Question 1

A couple who have three daughters would like to add a son to their family, and they have recently learned that the woman is pregnant. Which of the following phenomena would most likely be associated with the woman's eventual delivery of a healthy son?
A) The production of dihydrotestosterone (DHT) by the embryo and DHT's differentiation into testosterone
B) Development of testes under the influence of the X chromosome
C) Suppression of female reproductive structures by anti-Müllerian hormone (AMH)
D) Atrophy of the Wolffian ducts during embryonic development

Accepted Answer

AMH suppresses the development of female genital structures and is a normal aspect of normal sex differentiation. Testosterone is a precursor to DHT rather than vice versa, and testes develop under the influence of the Y chromosome. The Wolffian ducts are a component of male sex differentiation.

Question 2

The nurse knows that if which of the following hormones listed below are not available during embryonic development, a male embryo with an XY chromosomal pattern may develop female external genitalia? Select all that apply.
A) Anti-Müllerian hormone (AMH)
B) Testosterone
C) Dihydrotestosterone (DHT)
D) Acrosome
E) Follicle-stimulating hormone (FSH)

Accepted Answer

In the absence of testosterone (and DHT), a male embryo with an XY chromosomal pattern develops female external genitalia. AMH suppresses the Müllerian ducts and prevents development of the uterus and fallopian tubes in the male. Acrosome is the outside of the anterior two thirds of the head of a sperm. For spermatogenesis to occur, FSH binds to specific receptors in Sertoli cells.

Question 3

A 68-year-old male has visited his family physician because the size of his scrotum has increased exponentially in recent months. He has subsequently been diagnosed with an inguinal hernia. Which of the following statements best captures the nature of his health problem?
A) Part of his intestine and parietal peritoneum are protruding through the inguinal opening.
B) Rupture of the tunica vaginalis has allowed a part of his small bowel to protrude into the intrascrotal space.
C) Incomplete closure of the inguinal opening during his development has contributed to testicular hypertrophy and hyperplasia.
D) Occlusion of the efferent ductules and epididymis causes massive dilation of the testes.

Accepted Answer

An inguinal hernia is the protrusion of intestine and peritoneum into the scrotum through an incompletely sealed inguinal opening. The tunica vaginalis, occlusion of the duct system, nor testicular hypertrophy and hyperplasia contribute to the etiology.

Question 4

The cremaster muscles work in concert with the pampiniform plexus that surrounds the testicular artery to
A) move the testes into the scrotum.
B) maintain testicular temperature.
C) empty fluid from the seminal vesicles into the genital ducts.
D) move sperm from the ampulla to the penis.

Accepted Answer

The location of the testes in the scrotum is important for sperm production, which is optimal at 2°C to 3°C below body temperature. Two systems maintain the temperature of the testes at a level consistent with sperm production. One is the pampiniform plexus of testicular veins that surround the testicular artery. This plexus absorbs heat from the arterial blood, cooling it as it enters the testes. The other is the cremaster muscles. These muscles respond to decreases in testicular temperature by moving the testes closer to the body.

Question 5

A couple has been trying to get pregnant for over 2 years. After infertility testing, the physician has informed the male that he has a low sperm count. The nurse knows which of the following causes of low sperm count may lead to impaired spermatogenesis? Select all that apply.
A) Prolonged fever
B) Wearing tight briefs rather than boxers
C) Undescended testes
D) Swimming in cold-water lakes
E) Vacationing in a tropical location

Accepted Answer

Prolonged exposure to elevated temperatures, as a result of prolonged fever, tight undergarments, and failure of the testes to descend into the scrotum can result in decreased sperm counts.

Question 6

Following ejaculation in a healthy adult, approximately 300 million sperm is present. Which percent of these sperm would be considered normal (mobile and morphologically healthy) and able to fertilize an egg?
A) 95%
B) 75%
C) 55%
D) 45%

Accepted Answer

Approximately 3 mL of semen is expressed with each ejaculate, and each milliliter is made up of about 100 million sperm. However, approximately 20% of the sperm in any ejaculate are not morphologically normal and about 25% are immobile.

