maternal_ OB - Chapter 10 (Conception and Fetal Development) Practice Questions

A nurse is teaching a couple about the process of fertilization. Which statement by the couple would indicate understanding of fertilization?
a. "Fertilization takes place in the timbre, or other third of the Fallopian tube."
b. "Fertilization takes place in the uterine cavity."
c. "Fertilization takes place in the ampulla, or outer third, of the fallopian tube."
d. "Fertilization take place in the isthmus, or inner third, of the Fallopian tube."

c. "Fertilization takes place in the ampulla, or outer third, of the fallopian tube."

Rationale: Actual fertilization takes place in the ampulla (outer third) of the fallopian tube. The fallopian tubes have a dual ciliary action that facilitates movement of the ovum toward the uterus and movement of the sperm from the uterus toward the ovary.

A nurse in the fertility clinic is teaching clients about the process of fertilization. Which statement by the client would not require further teaching by the nurse?
a. "If the sperm plasma membrane is not removed (capacitation), the sperm will not be able to fertilize the ovum."
b. "Testosterone in the semen helps to transport the sperm by increasing uterine smooth muscle contractions."
c. "Transportation of the sperm to the fallopian tube takes an average of 12-24 hours after ejaculation."
d. "Progesterone increases peristalsis in the fallopian tubes during ovulation, moving the ovum toward the uterus."

a. "If the sperm plasma membrane is not removed (capacitation), the sperm will not be able to fertilize the ovum."

Rationale: The sperm must undergo two processes before fertilization can occur: capacitation and the acrosomal reaction. Capacitation is the removal of the plasma membrane. Capacitation occurs in the female reproductive tract (aided by uterine enzymes) and is thought to take about 7 hours. If the sperm plasma membrane is not removed, the sperm will not be able to fertilize the ovum. The acrosomal reaction follows capacitation. The acrosome caps of the sperm surrounding the ovum release their enzymes. These enzymes break down the hyaluronic acid that holds the elongated cells of corona radiata together. Hundreds of acrosomes must rupture to clear enough hyaluronic acid for even a single sperm to penetrate the ovum successfully. Transit time of sperm from the cervix into the fallopian tube can be as short as 5 minutes but usually takes an average of 2-7 hours after ejaculation. Prostaglandins in the semen can increase uterine smooth muscle contractions, which help transport the sperm. The fallopian tubes have a dual ciliary action that facilitates movement of the ovum toward the uterus and movement of the sperm from the uterus toward the ovary.

A pregnant client is concerned about a blow to the abdomen if she continues to play basketball during her pregnancy. The nurse's response is based upon her knowledge of which of the following facts concerning amniotic fluid?
a. The fetus does not contribute to the production of amniotic fluid.
b. Amniotic fluid functions as a cushion to protect against mechanical injury.
c. Amniotic fluid is slightly acidic.
d. The total amount of amniotic fluid during pregnancy is 300 mL.

b. Amniotic fluid functions as a cushion to protect against mechanical injury.

Rationale: During pregnancy, the amniotic fluid protects against mechanical injury. After 20 weeks of pregnancy, fluid volume ranges from 700-1000 mL. Some of the amniotic fluid is contributed by the fetus's excreting urine. Amniotic fluid is slightly alkaline.

A client states that she had a spontaneous abortion 12 months ago. The client asks if her hormones might have contributed to the loss of the pregnancy. The nurse's response is based upon her knowledge of which of the following facts?
a. The spontaneous abortion occurred at 16 weeks.
b. The client's estrogen levels are too high.
c. The client's hCG levels were not high enough to support the corpus luteum.
d. Progesterone is produced only by the corpus luteum during pregnancy.

c. The client's hCG levels were not high enough to support the corpus luteum

Rationale: The hormone hCG is similar to luteinizing hormone (LH), and prevents the normal involution of the corpus luteum at the end of the menstrual cycle. If the corpus luteum stops functioning before the 11th week of pregnancy, spontaneous abortion occurs. hCG also causes the corpus luteum to secrete increased amounts of estrogen and progesterone. After the 11th week, the placenta produces enough progesterone and estrogen to maintain pregnancy.

A nurse is teaching a group of student nurses about amniotic fluid. Which of the following statements by a student nurse reflect an understanding of the fetus's contribution to the quality of amniotic fluid? Select all that apply.
a. "Approximately 400 mL of amniotic fluid flows out of the fetal lungs each day."
b. "A fetus can move freely and develop normally, even if there is no amniotic fluid."
c. "The fetus swallows about 600 mL of the fluid in 24 hours."
d. "Abnormalities in fetal urine production can affect amniotic fluid volumes."
e. "The fetus contributes to the volume of amniotic fluid by excreting urine."

a. "Approximately 400 mL of amniotic fluid flows out of the fetal lungs each day."
c. "The fetus swallows about 600 mL of the fluid in 24 hours."
d. "Abnormalities in fetal urine production can affect amniotic fluid volumes."
e. "The fetus contributes to the volume of amniotic fluid by excreting urine."

