Preview Extract
Chapter 4
1) The nurse is explaining the difference between meiosis and mitosis. Which statement does
the nurse include?
1. Meiosis is the division of a cell into two exact copies of the original cell.
2. Mitosis is splitting one cell into two, each with half the chromosomes of the original cell.
3. Meiosis is the process by which gametes, or the sperm and ova, are formed.
4. Mitosis occurs in most of the cells of the body.
5. Meiotic division leads to cells that halve the original genetic material.
Answer: 3,5
Rationale 1:
Meiosis creates two cells that have half of the chromosomes of the original cell.
Rationale 2:
Mitosis creates two cells that are exact copies of the original cell.
Rationale 3:
Both sperm and ova are created through meiosis.
Rationale 4:
Mitosis is how the majority of cells reproduce so that the new cells have the same structure
and function as the original. Meiosis only occurs in gametes.
Rationale 5:
Meiosis creates two cells that have half of the chromosomes of the original cell.
2) The nurse has completed a presentation on reproduction. Which participant’s statement
indicates that the teaching has been successful?
1. “A male is born with all the sperm he will ever produce.”
2. “Females create new ova throughout their reproductive life.”
3. “Ova separate into two unequally sized cells.”
4. “Each primary spermatocyte divides into four haploid cells.”
Answer: 3
Rationale 1:
Males begin spermatogenesis at puberty and continue throughout their life. Each sperm
divides into four haploid cells.
Rationale 2:
Females are born with all the ova they will ever produce. The ova begin to be formed in early
fetal life. One ovum is released each month during the reproductive life of a female, from
menarche to menopause.
Rationale 3:
Each ovum undergoes meiotic division just prior to being released from the graafian follicle.
Each cell created by this meiosis has the same number of chromosomes, but the cytoplasm
does not split equally. This causes a polar body to be produced along with a secondary
oocyte.
Rationale 4:
Primary spermatocytes contain 46 chromosomes (46XY). Each primary spermatocyte
undergoes meiotic division into two haploid secondary spermatocytes (22X or 22Y). Haploid
cells each contain half of the genetic material of the original cell. Then each secondary
spermatocyte undergoes a second meiotic division into two haploid spermatids (remaining
either 22X or 22Y.) Spermatids mature into spermatozoa. Thus, a primary spermatocyte
eventually becomes four haploid spermatozoa.
3) After teaching a class about the female reproductive system, the nurse asks the attendees to
describe the process of meiosis. Which student response suggests successful comprehension
of the material?
1. "Completion of the second meiotic division results in formation of three polar bodies and
one ovum."
2. "At the time of ovulation, the first meiotic division begins."
3. "Completion of the first meiotic division produces three polar bodies and one primary
oocyte."
4. "At the time of puberty, the second meiotic division begins."
Answer: 1
Rationale 1:
Completion of the second meiotic division produces three polar bodies and one ovum.
Rationale 2:
The first meiotic division of oocytes begins before the female fetus is born.
Rationale 3:
Completion of the first meiotic division produces one polar body and one secondary oocyte.
Rationale 4:
The second meiotic division begins at the time of ovulation.
4) You are counseling a young woman regarding contraception. When asked if she currently
uses any form of contraception, she replies, "I can't get pregnant because I don't have
intercourse on the day I ovulate." Based upon her response, what information should you
include in your teaching?
1. Refraining from intercourse on the day of ovulation will effectively prevent pregnancy.
2. Sperm are believed to be healthy and highly fertile for at least five days.
3. After ovulation, ova are considered fertile for about 72-96 hours.
4. Sperm survive 48-72 hours in the female reproductive tract.
Answer: 4
Rationale 1:
Because sperm survive 48-72 hours in the female reproductive tract, avoidance of intercourse
for 24 hours will not reliably prevent pregnancy from occurring.
Rationale 2:
Sperm are believed to be most fertile for the first 24 hours following entry into the female
reproductive tract.
Rationale 3:
Ova are considered fertile for about 12-24 hours after ovulation.
Rationale 4:
Sperm survive 48–72 hours in the female reproductive tract.
5) When evaluating information taught about conception and fetal development, the patient
verbalizes understanding about transportation time of the zygote through the fallopian tube
and into the cavity of the uterus with which statement?
1. “It will take at least three days for the egg to reach the uterus.”
2. “It will take eight days for the egg to reach the uterus.”
3. “It will only take 12 hours for the egg to go through the fallopian tube.”
4. “It will take 18 hours for the fertilized egg to implant in the uterus.”
Answer: 1
Rationale 1:
It takes at least three days for the egg to reach the uterus.
Rationale 2:
“It will take eight days for the egg to reach the uterus” is an incorrect interpretation of the
information on conception.
Rationale 3:
“It will only take 12 hours for the egg to go through the fallopian tube” is an incorrect
interpretation of the information on conception.