Question 7

A nursing student studying obstetrics asks the faculty, "How does the sperm get so much energy to swim up the fallopian tubes?" The instructor responds based on which pathophysiological principle?
A) Usually the ejaculation is so powerful that it propels the sperm far up into the fallopian tubes.
B) Fructose is secreted by the seminal vesicles and provides energy for motility of the sperm.
C) The seminal vesicles secrete fluid for the semen, and they can secrete catecholamines that energize the sperm.
D) Estrogen, which is being secreted when the ova are ripe and ready for penetration, assists by attracting the sperm in the right direction.

Accepted Answer

The seminal vesicles consist of two highly tortuous tubes that secrete fluid for the semen. Each of the paired seminal vesicles is lined with secretory epithelium containing an abundance of fructose, prostaglandins, and several other proteins. The fructose secreted by the seminal vesicles provides the energy for sperm motility.

Question 8

Sperm follow a prescribed route through the excretory ducts of the male reproductive system. Place the following components of the genital duct system in the order that sperm follow. Use all the options.
A) Efferent ductules
B) Ductus deferens
C) Prostatic urethra
D) Urethra
E) Seminiferous tubules 
F) Epididymis

Accepted Answer

Seminiferous tubules combine in the testes to form the rete testes, which flow into the efferent ductules and the epididymis. The epididymis flows into the ductus deferens, which leaves the testes passing through the prostatic urethra before leaving the body by way of the urethra.

Question 9

An elderly male patient is complaining of dribbling after he urinates and feeling like he never empties his bladder. The nurse suspects the patient may have a problem with
A) kidney stones.
B) an enlarged prostate gland.
C) blood clots clogging the urethra.
D) calcium sediment in the bladder.

Accepted Answer

Symptoms of obstruction, including dribbling after urinating and the continuous sensation of having to urinate, are most likely due to enlargement of a prostate gland. Kidney stones cause intense flank pain; blood clots are usually associated with trauma or surgery; calcium sediment could imply a kidney stone or be a result of a procedure to break up kidney stones into smaller segments.

Question 10

Which of the following statements best captures an aspect of normal spermatogenesis?
A) Testosterone chemically lyses each primary spermatocyte into two secondary spermatocytes with 23 chromosomes each.
B) Sertoli cells differentiate into spermatids, each of which can contribute half of the chromosomes necessary for reproduction.
C) Spermatogonia adjacent to the tubular wall undergo meiotic division and provide a continuous source of new germinal cells.
D) Each primary spermatocyte undergoes two nuclear divisions yielding four cells with 23 chromosomes each.

Accepted Answer

The process of meiosis consists of two consecutive nuclear divisions of a primary spermatocyte with formation of four daughter cells, each containing a single set of 23 chromosomes. Testosterone does not chemically lyse immature sperm, and Sertoli cells play a nurturing and facilitative role in spermatogenesis rather than differentiating themselves into spermatocytes. Spermatogonia undergo mitosis, not meiosis.

Question 11

A student asks the instructor what are the parameters of infertility. The instructor responds, "Infertility is defined as"
A) 100 million of sperm in ejaculate.
B) 50% of sperm has good motility.
C) morphology that appears normal.
D) 10 million/mL sperm available in seminal fluid.

Accepted Answer

The sperm count in a normal ejaculate is approximately 100 to 400 million. Infertility may occur when insufficient numbers of motile, healthy sperm are present. A "fertile sample" on seminal fluid analysis is associated with a count greater than 20 million/mL, greater than 50% motility, normal morphology, and a volume of 1.5 to 6 mL.

Question 12

A 40-year-old male client with multiple health problems has been diagnosed with a testosterone deficiency. The nurse knows that which of the following assessment findings would correlate with a testosterone deficiency? Select all that apply.
A) A high-pitched voice
B) Long-lasting chronic hip dysplasia
C) Complaints of multiple upper respiratory infections
D) A low muscle mass in proportion to his total body weight
E) Hot flashes and diaphoresis

Accepted Answer

Vulnerability to infection and hip dysplasia would likely not be a manifestation of low testosterone. Low muscle mass, hot flashes and diaphoresis, and a lack of male voice characteristics could develop secondary to testosterone deficiency.

