Ricci Chapter 3: Anatomy and Physiology of the Reproductive System

A nurse is providing education to a client with infertility concerns. Which statement by the client indicates appropriate understanding of the Spinnbarkeit Test?

"Halfway in my cycle I will need to check my cervical mucus to see if I can stretch it into long strands, indicating I am close to ovulating. A nurse is providing education to a client with infertility concerns. Which statement by the client indicates appropriate understanding of the Spinnbarkeit Test?

When assessing an adolescent for the use of safer sex practices, which should be the nurse's first question?

"Have you engaged in oral, vaginal, and anal sex?" The nurse should first assess the client for sexual activity. All other responses assume that the client is already engaged in sexual activity and therefore not appropriate first responses.

When a woman is planning pregnancy, what is her window around ovulation to have intercourse?

2 days before to 1 day after ovulation At ovulation, the consistency of the mucus changes so that sperm can swim through it, allowing fertilization. At the same time, the mucus-secreting glands of the cervix actually become able to store live sperm for 2 or 3 days. These sperm can later move up through the corpus and into the fallopian tubes to fertilize the egg; thus, intercourse 1 or 2 days before ovulation can lead to pregnancy. Additionally, since the ovum lives approximately 24 hours, intercourse one day after ovulation may result in pregnancy.

It is important that couples who wish to practice natural forms of birth control understand that the mucus-secreting glands of the cervix can store live sperm for up to:

48 hours The mucus-secreting glands of the cervix are capable of storing live sperm for 48 to 72 hours (2 to 3 days), enabling pregnancy to occur after intercourse has occurred 1 or 2 days before ovulation.

A nurse is teaching a group of adolescent girls about the menstrual cycle. The nurse would integrate information about which hormones as being predominant during the cycle? Select all that apply.

FSH LH GnRH The predominant hormones involved in the menstrual cycle are gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, progesterone, and prostaglandins. Testosterone and prolactin do have a role in the female reproductive system are not considered predominant hormones for the menstrual cycle.

A young male asks the nurse at the clinic about what he can do to maintain his sperm production. The nurse would instruct him to take which action?

it is recommended that men wear boxer style underwear It is recommended that men wear loose fitting pants and underwear in order to keep the testes cooler than body temperature to best support sperm production. Tight pants and hot baths are counterproductive to sperm production; wearing cotton underwear does not affect it.

After teaching a class on the female reproductive system, the nurse determines that the teaching was successful when the class identifies which action as the primary function of the ovaries?

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

The mother of a 9-year-old girl is concerned because her daughter has already begun menstruating. The daughter is of normal height for her age and weighs 150 lbs (68 kg). The mother is concerned that this is not normal and asks about the factors that could be involved. Which response by the nurse would be best?

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

A 12-year-old girl expresses concern to the nurse because she has not begun her period yet. The nurse notes that the girl has grown 6 in (15 cm) in the past year and a half and is beginning to develop breast buds. Which response by the nurse is appropriate?

"It is normal for females to begin menstruating between the ages of 12 and 15" There is wide variation in the time required for adolescents to move through sexual developmental stages; however, the sequential order is fairly constant. In girls, pubertal changes typically occur in the following order: growth spurt, increase in transverse diameter of the pelvis, breast development, growth of pubic hair, onset of menstruation, growth of axillary hair, and vaginal secretions. Thelarche, which is the beginning of breast development, usually starts 1 to 2 years before menstruation. Given the signs of development that this client has already exhibited, it seems likely that she will begin her period in the coming year. Her development is completely normal, so the nurse should not suggest something is wrong by stating she will notify the health care provider. The client does not indicate another issue is concerning her; therefore, the nurse would address the client's current statement. The nurse would not tell the client to not be concerned as this statement is not therapeutic and does not address the client's concern.

A woman experiencing menopausal symptoms asks the nurse about herbal remedies for managing her symptoms. Which response by the nurse would be most appropriate?

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

The caregiver of a 10-year-old male client tells the nurse, "He is already showing signs of puberty. He has facial hair and his voice has changed. I want to have his hormone levels tested." Which response by the nurse is appropriate?

