Ch 9 Reproductive Physiology, Conception and Fetal Development
1) The nurse is working with a client who has experienced a fetal death in utero at 20 weeks. The client asks what her baby will look like when it is delivered. Which statement by the nurse is best? A) "Your baby will be covered in fine hair called lanugo." B) "Your child will have arm and leg buds, not fully formed limbs." C) "A white, cheesy substance called vernix caseosa will be on the skin." D) "The genitals of the baby will be ambiguous."
Answer: A Explanation: A) Downy fine hair called lanugo covers the body of a 20-week-old fetus. B) Limb buds have developed by 35 days post-fertilization. C) Vernix caseosa forms at about 24 weeks. D) Male and female external genitals appear similar until end of ninth week. At 16 weeks, sex determination is possible. Page Ref: 183
1) The nurse is caring for a client pregnant with twins. Which statement indicates that the client needs additional information? A) "Because both of my twins are boys, I know that they are identical." B) "If my twins came from one fertilized egg that split, they are identical." C) "If I have one boy and one girl, I will know they came from two eggs." D) "It is rare for both twins to be within the same amniotic sac."
Answer: A Explanation: A) Not all same-sex twins are identical or monozygotic, because fraternal, or dizygotic, twins can be the same gender or different genders. B) Identical, or monozygotic, twins develop from a single fertilized ovum. They are of the same sex and have the same phenotype (appearance). C) The only way to have twins of different sexes is if they come from two separate fertilized ova. D) If the amnion has already developed approximately 8 to 12 days after fertilization, division results in two embryos with a common amniotic sac and a common chorion (monochorionic-monoamniotic placenta). This type occurs rarely. Page Ref: 176—177
1) A client tells you that her mother was a twin, two of her sisters have twins, and several cousins either are twins or gave birth to twins. The client, too, is expecting twins. Because there is a genetic predisposition to twins in her family, there is a good chance that the client will have what type of twins? A) Dizygotic twins B) Monozygotic twins C) Identical twins D) Nonzygotic twins
Answer: A Explanation: A) Studies indicate that dizygotic twins tend to occur in certain families, perhaps because of genetic factors that result in elevated serum gonadotropin levels leading to double ovulation. B) Monozygotic twins, known also as identical twins, are not familial. C) Identical twins, known also as monozygotic twins, are not familial. D) Nonzygotic twins do not exist. Page Ref: 176
1) A pregnant client who is at 14 weeks' gestation asks the nurse why the doctor used to call her baby an embryo, and now calls it a fetus. What is the best answer to this question? A) "Fetus is the term used from the ninth week of gestation onward." B) "We call a baby a fetus when it is larger than an embryo." C) "An embryo is a baby from conception until the eighth week." D) "The official term for a baby in utero is really zygote."
Answer: A Explanation: A) The fetal stage begins in the ninth week. B) The embryonic stage ends with the eighth week, regardless of size. C) The preembryonic stage is from conception until day 15. D) A zygote is a fertilized ovum. Page Ref: 185
1) Which term will the nurse use when teaching a client information regarding the entire female external genitalia? A) Vulva B) Clitoris C) Mons pubis D) Perineal body
Answer: A Explanation: A) The vulva is the term the nurse will use when documenting information about the entire female external genitalia. B) The clitoris is a structure included in the female external genitalia. This term is not used when referring to the entire female external genitalia. C) The mons pubis is a structure included in the female external genitalia. This term is not used when referring to the entire female external genitalia. D) The perineal body is a structure included in the female external genitalia. This term is not used when referring to the entire female external genitalia. Page Ref: 158
1) What are the three functions of the fallopian tubes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Provide transport for the ovum from the ovary to the uterus B) Serve as a warm, moist, nourishing environment for the ovum or zygote C) Secrete large amounts of estrogens D) Provide a site for fertilization to occur E) Support and protect the pelvic contents
Answer: A, B, D Explanation: A) The fallopian tubes provide transport for the ovum from the ovary to the uterus. B) The fallopian tubes serve as a warm, moist, nourishing environment for the ovum or zygote. C) The ovaries, not the fallopian tubes, secrete large amounts of estrogens. D) The fallopian tubes provide a site for fertilization to occur. E) The female bony pelvis, not the fallopian tubes, supports and protects the pelvic contents. Page Ref: 161
1) The nurse educator is teaching student nurses what a fetus will look like at various weeks of development. Which descriptions would be typical of a fetus at 20 weeks' gestation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) The fetus has a body weight of 435-465 g. B) Nipples appear over the mammary glands. C) The kidneys begin to produce urine. D) Nails are present on fingers and toes. E) Lanugo covers the entire body.
