

"All of the major organs for my baby are formed in 8 weeks."

A pregnant woman asks, "How does my baby protect itself from amniotic fluid?" Which response by the nurse best explains how the fetus protects itself during development? "Protection from amniotic fluid is not necessary." "Both vernix and lanugo shield your baby in utero." "Lanugo secretes vernix that protects your baby's skin." "A cheese-like substance is secreted from your sebaceous glands to protect the baby."

"Both vernix and lanugo shield your baby in utero."

A woman at 12 weeks gestation reports not being able to feel any fetal movement and wonders when she will feel the baby move. Which response by the nurse is appropriate? "Don't worry; you are not far enough along." "This is concerning. Let's complete an ultrasound." "Even though you can't feel it yet, your baby is moving. I can use a Doppler so you can hear the baby's heart beating." "You may never feel your baby move."

"Even though you can't feel it yet, your baby is moving. I can use a Doppler so you can hear the baby's heart beating."

The instructor is discussing the embryonic period with a nursing student. Which statement by the student nurse would indicate a need for additional teaching? "The chromosomes carry the basic instructions for development." "Signaling to stimulate change may occur between two tissues." "Development occurs from the peripheral direction inward." "Early cells begin as specialized cells but later develop the ability to become other cells."

"Development occurs from the peripheral direction inward."

The nurse is caring for a patient who has just received genetic counseling and is visibly distressed. The patient tearfully explains to the nurse that the counselor informed her there was a 50% chance of her child having cystic fibrosis and asks, "What should I do about my pregnancy?" Which response from the nurse is appropriate for this patient? "Did the counselor say if there was anything you could do to lower the chance?" "We can get you information about adoption, if you think you might want to look at it." "A 50% chance isn't very high. There's an equal chance your baby will be perfectly healthy." "I know you're faced with a difficult decision, but I'm here to support the choices you make."

"Did the counselor say if there was anything you could do to lower the chance?" "We can get you information about adoption, if you think you might want to look at it." "A 50% chance isn't very high. There's an equal chance your baby will be perfectly healthy." "I know you're faced with a difficult decision, but I'm here to support the choices you make."

Two nursing students are reviewing the conception process in a study session with a tutor. Which statements demonstrate an understanding of the fertilization process? (Select all that apply.) "Fertilization causes the ovum to undergo mitosis." "Fertilization causes changes to the zona pellucida." "It only takes 1 day for fertilization to be complete." "Cell division occurs after the sperm and ovum merge." "Fertilization describes the union between the ovum and the sperm." "When the sperm penetrates the ovum, the head enlarges and the tail lengthens."

"Fertilization causes changes to the zona pellucida." "It only takes 1 day for fertilization to be complete." "Cell division occurs after the sperm and ovum merge." "Fertilization describes the union between the ovum and the sperm."

Which question would the antepartum nurse ask patients when determining the need for genetic counseling? "Have you ever had a miscarriage?" "Have you ever been diagnosed with depression or anxiety?" "Does anyone in your family need to use a wheelchair or a cane?" "Do you have any relatives who are developmentally delayed?"

"Have you ever had a miscarriage?" "Have you ever been diagnosed with depression or anxiety?" "Does anyone in your family need to use a wheelchair or a cane?" "Do you have any relatives who are developmentally delayed?"

The nurse is providing teaching about conception and ovulation to a patient seeking family-planning advice. Which statement by the patient on the timing of conception indicates that further teaching is needed? "I can get pregnant up to 7 days after ovulation." "Sperm can survive up to 2 days after sexual intercourse." "When trying to conceive, we should plan to have sex when I am ovulating." "Even if I am ovulating, my husband still has to produce enough healthy sperm for me to conceive."

"I can get pregnant up to 7 days after ovulation."

At a prenatal checkup, a woman at 26 weeks gestation expresses concern that her baby is in breech position as revealed by a sonogram. Which response by the nurse explains fetal position changes at this gestational age? "Don't worry; babies typically flip after 30 weeks." "I understand your concern, but babies usually do not flip until about week 28." "We need to plan for a cesarean delivery, as babies assume their birthing position now." "The baby's head is bigger than the feet but not heavy enough to cause him to turn yet."

"I understand your concern, but babies usually do not flip until about week 28."

The nurse provides teaching to a woman at 35 weeks gestation on normal fetal growth patterns during the third trimester. Which statement by the woman shows that additional teaching is needed? "My baby's lungs are still maturing until birth." "My baby is growing at a slower pace now." "The baby is plumping up this next month." "My baby will stop growing at 38 weeks."

"My baby will stop growing at 38 weeks."

A patient with no family history of genetic abnormalities asks the nurse if there may still be a need for prenatal genetic counseling. Which patient statement indicates that genetic counseling may be necessary? "My partner is 14 years older than me." "I was adopted by my biological mother's sister." "One of my children went deaf in one ear after an ear infection." "My family and I practice a religion that does not allow marriage outside of our religion."

"My partner is 14 years older than me." "I was adopted by my biological mother's sister." "One of my children went deaf in one ear after an ear infection." "My family and I practice a religion that does not allow marriage outside of our religion."

A woman admitted at 30 weeks gestation for preterm labor asks the nurse, "How important is surfactant for my baby's lungs, and when is it produced?" Which statement by the nurse best explains when and why surfactant is secreted? "Surfactant is first produced in the third trimester to help the baby breathe in utero." "Surfactant is produced for alveoli development when the lungs start developing in the first trimester." "Surfactant is initially produced at the beginning of the second trimester to keep the lungs from collapsing." "Surfactant is produced near the end of the second trimester to help the baby survive but it isn't used in utero by the lungs."

