OB chapter 3

A couple who has sought infertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following has occurred? a. The testes are overheated. b. The vas deferens is ligated. c. The prostate gland is enlarged. d. The flagella are segmented.

-Spermatogenesis occurs in the testes. High temperatures harm the development of the sperm.

The perinatal nurse explains to the student nurse that the growing embryo is called a _____________ beginning at 8 weeks of gestation.

Fetus -Major organs are being formed (organogenesis) during the first weeks following fertilization. During this time, the developing organism is called an embryo. By the end of 8 weeks, the embryo has sufficiently developed to be called a fetus.

_________ ___________ ____________ is when sperm and oocytes are mixed outside the woman's body and then placed into the fallopian tube via laparoscopy.

Gamete intrafallopian transfer -Gamete intrafallopian transfer, also referred to as GIFT, is used when there is a history of failed infertility treatment for involution, or unexplained infertility, or low sperm count.

The perinatal nurse defines a _____________ as any substance that adversely affects the growth and development of the embryo/fetus.

Teratogen -Teratogens (drugs, radiation, and infectious agents that can cause development of abnormal structures in an embryo) and a variety of internal and external developmental events may cause structural and functional defects.

True or False: The perinatal nurse explains to the student nurse that in the fetal circulation, the lowest level of oxygen concentration is found in the umbilical arteries.

True -The highest oxygen concentration (PO2=30-35 mmHg) is found in the blood returning from the placenta via the umbilical vein; the lowest oxygen concentration occurs in blood shunted to the placenta where reoxygenation takes place. The blood with the highest oxygen content is delivered to the fetal heart, head, neck, and upper limbs, and the blood with the lowest oxygen content is shunted towards the placenta.

A major fetal development characteristic at 16 weeks' gestation is: a. The average fetal weight is 450 grams. b. Lanugo covers entire body. c. Brown fat begins to develop. d. Teeth begin to form.

d. Teeth begin to form.

The color of a person's hair is an example of which of the following? a. Genome. b. Sex-link inheritance. c. Genotype. d. Phenotype.

d. Phenotype. -Phenotype referes to how genes are outwardly expressed, such as eye color, hair color, and height.

During prenatal class, the child birth educator describes the two membranes that envelope the fetus. The __________ contains the amniotic fluid, and the ________ is the thick outer membrane.

Amnion; Chorion. -The embryonic membranes (chorion and amnion) are early protective structures that begin to form at the time of implantation. The thick chorion, or outer membrane, forms first. It develops from the trophoblast and encloses the amnion, embryo, and yolk sac. The amnion arises from the ectoderm during early embryonic development. The amnion is a thin, protective structure that contains the amniotic fluid. With embryonic growth, the amnion expands and comes in contact with the chorion. The two fetal membranes are slightly adherent and form the amniotic sac.

The perinatal nurse is teaching nursing students about fetal circulation and explains that fetal blood flows through the superior vena cava into the right ____________ via the ____________.

Atrium; Foramen Ovale. -Blood flows through the vein from the placenta to the fetus. Most of the blood bypasses the liver and then enters the inferior vena cava by way of ductus venosus, a vascular channel that connects the umbilical vein to the inferior vena cava. The blood then empties into the right atrium, passes through the foramen ovale (an opening in the septum between the right and left atrium) into the left atrium, and them moves into the right ventricle and on into the aorta. From the aorta, blood travels to the head, upper extremities, and lower extremities.

An ultrasound of a fetus' heart shows that "normal fetal circulation is occurring." Which of the following statements is consistent with the finding? a. A right to left shunt is seen between the atria. b. Blood is returning to the placenta via the umbilical vein. c. Blood is returning to the right atrium from the pulmonary system. d. A right to left shunt is seen between the umbilical arteries.

a. A right to left shunt is seen between the atria. -The foramen oval is a duct between the atria. In fetal circulation, there is a right to left shunt through the duct.

A couple is undergoing an infertility workup. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? (Select all that apply) a. The man rides a bike to and from work each day. b. The man takes a calcium channel blocker for the treatment of hypertension. c. The man drinks 6 cups of coffee a day. d. The man was treated from prosthesis 12 months ago and has been symptom free since treatment.

a. The man rides a bike to and from work each day. b. The man takes a calcium channel blocker for the treatment of hypertension. -The daily riding of a bike can be the cause of prolonged heat exposure to the testicles. Prolonged heat exposure is a gonadotoxin. A number of medications, such as calcium channel blockers, can have an effect on sperm production. Coffee has not been associated with low sperm counts. Prostatitis or other infections within the last 3 months may have an effect on the sperm analysis. This man's episode of prostatitis was 12 months prior.

The nurse is interviewing a gravid woman during the first prenatal visit. The woman confides to the nurse that she lives with a number of pets. The nurse should advise the woman to be especially careful to refrain from coming in contact with the stool of which of the pets? a. Cat. b. Dog. c. Hamster. d. Bird.

a. Cat. -Cats often harbor toxoplasmosis, a teratogenic illness.