Question 13

A 31-year-old male has been referred to a fertility clinic following a count of 2 million sperm/mL on seminal fluid analysis. Which of the following hormone levels would a clinician want to examine in an effort to ascertain the cause of the client's low sperm count? Select all that apply.
A) Luteinizing hormone (LH)
B) Adrenocorticotropic hormone (ACTH)
C) Follicle-stimulating hormone (FSH)
D) Cortisol
E) Somatostatin 
F) Gonadotropin-releasing hormone (GnRH)

Accepted Answer

LH, FSH, and GnRH are all components of the hypothalamic-pituitary control of spermatogenesis. ACTH, cortisol, and somatostatin are not directly involved in the process.

Question 14

A 39-year-old male client has been recently diagnosed with primary hypogonadism. Which of the following lab results would be most indicative of this diagnosis?
A) Normal levels of free testosterone; low levels of total testosterone
B) Low free testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels
C) Low levels of gonadotropin-releasing hormone (GnRH)
D) Low testosterone levels; high levels of LH and FSH

Accepted Answer

Primary hypogonadism is associated with a defect in the testicular production of testosterone normally accompanied by high levels of the hormonal precursors. Free testosterone levels would not be normal given the client's diagnosis. Low GnRH levels are associated with tertiary hypogonadism.

Question 15

Which of the following statements best captures an aspect of the neural control of sexual function?
A) The sensory system contained in the testes communicates with the spinal cord by way of afferent pathways.
B) Perineal stimulation transmits signals to the thalamus and hypothalamus.
C) The spinal cord plays a central role, with the limbic system and cerebral cortex also contributing.
D) Sympathetic stimulation causes the shunting of blood resulting in erection, while parasympathetic stimulation results in detumescence.

Accepted Answer

Afferent impulses from sensory receptors in the glans penis pass through the pudendal nerve to ascending fibers in the spinal cord by way of the sacral plexus, while stimulation of other perineal areas can transmit signals to higher brain centers, such as the limbic system and cerebral cortex. The thalamus and hypothalamus do not play a central role in the neural control of male sexual function, and arousal can result from parasympathetic stimulation.

Question 16

A 24-year-old male patient with a complete transection of the spinal cord asks, "Will I be able to father children in the future?" The nurse responds,
A) "Probably not since your spinal cord has been completely severed."
B) "An urologist may be able to insert a needle into your testes and withdraw some sperm."
C) "With proper stimulation of your genitals, you may be able to produce an erection and ejaculation."
D) "It takes sympathetic innervation to produce an erection and ejaculation which is loss with your type of injury."

Accepted Answer

Genital stimulation can produce erection and ejaculation in some men with complete transection of the spinal cord; therefore, that negates answer choices A and D.

Question 17

A 71-year-old man has visited his family physician for a checkup, during which the physician has initiated a discussion about the client's sexual function. Which of the following phenomena would the physician most likely consider pathological rather than age-related changes?
A) The presence of an enlarging prostate gland
B) A decrease in the size and firmness of the client's testes
C) Cessation of androgen production
D) A decrease in the force of the man's ejaculation

Accepted Answer

Absence of androgen production and release would be considered a pathological finding rather than a normal accompaniment of the aging process. Androgen replacement in aging men with low androgen levels shows an increase in lean body mass and a decrease in bone turnover. Although they would not necessarily remain untreated, hypogonadism, testicular atrophy, and a decreased force of ejaculation are common reproductive changes that are associated with advanced age.

Question 18

If a male has a history of impaired blood flow in his vascular system, he may be prone to develop
A) premature ejaculation.
B) erectile dysfunction.
C) penile engorgement.
D) vascular clots in pudendal arteries.

Accepted Answer

Vascular disease affects male potency because it may impair blood flow to the pudendal arteries or their tributaries, resulting in loss of blood volume with subsequent poor distention of the vascular spaces of erectile tissue. Premature ejaculation is not caused by a vascular problem. Penile engorgement is expected as part of an erection. Vascular clots may relate to a trauma or surgery to the penis.