"Surfactant is produced near the end of the second trimester to help the baby survive but it isn't used in utero by the lungs."

The student nurse knows that during the latter part of the first trimester, the intestines descend into the abdomen. Which statement provides the best explanation for this physiologic change? "The intestines shrink, allowing descent to occur." "The umbilical cord expels the intestines into the abdominal cavity." "The kidneys and the liver must shrink to allow room for the intestines." "The abdominal cavity increases in size, allowing the intestines to descend."

"The abdominal cavity increases in size, allowing the intestines to descend."

The nurse is reviewing the stages of heart development in utero to nursing students in a prenatal clinic. Which statement by a student indicates an understanding of the timing of cardiovascular development during the embryonic period? "The heart chambers are formed in week 5." "Cardiac development occurs the most rapidly during weeks 7 and 8." "The cardiac system develops faster than the central nervous system." "The heart is beating, but the heart chambers don't form during the embryonic period."

"The heart chambers are formed in week 5."

A patient with a 2-year-old child with cystic fibrosis declines genetic counseling during her antepartum visit, stating that the birth defect has "already happened," and therefore her future children will not be affected. Which is the appropriate nursing education for this patient? "The risk for a child developing cystic fibrosis increases with maternal age." "This infant has an equal risk for developing cystic fibrosis as your first child." "The risk for your infant developing cystic fibrosis is less than your first child, but it is still present." "There is no longer a risk for your infant developing cystic fibrosis, but genetic counseling can help detect other abnormalities."

"The risk for a child developing cystic fibrosis increases with maternal age." "This infant has an equal risk for developing cystic fibrosis as your first child." "The risk for your infant developing cystic fibrosis is less than your first child, but it is still present." "There is no longer a risk for your infant developing cystic fibrosis, but genetic counseling can help detect other abnormalities."

A nurse is meeting with a woman to confirm her pregnancy at week 8; a sonogram technician is also present to confirm the fetal heartbeat by ultrasound. The woman says, "I'm so excited to see a little human." Which response would the nurse make to clarify development expectations for this woman? "Yes, your baby will definitely look like a tiny human now." "You should know the sex too!" "Your baby should look like a ball of cells." "Your baby will still look like a little tadpole."

"Yes, your baby will definitely look like a tiny human now."

A woman arrives at a prenatal clinic to confirm her pregnancy, and the nurse's assessment indicates that she is at 23 days gestation. The patient states, "Oh, so my baby is just beginning to grow." Which statement by the nurse is the best initial response? "Your baby has a beating heart now." "Your baby's face is already defined." "Your baby's major organs are already in place." "Your baby's central nervous system is developed now."

"Your baby has a beating heart now."

A woman at 8½ weeks gestation presents for a prenatal checkup. She is eager to find out the baby's sex. Which response by the nurse best explains genitourinary changes at this stage? "Your baby's external genitalia are evolving, but gender cannot be determined until week 10." "The baby's DNA will assign the sex after week 10." "At this phase, nothing changes in regard to the genitalia." "External genitalia begin differentiating at week 8, so let's take a look."

"Your baby's external genitalia are evolving, but gender cannot be determined until week 10."

Circulation after birth

-As the infant breathes, blood flow to the lungs increases, pressure in the right atrium falls, and pressure in the left atrium increases, causing the foramen ovale to close. -Pressure in the aorta rises as pressure in the pulmonary artery falls, causing the direction of blood flow through the ductus arteriosus to reverse, from the aorta into the pulmonary artery. -The ductus arteriosus constricts as the arterial oxygen level rises. -The ductus venosus constricts when blood flow from the umbilical cord stops.

On assessment, the nurse learns that a male toddler born with a congenital heart defect lives with his parents and two young siblings in the Midwest. The mother is pregnant with a fourth child. Which additional information would the nurse need to know to evaluate the risk for the fourth child being born with a heart defect? (Select all that apply.) Socioeconomic status of the family The mother's family history of tobacco use Variations of symptoms because of time or season Sex of family members born with a heart defect Number of close relatives born with a heart defect

-Socioeconomic status of the family -The mother's family history of tobacco use -Variations of symptoms because of time or season -Sex of family members born with a heart defect -Number of close relatives born with a heart defect

Auxiliary Structures

-placenta -umbilical cord -fetal membranes

Place the phases of the endometrial cycle in order, starting with day 1 of the female reproductive cycle. Proliferative Phase Secretory Phase Menstrual Phase Ischemic Phase

1. Menstrual Phase 2. Proliferative Phase 3. Secretory Phase 4. Ischemic Phase

Fetal Circulation Process

1. Oxygenated blood from the placenta enters the fetal body through the umbilical vein. 2. About half the oxygenated venous blood goes through the liver during early pregnancy, and the rest bypasses the liver and enters the inferior vena cava through the first shunt, the ductus venosus. 3. The blood then enters the right atrium. 4. Most of the blood passes directly into the left atrium through the second shunt, the foramen ovale, where it mixes with the small amount of blood returning from the lungs. 5. Blood flows from the left atrium into the left ventricle. 6. Blood is pumped from the left ventricle into the aorta to nourish the body. 7. A small amount of blood from the right ventricle is circulated to the lungs to nourish the lung tissue. 8. The rest of the blood from the right ventricle joins oxygenated blood in the aorta through the third shunt, the ductus arteriosus.