The ovarian cycle includes which of the following phases? (Select all that apply). a. Follicular phase. b. Secretory phase. c. Ovulatory phase. d. Luteal phase. e. Menstrual phase.

a. Follicular phase. c. Ovulatory phase. d. Luteal phase. -Follicular phase, ovulatory phase, and luteal phase are part of the ovarian cycle. Secretory and menstrual cases are part of the endometrial cycle.

Which of the following statements by a pregnant woman indicates she needs additional teaching on ways to reduce risks to her unborn child from the potential effects of exposure to toxoplasmosis? a. "I will avoid rare lamb." b. "I will wear a mask when cleaning my cat's litter box." c. "I understand that exposure to toxoplasmosis can cause blindness in the baby." d. "I will avoid rare beef."

b. "I will wear a mask when cleaning my cat's litter box." -Pregnant women and women who are attempting pregnancy should avoid contact with car feces. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef and lamb is ingested. Wearing a mask will not decrease the risk though ingestion of the parasite.

The clinic nurse recognizes that pregnant women who are in particular need of support are those who (Select all that apply). a. Are experiencing a second pregnancy. b. Are awaiting genetic testing results. c. Are experiencing a first pregnancy. d. Are trying to conceal this pregnancy as long as possible.

b. Are awaiting genetic testing results. d. Are trying to conceal this pregnancy as long as possible. -A second pregnancy is not an indication of a woman in need of additional support. A support system may be lacking for women who are trying to conceal a pregnancy or for women who are trying to keep the news of their pregnancy from relatives or friends until results form genetic tests are known. These individuals may need additional support from their nurses and other HCPs, as they are placed in a powerless situation while awaiting results and face a pregnancy that may be in jeopardy.

Information provided by the nurse that addresses the function of the amniotic fluid is that the amniotic fluid helps the fetus to maintain a normal body temperature and also: a. Facilitates asymmetrical growth of the fetal limbs. b. Cushions the fetus from mechanical injury. c. Promotes development of muscle tone. d. Promotes adherence of fetal lung tissue.

b. Cushions the fetus from mechanical injury. -Amniotic fluid cushion the fetus from mechanical injury.

After birth, the perinatal nurse explains to the new mother that ____________ is the hormone responsible for stimulating milk production.

Prolactin -Following birth and delivery of the placenta, there is an abrupt decrease in estrogen. This event triggers an increased secretion of prolactin (the hormone that stimulates milk production) by the anterior pituitary gland. The posterior pituitary gland and hypothalamus play a role in the production and secretion of oxytocin, a hormone that causes the release of milk from the alveoli.

During preconception counseling, the clinic nurse explains that the time period when the fetus is most vulnerable to the effects of teratogens occurs from: a. 2 to 8 weeks. b. 4 to 12 weeks. c. 5 to 10 weeks. d. 6 to 15 weeks.

a. 2 to 8 weeks. -The period of organogenesis lasts from approximately the second until the eighth week of gestation during which time the embryo undergoes rapid growth and differentiation. During organogenesis, the embryo is extremely vulnerable to teratogens such as medications, alcohol, tobacco, caffeine, illegal drugs, radiation, heavy metals, and maternal (TORCH) infections. Structural fetal defects are most likely to occur during this period because exposure to teratogens either before or during a critical period of development of an organ can cause malformation.

A couple who has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? (Select all that apply). a. Anger at other who have babies. b. Feelings of failure because they cannot make a baby. c. Sexual excitement because they want to conceive a baby. d. Guilt on the part of one partner because he or she is unable to give the other a baby.

a. Anger at other who have babies. b. Feelings of failure because they cannot make a baby. d. Guilt on the part of one partner because he or she is unable to give the other a baby. -Infertile couples often feel anger towards couples who have babies. Infertile couples often express feelings of personal failure. Guilt is often expressed by the couple.

Which of the following places a couple at higher risk for conceiving a child with a genetic abnormality? (Select all that apply). a. Maternal age over 35 years. b. Partner who has a genetic disorder. c. Maternal type 1 diabetes. d. Paternal heart disease.

a. Maternal age over 35 years. b. Partner who has a genetic disorder. -Fertility decreases after 25 years. A partner contributes half of the chromosomal makeup, and genetic disorders can be inherited. Maternal diabetes can have an effect on the fetus/neonate, such as causing complications such as macrosomia and hypoglycemia, but these are not genetic disorders. Paternal heart disease can place the neonate at risk for heart disease later in life, but this is not referred to as a genetic disorder, such as is trisomy 21 and hemophilia.

A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? a. The couple has established a set schedule for their sexual encounters. b. The couple has been married for more than 8 years. c. The couple lives with one set of parents. d. The couple has close friends who gave birth within the last year.

a. The couple has established a set schedule for their sexual encounters. -Couples who "schedule" intercourse often complain that their sexual relationship is unsatisfying.

