PRACTICE NCLEX QUESTIONS BASED ON REPRODUCTIVE SYSTEM PART 12

PRIORITY CONCEPTS ARE REPRODUCTION AND SEXUALITY

KEY POINTS TO REMEMBER:

1. MENSTRUAL CYCLE:
   • OVARIAN CHANGES:
     • Preovulatory phase:
       • Hypothalamus releases gonadotrophin-releasing hormone through the portal system to the anterior pituitary system.
       • Secretion of follicle-stimulating hormone (FSH) by the anterior lobe of the pituitary gland stimulates growth of the follicles
       • Most follicles die, leaving one to mature into a large graafian follicle.
       • Estrogen produced by the follicle stimulates increased secretions of luteinizing hormone (LH) by the anterior lobe of the pituitary gland
       • The follicle ruptures and releases an ovum into the peritoneal cavity.
     • Luteal phase:
       • Begins with ovulation
       • Body temperature decreases and then increases by 0.5-degree F to 1 degree F around the time of the ovulation.
       • CORPUS LUTEUM is formed from follicle cells that remain in the ovary after ovulation.
       • Corpus Luteum secretes estrogen and progesterone during the remaining 14 days of the cycle.
       • Corpus Luteum degenerates if the ovum is not fertilized, and secretion of the estrogen and progesterone declines
       • Decline in the estrogen and progesterone stimulates the anterior pituitary to secrete more FSH and LH, initiating a new reproductive cycle.
   • UTERINE CHANGES:
     • Menstrual phase: 4-6 days of bleeding, endometrium breaks down because of the decreased levels of estrogen and progesterone; FSH level increases, enabling the beginning of a new cycle.
     • Proliferative phase: (Lasts about 9 days) as estrogen increases which suppresses secretion of FSH and increase secretion of LH (LH stimulates ovulation and the development of the corpus luteum) and (estrogen stimulates proliferation and growth of the endometrium). Estrogen level is high and progesterone level is low.
     • Secretary phase Lasts about 12 days and follows ovulation. This phase is initiated in response to the increase in LH level. The graafian follicle is replaced by the corpus luteum. Corpus luteum secretes progesterone and estrogen. Progesterone prepares the endometrium for pregnancy if a fertilized ovum is implanted.
2. The GYNECOID PELVIS is most favorable for successful labor and birth.
3. If CPD cephalopelvic disproportion exists, the normal labor process will be delayed and most likely result in a cesarean delivery.
4. FEMALE PELVIS:
   • Gynecoid: normal pelvis, transversely rounded or blunt
   • Anthropoid: oval shape, adequate outlet with a narrow pubic arch
   • Android: Heart shaped or angulated, resembles as male pelvis, not favorable for labor and vaginal birth
   • Platypelloid pelvis: Flat with an oval inlet, wide transverse diameter, but short antero-posterior diameter, making labor and vaginal birth difficult
5. FERTILIZATION: occurs in the ampulla of the fallopian tube when sperm and ovum unite.
6. When FERTILIZED, the membrane of the ovum undergoes changes that prevent entry of the other sperm. Each reproductive cell carries 23 chromosomes.
7. IMPLANTATION: The ZYGOTE is propelled towards the uterus and implants 6 to 8 days after ovulation.
8. The BLASTOCYST secretes chorionic gonadotrophin to ensure that the corpus luteum remains viable and secretes estrogen and progesterone for the first 2 to 3 months of gestation.

FETAL DEVELOPMENT:

FETAL DEVELOPMENT

PREEMBRYONIC PERIOD First 2 weeks after conception

EMBRYONIC PERIOD Beginning day 15 through approximately week 8 after conception

FETAL PERIOD Week 9 after conception to birth

WEEK 1 Blastocyst is free- floating

WEEK 2-3 Embryo is 1.5 to 2mm in length Lung buds appear Blood circulation begins Heart is tubular and begins to beat Neural plate between brain and spinal cord

WEEK 5 Embryo is 0.4 – 0.5cm in length Embryo is 0.4 g Double heart chambers are visible Heart is beating Limb buds form