Place the events of conception after fertilization in the correct order. The morula forms. The zygote divides in the fallopian tube. The blastocyst develops. The zygote cells divide and shrink in size.

1. The zygote divides in the fallopian tube. 2. The zygote cells divide and shrink in size. 3. The morula forms. 4. The blastocyst develops.

Which response is most appropriate when the parents (both heterozygotes) of a child born with cystic fibrosis ask the probability of future pregnancies resulting in a child inheriting the disease?

25% A child that inherits an autosomal recessive disorder must receive the affected gene from both parents. Using a Punnett square, the probability can be seen to be 25%.

The nurse enters a woman's room as the health care provider is talking about the features appearing in the embryo. "The face and upper respiratory tract are beginning to take shape. Also, the neural tube should be closed." Based on this information, the nurse knows the embryo is at least _____________ weeks old.

4

A woman of advanced maternal age undergoes genetic testing during her pregnancy. If the fetus has Down syndrome, how many chromosomes would the test identify?

47 The typical child with Down syndrome has 3 copies of the 21st chromosome, which results in a total of 47 chromosomes found in each cell.

What is the probability of having a child with cystic fibrosis if one parent has the disease and the other is a carrier?

50% The probability is 50% because the affected parent will pass on the gene to all children and the other has a 50% chance of passing on the gene.

Monosomy

A monosomy occurs when each body cell has a missing chromosome, for a total number of 45. The only monosomy that is compatible with extended postnatal life is Turner syndrome, or monosomy X. Individuals with Turner syndrome have a single X chromosome and are women.

Which patient may be a carrier for an X-linked recessive trait? A patient whose father was born with cystic fibrosis A patient whose son is color-blind A patient whose daughter was born with Turner syndrome A patient whose brother was born with trisomy 21 (Down syndrome)

A patient whose father was born with cystic fibrosis A patient whose son is color-blind A patient whose daughter was born with Turner syndrome A patient whose brother was born with trisomy 21 (Down syndrome)

Which patient would benefit from prenatal genetic counseling? A patient with sickle cell disease (SCD) A patient who is having difficulty conceiving A patient with history of two multifetal pregnancies A patient with a history of miscarriage resulting from polyploidy

A patient with sickle cell disease (SCD) A patient who is having difficulty conceiving A patient with history of two multifetal pregnancies A patient with a history of miscarriage resulting from polyploidy

A patient with a family history of spina bifida reports reluctance to attempt conception without knowing the risk for having an infant with spina bifida. Which response from the nurse is appropriate? A. "Development of spina bifida depends on more than just genetic factors." B. "The only way to screen for spina bifida is through testing after conception." C. "Spina bifida is not affected by genetics; therefore the risk cannot be determined." D. "Genetic counseling can determine your exact risk for having a child with spina bifida."

A. "Development of spina bifida depends on more than just genetic factors." B. "The only way to screen for spina bifida is through testing after conception." C. "Spina bifida is not affected by genetics; therefore the risk cannot be determined." D. "Genetic counseling can determine your exact risk for having a child with spina bifida."

The antepartum nurse is caring for a patient who has a 2-year-old child with Down syndrome. The patient declines genetic counseling for her current pregnancy because she states, "There is nothing I can do about it now." Which education is appropriate for this patient regarding the use of genetic counseling? A. "If genetic counseling is done early in the pregnancy, defects can be prevented." B. "Genetic counseling is necessary because the risk for Down syndrome increases with each child." C. "Genetic counseling can help us determine if the abnormality came from you or your partner." D. "Genetic counseling can help us determine the risk for your second child being born with Down syndrome."

A. "If genetic counseling is done early in the pregnancy, defects can be prevented." B. "Genetic counseling is necessary because the risk for Down syndrome increases with each child." C. "Genetic counseling can help us determine if the abnormality came from you or your partner." D. "Genetic counseling can help us determine the risk for your second child being born with Down syndrome."

The antepartum nurse is caring for a patient with a family history of neural tube defects. The patient declines genetic counseling after listening to the health care provider's explanation. Which nursing intervention is appropriate for this patient? A. Continue to the next part of the visit. B. Inform the patient that declining genetic counseling may lead to inadequate preparation if the infant is born with a defect. C. Provide the patient with printed material regarding genetic counseling to take home should the patient have a change of mind. D. Explain to the patient that the test must be done because a family history of neural tube defects indicates a need for genetic counseling.

A. Continue to the next part of the visit. B. Inform the patient that declining genetic counseling may lead to inadequate preparation if the infant is born with a defect. C. Provide the patient with printed material regarding genetic counseling to take home should the patient have a change of mind. D. Explain to the patient that the test must be done because a family history of neural tube defects indicates a need for genetic counseling.

A 38-year-old patient declines prenatal diagnostic testing as result of a lack of family history of genetic or chromosomal abnormalities. Which nursing education is appropriate for this patient? A. If no family history of abnormalities is present, prenatal diagnostic testing is not recommended. B. Prenatal diagnostic testing is recommended even if no risk factors are present. C. The patient's age increases the risk for having a child with an abnormality. D. The patient should receive prenatal diagnostic testing to screen for potential recessive gene abnormalities.

