Chapter 39: Introduction to the Reproductive System
As the lining of the uterus sloughs away, clotting at the site of the separating blood vessels in the uterus is prevented by the presence of what chemical? A) Plasminogen B) Fibrinolysis C) Luteinizing hormone (LH) D) Follicle-stimulating hormone (FSH)
Ans: A Feedback: High levels of plasminogen in the uterus prevent clotting of the lining as the vessels shear off. Fibrinolysis, LH, and FSH do not contribute to clot prevention.
When caring for an older adult patient following surgical castration as part of prostate cancer treatment, the patient asks the nurse what physical changes he can expect because of this surgery. The nurse explains he can expect what? A) To maintain his deep voice B) To develop a wide and flat pelvis C) To lose his facial hair D) To begin to grow taller
Ans: A Feedback: Increased testosterone levels in boys at puberty results in thickening of the skin, a deeper voice, development of facial hair, and closure of the epiphyses. These previously established effects would be maintained by the androgens, which still remain in the body following surgical castration. Development of a wide flat pelvis and loss of facial hair are associated with estrogens effects. An older adult male would not grow taller following surgery.
The nurse expects the level of what chemical to increase to stimulate uterine contraction and the onset of labor? A) Follicle-stimulating hormone (FSH) B) Progesterone C) Estrogen D) Prostaglandins
Ans: D Feedback: Local prostaglandins are released stimulating the uterus to contract and the onset of labor begins. High levels of estrogen and progesterone support the uterus and block uterine contractions. FSH is not responsible for the onset of labor.
The nursing instructor is discussing the physiology of pregnancy with her clinical group. What hormone, produced during pregnancy, would the instructor tell the students helps to maintain the pregnancy until birth of the fetus? A) High levels of estrogen only B) High levels of estrogen, low levels of progesterone C) Low levels of estrogen, high levels of progesterone D) High levels of estrogen and progesterone
Ans: D Feedback: In a pregnant woman, both estrogen and progesterone hormones have specific functions. High levels of both hormones are needed for the maintenance of pregnancy. Options A, B, and C are not correct.
The nurse reviews the patients laboratory results and finds the level of Gonadotropin-releasing hormone (GnRH) has increased significantly since yesterday. When assessing this patient, what will the nurse expect to find? A) The patient is pregnant. B) The patients menses have begun. C) The patient is ovulating. D) The patient is preparing to deliver.
Ans: B Feedback: The dropping levels of estrogen and progesterone trigger the release of Gonadotropin-releasing hormone (GnRH) and then follicle-stimulating hormone (FSH) and luteinizing hormone (LH) again, along with the start of another menstrual cycle. Lowered hormone levels cause the inner lining of the uterus to slough off because it is no longer stimulated by the hormones, demonstrated by the beginning of menses. The patient is not pregnant or ovulating at the start of another menstrual cycle nor is she preparing to deliver a baby.
The nurse is caring for an adolescent boy who is suspected of taking supplemental testosterone to improve his performance as a wrestler. What assessment findings would support this suspicion? (Select all that apply.) A) Excessive hair growth on face and body B) Enlarged muscular development C) Reduced hematocrit levels D) Growth of testes and scrotal sac E) Increased thickening of the skin
Ans: A, B, D, E Feedback: Testosterone is responsible for hair growth on the body and face, muscle development, increased hematocrit levels, growth of testes and scrotal sac, and increased thickening of the skin. Option C is a distracter.
What hormone causes ovulation to occur? A) Adrenocorticotropic hormone (ACTH) B) Luteinizing hormone (LH) C) Prolactin D) Follicle-stimulating hormone (FSH)
Ans: B Feedback: When the circulating estrogen level rises high enough, it stimulates a massive release of LH from the anterior pituitary causing one of the developing follicles to burst and release the ovum with its stored hormones into the system. ACTH targets the adrenal corticosteroid hormone, which helps prepare the body for the fight or flight response. Prolactin is responsible for milk production and FSH in combination with LH stimulate follicles on the outer surface of the uterus to grow and develop and also stimulates the release of estrogen and progesterone.
The nursing instructor is talking with her class of students about the female reproductive system. A student is trying to understand the role of progesterone in the body. What nonreproductive affect does progesterone have on the body? A) Decreased body temperature B) Decreased appetite C) Anti-insulin D) Increased uterine motility
Ans: C Feedback: Progesterone has an anti-insulin effect to generate a higher blood glucose concentration to allow for rapid diffusion of glucose to the developing embryo. Body temperature and appetite are increased by progesterone. Uterine motility is decreased to provide increased chance that implantation can occur.