"This is normal for his age. Puberty can begin as early as 8 years of age" While the average age for puberty to begin in males is 12 years of age, it can occur anytime between the ages of 8 and 14. When the primary androgenic hormone testosterone rises, it influences the following: pubertal changes in the testes, scrotum, penis, prostate, and seminal vesicles; the appearance of male pubic, axillary, and facial hair; laryngeal enlargement with its accompanying voice change; maturation of spermatozoa; and closure of growth plates in long bones (termed adrenarche). Stating the client's hormone levels should be tested is inaccurate and unnecessary as this is an expected developmental change. Determining if the client's father had the same experience or only notifying the primary health care provider does not address the caregiver's concerns.

The nurse educates a client who is confused about her ovarian cycle. Which client statement would best validate her understanding of the education?

"Two hormones control my ovulation, follicle stimulating hormone (FSH) and luteinizing hormone (LH)" Ovulation is controlled by FSH and LH, with the follicle-stimulating hormone encompassing days 1 to 14 of a 28-day cycle and the luteinizing hormone controlling the luteal phase, which is days 15 to 28. The follicle forms only in the ovary, not the uterus. Ovulation should occur on Day 14 of a normal 28-day cycle. Both estrogen and progesterone are necessary to the menstrual cycle, not just progesterone.

During a prenatal visit, a pregnant woman tells the nurse, "I have had to buy some new bras because my breasts are getting bigger. I know this is supposed to happen, but what is going on in my body?" Which response by the nurse would be appropriate?

"Your hormones are causing the glands in your breasts to grow" During pregnancy, placental estrogen and progesterone stimulate the development of the mammary glands. Because of this hormonal activity, the breasts may double in size during pregnancy in preparation for milk production. At the same time, glandular tissue replaces the adipose tissue of the breasts. Following childbirth and the expulsion of the placenta, levels of placental hormones (progesterone and lactogen) fall rapidly, and the action of prolactin (milk-producing hormone) is no longer inhibited. Prolactin stimulates the production of milk within a few days after child birth, but in the interim, dark yellow fluid called colostrum is secreted. The substances in breast milk are not present until breast milk is produced.

The nurse is caring for a couple trying to conceive. The nurse learns the male client relaxes in the couple's home hot tub daily for 30 to 60 minutes and the female client uses the hot tub once a week for 5 to 10 minutes. What information is best for the nurse to include when providing education to the couple at this time?

"men desiring to conceive should limit their time in the hot tub" The nurse would educate the male client to limit time in the hot tub to promote an adequate sperm count and development. Prolonged exposure of the testes to high temperatures can lead to decreased sperm counts. The male's sperm count will rise once the hot tub is avoided. The couple states using their personal home hot tub; therefore, the risk of infection is not a concern. There is limited research showing a risk to the fetus exposed to high temperatures. Current recommendations state the pregnant client should not spend more than 10 minutes in a hot tub. The nurse would provide education on this information once the client is pregnant. Although it is healthy for the couple to limit stress, this is not the most appropriate response from the nurse. The nurse would address the issue of hot tub use because stress is not mentioned as an issue for the couple at this time.

The nurse is caring for a premenopausal client scheduled for a bilateral oophorectomy. Which education will the nurse provide the client regarding this procedure?

"this procedure will greatly reduce your estrogen and progesterone levels" In a bilateral oophorectomy, both ovaries, the two almond-shaped bodies lying on either side of the uterus, are surgically removed. They contain ova and female hormones, specifically estrogen and progesterone. Following the procedure, premenopausal clients will have a sharp reduction in estrogen and progesterone levels. This can cause a sudden onset of menopause, and the client needs to be prepared. An oophorectomy will decrease the client's probability of developing breast cancer by up to 50% but will not prevent it. There is no need for monthly hormone level testing unless the client experiences complications. Contraceptive use is no longer needed because the ovaries contain the client's ova.

A sex education class is being conducted at a local women's center. The attendees ask the nursing instructor about why they experience sensations of increased warmth during sex and redness of the neck and chest. Which information would the nurse provide to explain this experience? Select all that apply.