Answer: A, B, D, E Explanation: A) A fetus at 20 weeks' gestation has a body weight of 435-465 g. B) A fetus at 20 weeks' gestation has nipples appear over the mammary glands. C) Kidneys of a fetus begin to produce urine at 12 weeks' gestation. D) A fetus at 20 weeks' gestation has nails present on fingers and toes. E) A fetus at 20 weeks' gestation has lanugo that covers the entire body. Page Ref: 183
1) Ovarian hormones include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Estrogens B) Progesterone C) Parathyroid hormone D) Luteinizing hormone E) Testosterone
Answer: A, B, E Explanation: A) Ovarian hormones include the estrogens, progesterone, and testosterone. B) Ovarian hormones include the estrogens, progesterone, and testosterone. C) Ovarian hormones do not include the parathyroid hormone. D) Ovarian hormones do not include the luteinizing hormone, although the ovary is sensitive to it. E) Ovarian hormones include the estrogens, progesterone, and testosterone. Page Ref: 162
1) Student nurses in their obstetrical rotation are learning about fertilization and implantation. The process of implantation is characterized by which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) The trophoblast attaches itself to the surface of the endometrium. B) The most frequent site of attachment is the lower part of the anterior uterine wall. C) Between days 7 and 10 after fertilization, the zona pellucida disappears, and the blastocyst implants itself by burrowing into the uterine lining. D) The lining of the uterus thins below the implanted blastocyst. E) The cells of the trophoblast grow down into the uterine lining, forming the chorionic villi.
Answer: A, C, E Explanation: A) During implantation, the trophoblast attaches itself to the surface of the endometrium for further nourishment. B) The most frequent site of attachment is the upper part of the posterior uterine wall. C) Between days 7 and 10 after fertilization, the zona pellucida disappears, and the blastocyst implants itself by burrowing into the uterine lining and penetrating down toward the maternal capillaries until it is completely covered. D) The lining of the uterus thickens, not thins. E) The cells of the trophoblast grow down into the thickened lining, forming the chorionic villi. Page Ref: 170—173
1) The true moment of fertilization occurs when what happens? A) Cortical reaction occurs B) Nuclei unite C) Spermatozoa propel themselves up the female tract D) Sperm surrounding the ovum release their enzymes
Answer: B Explanation: A) At the moment of penetration by a fertilizing sperm, the zona pellucida undergoes a reaction that prevents additional sperm from entering a single ovum, known as the block to polyspermy. This cellular change is mediated by release of materials from the cortical granules, organelles found just below the ovum's surface, and is called the cortical reaction. B) The true moment of fertilization occurs as the nuclei unite. Their individual nuclear membranes disappear, and their chromosomes pair up to produce the diploid zygote. C) Fertilization has not yet occurred when the spermatozoa are still in the female reproductive tract. D) This is part of the acrosomal reaction and occurs prior to fertilization. Page Ref: 172
1) The female and male reproductive organs are homologous, which means what? A) They are believed to cause vasoconstriction and muscular contraction B) They are fundamentally similar in function and structure C) They are rich in sebaceous glands D) They are target organs for estrogenic hormones
Answer: B Explanation: A) Efferent sympathetic motor nerves are believed to cause vasoconstriction and muscular contraction. B) The female and male reproductive organs are homologous; that is, they are fundamentally similar in function and structure. C) The labia minora are rich in sebaceous glands. D) The female internal reproductive organs are target organs for estrogenic hormones. Page Ref: 169