Rationale 4:
“It will take 18 hours for the fertilized egg to implant in the uterus” is an incorrect
interpretation of the information on conception.
6) If only a small volume of sperm is discharged into the vagina, an insufficient amount of
enzymes might be released when sperm encounters the ovum. In that case, pregnancy would
probably not result because:
1. Peristalsis of the fallopian tube would decrease, making it difficult for the ovum to enter
the uterus.
2. The block to polyspermy (cortical reaction) would not occur.
3. The fertilized ovum would be unable to implant in the uterus.
4. Sperm would be unable to penetrate the zona pellucida of the ovum.
Answer: 4
Rationale 1:
“Peristalsis of the fallopian tube would decrease, making it difficult for the ovum to enter the
uterus” is an incorrect statement.
Rationale 2:
The answer choice of the block to polyspermy (cortical reaction) not occurring is incorrect
because it is mediated by release of materials from cortical granules below the ovum’s
surface and not the result of low sperm count.
Rationale 3:
The fertilized ovum would be unable to implant in the uterus because fertilization is unlikely
to occur with a low sperm count.
Rationale 4:
Sperm would be unable to penetrate the zona pellucida of the ovum because it takes hundreds
of acrosomes (the result of the acrosomal reaction) to rupture and release enough hyaluronic
acid to clear the way for a single sperm to penetrate the ovum’s zona pellucida successfully.
7) The nurse is caring for a patient who is pregnant with twins. Which statement indicates the
patient needs additional information?
1. “Because both of my twins are boys, I know that they are identical.”
2. “If my twins came from one fertilized egg that split, they are identical.”
3. “If I have one boy and one girl, I will know they came from two eggs.”
4. “It is rare for twins to both be within the same amniotic sac.”
Answer: 1
Rationale 1:
Not all same-sex twins are identical or monozygotic, because fraternal, or dizygotic, twins
can be the same gender or different genders.
Rationale 2:
When the zygote splits, identical twins share the same genotype result.
Rationale 3:
The only way to have twins of different genders is if they came from two separate fertilized
ova. Monozygotic twins are identical and are the same gender.
Rationale 4:
Monoamnionic-monochorionic twins are very rare and occur as a result of the zygote
splitting seven or more days after fertilization.
8) A pregnant patient asks you to describe the differences between monozygotic and
dizygotic twins. Which statement should you include in your teaching?
1. Dizygotic twinning occurs less frequently than does monozygotic twinning.
2. Monozygotic twins originate from division of the fertilized ovum at different stages.
3. Dizygotic twins share one placenta and one chorion.
4. Monozygotic twins are also referred to as "fraternal" twins.
Answer: 2
Rationale 1:
Dizygotic twinning occurs more frequently than does monozygotic twinning.
Rationale 2:
Monozygotic twins originate from division of the fertilized ovum at different stages of early
development.
Rationale 3:
Dizygotic twins each have a separate chorion and amnion.
Rationale 4:
Monozygotic twins are also referred to as "identical" twins.
9) Which statement by a pregnant patient would indicate that additional teaching was
necessary?
1. “Because of their birth relationship, fraternal twins are more similar to each other than if
they had been born singly.”
2. “Identical twins can be the same or different sex.”
3. “Congenital abnormalities are more prevalent in identical twins.”
4. “Identical twins occur more frequently than fraternal twins.”
Answer: 3
Rationale 1:
Fraternal twins are not more similar to each other than if they had been born singly.
Rationale 2:
Identical or monozygotic twins have identical chromosomal structures and therefore are
always the same sex.
Rationale 3:
Due to variations in the timing of the splitting of the embryo, congenital abnormalities such
as conjoining are more common in monozygotic twins.
Rationale 4:
Dizygotic, or fraternal, twins occur more frequently than do monozygotic twins.
10) The nurse is creating a poster for pregnant mothers. Which description of fetal
development does the nurse include?
1. Four layers of cells form after the embryo is at the ball stage.
2. After fertilization, the cells only become larger for several weeks.
3. Most organs are formed by 8 weeks after fertilization.
4. The embryonic stage is from fertilization until 5 months.
Answer: 3
Rationale 1:
Three primary germ layers form from the ball of undifferentiated cells called the blastocyst:
ectoderm, mesoderm, and endoderm.
Rationale 2:
After fertilization, the cells reproduce by mitosis, resulting in more cells, not larger cells.
Rationale 3:
Most organs are formed during the embryonic stage, which lasts from the 15th day after
fertilization until the end of the 8th week after fertilization.
Rationale 4:
The embryonic stage begins on the 15th day after fertilization and ends at the completion of
the 8th week after fertilization.
11) The nurse is presenting an early pregnancy class to a group of pregnant women. Which
statement indicates a need for further education? “The placenta:
1. “Develops and grows larger until about 20 weeks’ gestation.”
2. “Creates hormones and enzymes that are necessary during pregnancy.”
3. “Ages and becomes less permeable during the last month of pregnancy.”