A person's heart rate increases during sex, making them warmer. The blood pressure will increase, which can cause a feeling of warmth. Vessels in the pelvis are receiving more blood and can cause a warm sensation During the excitement phase of the sexual response, the body undergoes several physical changes. An increase in the heart rate and blood pressure are two of the normal responses noted; these cause an increase in body warmth. Additionally, the pelvic vessels become congested and this increases blood flow and the area becomes warmer. Reddening of the neck and chest are noted in many people during sex and adds to the sensation of increased warmth. The respiratory rate increases, not decreases, during sex.

A nurse is conducting an orientation at a health clinic for newly hired nurses comparing normal and abnormal findings from a female physical assessment. The nurse determines the session is successful when they correctly point out which structure's secretions assist with sexual intercourse?

Bartholin glands The Bartholin glands are located in the vestibule and secrete a mucus that moistens the vaginal mucosa during sexual intercourse. The introitus is the opening to the vagina. The vulva vestibule is the area between the labia minora. It contains the ureteral meatus, Skene glands, introitus, and Bartholin glands. The labia minora are paired erectile tissue folds that extend anteriorly from the clitoris and join at the perineum.

The nurse is caring for a couple trying to conceive their first child. The couple state they have been attempting to become pregnant for the past year. Which finding in the couple's history most concerns the nurse?

a female client with a history of pelvic inflammatory disease The nurse would be most concerned learning the female client has a history of PID, because this can cause scarring and lead to subfertility. Consuming 4 to 5 alcoholic drinks per week is not concerning. Excessive alcohol consumption can interfere with fertility and would be addressed. The female client's mother having breast cancer does place the client at increased risk; however, this is not the primary concern at this time. The male client's sister having infertility does not indicate a genetic complication because one sibling is male and the other female.

The seminiferous tubules are tiny coils of tissue where spermatogenesis occurs. Where do the sperm mature?

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

The vagina is a hostile environment for sperm. What characteristic of semen protects sperm from the vaginal environment?

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

The nurse is reviewing the structure and function of various organs in the female reproductive system. Which information should the nurse include about the ovum in the review with the client?

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

The nurse is reviewing hormonal regulation of the female reproductive system with a group of nursing students. A student nurse states, "Progesterone prepares a woman's uterus to receive and welcome a fertilized ovum." Which action will the nurse complete based on the student's response?

applaud the student for understanding the material The nurse would applaud the student's understanding of the material. There is no need for a more in-depth discussion with the student or to clarify material because the student is showing comprehension of the hormone's function. Asking the student about her past medical history is inappropriate in the group setting. This information is irrelevant to the situation as well.

A client asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which statement should the nurse expect to include in the client's teaching plan?

as ovulation approaches, cervical mucus is abundant and stretchable During ovulation, the cervix produces thin, clear, stretchy, slippery mucus that is designed to capture the man's sperm, nourish it, and help the sperm travel up through the cervix to meet the ovum for fertilization.

A client asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which statement should the nurse expect to include in the client's teaching plan?

as ovulation approaches, cervical mucus is abundant and stretchy During ovulation, the cervix produces thin, clear, stretchy, slippery mucus that is designed to capture the man's sperm, nourish it, and help the sperm travel up through the cervix to meet the ovum for fertilization.

A nurse is providing information regarding ovulation to a couple who want to have a baby. Which fact should the nurse tell the clients?

at ovulation, a mature follicle ruptures, releasing an ovum At ovulation, a mature follicle ruptures, releasing a mature oocyte (ovum). Ovulation always takes place 14 days, not 10 days, before menstruation. The lifespan of the ovum is only about 24 hours, not 48 hours; unless it meets a sperm on its journey within that time, it will die. When ovulation occurs, there is a drop, not a rise, in estrogen levels.

The nurse is examining a pregnant female in her third trimester and measuring to determine if fetal growth has increased. Where would the nurse place the measuring tape?

at the top of the fundus The uterine fundus is located that the uppermost portion of the uterus; that is where the uterus is measured to determine fetal size and gestation. The isthmus is the uterine segment that connects the cervix to the uterus. The corpus, the main body of the uterus, is not the top of the uterus. One end of the measuring tape is placed at the top of the pubic symphysis and extended to the top of the fundus.