1) A pregnant woman tells the nurse-midwife, "I've heard that if I eat certain foods during my pregnancy, the baby will be a boy." The nurse-midwife should explain that this is a myth, and that the sex of the baby is determined at what time? A) At the time of ejaculation B) At the time of fertilization C) At the time of implantation D) At the time of differentiation
Answer: B Explanation: A) Ejaculation is the release of sperm from the male, and does not necessarily cause a pregnancy. B) Fertilization is the point at which the sex of the zygote is determined. C) Implantation is when the fertilized ovum is implanted in the uterine endometrium. The sex of the zygote has already been determined at this stage. D) Differentiation refers to a cell division process. Page Ref: 172
1) A nurse teaches newly pregnant clients that if an ovum is fertilized and implants in the endometrium, the hormone the fertilized egg begins to secrete is which of the following? A) Estrogen B) Human chorionic gonadotropin (h C G) C) Progesterone D) Luteinizing hormone
Answer: B Explanation: A) Estrogen and progesterone are ovarian hormones. B) If the ovum is fertilized and implants in the endometrium, the fertilized egg begins to secrete human chorionic gonadotropin (h C G), which is needed to maintain the corpus luteum. C) Estrogen and progesterone are ovarian hormones. D) Luteinizing hormone is excreted by the anterior pituitary gland. Page Ref: 180
1) A woman has been unable to complete a full-term pregnancy because the fertilized ovum failed to implant in the uterus. This is most likely due to a lack of which hormone? A) Estrogen B) Progesterone C) F S H D) L H
Answer: B Explanation: A) Estrogens are associated with characteristics contributing to femaleness. B) Progesterone is often called the hormone of pregnancy because it inhibits uterine contractions and relaxes smooth muscle to cause vasodilation, allowing pregnancy to be maintained. C) F S H is a hormone secreted by the pituitary gland, and its lack would not affect the ability of the uterus to be prepared for implantation of the fertilized ovum. D) L H is a hormone secreted by the pituitary gland, and its lack would not affect the ability of the uterus to be prepared for implantation of the fertilized ovum. Page Ref: 163
1) The nurse is preparing a class on reproduction. What is the cell division process called that results in two identical cells, each with the same number of chromosomes as the original cell? A) Meiosis B) Mitosis C) Oogenesis D) Gametogenesis
Answer: B Explanation: A) Meiosis is a process of cell division that leads to the development of ova and sperm. B) Mitosis results in the production of diploid body (somatic) cells, which are exact copies of the original cell. C) Oogenesis is the process that produces the female gamete, called an ovum (egg). D) Gametogenesis is the process by which germ cells, or gametes (ova and sperm), are produced. Page Ref: 170
1) The nurse teaching a high school class explains that during the menstrual cycle, the endometrial glands begin to enlarge under the influence of estrogen and cervical mucosal changes occur; the changes peak at ovulation. In which phase of the menstrual cycle does this occur? A) Menstrual B) Proliferative C) Secretory D) Ischemic
Answer: B Explanation: A) Menstruation occurs during the menstrual phase. B) The proliferative phase begins when the endometrial glands begin to enlarge under the influence of estrogen and cervical mucosal changes occur; the changes peak at ovulation. C) The secretory phase occurs after ovulation. D) The ischemic phase occurs if fertilization does not occur. Page Ref: 163-164
1) The nurse is presenting a class to pregnant clients. The nurse asks, "The fetal brain is developing rapidly, and the nervous system is complete enough to provide some regulation of body function on its own, at which fetal development stage?" It is clear that education has been effective when a participant makes which response? A) "The 17th-20th week" B) "The 25th-28th week" C) "The 29th-32nd week" D) "The 33rd-36th week"