The nurse is caring for an Olympic athlete who reports she has not had a menstrual cycle for 6 months, ever since she started training for the next Olympic tryout. The nurse suspects the cause of this patients amenorrhea is what? A) Hypothalamus is not releasing gonadotropin-releasing hormone (GnRH) B) Absence of estrogen production C) Increased production of follicle-stimulating hormone (FSH) D) Decreased production of progesterone
Ans: A Feedback: Enormous amounts of energy are expended in reproduction, and if the body needs energy for other reasons, such as this patients tremendous energy output while training, the hypothalamus shuts down the reproductive activities, stopping the release of GnRH, which results in no FSH or luteinizing hormone (LH) release and no stimulation of the follicles. Estrogen and progesterone production are not impacted and FSH production decreases.
A school nurse who is teaching a health course at the local high school is presenting information on human development and sexuality. When talking about the role of hormones in sexual development, which hormone does the nurse teach is most important for developing and maintaining the female reproductive organs? A) Estrogen B) Progesterone C) Androgens D) Follicle-stimulating hormone
Ans: A Feedback: Estrogens are responsible for developing and maintaining the female reproductive organs. Progesterone is the most important hormone for conditioning the endometrium in preparation for implantation of the fertilized ovum. Androgens, secreted by the ovaries in small amounts, are involved in the early development of the follicle and affect the female libido. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete estrogen.
What factor might influence the hypothalamus to release the hormones necessary for the human reproductive cycle? A) Light B) Heat C) Cold D) Humidity
Ans: A Feedback: Light has been found to have an influence on the functioning of the hypothalamus. Increased light levels boost the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and increase the release of estrogen and progesterone. Heat, cold, and humidity have not been shown to play a role in human reproduction unless temperature extremes occur and increase stress significantly.
When testosterone enters a cell it reacts with what to influence messenger ribonucleic acid (mRNA) activity? A) Cytoplasmic receptor site B) Cytoplasmic reticular site C) Endoplasmic receptor site D) Endoplasmic reticular site
Ans: A Feedback: Like estrogen, testosterone enters the cell and reacts with a cytoplasmic receptor site to influence mRNA activity, resulting in the production of proteins for cell structure or function.
The physiology instructor is discussing the effects of the sex hormones on the human body. Testosterone is responsible for what effects on the male body? A) Baldness B) Decreased hematocrit levels C) Thinning of the skin D) Delay of epiphyseal closure
Ans: A Feedback: Testosterone enters the cell and reacts with a cytoplasmic receptor site to influence messenger ribonucleic acid (mRNA) activity resulting in the production of proteins for cell structure or function. Testosterone is responsible for both baldness and hair growth. It causes hematocrit to increase and causes thickening of skin and cartilage, which affects the male gait. Also, testosterone stimulates the closure of the epiphyses.
The nurse is caring for a patient whose fallopian tubes were damaged by recurrent pelvic infections resulting in complete obstruction of both tubes. The patient asks the nurse, Why cant I get pregnant? What is the nurses best response? A) You can get pregnant but the embryo, once fertilized, cannot travel to the uterus to implant and grow. B) The blockage of your fallopian tubes prevents the high levels of estrogen and progesterone needed to sustain the pregnancy. C) You cannot become pregnant because damage to your fallopian tubes causes ova to stop being released from the ovary. D) You cannot become pregnant because sperm cannot travel through the fallopian tubes to fertilize the ova released by the ovary.
Ans: A Feedback: The sperm travels through the fallopian tube to the ova, released into the abdomen near the end of one of the fallopian tubes. With both fallopian tubes blocked, no passageway exists for sperm to reach the ova. Damage to the fallopian tubes does not impact hormone secretion or ova production. Because the ova are not fertilized, there would be no embryo to travel through the fallopian tubes to implant in the uterus.
The nurse is teaching adolescent boys about their reproductive organs using a model of the system. One of the boys asks, Where is sperm made? What is the nurses best response? A) Seminiferous tubules B) Interstitial cells C) Leydig cells D) Vas deferens
Ans: A Feedback: The testes are made up of two distinct parts: the seminiferous tubules, which produce the sperm, and the interstitial or Leydig cells, which produce the hormone testosterone. Other components include the vas deferens, which stores produced sperm and carries sperm from the testes to be ejaculated from the body.