A. If no family history of abnormalities is present, prenatal diagnostic testing is not recommended. B. Prenatal diagnostic testing is recommended even if no risk factors are present. C. The patient's age increases the risk for having a child with an abnormality. D. The patient should receive prenatal diagnostic testing to screen for potential recessive gene abnormalities.

ovulatory phase

About 2 days before ovulation, LH secretion rises markedly. Secretion of FSH also rises, but to a lesser extent than secretion of LH. These surges in LH and FSH cause a slight fall in follicular estrogen production and a rise in progesterone secretion, stimulating final maturation of a single follicle and release of its mature ovum. Ovulation marks the beginning of the luteal phase of the female reproductive cycle and occurs about 14 days before the next menstruation.

luteal phase

After ovulation and under the influence of LH, the remaining cells of the old follicle persist for about 12 days as a corpus luteum. The corpus luteum secretes estrogen and large amounts of progesterone to prepare the endometrium for a fertilized ovum. Levels of FSH and LH decrease during this phase in response to higher levels of estrogen and progesterone. If the ovum is fertilized, it secretes human chorionic gonadotropin (hCG), which causes the corpus luteum to persist to maintain an early pregnancy. If the ovum is not fertilized, FSH and LH fall to low levels, and the corpus luteum regresses. Decline of estrogen and progesterone levels with the regression of the corpus luteum results in menstruation as the uterine lining breaks down. The loss of estrogen and progesterone from the corpus luteum at the end of one cycle stimulates the anterior pituitary to increase secretion of FSH and LH, initiating a new cycle.

X-linked Disorders

Alleles on the X chromosome are the determinants in X-linked disorders due to the Y chromosome carrying very little genetic information. Heterozygous women pass the defective gene to 50% of their offspring. The resulting females will be carriers, and males will be affected by the disorder. An affected male will transmit the defect to all his daughters, who become carriers, whereas his sons will neither be affected nor be carriers because the male passes only the unaffected Y chromosome to his sons. X-Linked dominant Fragile X syndrome X-Linked recessive Duchenne muscular dystrophy Hemophilia A Color blindness

The antepartum nurse is caring for a couple whose amniocentesis results indicated a positive neural tube defect. The couple is visibly upset and concerned about the future of the pregnancy. Which kinds of nursing care are appropriate for this couple? (select all the apply) Allow the couple time to grieve the loss of the healthy infant they had anticipated. Provide the couple with contact information for available counseling services. Caution the couple against terminating the pregnancy before determining the nature of the defect. Explain to the couple that the decision to continue or to terminate the pregnancy is entirely their choice. Ask for clarification when the couple states they are "not making a decision" as to whether to continue the pregnancy.

Allow the couple time to grieve the loss of the healthy infant they had anticipated. Provide the couple with contact information for available counseling services. Caution the couple against terminating the pregnancy before determining the nature of the defect. Explain to the couple that the decision to continue or to terminate the pregnancy is entirely their choice. Ask for clarification when the couple states they are "not making a decision" as to whether to continue the pregnancy.

Components of Fetal Membranes

Amnion Chorion - outer layer Amniotic Fluid- housed in the chorion

A woman is at 36 weeks gestation when her toddler hits her in the abdomen with a Wiffle-ball bat. Which auxiliary component protects the fetus from this impact? Placenta Amniotic fluid Amnion membrane Chorion membrane

Amniotic fluid

Which description regarding the effects of hormones on the reproductive cycle is accurate? A decrease in estrogen assists with fertilization. An abrupt increase in luteinizing hormone (LH) causes ovulation. Increased progesterone stimulates follicle-stimulating hormone (FSH) secretion. A sudden increase in human chorionic gonadotropin (hCG) causes the corpus luteum to regress.

An abrupt increase in luteinizing hormone (LH) causes ovulation.

Autosomal Dominant Traits

An autosomal dominant trait is produced by a dominant gene on a non-sex chromosome, or autosome. Only one copy of the gene is sufficient to cause the disorder.

Autosomal Recessive Traits

An autosomal recessive trait occurs when a person receives two copies of a recessive gene carried on an autosome. If one member of the couple has the autosomal recessive disorder, all of their children will be carriers.

Which placental function has the potential to cause harm to the fetus? Gas exchange Waste removal Antibody transfer Endocrine production

Antibody transfer

3 Classes of Single Gene Disorders

Autosomal Recessive Autosomal Dominant X-linked Disorders

Place the changes in female sexual maturation in the typical order of occurrence. Axillary hair growth Breast development Pubic hair development Menstruation

Breast development Pubic Hair development Axillary Hair Growth Menstruation

Which placental variations present a risk for fetal hemorrhage? Select all that apply. Discoid Battledore Vasa previa Velamentous Decidua basalis

Battledore Vasa previa Velamentous

Autosomal Recessive

Both parents must pass on the defective gene, thus producing an affected (homozygous) child in recessive disorders. Male and female children are affected equally. If the child is heterozygous(that is, if one affected gene and one unaffected gene are present in the pair), then that child is a carrier and shows no clinical signs of disease. Pregnancies in which each parent is heterozygous for the recessive disease trait confer a probability of inheritance of: 25% that the child will be born with the unaffected genotype, 50% that the child will be born with the carrier genotype, and 25% that the child will be born with the affected or disease genotype. Subsequent pregnancies will have the same probabilities of inheritance. Cystic fibrosis Sickle cell anemia Phenylketonuria (PKU) Tay-Sachs disease

Which statements explain the changes that occur during the fusion of the sperm and ovum? (Select all that apply.) The sperm attempts to enter the ovum. Both the sperm head and tail change. Fertilization is complete within 12 hours. Nuclei of the gametes cluster at the center of ovum. Changes in the ovum prevent other sperm from entering.

