OB- Chp 14
When educating parents on recessive genetic disease statistics, the nurse understands that which statement by the parents indicates an accurate understanding of genetic inheritance?
"Each child will have a 25% chance of developing the disease." The statistics of inheritance are reset with each pregnancy; therefore, each pregnancy has the same statistical probability of displaying the genetic disease.
The nurse is providing teaching to an adolescent girl on the function of the female reproductive system. Which statement by the client best reflects understanding of the material presented?
"My menstrual cycle lasts about 28 days each month but varies sometimes, which is normal." The normal menstrual cycle lasts an average of 28 days, but there is a variance between women and even between cycles in some women, which is normal. Counting to determine ovulation time is based upon the beginning of the menstrual cycle, not the end. The mucus during ovulation is thin, clear and somewhat stretchable. At ovulation, the ova are released into the abdominal cavity and are propelled along by tiny finger-like projections that direct it to the fallopian tube.
When providing preconception care to a client, which instruction would be most important for the nurse to provide about medications during pregnancy?
"You need to talk with your health care provider about using medications."
You care for a woman in a prenatal clinic who thinks she might be pregnant. Which of the following assessments is a probable sign of pregnancy?
A positive pregnancy test Most probable signs of pregnancy are objective signs; laboratory testing is probable, not positive, because error can occur.
A woman tells the nurse that she is going to use a home pregnancy test to determine whether she is pregnant. Which precautions should the nurse give her?
Arrange for prenatal care if the test is positive. Home pregnancy testing can be accurate as soon as a period is missed; it should not take the place of prenatal care.
What does the genetic analysis always include?
Assessment for any other potentially inherited condition
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
Which body system is most affected throughout the embryonic and fetal period by teratogens?
Central nervous system Whether the teratogen is ingested, injected, occurs through an infectious agent or is environmental, the CNS and brain are the body systems that are most seriously affected during this period.
What should the nurse include when counseling potential parents about genetic disorders?
Environmental influences may affect multifactorial inheritance.
A boy tells you that his family celebrates the Fourth of July by eating out at a local restaurant. He tells you this is a better way to celebrate the holiday than having a picnic like his neighbors. This statement represents which of the following?
Ethnocentrism Ethnocentrism is a belief that one's own culture or customs are superior to others
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 new client has come to the clinic. While the nurse is taking the client's history, the client tells the nurse she is trying to get pregnant and she is very fearful she will have another miscarriage. The client states she has lost two pregnancies and she shares with the nurse that she does not know why this occurred. Based on this client's history, what recommendation is best for the nurse to make at the present time?
Instruct the client on chromosome testing studies
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.
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 to 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 client is attempting to become pregnant and is using varied methods to identify ovulation. What assessment finding would most clearly suggest that the client is ovulating?
The client has clear, thin cervical mucus Cervical mucus is clear and thin near ovulation. Ovulation typically occurs near day 14 of the menstrual cycle. Progesterone levels are low near the time of ovulation.
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
A student nurse is assigned to care for a woman who is being admitted for delivery of her baby. Where would the nurse expect to find the urethral meatus?
Within the vestibule The urethral meatus (opening to the urethra), paraurethral (Skene's) glands, vaginal opening or introitus, and Bartholin glands are located within the vestibule.
After teaching a health education class on the female reproductive cycle, the nurse determines that the teaching was effective when the group identifies which phase as belonging to the ovarian cycle?
follicular phase The ovarian cycle consists of the follicular phase, ovulation, and the luteal phase. The proliferative, secretory, and ischemic phases occur in the endometrial cycle.
A pregnant woman needs an update in her immunizations. Which vaccination would the nurse ensure that the woman receives?
hepatitis B Hepatitis B vaccine should be considered during pregnancy. Immunizations for measles, mumps, and rubella are contraindicated during pregnancy.
A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client?
knowledge of child development
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.
The nurse is meeting with a young couple who desire to get pregnant to teach them how to determine the best times for intercourse. During which time frame should the nurse encourage them to engage in intercourse to increase their chances of getting pregnant?