The nurse working with obstetric patients understands the role of the placenta includes what? A) Endocrine gland B) Protection C) Production of glucose D) Expelling the fetus
Ans: A Feedback: The uterus is a muscular organ, which can develop a blood-filled inner lining or endometrium, which will support the development of the placenta, which provides nourishment for the developing fetus and acts as an endocrine gland producing the hormones needed to maintain the active metabolic state of the pregnancy. The amniotic sac protects the fetus. Although nutrients are sent to the growing fetus through the placenta, glucose is not produced by the placenta. The muscles in the uterus contract to expel both the fetus and the placenta.
The nurse is talking with a woman about menopause when the woman turns to her husband and says, Youre so lucky not to have to go through anything like this! What is the nurses best response? A) Men go through something called andropause when less testosterone is produced. B) Men are fortunate to maintain the same hormone levels throughout their life. C) With age, sexual function declines but that is not due to hormonal changes in men. D) The ability to obtain and maintain an erection will decline with age.
Ans: A Feedback: With age, the seminiferous tubules and interstitial cells atrophy and the male climacteric or andropause, a period of lessened sexual activity and loss of testosterone effects, occurs. This indicates a decline in hormone levels in men similar to what women experience. Sexual function and the ability to obtain and maintain an erection do not occur in all men, but usually is most often seen in those with problems such as hypertension, diabetes, and heart disease. Healthy men who make healthy lifestyle choices can maintain sexual activity well into their senior years.
As a woman goes through menopause what happens? (Select all that apply.) A) Hypothalamus increases production of gonadotropin-releasing hormone (GnRH) B) Reversal of primary sex characteristics C) Loss of calcium retention in bones D) Serum lipid levels increase E) Decreased serum levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
Ans: A, C, D Feedback: The follicles contained in the ovary become depleted over time, the ovaries no longer produce estrogen and progesterone, and menopause begins with the cessation of menses. The hypothalamus and pituitary gland produce increased levels of GnRH, FSH, and LH for a while in an attempt to stimulate the ovaries to produce estrogen and progesterone. If that does not happen, the levels of these hormones fall back within a normal range in response to their own negative feedback systems. Menopause is associated with loss of many effects of these two hormones resulting in loss of calcium in the bones, increased serum lipid levels, and maintenance of secondary sex characteristics. Primary sexual characteristics are not impacted.
The nurse is teaching students about sexual health and explains that the symptoms of arousal include what? (Select all that apply.) A) Increased heart rate B) Decreased blood pressure C) Sweating D) Pupil constriction E) Increased blood glucose levels
Ans: A, C, E Feedback: The sympathetic stimulation that results from sexual stimulation causes increased heart rate, increased blood pressure, sweating, pupil dilation, glycogenolysis (breakdown of stored glycogen to glucose for energy), and other sympathetic responses. Options B and D are distracters.
What external factor has been found to have a negative impact on the reproductive cycle related to the controls of the hypothalamus? (Select all that apply.) A) Starvation B) Extreme temperatures C) Social/cultural expectations D) Emotional problems E) Extreme exercise
Ans: A, D, E Feedback: In addition to stress, starvation, extreme exercise, and emotional problems are all associated with a decrease in reproductivity related to the controls of the hypothalamus. Extreme temperatures and social/cultural expectations have not been found to have a negative impact on the reproductive cycle relative to the hypothalamus.
What hormone is the first to be produced when the ovum is fertilized and implanted in the uterine wall? A) Growth hormone (GH) B) Human chorionic gonadotropin C) Prolactin D) Adrenocorticotropic hormone (ACTH)
Ans: B Feedback: After the ovum is fertilized and implants itself in the uterine wall, human chorionic gonadotropin is produced by the junction of the fertilized embryo with the uterine wall. ACTH and GH are not involved with his process. The release of prolactin helps with milk production for the delivered fetus.
A nurse is teaching a health class for girls at the local high school and explains the primary goal of sex hormones is what? A) To develop the bodys reproductive system B) To prepare the body for pregnancy C) To initiate the bodys change into puberty D) To deepen the voice and promote facial hair growth
Ans: B Feedback: Each ovum is contained in a storage site called a follicle. The follicles act as endocrine glands producing the hormones estrogen and progesterone. The primary goal of these hormones is to prepare the body for pregnancy and to maintain the pregnancy until delivery. Although secretion of these hormones develops the bodys reproductive system and initiates the change into puberty, these occur to prepare the body for pregnancy, the primary goal of the hormones. Development of facial hair and deepening of the voice is seen in men as a result of testosterone.
A nurse is providing patient education to a patient as part of her work in a fertility clinic. The nurse explains possible reasons for infertility. When explaining how the ovaries are involved in conception, what will the nurse stress? A) Ova quickly degenerate and most are absorbed in the body before the age of 12. B) The ovaries at birth contain all of the ova that a woman will have. C) Ova aggregate, causing millions to be contained in a storage site called a follicle. D) Follicles produce only estrogen; the uterus produces progesterone.