Both the sperm head and tail change. Nuclei of the gametes cluster at the center of ovum.

Prenatal Diagnosis

CVS Amniocentesis Ultrasonography Percutaneous umbilical blood sampling (PUBS)

Which disease is known to have a strong familial association, attributed to several different genes, and requires early and increased screening? Colon Cancer Cystic Fibrosis Hemophilia A Marfan Syndrome

Colon Cancer

Primary amenorrhea

Delayed onset of menstruation is called primary amenorrhea if a girl's menstruation has not begun by the age of 16 years. Amenorrhea, or absence of menstruation, may also be considered primary if a girl is more than 1 year older than her mother or sisters were when their menarche occurred.

Delayed puberty in girls

Delayed puberty occurs when secondary sex characteristics have not appeared by age 13 years in girls. Delayed puberty may also be related to chronic disease (renal failure, lung disease, cystic fibrosis) or a result of corticosteroid use in adolescents with asthma.

Which noticeable, initial change is expected during the process of sexual maturation in females? Development of breast buds Increasing height and weight Endometrial gland secretions Growth of axillary and pubic hair

Development of breast buds

X-linked Recessive Traits

Diseases of the X-linked recessive gene occur mostly in men, because they have only one X chromosome that can cause the disease. Women can show the full disorder in two uncommon circumstances: When a woman has a single X chromosome (Turner syndrome) When a female child is born to an affected father and a carrier mother

Which disorders have a known chromosomal inheritance pattern? (select all that apply) Down Syndrome Turner Syndrome Marfan Syndrome Fragile X Syndrome Edwards Syndrome

Down Syndrome Turner Syndrome Edwards Syndrome

Chromosomal Abnormalities

Error during crossover of meiosis resulting in altered structure (deletion chromosome), addition of chromosome, or misplacement (translocation) of chromosome. Common if mother >35 Trisomy 21 (Down Syndrome) Monosomy X (Turner syndrome) Polysomy X (Klinefelter syndrome) Trisomy 18 (Edwards syndrome)

Which hormones are responsible for the development of female secondary sex characteristics? (Select all that apply.) Gonadotropin-releasing hormone (GnRH) Estrogen Follicle-stimulating hormone (FSH) Progesterone Luteinizing hormone

Estrogen Progesterone

First Trimester Genital Development

External genitalia look similar until the end of the ninth week. By the end of the 12th week, the fetal sex can often be determined by the appearance of the external genitalia on a sonogram.

two ways to measure developmental time of a fetus

Fertilization age (2 weeks less than) Gestational age

Which characteristics allow the fetus to thrive despite a lower-than-average blood partial pressure of oxygen (PO2)? (Select all that apply.) Blood entering the placenta has a low partial pressure of carbon dioxide (PCO2). Low partial pressure of carbon dioxide (PCO2) causes the fetal hemoglobin to carry more oxygen. Blood entering the placenta from the fetus has a high partial pressure of carbon dioxide (PCO2). Fetal hemoglobin can carry more oxygen than adult hemoglobin can. The fetus has a lower oxygen-carrying capacity because of higher average hemoglobin and hematocrit.

Fetal hemoglobin can carry more oxygen than adult hemoglobin can. Low partial pressure of carbon dioxide (PCO2) causes the fetal hemoglobin to carry more oxygen. Blood entering the placenta from the fetus has a high partial pressure of carbon dioxide (PCO2).

2nd Trimester weeks 17-20

Fetal movements feel like fluttering or "butterflies." Changes in the skin and hair are evident. Vernix caseosa (waxy, white substance coating newborn skin) and lanugo (soft hair covering limbs and body of some newborns) develop. Eyebrows and head hair appear. Brown fat, which helps the neonate maintain temperature stability after birth, develops.

Maternal Age Risk for Down Syndrome

For maternal age 30, risk is 1 in 1000 For maternal age 35, risk is 1 in 500 For maternal age 40, risk is 1 in 100

Which shunt allows for the delivery of blood from the right to the left atrium in the fetus? Aorta Foramen ovale Ductus venosus Ductus arteriosus

Foramen ovale

Match the fetal shunt with the physiologic event associated with its closing/constriction after birth. Foramen ovale Ductus venosus Ductus arteriosus Aorta

Foramen ovale - Increased O2 to lungs Ductus venosus - cessation of umbilical cord circulation Ductus arteriosus - Increase in arterial O2 Aorta - decrease in aortic pressure

Which statement explains how a 5-year-old girl could present with pubic hair growth? Estrogen is released prematurely by the anterior pituitary gland. Luteinizing hormone (LH) is released in large quantities from the ovaries. Gonadotropin-releasing hormone (GnRH) is released prematurely by the hypothalamus. Follicle-stimulating hormone (FSH) is released in large quantities from the hypothalamus.

Gonadotropin-releasing hormone (GnRH) is released prematurely by the hypothalamus.

Third Trimester Weeks 33-38

Growth of all body systems continues until birth, but the rate of growth slows as birth approaches. The pulmonary system matures to enable efficient and unlabored breathing after birth. The well-nourished term fetus is rotund, with abundant subcutaneous fat. Lanugo may be present over the forehead, upper back, and upper arms. Vernix caseosa may remain in major creases, such as the groin and axillae. In male fetuses, the testes have descended to the scrotum. Breast tissue is palpable beneath the areola and nipple, and tissue is enlarged in both male and female infants.