The nurse is teaching a group of college students about the four phases of the sexual response. Which phase will the nurse point out as producing an elevation in heart rate, blood pressure, and respirations?

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

The nurse at a health fair is teaching about the various changes of puberty. Which sequence of events will be best for the nurse to present when illustrating pubertal changes in females?

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

The nurse is assessing a female client who is having difficulty experiencing an orgasm. Which action should the nurse point out as often being necessary for an orgasm in females?

clitoral stimulation The clitoris is highly sensitive and allows the woman to experience pleasure during sexual stimulation. It is thought to be the main stimulus for initiating orgasm in women. Penetration may be pleasurable, but alone it is not enough to stimulate orgasm. Uterine stimulation does not affect orgasm. Sensory arousal also plays a major role in attaining female orgasm.

A group of nursing students are comparing male and female reproductive organs. The instructor determines the class is successful when the students correctly deduce the male glans penis is complementary to which female structure?

clitoris The female clitoris is complementary (equitable) to the glans; both of these are composed of erectile tissue and are the primary organs responsible for orgasm. Other comparable structures include the testes and ovaries, and scrotum and labia majora. The vagina does not have a comparable male structure.

The school nurse is preparing to illustrate the menstrual cycle to a group of high school students. Which change in the hormones will the nurse point out as being responsible for the onset of menstruation?

decrease in progesterone A decrease in progesterone and estrogen during the menstrual phase is responsible for the shedding of the uterine lining, resulting in menstruation. Increases in estrogen and progesterone result in the growth of the endometrium in preparation for implantation of the fertilized ovum. An increase in luteinizing hormone will result in ovulation. An increase in follicle-stimulating hormone will result in the formation of a follicle, which results in a mature ovum being released at ovulation.

A nurse is preparing a presentation for a group of young adults about the sexual response cycle. Place the events in the sequence that they would occur. Use all options.

desire excitement plateau orgasm resolution The sexual response cycle for males and females is as follows: Desire, excitement, plateau, orgasm, and resolution.

The nurse is assessing a 16-year-old female on a routine well-child visit. Which assessment finding will the nurse predict this healthy female will report concerning her menstrual cycles?

flow usually lasts 4-6 days The average menstrual flow is 4 to 6 days in length. The cycle usually lasts 28 days. There should be no mucus during the menstrual cycle, with clear mucus being noted at the time of ovulation or approximately day 14. Menstruation usually begins at the age of 12 to 14 years.

The nurse is teaching a group of women about the hormone that makes the ovum within the ovaries mature each month. Which hormone is responsible for stimulating the ovum?

follicle stimulating hormone The follicle-stimulating hormone (FSH) is the messenger from the pituitary gland to stimulate the ovum to mature. Luteinizing hormone is the hormone that is released from the pituitary gland once the follicle containing the ovum is mature, but it has no role in maturing the ovum. Estrogen and progesterone are integral parts of the ovulatory cycle but do not mature ovum.

A nurse is conducting an in-service education program about the female reproductive cycle for a group of nurses working at a women's health clinic. When describing the phases of the endometrial cycle, the nurse would explain that the proliferative phase of the endometrial cycle corresponds to which phase in the ovarian cycle?

follicular The endometrial cycle consists of four phases: proliferative, secretory, ischemic, and menstrual. The proliferative phase of the endometrial cycle corresponds to the follicular phase of the ovarian cycle.

A mother brings her 10-year-old daughter to the clinic for a routine visit. The mother tells the nurse that she has noticed her daughter beginning to develop and asks the nurse about when her daughter may begin menstruating. The nurse understands that many factors are involved in determining the age at which menstruation begins. Which factor would the nurse include in the response as most important?

genetics Genetics is the most important factor in determining the age at which menarche starts, but geographic location, nutrition, weight, general health, nutrition, cultural and social practices, the girl's educational level, attitude, family environment, and beliefs are also important.

A young woman is trying to get pregnant. She asks the nurse to recommend a practical way that she can tell the point in her monthly cycle when she will have the best odds of getting pregnant. Which recommendation by the nurse would be best?

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

The nurse, while teaching a group of pregnant women about the production of breast milk, describes colostrum and compares it with mature breast milk. Which characteristic would the nurse identify as associated with colostrum?