WEEK 8 Embryo is 3 cm in length Embryo is 2 g Eyelids begin to fuse Circulatory system through umbilical cord is well established Every organ system is present

WEEK 12 Fetus is 6 to 9 cm in length Fetus is 19g Face is well formed Limbs are long and slender Kidneys begin to form urine Spontaneous movements occur Heartbeat is detected by Doppler transducer between 10 and 12 weeks

WEEK 16 Fetus is 11.5 to 13.5 cm in length Fetus id 100g Active movements are present Fetal skin is transparent Lanugo hair begins to develop Skeletal ossification occurs Sex of fetus is visually recognizable on ultrasound

WEEK 20 Fetus is 16 to 18.5 cm in length Fetus is 300 g Lanugo covers the entire body Fetus has nails Muscles are developed Enamel and dentin are depositing Heartbeat is detected by regular fetoscope

WEEK 24 Fetus is 23 cm in length 600g Fetus Hair on head is well formed Skin is reddish and wrinkled Reflex hand grasp function is present Vernix caseosa covers the entire body Fetus has ability to hear

WEEK 28 Fetus is 27 cm in length Fetus is 1100g Limbs are well flexed Brain is developing rapidly Eyelids open and close Lungs are developed sufficiently to provide gas exchange (lecithin forming) If born, neonate can breathe at this time.

WEEK 32 Fetus is 31 cm in length Fetus is 1800 to 2100 g Bones are fully developed Collection of the subcutaneous fat Lecithin-to-sphingomyelin (L/S) ratio is 1.2:1

WEEK 36 35 cm fetus length 2200 – 2900 g fetus Skin is pink and body is rounded Skin is less wrinkled Lanugo is disappearing L/S ratio is greater than 2:1

WEEK 40 Fetus is 40 cm in length Fetus is more than 3200 g Skin is pinkish and smooth Lanugo may be present on upper arms and shoulders Vernix caseosa decreases Fingernails extend beyond fingertips Sole (plantar) creases run down to the level Testes are in the scrotum Labia majora are well developed.

FETAL ENVIRONMENT:

1. Amnion
   • encloses the amniotic cavity
   • inner membrane
   • forms about the second week of embryonic development
   • Forms a fluid- filled sac that surrounds the embryo and later the fetus
2. Chorion
   • outer membrane enclosing the amniotic cavity
   • becomes vascularized and forms the fetal part of placenta
3. Amniotic fluid
   • Consists of 800 – 1200 mL by the end of pregnancy
   • Surrounds, cushions, and protects the fetus and allows for fetal movement
   • Maintains the body temperature of the fetus
   • Contains fetal urine and is a measure of fetal kidney function
   • The fetus modifies the amniotic fluid through the processes of swallowing, urinating, and movement of fluid through the respiratory tract
4. Placenta
   • Provides for exchange of nutrients and waste products between the fetus and mother
   • Begins to form at implantation; the structure is complete by week 12
   • Produces hormones to maintain pregnancy
   • In the third trimester, transfer of maternal immunoglobin provides the fetus with passive immunity to certain diseases for thr first few months after birth.
   • By week 10 to 12, genetic testing can be done via chorionic villus sampling (CVS).

FETAL CIRCULATION:

1. UMBILICAL CORD:
   • Contains 2 arteries and 1 vein
   • Arteries carry deoxygenated blood and waste products from the fetus
   • Vein carries oxygenated blood and provides oxygen and nutrients to the fetus.
2. FETAL HEART RATE (FHR):
   • Depends on gestational age;
   • In the first trimester, FHR is 160-170 beats per minutes
   • It slows with fetal growth to 110- 160 beats per minute.
   • FHR is about twice the maternal heart rate
3. FETAL CIRCULATION BYPASS:
   • It is present because of the non-functioning lungs
   • It must CLOSE after birth to allow blood to flow through the lungs and the liver.
   • The DUCTUS ARTERIOSUS connects the pulmonary artery to the aorta, bypassing the lungs
   • The DUCTUS VENOSUS connects the umbilical vein and the inferior vena cava, bypassing the liver.
   • The FORAMEN OVALE is the opening between the right and left atria of the heart, bypassing the lungs.