A newlywed couple has an ultrasound that shows that they are having a boy. Which genetic disorders are more likely in their child? (select all that apply) PKU Hemophilia A Fragile X Syndrome Huntington Disease Duchenne Muscular Dystrophy

Hemophilia A Fragile X Syndrome Duchenne Muscular Dystrophy

Preconception Screening

Includes elements of genetic evaluation Carrier testing People from ethnic groups with a higher incidence of some disorders People with a family history suggesting that they may carry a gene for a specific disorder Chromosome analysis Deoxyribonucleic acid (DNA) analysis Examination of photographs, particularly for deceased or unavailable family members

In which way is the hypothalamus responsible for sexual maturation? It produces estrogen to stimulate growth of breast tissue. It releases luteinizing hormone (LH) to stimulate growth of the ovaries. It produces follicle-stimulating hormone (FSH) to stimulate maturation of the follicles. It releases gonadotropin-releasing hormone (GnRH) to stimulate the anterior pituitary gland.

It releases gonadotropin-releasing hormone (GnRH) to stimulate the anterior pituitary gland.

Which female anatomic structure protects the labia minora? Clitoris Perineum Mons pubis Labia majora

Labia majora

Which effect does secretion of human chorionic gonadotropin have on the endometrial cycle of the female reproductive cycle? Lack of menstruation Release of multiple ova Necrosis of the endometrium Decreased levels of follicle-stimulating hormone (FSH)

Lack of menstruation

A 70-year-old man and his 45-year-old wife have a child who is found to have a genetic disorder. What signs and symptoms are likely to be seen in this child born to parents of advanced maternal and paternal age? (select all that apply) Leukemia Gowers Sign Visual Problems Hearing Disorders Congenital Heart Defects

Leukemia Visual Problems Hearing Disorders Congenital Heart Defects

Which statements regarding sperm preparation for conception are accurate? (Select all that apply.) Most sperm are able to fertilize an egg for only 24 hours after ejaculation. Sperm obtain fructose for energy from semen. Most sperm do not survive more than 24 hours in the female reproductive tract. Sperm are protected by the alkaline pH of the semen. Sperm immediately fertilize the ovum after ejaculation.

Most sperm are able to fertilize an egg for only 24 hours after ejaculation. Sperm obtain fructose for energy from semen. Sperm are protected by the alkaline pH of the semen.

Match the female reproductive structure with its role during childbirth. Muscle contracts to expel fetus. Fibrous tissue opens to accommodate fetus's passage into the birth canal. Muscle expands as fetus moves through birth canal. Muscle stretches as fetal head emerges.

Muscle contracts to expel fetus.- (Uterus) Fibrous tissue opens to accommodate fetus's passage into the birth canal. (Cervix) Muscle expands as fetus moves through birth canal. (Vagina) Muscle stretches as fetal head emerges. (Perineum)

Which probabilities are associated with a man with hemophilia A having a child with a woman who does not have the disease and who is not a carrier? (select all that apply) All of his sons will be affected. None of his sons will be affected. All of his daughters will be carriers. None of his daughters will be carriers.

None of his sons will be affected. All of his daughters will be carriers.

Placental variations

Normal- Cord near center, umbilical vessels over the surface. Battledore- cord near margin of placenta, ^ risk for hemorrhage Vasa Previa- fetal vessels lie over the cervical os, the cord vessels branch far out on membranes instead of the placenta. 2 types. -Velamentous insertion, in which the cord vessels branch at the membranes and then enter the placenta -Succenturiate placenta, in which the placenta is divided into two or more lobes and the fetal vessels track between lobes of the placenta.

Which statements accurately characterize how the female body prepares for conception? (Select all that apply.) Oocytes remain in the ovary in the graafian follicle. The ovum is released on the fallopian tube surface. An ovum is released 14 days before the menstrual period begins. The graafian follicle prepares the uterine lining by producing estrogen and progesterone. The ovum matures as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are released.

Oocytes remain in the ovary in the graafian follicle. An ovum is released 14 days before the menstrual period begins. The graafian follicle prepares the uterine lining by producing estrogen and progesterone.

Which statements describe how the uterus, ovaries, and fallopian tubes function together to assist in conception? (Select all that apply.) Ovaries mature the ovum. The uterus stores glycogen. Fallopian tubes transport the ovum. The uterus supports pelvic structures. The ovaries release follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

Ovaries mature the ovum. The uterus stores glycogen. Fallopian tubes transport the ovum.

Match the phase of the ovarian cycle with the event that occurs. Ovum Matures Follicle Ruptures Cells from Follicle Persist

Ovum Matures- Follicular Phase Follicle Ruptures- Ovulatory Phase Cells from Follicle Persist- Luteal Phase

A newborn child is noted to have malodorous, musty urine and later shows signs of developmental delay and seizures. Which disorder presents with these characteristics? A. Sickle Cell B. Phenylketonuria C. Marfan Syndrome D. Muscular Dystrophy

Phenylketonuria Phenylketonuria leads to buildup of toxic phenylalanine. This can be neurotoxic, causing brain damage, developmental delay, and seizures. There is also a characteristic musty odor to the urine.