4. “Floats in the amniotic sac and filters waste products from the fetus.”
Answer: 4
Rationale 1:
The chorionic villi of the placenta become more differentiated with time. The placenta grows
in size until about 20 weeks. After this point, the placenta thickens but does not increase in
size.
Rationale 2:
The placenta creates glycogen, cholesterol, hormones such as human chorionic gonadotropin
(hCG), and enzymes such as sulfatase and insulinase.
Rationale 3:
The placenta is designed to last for 40 weeks, the average length of human gestation. The
permeability to nutrients and oxygen begins to decrease starting at about 36 weeks as a part
of the aging of the placenta.
Rationale 4:
The placenta is attached to the uterine wall, and does not float in the amniotic sac. One
function of the placenta is to filter metabolic waste products from the baby’s blood so that
they can be excreted by the mother.
12) The nurse is working with a patient who has experienced a fetal death in utero at 20
weeks. The patient asks what her baby will look like when it is delivered. Which statement by
the nurse is the best response?
1. “Your baby will be covered in fine hair called lanugo.”
2. “Your child will have arm and leg buds, but not fully formed limbs.”
3. “A white, cheesy substance called vernix caseosa will be on the skin.”
4. “The genitals of the baby will be ambiguous.”
Answer: 1
Rationale 1:
Downy fine hair called lanugo covers a 20-week fetus.
Rationale 2:
Limb buds have developed by 35 days post-fertilization. At 20 weeks, the fetus will have
well developed well differentiated arms and legs.
Rationale 3:
Vernix caseosa forms at about 24 weeks. This fetus is only 20 weeks and will not have
vernix.
Rationale 4:
The genitals are apparent by 12 weeks after fertilization. This fetus would have had
specifically male or female genitals 8 weeks ago.
13) At her first prenatal visit, the patient states, "I'm five weeks' pregnant now and I would
like to hear my baby's heartbeat today." How should the nurse respond?
1. Prepare to assist with auscultation of the fetal heartbeat using a fetoscope.
2. Explain to the patient that the fetal heart does not begin to beat until approximately 7
weeks' gestation.
3. Anticipate that the patient will be scheduled for Doppler ultrasound.
4. Explain to the patient that the fetal heartbeat is not yet detectable at 5 weeks' gestation.
Answer: 4
Rationale 1:
Fetal heart tones can be identified through use of a fetoscope at approximately the 20th week
of pregnancy.
Rationale 2:
The fetal heart begins to beat by the 4th week of gestation.
Rationale 3:
Generally, fetal heart tones cannot be heard until approximately the 8th week of pregnancy
by ultrasound Doppler device.
Rationale 4:
While the tubular heart begins to form during the 3rd week, fetal heart tones generally are not
be detectable until at least 7 weeks' gestation.
14) The patient at 18 weeks’ gestation thinks she might have been exposed to a toxin at work
that could affect fetal development. The patient asks the nurse what organs might be affected
at this point in pregnancy. The best response of the nurse is:
1. “The brain is developing now and could be affected.”
2. “Because you are in the second trimester, there is no danger.”
3. “The internal organs like the heart and lungs could be impacted.”
4. “It’s best to not worry about possible problems with your baby.”
Answer: 1
Rationale 1:
Maximum brain growth and myelination are occurring at this point in fetal development.
Rationale 2:
Although the greatest danger from teratogens is during the embryonic stage (the first 8 weeks
of pregnancy), the fetus at 20 weeks is still vulnerable to exposure to teratogens.
Rationale 3:
The heart, lungs, and other internal organs form during the embryonic state, or the first 8
weeks of pregnancy. During their formation is when they are most likely to be affected by a
teratogen.
Rationale 4:
Avoid telling patients to not worry. Doing so indicates to the patient that you don’t care about
their concerns and will end effective communication.
15) The nurse is preparing a preconception information class. Information about causes of
fetal organ malformation in the first trimester will be presented. What prenatal influences on
the intrauterine environment should be included in the instruction?
1. The use of saunas or hot tubs
2. The use of drugs
3. The quality of the sperm or ovum
4. Maternal nutrition
5. Age of the mother at conception
Answer: 1,2,4
Rationale 1:
The use of saunas or hot tubs is associated with maternal hyperthermia and neural tube
defects.
Rationale 2:
Many drugs can have teratogenic effects.
Rationale 3:
The quality of the sperm or ovum can affect fertility but not organ formation.
Rationale 4:
Maternal nutrition, if deficient, can cause damage to the fetus. Vitamins and folic acid taken
prior to and during the pregnancy can have beneficial effects.
Rationale 5:
A maternal age of 35 or older is associated with genetic defects that occur at conception, not
with first-semester organ malformation.
Test Bank for Contemporary Maternal-Newborn Nursing
Patricia W Ladewig, Marcia L London, Michele Davidson
9780133429862, 9780134257020