3 days before to 2 days after ovulation Sperm are able to live for up to 72 hours after ejaculation and the ovum remains fertile for a maximum of 48 hours after ovulation. The window of opportunity for conception is 3 days before to 2 days after 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.
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.
A woman trying to conceive has been prescribed metronidazole (Flagyl) for bacterial vaginosis. What should the nurse caution this patient while taking this medication?
This drug can be teratogenic early in pregnancy and shouldn't be continued if a pregnancy is suspected.
A mother has come to the clinic with her 13-year-old daughter to find out why she has not started her menses. After a thorough examination and history, genetic testing is prescribed to rule out which abnormality?
Turner syndrome
Cystic fibrosis is an example of which type of inheritance?
autosomal recessive Cystic fibrosis is an autosomal recessive inherited condition. Huntington disease would be an example of an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Cleft lip is a multifactorial inherited condition.
The nursing instructor is preparing a class presentation covering the various hormones and their functions during pregnancy. The instructor determines the class is successful when the class correctly matches which function with hCG?
continues progesterone production by corpus luteum The corpus luteum is responsible for producing progesterone until this function is assumed by the placenta. hCG is a fail-safe mechanism to prolong the life of the corpus luteum and ensure progesterone production. Estrogen is responsible for providing a rich blood supply to the decidua. Progesterone helps maintain a nutrient-rich decidua.
A group of nursing students are preparing a presentation for a health fair illustrating what happens to the body during pregnancy. Which structure will the students point out is influenced the most by hormones to prepare for conception?
endometrium The endometrium is the inner layer of the uterus; it builds with hormones during the month in potential preparation for pregnancy. The myometrium is the muscular layer. The perimetrium is a protective layer, and the fundus is the upper area of the uterus.
After a reproductive class at the local school, the public health nurse realizes more training is needed when the class identifies the layers of the uterus to include:
epimetrium. The three layers of the uterus are the endometrium, myometrium, and serosa. The epimetrium is not a layer of the uterus.
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.
Which hormone is secreted from the hypothalamus in a pulsatile manner throughout the reproductive cycle?
gonadotropin-releasing hormone (GnRH) GnRH is secreted from the hypothalamus in a pulsatile manner throughout the reproductive cycle. It induces the release of FSH and LH to assist with ovulation, both of which are secreted by the anterior pituitary gland. Estrogen is secreted by the ovaries and is crucial for the development and maturation of the follicle.
A nurse is interviewing the family members of a pregnant client to obtain a genetic history. While asking questions, which information would be most important?
if couples are related to each other or have blood ties While obtaining the genetic history of the client, the nurse should find out if the members of the couple are related to each other or have blood ties, as this increases the risk of many genetic disorders.
The nursing instructor is teaching a class on the menstrual cycle. The instructor determines the class is successful when the class correctly chooses which hormone that is responsible for imitating ovulation?
luteinizing hormone At the beginning of each menstrual cycle, a follicle on one of the ovaries begins to develop in response to rising levels of FSH from the pituitary gland. The follicle produces estrogen, which causes the ovum contained within the follicle to mature. When the pituitary gland detects high levels of estrogen from the mature follicle, it releases a surge of LH. This sudden release of LH causes the follicle to burst open, releasing the mature ovum into the abdominal cavity in a process called ovulation. This follicle then becomes the corpus luteum, which continues to secrete estrogen and progesterone, preparing the endometrium for possible implantation of a fertilized ovum. If the ovum is not fertilized, the hormone levels subsequently fall and menstruation occurs
When teaching an adolescent about ovulation, the nurse would include that ovulation is initiated by a surge in which hormone?
luteinizing hormone Luteinizing hormone is released from the pituitary gland to stimulate ovulation on approximately the 14th day of a typical cycle.