Postnatal Diagnosis

Physical examination and measurements Imaging procedures (such as ultrasonography, radiography, echocardiography) Chromosome analysis DNA analysis Tests for metabolic disorders (phenylketonuria, cystic fibrosis) Hemoglobin analysis for disorders, such as SCD Immunologic testing for infections Autopsy

Which auxiliary structures play a role in the elimination of fetal waste? (Select all that Apply) Which auxiliary structures play a role in the elimination of fetal waste? Select all that apply. Placenta Umbilical vein Amniotic fluid Fetal membranes Umbilical arteries

Placenta Umbilical Arteries

A child is born with a genetic disorder and is found to have 46 chromosomes. Which type of disorder could have caused the genetic disorder? (select all that apply) Polygenic Disorder Single Gene Disorder Chromosomal Disorder Autosomal Recessive Disorder Autosomal Dominant Disorder

Polygenic Disorder Single Gene Disorder Autosomal Recessive Disorder Autosomal Dominant Disorder

Polygenic Disorders

Polygenic disorders are inherited through changes in multiple genes and can also involve multiple chromosomes. The inheritance patterns are more complex than in single gene disorders and can also be influenced by external factors. Many traits such as eye color and blood type are polygenic, meaning that more than one allele determines the genotype and thus the phenotype of the individual. Diabetes Coronary artery disease Breast/Colon Cancer cleft palate, congenital hip dislocation, congenital heart disease, type 2 diabetes mellitus, anencephaly, and hydrocephalus.

Polyploidy

Polyploidy occurs when gametes do not halve their chromosome number during meiosis and retain both members of the pair, or when two sperm fertilize an ovum simultaneously. The result is an embryo with one or more extra sets of chromosomes. The total number of chromosomes is a multiple of the haploid number of 23 (69 or 92 total chromosomes). An example of this is called tetraploidy, in which an embryo has four copies of each chromosome. Polyploidy usually results in an early spontaneous abortion but is occasionally seen in a live-born infant.

percosious puberty

Precocious puberty is sexual maturation that occurs before age 6 years in African American girls or before age 7 years in Caucasian girls. Precocious puberty occurs in three forms: isosexual, heterosexual, and incomplete. Isosexual precocious puberty is GnRH-dependent and occurs when the hypothalamic-pituitary-gonadal axis is working normally but prematurely.Heterosexual precocious puberty is virilization in a girl and causes her to develop some male secondary sex characteristics. The condition is present at birth and is rare in older children.Incomplete precocious puberty is when secondary sex characteristics are only partially developed, and complete puberty (ovulation, menstruation in girls) is not achieved. The majority of girls with precocious puberty are obese.

Two types of Prenatal Genetic Testing

Prenatal Screening-pre pregnancy, screening of parents to determine the chances of fetus will have a genetic disorder Prenatal Diagnostic- during pregnancy, performed on cells of fetus or placenta to determine if the fetus actually has a genetic disorder

Which cardiovascular changes that occur in fetal circulation occur after birth? (Select all that apply.) Pressure decreases in the left atrium. Pressure decreases in the right atrium. The three fetal shunts constrict or close. Pressure in the aorta and pulmonary artery increases. Blood flow from the pulmonary artery to the aorta reverses.

Pressure decreases in the right atrium. The three fetal shunts constrict or close. Blood flow from the pulmonary artery to the aorta reverses.

Development of female breast tissue is related to which process of sexual maturation? Release of luteinizing hormone from the anterior pituitary Oxytocin production by the posterior pituitary gland Release of estrogen from the ovaries Release of prolactin from the breasts

Release of estrogen from the ovaries

In which direction does neonate blood flow from the inferior vena cava? Place the structures in the order of blood flow from the inferior vena cava in the neonate. Pulmonary artery Lungs Right ventricle Right atrium

Right atrium Right ventricle Pulmonary artery Lungs

Which description represents the normal anatomic structure of the external os of the cervix in a nulliparous woman? Rounded with tags Round and smooth Large, slit-like opening Irregular and softened

Round and smooth

secondary amenorrhea

Secondary amenorrhea describes absence of menstruation for at least three cycles after regular cycles have been established. Both primary and secondary amenorrhea are more common in girls who are thin because they may have too little fat to produce enough sex hormones to stimulate ovulation and menstruation.

An 18-year-old presents with a history of hip pain and is found to have avascular necrosis. Which genetic disorder may be present? Cystic Fibrosis Sickle Cell Disease Tay-Sachs Disease Edwards Syndrome

Sickle Cell Disease

Which genetic disorders can be understood using Punnett squares? (select all that apply) Polygenic Disorder Single Gene Disorder Chromosomal Disorder Autosomal Recessive Disorder Autosomal Dominant Disorder

Single Gene Disorder Autosomal Recessive Disorder Autosomal Dominant Disorder

1st Trimester Body Development

The body begins growing faster than the head. The extremities approach their final relative lengths; the legs remain proportionally shorter than the arms. The first fetal movements begin but are too slight for the mother to detect.

Third Trimester Weeks 25-28

The fetus becomes plumper and smoother skinned, and the fetal skin becomes less red. The eyes, closed since 9 weeks, reopen. Head hair is abundant. Blood formation shifts from the spleen to the bone marrow. The fetus, which has been floating freely in the head-up position (breech) within the amniotic sac, usually assumes a head-down position for two reasons: the uterus is shaped like an inverted egg, and the fetal head is heavier than the feet; and gravity causes the head to drift downward in the pool of amniotic fluid.

2nd Trimester weeks 21-24

The fetus continues gaining weight but is thin and has little subcutaneous fat. Skin is translucent and looks red because the capillaries are close to the surface. Lungs begin to produce lung surfactant, which will help the infant breathe after birth. The capillary network surrounding the alveoli is increasing but is still very immature.