Rationale: The fetus contributes to the volume of amniotic fluid by excreting urine. Approximately 400 mL of amniotic fluid flows out of the fetal lungs each day. The fetus swallows about 600 mL of the fluid in 24 hours. A normal volume of amniotic fluid is necessary for good fetal movement. Normal movement is necessary for good musculoskeletal development.

The nurse is preparing an educational workshop on fetal development. Which statement by the student would require the nurse to explain further?
a. "The high blood volume and Wharton's jelly content of the umbilical cord prevent compression of the cord."
b. "The umbilical cord normally contains two veins and one artery."
c. "The average cord length at term is 22 inches."
d. "True knots are usually associated with a cord that is too long."

b. "The umbilical cord normally contains two veins and one artery."

Rationale: Umbilical cords form from the body stalk, which attaches the embryo to the yolk sac and fuses with the embryonic portion of the placenta, providing a circulatory pathway to the embryo. Umbilical cords appear twisted or spiraled. This is most likely caused by fetal movement. A true knot in the umbilical cord rarely occurs; if it does, the cord is usually too long. More common are so-called false knots, caused by the folding of cord vessels. A nuchal cord is said to exist when the umbilical cord encircles the fetal neck. A normal umbilical cord contains one large vein and two smaller arteries. A specialized connective tissue known as Wharton's jelly surrounds the blood vessels in the umbilical cord. This tissue, plus the high blood volume pulsating through the vessels, prevents compression of the umbilical cord in utero.

At 17 weeks pregnant, a mother asks the nurse questions about the development of her baby. The mother states that it might be too early to visualize any body structures via ultrasound. The nurse's best response in relation to fetal development at 17 weeks is:
a. "The earlobes are soft with little cartilage."
b. "Differentiation of hard and soft palate can be seen."
c. "Myelination of the spinal cord has occurred."
d. "Hard tissue (enamel) for teeth has developed."

b. "Differentiation of hard and soft palate can be seen."

Rationale: Differentiation of hard and soft palate occurs by 16 weeks' gestation. Myelination of the spinal cord begins at 20 weeks' gestation. Soft earlobes with little cartilage develop at 36 weeks' gestation. Teeth form hard tissue (enamel) at 18 weeks' gestation.

The nurse is preparing an educational workshop on the time frames for fetal exposure to potential teratogens. Which defect is most likely to occur at 7 weeks' gestation?
a. A cleft lip.
b. A cleft palate.
c. Septal or aortic abnormalities.
d. The shortening of fingers and toes.

b. A cleft palate.

Rationale: Cleft palate is the defect most likely to occur at 7 weeks' gestation. Shortening of fingers and toes most likely occurs at 8 weeks' gestation. Cleft lip most likely occurs at 6 weeks' gestation. Septal or aortic abnormalities are most likely to occur at 6 weeks' gestation.

A client in the prenatal clinic tells the nurse that her sister has twins. The client is concerned that she also might have twins. The nurse's response is based upon her knowledge of which of the following facts?
a. The survival rate of monozygotic twins is about 10% higher than that of dizygotic twins.
b. Genetic factors in the mother can lead to elevated serum gonadotropin levels, causing double ovulation.
c. Twinning occurs more often in Asian women.
d. The chance of dizygotic twins decreases with maternal age up to about 35 years.

b. Genetic factors in the mother can lead to elevated serum gonadotropin levels, causing double ovulation.

Rationale: A genetic factor that results in elevated serum gonadotropin levels can cause double ovulation. The chance of dizygotic twins increases with maternal age up to about 35 years and then decreases abruptly. Dizygotic twinning occurs more often in black women than white women whereas the incidence of monozygotic twins is approximately the same in all populations. The survival rate of monozygotic twins is about 10% lower than that of dizygotic twins.

A nurse is instructing her students where to listen for a uterine souffle. Each student has placed the fetoscope on the pregnant woman's abdomen. Based on the following placements of the fetoscopes, the student most likely to hear a uterine souffle is the one who placed her fetoscope on which of the following area?
a. Under the area of the umbilical cord of the fetus.
b. Just above the symphysis pubis.
c. Just below the symphysis pubis.
d. Over the area of the umbilical cord of the fetus.

b. Just above the symphysis pubis.

Rationale: A uterine souffle is best heard just above the mother's symphysis pubis. There are no specific placental circulatory sounds that can be heard under the area of the umbilical cord of the fetus. A funic souffle can be heard over the area of the umbilical cord of the fetus in late pregnancy. There are no specific placental circulatory sounds that can be heard in the area just below the symphysis pubis.