Put the phases of the menstrual cycle in correct order from first to last. All options must be used.
proliferative phase secretory phase ischemic phase menses phase The menstrual cycle consists of four phases: 1) proliferative phase (also known as the estrogenic, follicular, or postmenstrual phase), in which the ovary begins to produce estrogen and the endometrium begins to proliferate and thicken; 2) secretory phase (also known as the progestational, luteal, or premenstrual phase), in which progesterone forms in the corpus luteum and causes the glands of the uterine endometrium to become corkscrew or twisted in appearance and dilated with quantities of glycogen; 3) ischemic phase, in which the ovary begins to regress, production of progesterone decreases, and the endometrium of the uterus begins to degenerate; and 4) menses phase, in which a mixture of blood from ruptured capillaries, mucin, fragments of endometrial tissue, and the ovum flow from the vagina.
The nursing instructor is teaching a group of nursing students about the menstrual cycle. The instructor determines the session is successful when the students correctly choose which action as responsible for the increased thickness of the endometrium?
the increasing level of estrogen Estrogen levels increase after menstruation. These levels promote a thickening of the endometrial tissue. FSH and LH are responsible for ovarian changes. Progesterone will be increasing not decreasing, and works with estrogen in influencing the menstrual cycle.
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.
After an assessment, a couple planning marriage decides to schedule an appointment for genetic counseling in several months. Which information from the assessment would support this couple's decision? (Select all that apply.) The male and female are second cousins. The male has a friend who has hemophilia. The female has a foster brother with sickle-cell anemia. The male and female are both of Mediterranean descent. The female's sister gave birth to a baby with Down syndrome.
-The male and female are second cousins. -The male and female are both of Mediterranean descent. -The female's sister gave birth to a baby with Down syndrome. Couples who are most apt to benefit from a referral for genetic testing or counseling include a closely related couple, are of ethnic backgrounds in which specific illnesses are known to occur, and those whose close relatives have a child with a genetic disorder. Having a friend with hemophilia and a foster brother with sickle-cell anemia would not support the couple's decision to have genetic counseling.
How should the nurse document a pregnant patient's gestational status using the GTPAL system after collecting the following data?Currently 18 weeks pregnantPatient's fourth pregnancyDelivered one nonviable fetus at 26 weeksExperienced one miscarriageDelivered one viable fetus at 38 weeks' gestation
4, 1, 1, 1, 1 GTPAL is a more comprehensive system for classifying pregnancy status. By this system, the gravida classification remains the same, but para is broken down into T: the number of full-term infants born (infants born at 37 weeks or after), P: the number of preterm infants born (infants born before 37 weeks), A: the number of spontaneous miscarriages or therapeutic abortions, and L: the number of living children. The patient has been pregnant four times. The patient delivered one viable infant at 38 weeks. The patient delivered one nonviable fetus at 26 weeks. The patient had one miscarriage. The patient has one living child.
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 are 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.
While conducting the first prenatal health history visit, the nurse learns that a pregnant patient is taking various herbal remedies and over-the-counter medications for minor ailments. Which nursing diagnosis should the nurse identify as being appropriate for the patient at this time?
Deficient knowledge regarding exposure to teratogens during pregnancy The patient is taking herbal remedies and over-the-counter medications, many of which can be teratogenic to the developing fetus. This is the most appropriate nursing diagnosis for the nurse to select for this assessment finding. There is no enough information to determine if the fetus is at risk because of the patient's lifestyle choices. The patient has not asked for specific information so health-seeking behavior diagnoses would not be appropriate for the patient at this time.
Which characteristics of a female client would likely warrant intervention? Select all that apply. The client typically loses around 30 ml of blood during menstruation. A peak in luteinizing hormone levels occurs prior to the client's ovulation. Each of the client's fallopian tubes is approximately 6 cm long. The client's vaginal environment is alkaline. The client's clitoris is covered by the prepuce.
Each of the client's fallopian tubes is approximately 6 cm long. The client's vaginal environment is alkaline. The vaginal environment is normally acidic and the fallopian tubes are usually between 8 and 14 cm in length. The clitoris is normally covered by the prepuce and blood loss during menstruation is usually between 25 and 60 ml. Luteinizing hormone levels normally peak before ovulation.
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as:
G = 3, T = 1, P = 0, A = 1, L = 1 The GTPAL stands for Gravida -- number of pregnancies, which is 3 (current, 4-year-old, and miscarriage); Term -- only one pregnancy thus far carried to term; Preterm deliveries -- 0; Abortions (including miscarriages) -- 1; Living children -- 1. Do not be distracted by the twins. That is still one pregnancy.