2nd Trimester weeks 13-16

The fetus rapidly grows in length. The head becomes smaller in proportion to the total length of the fetus. Fetal movements produce the experience of "quickening." The face looks human because the eyes face forward. The external ears approach their final position, in line with the eyes.

follicular phase

The follicular phase is the period during which an ovum matures. It begins with the first day of menstruation and ends about 14 days later in a 28-day cycle.

Which statement describes how the endometrium responds to the female reproductive cycle? The myometrium causes blood loss during menarche. The functional layer of the endometrium releases estrogen and progesterone. The functional layer of the endometrium is shed during the menstrual period. The basal layer of the endometrium regenerates the myometrium each month.

The functional layer of the endometrium is shed during the menstrual period.

1st Trimester Head Development

The head is large, about half the total length of the fetus. The face is broad, with a wide nose and widely spaced eyes. The eyes close at 9 weeks and reopen at 26 weeks. The ears appear low set because the mandible is still small.

Which factors allow for the exchange of nutrients and waste products between maternal and fetal blood without the physical mixing of their blood? (Select all that apply.) The presence of a fetal artery The presence of the two umbilical arteries The intervillous space of the placenta The presence of the umbilical vein and fetal capillaries The lack of direct contact between fetal capillaries in chorionic villi and mother's blood

The intervillous space of the placenta The lack of direct contact between fetal capillaries in chorionic villi and mother's blood

1st Trimester Internal Structures Development

The intestinal contents that were partly contained within the umbilical cord enter the abdominal cavity, which has increased in size. Blood formation primarily occurs in the liver during the ninth week. Blood shifts to the spleen by the end of the 12th week. The fetus begins producing urine during this period. Urine is excreted into the amniotic sac as part of the amniotic fluid.

Autosomal Dominant

The presence of the defect in only one of the alleles produces clinical expression of the disease in autosomal dominant disorders. An affected parent has a 50% probability of passing the disorder on to each child. There are no carriers, and unaffected persons do not transmit the disorder. Huntington disease Adult polycystic kidney disease Familial- hypercholesterolemia(FH) Marfan syndrome

4 phases of the endometrial cycle

The proliferative phase: approximately fifth day to time of ovulation. The secretory phase: day of ovulation to about 3 days before the next menstrual period. The ischemic phase: blood supply to the functional endometrium is blocked, and necrosis develops (if implantation does not occur within 7 to 10 days postovulation. The menstrual phase: menstrual bleeding begins, marking day 1 of the female reproductive cycle.

Third Trimester Weeks 29-32

The skin is pigmented according to ethnicity and is smooth. Larger vessels are visible over the fetal abdomen, but small capillaries cannot be seen. Toenails are present, and the fingernails extend to the fingertips. The fetus has more subcutaneous fat, rounding the body contours.

Which statements regarding the secretion of human chorionic gonadotropin (hCG) are accurate? (Select all that apply.) The zygote secretes hCG. A high level of hCG is a pregnancy indicator. Pregnant women have high levels of hCG and progesterone. Ovulating women have higher amounts of hCG in their system. Increased hCG production causes decreased estrogen secretion.

The zygote secretes hCG. A high level of hCG is a pregnancy indicator. Pregnant women have high levels of hCG and progesterone.

Which physical change indicates impending ovulation? Necrotic endometrium Thin, stringy cervical mucus Thickened endometrial secretions Dilation of endometrial blood vessels

Thin, stringy cervical mucus

Which phrase describes the purpose of the luteal phase of the female reproductive cycle? To release the mature ovum To promote the growth of the follicle To enable menstrual flow To prepare the endometrium for the ovum

To prepare the endometrium for the ovum

Which statement best describes the function of the fallopian tube? Receives the male sperm Contracts to expel the fetus Transports ovum to the uterus Secretes colostrum

Transports ovum to the uterus

Which chromosomal abnormalities result in a form of Down syndrome? (select all that apply) Trisomy 18 Trisomy 21 Polysomy X Monosomy X Translocation

Trisomy 21 Translocation

Layers of embryonic disk

ectoderm, mesoderm, endoderm

Trisomy

exists when each body cell contains an extra copy of one chromosome, bringing the total number to 47 instead of the normal number (46). Each chromosome is normal, but there is an extra chromosome in every cell. The most common trisomy is Down syndrome, or trisomy 21. In Down syndrome, each body cell has three copies of chromosome 21.

pre-embryonic period

fertilization to week 2 Zygote divides into 2, then 4, then 8 cells etc. When it reaches 12-16 cells its called a Morula. The outer cells of the morula secrete fluid creating a sack of cells called the blastocyst. The inner cell mass of the blastocyst develops into the fetus, the outer cell mass of the blastocyst develops into the placenta and fetal membranes.

embryonic period

occurs from day 15 through the eighth week after conception. Basic structures of all major body organs are completed during the embryonic period. The cells of the embryo undergo differentiation. By the end of the eighth week, all major organ systems are developed, and many are functioning.

Multifactorial Disorders

some of the most common birth defects that a maternal-child nurse encounters. Heart defects Neural tube defects, such as anencephaly (absence of most of the brain and skull) and spina bifida Cleft lip and cleft palate Pyloric stenosis

Down Syndrome

three chromosomes in the 21st chromosome Upward-slanting peripheral features, epicanthal folds, and a flat nasal bridge Brushfield spots are seen in the eyes A bridged palmar crease A wide space between first and the second toes Short 5th Finger Small ears and Flat Occiput

Transfer functions of the placenta

• Gas exchange • Nutrient transfer • Waste removal • Antibody transfer (IgG) • Maternal hormones