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

The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of nursing students. What would be the best response by a nursing student about the function of the uterus?

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

The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of nursing students. What would be the best response by a nursing student about the function of the uterus?

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

A nurse is assessing a female client. When obtaining the client's history, the client tells the nurse that her menstrual cycle is usually 30 days and that she expects her next menstruation on March 20. Based on the client's information and the nurse's understanding of the female reproductive cycle, the nurse would identify ovulation as most likely occurring at which time?

march 6 Ovulation usually occurs on day 14 in a 28-day cycle; however, whether a woman's cycle is 28 days or 120 days, ovulation takes place 14 days before menstruation.

A 47-year-old woman is being seen at the local clinic reporting irregular menstrual cycles. The nurse would explain to the client that the irregularity is most likely due to:

menopause As a woman's reproductive capabilities end, her menstrual cycles will become irregular and finally cease. The average age for menopause is 47 to 55 years. This client meets these criteria. Pregnancy would cause absence of menstrual cycles. Hormonal fluctuations and underlying endocrine problems would not be the anticipated causality.

A 47-year-old woman is being seen at the local clinic reporting irregular menstrual cycles. The nurse would explain to the client that the irregularity is most likely due to:

menopause As a woman's reproductive capabilities end, her menstrual cycles will become irregular and finally cease. The average age for menopause is 47 to 55 years. This client meets these criteria. Pregnancy would cause absence of menstrual cycles. Hormonal fluctuations and underlying endocrine problems would not be the anticipated causality.

When teaching a group of female adolescents about reproduction and reproductive organs, the nurse describes the vulva. Which structure(s) would the nurse identify as being included? Select all that apply.

mons pubis labia clitoris The structures that make up the vulva include the mons pubis, the labia majora and minora, the clitoris and prepuce, the structures within the vestibule, and the perineum. The vagina and fallopian tubes are internal reproductive structures.

A woman experiencing menopausal symptoms asks the nurse about herbal remedies for managing her symptoms. Which response by the nurse would be most appropriate?

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

After teaching a group of women about reproduction and the structures involved, the nurse determines that the teaching was successful when the group identifies which female reproductive structure as comparable to the male testes?

ovaries The ovaries are a set of paired glands resembling unshelled almonds that are the organs of gamete production in the female. They are homologous to the male testes. The fallopian tubes are the site of fertilization. The clitoris is a small, cylindrical mass of erectile tissue and nerves that is analogous to the male penis. The fundus is the upper portion of the uterus.

With sexual stimulation the penis becomes erect. What is the physiologic cause of an erection?

penile sinuses fill up with blood The sinuses within the erectile tissue fill up with blood, causing an erection.

A client is returning with a third vaginal infection within a six-month period. During the health assessment, the nurse should ask about the client's use of which products? Select all that apply.

perineal hygiene sprays douches deodorants Antibiotic therapy, douching, perineal hygiene sprays, and deodorants upset the acid balance within the vaginal environment and can predispose women to infections. The vagina depends on its acidic environment to protect it against ascending infections. Using herbs and eating yogurt are not recognized for increasing the risk of infections.

The nurse is answering questions from a newborn's parents concerning a circumcision. Which structure will the nurse point out is removed during the procedure?

prepuce The foreskin or prepuce is a fold of skin which covers the glans of the penis. This fold of skin is removed in a circumcision. The tunica albuginea is connective tissue found inside the penile shaft. The corpus spongiosum is erectile tissue that runs the full length of the penis. Rugae are folds that allow for stretching during an erection.

In taking a client history, a client tells the nurse she is having vaginal itching and irritation. Which reported practice could be contributory to this problem?

previous history of taking clindamycin Antibiotic therapy, use of tampons or deodorant sanitary pads, or douching can all cause vaginal irritation and infection. Wearing cotton underwear is a good habit, allowing air to circulate in the vaginal area. Use of hypoallergenic soaps for bathing is a good idea. Lastly, there is no problem with taking a tub bath as related to vaginal irritation, as long as the person does not remain in the tub for a protracted time frame.