Answer: B Explanation: A) The nervous system function is not developed between the 17th and 20th weeks of gestation. B) Between the 25th and 28th week, the brain is developing rapidly, and the nervous system is complete enough to provide some degree of regulation of body functions. C) The complexity of the nervous system develops long before the 29th-32nd week. D) The complexity of the nervous system develops long before the 33rd-36th week. Page Ref: 183
1) What are the three functions of cervical mucosa? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Form the relatively fixed axis of the birth passage B) Provide lubrication for the vaginal canal C) Provide nourishment and protective maternal antibodies to infants D) Provide an alkaline environment to shelter deposited sperm from the acidic vaginal secretions E) Act as a bacteriostatic agent
Answer: B, D, E Explanation: A) The female boney pelvis forms the relatively fixed axis of the birth passage. B) The cervical mucosa provides lubrication for the vaginal canal. C) The breasts provide nourishment and protective maternal antibodies to infants. D) The cervical mucosa provides an alkaline environment to shelter deposited sperm from the acidic vaginal secretions. E) The cervical mucosa acts as a bacteriostatic agent. Page Ref: 161
1) A woman is experiencing mittelschmerz and increased vaginal discharge. Her temperature has increased by 0.6°C (1.0°F) over the past 36 hours. This most likely indicates what? A) Menstruation is about to begin. B) Ovulation will occur soon. C) Ovulation has occurred. D) She is pregnant, and will not menstruate.
Answer: C Explanation: A) A temperature increase does not occur when menstruation is about to begin. B) A temperature increase does not occur before ovulation has occurred. C) In some women, ovulation is accompanied by mid-cycle pain, known as mittelschmerz. This pain may be caused by a thick tunica albuginea or by a local peritoneal reaction to the expelling of the follicular contents. Body temperature increases about 0.3°C to 0.6°C (0.5°F to 1°F) 24 to 48 hours after the time of ovulation. D) Pregnancy can be detected through the presence of human chorionic gonadotropin hormone. Page Ref: 165
1) Which statement regarding cervical mucus is accurate during ovulation and appropriate to include in an educational session with the client? A) Cervical mucus is thicker during ovulation. B) Cervical mucus is opaque during ovulation. C) Cervical mucus is clearer during ovulation. D) Cervical mucus is acidic during ovulation.
Answer: C Explanation: A) Cervical mucus is thinner, not thicker, during ovulation. B) Cervical mucus is clearer, not opaque, during ovulation. C) Cervical mucus is clearer during ovulation. D) Cervical mucus is alkaline, not acidic, during ovulation. Page Ref: 161
1) Which statement by a pregnant client to the nurse would indicate that the client understood the nurse's teaching? A) "Because of their birth relationship, fraternal twins are more similar to each other than if they had been born singly." B) "Identical twins can be the same or different sex." C) "Congenital abnormalities are more prevalent in identical twins." D) "Identical twins occur more frequently than fraternal twins."
Answer: C Explanation: A) Fraternal twins are not more similar to each other than if they had been born singly. B) Identical, or monozygotic twins, have identical chromosomal structures, and, therefore, are always the same sex. C) Monozygotic twinning is considered a random event and occurs in approximately 3 to 4 per 1000 live births. Congenital anomalies are more prevalent and both twins may have the same malformation. D) Dizygotic, or fraternal, twins occur more frequently than do monozygotic twins. Page Ref: 177
1) The nurse is creating a handout on reproduction for teen clients. Which piece of information should the nurse include in this handout? A) The fertilized ovum is called a gamete. B) Prior to fertilization, the sperm are zygotes. C) Ova survive 12-24 hours in the fallopian tube if not fertilized. D) Sperm survive in the female reproductive tract up to a week.