PRACTICE QUESTIONS:

1. The nurse is preparing to teach a prenatal class about fetal circulation. Which statements should be included in the teaching plan? Select all that apply
   1. The ductus arteriosus allows blood to bypass the fetal lungs
   2. One vein carries oxygenated blood from the placenta to the fetus
   3. The normal fetal heartbeat range is 160 to 180 beats per minute in pregnancy
   4. Two arteries carry deoxygenated blood and waste products away from the fetus to the placenta
   5. Two veins carry blood that is high in carbon dioxide and other waste products away from the fetus to the placenta
2. The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement by the students indicates an understanding of the ductus venosus?
   1. It connects the pulmonary artery to the aorta
   2. It is an opening between the right and left atria
   3. It connects the umbilical vein to the inferior vena cava
   4. It connects the umbilical artery to the inferior vena cava
3. A pregnant client tells the clinic nurse that she wants to know the sex of her baby as soon as it can be determined. The nurse informs the client that she should be able to find out the sex at 16 weeks’ gestation because of which factor?
   • 1. The appearance of the fetal external genitalia
   • 2.The beginning of the differentiation in the fetal groin
   • 3.The fetal testes are descended into the scrotal sac
   • 4.The internal differences in males and females become apparent
4. The nurse is performing an assessment on a client who is at 38 week’s gestation and notes that the fetal heart rate (FHR) is 174 beats per minute. On the basis of this finding, what is the priority nursing action?
   1. Document the findings
   2. Check the mother’s heart rate
   3. Notify the obstetrician (OB)
   4. Tell the client that the fetal heart rate is normal
5. The nurse is conducting a prenatal class on the female reproductive system. When a client in the class asks why the fertilized ovum stays in the fallopian tube for 3 days, what is the nurse’s best response?
   • 1.It promotes the fertilized ovum’s chances of survival
   • 2.It promotes the fertilized ovum’s exposure to estrogen and progesterone
   • 3.It promotes the fertilized ovum’s normal implantation in the top portion of the uterus
   • 4.It promotes the fertilized ovum’s exposure to luteinizing hormone and follicle-stimulating hormone
6. The nursing instructor asks a nursing student to explain the characteristics of the amniotic fluid. Select all that apply.
   1. Allows for fetal movement
   2. Surrounds, cushions, and protects the fetus
   3. Maintains the body temperature of the fetus
   4. Can be used to measure fetal kidney function
   5. Prevents large particles such as bacteria from passing to the fetus
   6. Provides an exchange of nutrients and waste products between the mother and the fetus
7. A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the nurse should determine whether this method of family planning would be most appropraite?
   1. Have you ever had surgery?
   2. Do you plan to have any other children?
   3. Do either of you have diabetes mellitus?
   4. Do either of you have problems with high blood pressure?
8. The nurse should make which statement to a pregnant client found to have a gyneoid pelvis?
   1. Your type of pelvis has a narrow pubic arch
   2. Your type of pelvis is the most favorable for labor and birth
   3. Your type of pelvis is a wide pelvis, but it has a short diameter
   4. You will need a cesarean section because this type of pelvis is not favorable for a vaginal delivery
9. Which purposes of placental functioning should the nurse include in a prenatal class? Select all that apply
   1. It cushions and protect the baby
   2. It maintains the temperature of the baby
   3. It is the way the baby gets foods and oxygen
   4. It prevents all antibodies and viruses from passing to the baby
   5. It provides an exchange of nutrients and waste products between the mother and developing fetus
10. A 55-year-old male client confides in the nurse that he is concerned about his sexual function. What is the nurse’s best response?
    1. How often do you have sexual relations
    2. Please share with me more about your concerns
    3. You are still young and have nothing to be concerned
    4. You should not have a decline in testosterone until you are in your 80s.

ANSWERS

1. 1,2,4
2. 3
3. 1
4. 3
5. 3
6. 1,2,3,4
7. 2
8. 2
9. 3,5
10. 2