Which hormone is called the hormone of pregnancy because it reduces uterine contractions during pregnancy?

progesterone Progesterone is called the hormone of pregnancy because it reduces uterine contractions, thus producing a calming effect on the uterus, allowing pregnancy to be maintained. FSH is primarily responsible for the maturation of the ovarian follicle. LH is required for both the final maturation of preovulatory follicles and the luteinization of the ruptured follicle. Estrogen is crucial for the development and maturation of the follicle.

The nurse is caring for a 16-year-old female client. The client states, "I recently had sex for the first time and I had some bleeding afterward. It was not time for my period. Could something bad have happened?" Which action will the nurse complete next?

provide education to the client about sexual intercourse The nurse would educate the client on the potential tearing of the hymen during sexual intercourse. The hymen is a tough but elastic semicircle of tissue that covers the opening to the vagina during childhood. It is often torn during the time of first sexual intercourse. It is less likely that the blood is a result of an irregular period or an injury to the vagina, as there is no evidence for either in the scenario. Bleeding is not a sign of pregnancy or a sexually transmitted infection. The nurse would discuss with the client the potential need for testing and then determine if there is a need. The health care provider could discuss the option of an oral contraceptive with the client; the nurse would not assume the client desires contraceptives.

A female client states, "I am concerned because when I have sex with my spouse, I have an area near my vagina that is really sensitive to touch." Which action will the nurse complete?

provide education to the client on the female anatomy The nurse understands this is a normal, expected experience and would provide education to the client on the clitoris and its function. The clitoris is a small, cylindrical mass of erectile tissue and nerves that is highly sensitive and analogous to the head of the male penis. There is no indication for counseling because no signs of current or past abuse are present. This is not an indication of an STI or urinary tract infection; therefore, no additional testing or specimens are needed.

The nurse is caring for a client experiencing perimenopausal symptoms. The client states intercourse has become painful. Which nursing action is appropriate?

recommend the client to use lubrication during intercourse During sexual activity, the walls of the vagina secrete a thin watery material, necessary for the comfortable placement and movement of the penis in the vagina during intercourse. Decreased lubrication is a symptom of perimenopause, which often results in painful intercourse. The nurse would first recommend the client use lubrication with intercourse before invasive procedures are performed. Hormone levels may be assessed if lubrication is not effective. There is no indication the client needs to see a specialist at this time. Intercourse frequency does not need to be assessed based on the client's symptoms. The findings do not indicate a concern with frequency.

The nurse is caring for a client experiencing perimenopausal symptoms. The client states intercourse has become painful. Which nursing action is appropriate?

recommend the client use lubrication during intercourse During sexual activity, the walls of the vagina secrete a thin watery material, necessary for the comfortable placement and movement of the penis in the vagina during intercourse. Decreased lubrication is a symptom of perimenopause, which often results in painful intercourse. The nurse would first recommend the client use lubrication with intercourse before invasive procedures are performed. Hormone levels may be assessed if lubrication is not effective. There is no indication the client needs to see a specialist at this time. Intercourse frequency does not need to be assessed based on the client's symptoms. The findings do not indicate a concern with frequency.

A woman has been assessing her basal body temperature for 4 months. Upon reviewing her temperature history log, the nurse notes no change in her daily temperatures. Which should the nurse expect the health care provider to prescribe first?

serum progesterone level There should be a significant increase in temperature, usually 0.5° to 1° F, within a day or two after ovulation has occurred. The temperature remains elevated for 12 to 16 days, until menstruation begins. The cause of this rise in temperature is the hormone progesterone. If there is no change in the woman's monthly temperature, the progesterone level should be assessed.

The nurse at the fertility clinic is counseling two women in a relationship about their decision to start a family. Which decision would the nurse discuss that is unique to their situation?

which partner carrier the pregnancy A unique decision that needs to be made by two women who decide to seek pregnancy is who will carry the pregnancy. The other decisions such as selection of a sperm donor, the methods of insemination, and the cost of the attempts to conceive are decisions made by all couples seeking fertility services.