Answer: C Explanation: A) Ova and sperm are gametes; a fertilized ovum is a zygote. B) Sperm are gametes (as are ova); a zygote is a fertilized ovum. C) Ova are considered fertile for about 12 to 24 hours after ovulation. D) Sperm can survive in the female reproductive tract for 48 to 72 hours but are believed to be healthy and highly fertile for only about the first 24 hours. Page Ref: 172
1) The student nurse encounters a 15-year-old girl who reports that she has no pubic or axillary hair and has not yet experienced growth of her breasts. The student asks the nurse about the physiology of this occurrence. The nurse explains that the client probably lacks which hormone? A) Testosterone B) Progesterone C) Estrogen D) Prolactin
Answer: C Explanation: A) Testosterone is responsible for the development of secondary sex characteristics in males. B) Progesterone and prolactin do not accomplish this change. C) Estrogens influence the development of secondary sex characteristics in females. D) Progesterone and prolactin do not accomplish this change. Page Ref: 163
1) The nurse is preparing a presentation on the menstrual cycle for a group of high school students. Which statement should the nurse include in this presentation? A) "The menstrual cycle has five distinct phases that occur during the month." B) "One hormone controls the phases of the menstrual cycle." C) "The secretory phase occurs when a woman is most fertile." D) "Menstrual cycle phases vary in order from one woman to another."
Answer: C Explanation: A) There are four phases of the menstrual cycle. B) Four hormones control ovulation and, therefore, the menstrual cycle. C) During the secretory phase, the vascularity of the entire uterus increases greatly, providing a nourishing bed for implantation. D) Although the length of the menstrual cycle might vary, the phases of the menstrual cycle always occur in the same order. Page Ref: 165, 167
1) The nurse is creating a poster for pregnant mothers. Which description of fetal development should the nurse include? A) Four primary germ layers form from the blastocyst. B) After fertilization, the cells only become larger for several weeks. C) Most organs are formed by 8 weeks after fertilization. The embryonic stage is from fertilization until 5 months
Answer: C Explanation: A) Three primary germ layers form from the blastocyst: ectoderm, mesoderm, and endoderm. B) After fertilization, the cells reproduce by mitosis, resulting in more cells, not larger cells. C) Most organs are formed during the embryonic stage, which lasts from the 15th day after fertilization until the end of the 8th week after conception. D) The embryonic stage ends before the fifth month. Page Ref: 182—183
1) The nurse is explaining the difference between meiosis and mitosis. Which statements would be best? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Meiosis is the division of a cell into two exact copies of the original cell. B) Mitosis is splitting one cell into two, each with half the chromosomes of the original cell. C) Meiosis is a type of cell division by which gametes, or the sperm and ova, reproduce. D) Mitosis occurs in only a few cells of the body. E) Meiotic division leads to cells that halve the original genetic material.
Answer: C, E Explanation: A) Meiosis creates two cells that have half of the chromosomes of the original cell. B) Mitosis creates two cells that are exact copies of the original cell. C) Meiosis is a special type of cell division by which diploid cells give rise to gametes (sperm and ova). D) Mitosis makes growth and development possible. In mature individuals it is the process by which our body cells continue to divide and replace themselves. E) Meiosis creates two cells that contain half the genetic material of the parent cell. Page Ref: 170
1) The nurse is presenting a community education session on female hormones. Which statement from a participant indicates the need for further information? A) "Estrogen is what causes females to look female." B) "The presence of some hormones causes other to be secreted." C) "Progesterone is present at the end of the menstrual cycle." D) "Prostaglandin is responsible for achieving conception."
Answer: D Explanation: A) Estrogens are associated with characteristics contributing to femaleness, including breast alveolar lobule growth and duct development. B) It is true that the presence of some hormones causes other to be secreted. .X X C C) It is true that the proportions of progesterone and estrogen control the events of both ovarian and menstrual cycles. D) Prostaglandin is not related to conception. Prostaglandin production increases during follicular maturation and has basic regulatory functions in cells. Page Ref: 163
1) The nurse is preparing a handout on the ovarian cycle to a group of middle school girls. Which information should the nurse include? A) The hormone human chorionic gonadotropin stimulates ovulation. B) Irregular menstrual cycles have varying lengths of the luteal phase. C) The ovum leaves its follicle during the follicular phase. D) There are two phases of the ovarian cycle: luteal and follicular.