A woman seeks care at an infertility clinic. Which of the following tests may this woman undergo to determine what, if any, infertility problems she may have? (Select all that apply) a. Chorionic villus sampling. b. Endometrial biopsy. c. Hysterosalpingogram. d. Serum FSH analysis.

b. Endometrial biopsy. c. Hysterosalpingogram. d. Serum FSH analysis. -Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium's response to progesterone. Hysterosalpingogram is used to determine if fallopian tubes are patent. Serum FSH levels are used to assess ovarian function.

A clinic nurse explains to the pregnant woman that the amount of amniotic fluid present at 24 weeks gestation is approximately: a. 500 mL. b. 750 mL. c. 800 mL. d. 1000 mL.

c. 800 mL. -Amniotic fluid first appears at about 3 weeks. There are approximately 30 mL of amniotic fluid present at 10 weeks' gestation, and this amount increases to approximately 800 mL at 24 weeks gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term.

The fetal circulatory structure that connects the pulmonary artery with the descending aorta is known as which of the following? a. Ductus venosus. b. Foramen ovale. c. Ductus arteriosus. d. Internal iliac artery.

c. Ductus arteriosus.

A diagnostic test commonly used to assess problems of the fallopian tubes is: a. Endometrial biopsy. b. Ovarian reserve testing. c. Hysterosalingogram. d. Screening for STI.

c. Hysterosalingogram. -Hysterosalingogram provides information on the endocervical cavity, uterine cavity, and fallopian tubes.

The clinic nurse knows that the part of the endometrial cycle occurring from ovulation to just prior to menses is known as the: a. Menstrual phase. b. Proliferative phase. c. Secretory phase. d. Ischemic phase.

c. Secretory phase. -The secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26.

The nurse takes the history of a client, G2 P1, at her first prenatal visit. The client is referred to a genetic counselor, due to her previous child having a diagnosis of _____________. a. Unilateral amblyopia. b. Subdural hematoma. c. Sickle cell anemia. d. Glomerular nephritis.

c. Sickle cell anemia. -Sickle cell anemia is an autosomal recessive illness. The client needs to be seen by a genetic counselor.

A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication? a. Decrease the symptoms of endometriosis. b. Increase serum progesterone levels. c. Stimulate release of FSH and LH. d. Reduce the acidity of vaginal secretions.

c. Stimulate release of FSH and LH. -Clomiphene Citrate stimulates release of FSH and LH.

A woman at 40 weeks' gestation has a diagnosis of oligohydramnios. Which of the following statements related to oligohydramnios is correct? a. It indicates that there is a 25% increase in amniotic fluid. b. It indicates that there is a 25% reduction of amniotic fluid. c. It indicates that there is a 50% increase in amniotic fluid. d. It indicates that there is a 50% reduction of amniotic fluid.

d. It indicates that there is a 50% reduction of amniotic fluid. -Oligohydramnios refers to a decreased amount of amniotic fluid of less than 500 mL at term or 50% reduction of normal amounts.

A nurse is teaching a woman about her menstrual cycle. The nurse states that ________ is the most important change that happens during the secretory phase of the menstrual cycle. a. Maturation of the Graafian follicle. b. Multiplication of the fimbriae. c. Secretion of human chorionic gonadotropin. d. Proliferation of the endometrium.

d. Proliferation of the endometrium. -The proliferation of the endometrium occurs during the secretory phase of the menstrual cycle.

Karen, a 26-year-old woman, has come for preconception counseling and asks about caring for her cat as she has heard that she "should not touch the cat during pregnancy." The clinic nurse's best response is: a. It is best if someone other than you changes the cat's litter pan during pregnancy so that you have no risk of toxoplasmosis during pregnancy. b. It is important to have someone else change the little pan during pregnancy and also avoid consuming raw vegetables. c. Have you had any "flu-like" symptoms since you got your cat? If so, you may have already had toxoplasmosis and there is nothing to worry about. d. Toxoplasmosis is a concern during pregnancy, so it is important to have someone else change the cat's litter pan and also to avoid consuming uncooked meat.

d. Toxoplasmosis is a concern during pregnancy, so it is important to have someone else change the cat's litter pan and also to avoid consuming uncooked meat -Women need to be aware that Toxoplasma gondii, a single-celled parasite, is responsible for the infection of toxoplasmosis. The majority of individuals who become infected with toxoplasmosis are asymptomatic, although when present, symptoms are described as "flu-like" and include glandular pain and enlargement and myalgia. Severe toxoplasmosis infection may cause damage to the fetal brain, eyes, or other organs. Toxoplasmosis is usually acquired by consuming raw or poorly cooked meat that has been contaminated T. gondii. Toxoplasmosis may also be acquired through close contact with feces from an infected animal (usually cats) or soil that has been contaminated with T. gondii.