A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records?
G3 T0 P1 A1 L2 G indicates the total number of pregnancies (2 prior, now pregnant = 3); T indicates term deliveries at or beyond 38 weeks' gestation (none = 0); P is for preterm deliveries (at 20 to 37 weeks = 1; multiple fetus delivery are scored as 1); A is for abortions or pregnancies ending before 20 weeks' gestation (1); and L refers to living children which is 2. Thus, G3 T0 P1 A1 L2 is what the nurse should note in the client's record.
As part of the first prenatal visit, the nurse is assessing a pregnant woman's obstetrical history, which includes an 18-month-old daughter, born 2 days after her estimated date of birth; a 3-year-old son born at 35 weeks' gestation; and two lost pregnancies, one at 12 weeks and one at 21 weeks. How should the nurse document this history?
G5 T1 P2 A1 L2
Which of a client's cells are most likely to reproduce by meiosis?
Ova Ova and other sex cells reproduce by meiosis. All of the other tissues are made up of somatic cells, which reproduce by mitosis.
What effect does progesterone have on normal gallbladder function?
Progesterone interferes with gallbladder contraction, leading to stasis of bile. Progesterone interferes with normal gallbladder contractions, which leads to stasis of bile. This stasis results in cholestasis, either seen in the gallbladder or the liver.
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 and 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.
The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of nursing students. What would be the correct response by a nursing student about the function of the ovaries?
They produce female gametes or ova and secrete female sex hormones The ovaries' functions are to produce female gametes or ova and secrete female sex hormones. The uterus's functions are to receive the fertilized ovum and provide housing and nourishment for a fetus. 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 explaining the phases of the uterine cycle to a client. What action during the proliferative phase of the uterine cycle should the nurse include in the teaching session with the client?
While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth. While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth during the proliferative phase. If fertilization does not occur, the corpus luteum degenerates, and hormonal levels fall during the secretory phase. Withdrawal of hormones causes the endometrial cells to change, and menstruation begins. Maturation of an ovum occurs during the ovarian cycle; growth of the lining (endometrium) of the uterus occurs during the uterine cycle. Together, these cycles are known as the menstrual cycle.
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.
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 the class is the most important for developing and maintaining the female reproductive organs?
estrogen Estrogens are responsible for developing and maintaining the female reproductive organs.
The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence?
quickening The fluttering sensation that can be confused with gas is called "quickening." In the 2 weeks leading up to the 20-week mark, she may feel "flutters" that she may confuse with gas.
Genetic testing has revealed that a couple's unborn child shows the possibility of mosaicism. When counseling this couple, the nurse explains this means that:
the genetic abnormality occurred after fertilization and during the mitotic cell division. Mosaicism refers to when the chromosomal abnormalities do not show up in every cell and only some cells or tissues carry the abnormality. It occurs after fertilization and during the mitotic cell division. The symptoms are usually less severe.
A school nurse is talking to an adolescent who asks about why she has monthly menstrual cycles. The best explanation that the nurse can offer regarding the menstrual phase is to tell her that:
the uterine lining is being shed due to lowering of hormone levels. During the menstrual phase of the cycle, the endometrium, or lining of the uterus, is shed because of low estrogen and progesterone levels. The uterus does not fill up with blood monthly, nor do her hormones cause blood accumulation on the uterus. Also, the uterine lining thickens (rather than thins out) each month in preparation of implantation of the fertilized egg.
A nurse is teaching a group of women at the local health clinic about reproduction. After describing the various internal structures involved, the nurse determines that the teaching was successful when the group identifies which structure as connecting the external structures with the cervix?
vagina The vagina is a canal that connects the external genitals to the cervix. The uterus is an inverted, pear-shaped muscular organ at the top of the vagina and is subdivided into the convex portion above the uterine tubes, called the fundus, the central portion or corpus between the fundus and the cervix, and the cervix, or neck which opens into the vagina. Rugae are transverse folds in the vagina that allow it to dilate during labor and birth.