Answer: D Explanation: A) Human chorionic gonadotropin (h C G) is secreted by a fertilized ovum, and does not stimulate ovulation. B) In women whose menstrual cycles vary, usually it is only the length of the follicular phase that varies, while the luteal phase is of fixed length. C) The luteal phase begins when the ovum leaves its follicle. D) The ovarian cycle has two phases: the follicular phase (days 1 to 14) and the luteal phase (days 15 to 28 in a 28-day cycle). Page Ref: 164
1) The nurse teaching the phases of the menstrual cycle should include that the corpus luteum begins to degenerate, estrogen and progesterone levels fall, and extensive vascular changes occur in which phase? A) Menstrual phase B) Proliferative phase C) Secretory phase D) Ischemic phase
Answer: D Explanation: A) In the menstrual phase, estrogen levels are low, cervical mucus is scant, viscous, and opaque, and endometrium is shed. B) In the proliferative phase, endometrium and myometrium thickness increases and estrogen peaks just before ovulation. C) In the secretory phase, estrogen drops sharply, and progesterone dominates; vascularity of the entire uterus increases; and tissue glycogen increases, making the uterus ready for implantation. D) In the ischemic phase, the corpus luteum begins to degenerate, and as a result, both estrogen and progesterone levels fall. Small blood vessels rupture, and the spiral arteries constrict and retract, causing a deficiency of blood in the endometrium, which becomes pale. Page Ref: 160
1) The nurse is preparing a handout for female adolescents on the menstrual cycle. What phase of the cycle occurs if fertilization does not take place? A) Menstrual B) Proliferative C) Secretory D) Ischemic
Answer: D Explanation: A) Menstruation occurs during the menstrual phase. Some endometrial areas are shed, whereas others remain. B) The proliferative phase begins when the endometrial glands enlarge, the blood vessels become prominent and dilated, and the endometrium increases in thickness. C) The secretory phase follows ovulation. D) The ischemic phase occurs if fertilization does not occur. Page Ref: 160
1) The nurse explains to a preconception class that if only a small volume of sperm is discharged into the vagina, an insufficient quantity of enzymes might be released when they encounter the ovum. In that case, pregnancy would probably not result, because of which of the following? A) Peristalsis of the fallopian tube would decrease, making it difficult for the ovum to enter the uterus. B) The block to polyspermy (cortical reaction) would not occur. C) The fertilized ovum would be unable to implant in the uterus. D) Sperm would be unable to penetrate the zona pellucida of the ovum.
Answer: D Explanation: A) Peristalsis of the fallopian tube is not a factor in this stage of fertilization. B) A block to polyspermy would indicate that the ovum had already been penetrated by a fertilizing sperm, which would occur later in the fertilization process. C) The ovum has not yet been fertilized in this example. D) About a thousand acrosomes must rupture to clear enough hyaluronic acid for even a single sperm to penetrate the ovum's zona pellucida successfully. If only a small amount of sperm were released, there most likely would be an insufficient quantity of acrosomes to penetrate the zona pellucida of the ovum and allow fertilization. Page Ref: 170
1) What is the function of the scrotum? A) Produce testosterone, the primary male sex hormone B) Deposit sperm in the female vagina during sexual intercourse so that fertilization of the ovum can occur C) Provide a reservoir where spermatozoa can survive for a long period D) Protect the testes and the sperm by maintaining a temperature lower than that of the body
Answer: D Explanation: A) The interstitial cells produce testosterone, the primary male sex hormone. B) The primary reproductive function of the penis is to deposit sperm in the female vagina during sexual intercourse so that fertilization of the ovum can occur. C) The epididymis provides a reservoir where spermatozoa can survive for a long period. D) The function of the scrotum is to protect the testes and the sperm by maintaining a temperature lower than that of the body. Page Ref: 167