Ans: B Feedback: It would be important to explain that the womans ova do not increase or decrease from birth to childbearing years. The nurse will stress that all the ova that a woman will have will be present at birth. The patient should understand that if she does not ovulate 1 month or for several months, it is not because she has done something to her body to cause this. Ova slowly degenerate over a lifetime or they are released once a month until menopause is complete. Each ovum is contained in a storage site called a follicle, which produces the female sex hormones, estrogen and progesterone.
The nurse who provides holistic care includes sexuality in the plan of care. What patient will need further assessment to determine whether sexual activity will be safe? A) The patient with benign prostatic hypertrophy B) The patient with cardiovascular disease C) The patient who is post-menopausal with vaginal dryness D) The patient taking antiviral medications to treat HIV.
Ans: B Feedback: The stimulation of the sympathetic nervous system that occurs with sexual response could be dangerous in some cardiovascular conditions if they are exacerbated by sympathetic effects, so the patient with cardiovascular disease would require further assessment. Many patients with cardiovascular disease maintain a satisfactory sex life, but each requires careful assessment to determine who might be at risk. The patient with benign prostatic hypertrophy can safely participate in sex if he is capable of obtaining an erection. The post-menopausal woman can use lubricants to reduce dryness and make sexual activity more comfortable. The patient with HIV can have sex safely but will require teaching on actions to take to protect the sex partner from contracting the disease.
Progesterone is released into the bloodstream of a female when her developing follicle ruptures. What physiologic effect might the woman experience related to the release of progesterone into the womans body? (Select all that apply.) A) Diarrhea B) Abdominal fullness C) Increased appetite D) Breast atrophy E) Bloating
Ans: B, C, E Feedback: The woman experiences increased body temperature, increased appetite, breast tenderness, bloating and abdominal fullness, constipation, among other symptomsthe effects associated with progesterone, which is released into the system when the follicle ruptures. Breast atrophy is an effect of estrogen; diarrhea is not related to progesterone.
The nurse is caring for a woman who went through menopause 5 years earlier. The nursing plan of care for this patient includes teaching related to the importance of what dietary change? A) Increased intake of fatty foods to maintain lipid levels B) Reduced caloric intake because of lower activity levels C) Increased calcium intake to reduce calcium loss in bones D) Increased fluid intake to prevent dehydration from increased urination
Ans: C Feedback: Estrogen and progesterone levels are reduced in menopause resulting in loss of protective mechanisms provided by these hormones. The patient requires extra calcium intake to prevent osteoporosis caused by loss of calcium in the bones. Serum lipid levels rise after menopause, thus putting the woman at increased risk of heart disease so the patient should be taught to limit fat intake. Post-menopausal womens activity levels do not need to decline and they may be as active as they wish to be. No need exists for increased fluid intake secondary to menopause.
Spermatogenesis occurs in response to what hormone? A) Luteinizing hormone (LH) B) Gonadotropin-releasing hormone (GnRH) C) Follicle-stimulating hormone (FSH) D) GfRH
Ans: C Feedback: FSH directly stimulates the seminiferous tubules to produce sperm, a process called spermatogenesis. Spermatogenesis does not occur in response to LH or GnRH (options A and B). Option D, GfRH is a distracter for this question.
The patient asks, Why do I feel so bloated before my menstrual period begins? I am constipated, my breasts are tender, and Im always hungry. How would the nurse best respond? A) This is the result of the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), hormones to start your period. B) This is the result of estrogen release preparing your body to release an ovum. C) These are the effects of progesterone, a hormone released to thicken your uterine lining. D) This is the result of the secretory endometrium release preparing the body for pregnancy.
Ans: C Feedback: Increased body temperature, increased appetite, breast tenderness, bloating, abdominal fullness, and constipation result from the effects associated with progesterone, which is released into the system when the follicle ruptures. These symptoms are not related to FSH and LH. Estrogen may cause mild bloating and water retention, but the more significant symptoms reported by this patient in conjunction with other symptoms is not caused by estrogen. Secretory endometrium causes production of glucose and other nutrients to nurture a growing embryo and does not produce the reported symptoms.