A newly married female is talking to the nurse about her desire to get pregnant soon. Which suggestion would the nurse make to assist this client?

sexual intercourse should occur between day 13-15 of her menstrual cycle Fertilization occurs when the woman ovulates and has intercourse within a day either before or after ovulation. The mucus near ovulation is clear, stretchable and thin to facilitate the movement of the sperm. Conception can only occur at the time of ovulation, so having the client engage in intercourse on the same days monthly will not help her conceive. Waiting one week following ovulation will lessen the chance of conception greatly.

A client is at the clinic for her yearly physical and is found to be anemic. What information from her history would most likely be a contributory factor to this finding?

she reports that her menstrual cycle is irregular and often lasts up to 7-10 days Prolonged menstrual cycles can cause anemia and iron deficiency due to the blood loss. The other factors will not make the client anemic.

A nurse is assisting with the pelvic examination of a female client. The client has given birth to two living children, ages 5 and 2 years. The nurse would expect the client's cervical os to appear as which shape on examination?

slit like Before birth, the external cervical os is a small, regular, oval opening. After birth, the opening is converted into a transverse slit that resembles lips.

The school nurse is teaching a health education class on the male reproductive system. The nurse determines the class is successful when the students correctly point out which structure produces sperm?

testes The testes are responsible for sperm production. The seminal vesicles produce nutrient seminal fluid. The scrotum surrounds and protects the testes. The prostate gland and the seminal vesicles produce fluid to nourish the sperm.

A nurse is conducting a health class for a group of adolescents about male and female reproduction. When describing the testes, the nurse would explain that these organs are important for manufacturing which hormone?

testosterone The testes serve two functions: production of sperm and synthesis of testosterone, the primary male sex hormone. Estrogen is secreted by the ovaries; progesterone is secreted by the corpus luteum. Luteinizing hormone is secreted by the anterior pituitary gland and is responsible for both the final maturation of the preovulatory follicles and luteinization of the ruptured follicle.

The school nurse is preparing a teaching session for a group of adolescent girls explaining the menstrual cycle. The nurse determines the session is successful when the young students correctly choose which fact?

the average menstrual flow lasts 4-6 days The average flow lasts 4 to 6 days and is caused by casting away of blood, tissue, and debris from the uterus. The average age for menarche is from 12 to 14 years. Menarche is the end of puberty, which follows breast budding and the appearance of pubic hair. The total blood loss each month is 25 to 60 ml.

A young male client asks the nurse about circumcision, since he was never circumcised as an infant. Which rationale would be appropriate for exploring circumcision in an adult male?

the client has experienced recurring infections of the glans If an uncircumcised client is experiencing medical problems such a recurrent infections of the glans and difficulty retracting the foreskin in adulthood, circumcision is a consideration. Having premature ejaculation is not a reason for circumcision. The foreskin covering the glans is a normal finding, as is one side of the scrotum being higher than the other.

Which statement best expresses the role of the corpus luteum?

the corpus luteum secretes progesterone to promote the preparation of the endometrium for implantation The mature ovum is released from the ovary, resulting in the corpus luteum. Progesterone is produced by the corpus luteum. Estrogen is secreted by the ovaries. Glycogen is secreted by the endometrial glands during the luteal phase. Luteinizing hormone is not a product of the corpus luteum.

Which client should the nurse flag for the health care provider to assess first?

the male client with three palpable masses in his testes The testes should have two nut-like structures present in males. The third mass could indicate a tumor or other anomaly. All the remaining clients have normal, expected findings.

The nurse is teaching a couple trying to conceive about the changes in the cervical mucus near the time of ovulation. The nurse determines the session is successful when the couple correctly choose mucus in which form as indicating ovulation has occurred?

thin and copious During ovulation, the mucus will be distensible and stretchable. After ovulation, the mucus will be scant, thick and opaque in nature. During the proliferative phase before ovulation, it is tacky, crumbly, and yellow or white in color. During the menses, there will be no mucus noted.

The nurse is explaining about the function of the mons pubis to a client. Which explanation describes the function of the mons pubis?

to protect the pelvic bones in sexual intercourse The mons pubis is a fatty pad that lies over the pubic symphysis and serves to protect the pelvic bones during intercourse. The vagina is the receptacle for sperm, the clitoris is the body that enhances sexual pleasure in the female, and the perineum and pelvic floor are the structures that stretch during birth.