A 16-year-old girl comes to the clinic complaining of severe menstrual cramps. The girl is concerned about the pain and worried that something is wrong. The nurse explains to the patient that she has cramping during her menstrual period because of what? A) An increase in the levels of estrogen and progesterone, which cause uterine contractions B) Low levels of plasminogen in the uterus that cause the shedding of the lining of the uterus C) Prostaglandins in the uterus, which stimulate uterine contractions to clamp off vessels as the lining of her uterus sheds D) An increase in progesterone and a decrease of estrogen cause the lining of the uterus to slough away
Ans: C Feedback: Prostaglandins in the uterus stimulate uterine contractions to clamp off vessels in the lining of the uterus, which is the cause of the cramping. The decrease of estrogen and progesterone after the involution of the corpus luteum triggers the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The decreased levels of FSH and LH cause the inner lining of the uterus to slough off because the vascular system is no longer being stimulated. High, not low, levels of plasminogen in the uterus prevent clotting of the lining as the vessels shear off.
A nurse is teaching a sex education course in a local high school. What statement, made by the nurse, would be accurate regarding the human sexual response? A) Humans require endocrine stimuli during a time period called estrus for a sexual response to occur. B) Stimulation occurs with massive increases in sensitivity. C) Sexual climax occurs from massive sympathetic stimulation. D) The period of recovery is initiated with parasympathetic stimulation.
Ans: C Feedback: Stimulation in humans occurs with mild increases of sensitivity and the climax occurs from massive sympathetic stimulation. Many animals require an estrous cycle to become stimulated, but that is not true of humans. The period of recovery occurs when the sympathetic stimulation is resolved.
During their physiology class, the students are learning about the male reproductive system. What naturally occurring substance would the students learn is thought to affect only sperm production? A) Estrogen B) Testosterone C) Gonadotropin-releasing hormone (GnRH) D) Inhibin
Ans: D Feedback: Inhibin has been investigated for many years as a possible male birth control drug, because it is thought to affect only sperm production. Estrogen, testosterone, and GnRH have multiple effects on the body other than just sperm production.
Because of the effects of estrogen during the first 14 days of a womans menstrual cycle, a woman is at higher risk for what? A) Emotional outbursts B) Broken bones C) Pregnancy D) Infection
Ans: D Feedback: The woman may notice many effects of estrogen, such as breast tenderness and water retention. In addition, estrogen thins cervical mucosa and increases susceptibility to infections. Generally, it is the last 14 days of a womans cycle when she is most at risk for emotional outbursts. A womans menstrual cycle does not make her more at risk for broken bones. The first 14 days of a womans menstrual cycle do not make her more at risk to become pregnant.
The nurse is caring for a patient scheduled for removal of the testes secondary to cancer. The patient voices concern that he will look like a woman if he doesnt take testosterone supplementation, which is contraindicated by testicular cancer. The nurse explains that he will maintain his masculine traits as the result of what action? A) Residual testosterone found in muscle cells B) Hormones secreted by the penis during arousal C) Androgens secreted by the adrenal glands D) Supplemental medications taken daily.
Ans: C Feedback: The androgens released by the adrenal glands are sufficient to sustain male sexual characteristics. Androgens are very similar in structure to testosterone and are able to influence cells to maintain the changes caused by testosterone. No residual testosterone is found in muscle cells, the penis does not secrete hormones, and supplemental medications are not required.
What hormone stimulates the release of the follicle-stimulating hormone (FSH) from both male and female glands? A) Growth hormone-releasing hormone (GHRH) B) Thyrotropin-releasing hormone (TRH) C) Gonadotropin-releasing hormone (GnRH) D) Prolactin-releasing hormone (PRH)
Ans: C Feedback: The male and female glands respond to luteinizing hormone (LH) and FSH, which are released from the anterior pituitary in response to stimulation from GnRH that is released from the hypothalamus. GHRH stimulates the release of the growth hormone, which targets cell growth. TRH stimulates the thyroid-stimulating hormone, which targets the thyroid gland. PRH stimulates the release of prolactin, which is necessary for milk production.
The parents of an infant boy have been told surgery is needed because their sons testes have not descended into the scrotal sac. The father asks the nurse, What would happen if the testes remained in the lower abdomen? What is the nurses best response? A) The testes need to be placed in the scrotum to protect sperm-producing cells from body heat. B) If the testes remain in the abdomen, it would help to protect them from accidental trauma. C) Leaving the testes in the abdomen would damage their ability to produce testosterone. D) The risks associated with surgery are greater than the risks associated with leaving the testes in the abdomen.
Ans: A Feedback: During fetal development, the two testes migrate down the abdomen and descend into the scrotum outside the body where they are protected from the heat of the body to prevent injury to the sperm-producing cells. Leaving them in the abdomen would not protect them, testosterone production would not be impacted, and the risk to sperm production is far greater than surgical risks.