Question 19

A 68-year-old man has revealed to his care provider that he is distraught over his increasingly frequent inability to maintain an erection. Which of the following teaching points is most warranted?
A) "Above the age of 65, erectile dysfunction is largely inevitable and untreatable."
B) "With lifestyle modifications like exercise, weight loss, and quitting smoking, you can most likely correct this and prevent it in the future."
C) "While this problem is often a part of the aging process, it might be a result of some of the medications that you take."
D) "Most often this problem is transient and will resolve with time."

Accepted Answer

The incidence and prevalence of ED increase with age, and medications often contribute to the problem. ED is not inevitable or untreatable, but it is unlikely to spontaneously resolve. Lifestyle modifications can lessen the risk of developing ED but cannot guarantee correction or prevention.

Question 20

A 21-year-old college football player has acknowledged to a nurse at a campus clinic that he has been injecting androgens in an effort to increase the size of his musculature and enhance his on-field performance. Which of the following teaching points should the nurse include in a conversation with the player?
A) "You run a real risk of developing acne and developing breasts by doing this."
B) "You will indeed be able to increase your muscles, but they will rebound by shrinking smaller than they ever were within a few months."
C) "Most of the people who do this cause themselves to be permanently sterile."
D) "A reduction in the size of your penis and the production of mutated sperm can be an effect of steroid use."

Accepted Answer

Testicular atrophy and gynecomastia are identified as the effects of anabolic steroid use. Rebound muscle atrophy is not a noted phenomenon that accompanies the steroid use, nor is a permanent cessation of spermatogenesis. Changes in penis size and mutation in sperm cell divisions are similarly unlikely.

Quiz 48: Disorders of Musculoskeletal Function: Trauma, Infection, Neoplasms

A couple who have three daughters would like to add a son to their family, and they have recently learned that the woman is pregnant. Which of the following phenomena would most likely be associated with the woman's eventual delivery of a healthy son?

The nurse knows that if which of the following hormones listed below are not available during embryonic development, a male embryo with an XY chromosomal pattern may develop female external genitalia? Select all that apply.

A 68-year-old male has visited his family physician because the size of his scrotum has increased exponentially in recent months. He has subsequently been diagnosed with an inguinal hernia. Which of the following statements best captures the nature of his health problem?

The cremaster muscles work in concert with the pampiniform plexus that surrounds the testicular artery to

A couple has been trying to get pregnant for over 2 years. After infertility testing, the physician has informed the male that he has a low sperm count. The nurse knows which of the following causes of low sperm count may lead to impaired spermatogenesis? Select all that apply.

Following ejaculation in a healthy adult, approximately 300 million sperm is present. Which percent of these sperm would be considered normal (mobile and morphologically healthy) and able to fertilize an egg?

A nursing student studying obstetrics asks the faculty, "How does the sperm get so much energy to swim up the fallopian tubes?" The instructor responds based on which pathophysiological principle?

Sperm follow a prescribed route through the excretory ducts of the male reproductive system. Place the following components of the genital duct system in the order that sperm follow. Use all the options.

An elderly male patient is complaining of dribbling after he urinates and feeling like he never empties his bladder. The nurse suspects the patient may have a problem with

Which of the following statements best captures an aspect of normal spermatogenesis?

A student asks the instructor what are the parameters of infertility. The instructor responds, "Infertility is defined as"

A 40-year-old male client with multiple health problems has been diagnosed with a testosterone deficiency. The nurse knows that which of the following assessment findings would correlate with a testosterone deficiency? Select all that apply.

A 31-year-old male has been referred to a fertility clinic following a count of 2 million sperm/mL on seminal fluid analysis. Which of the following hormone levels would a clinician want to examine in an effort to ascertain the cause of the client's low sperm count? Select all that apply.

A 39-year-old male client has been recently diagnosed with primary hypogonadism. Which of the following lab results would be most indicative of this diagnosis?

Which of the following statements best captures an aspect of the neural control of sexual function?

A 24-year-old male patient with a complete transection of the spinal cord asks, "Will I be able to father children in the future?" The nurse responds,

A 71-year-old man has visited his family physician for a checkup, during which the physician has initiated a discussion about the client's sexual function. Which of the following phenomena would the physician most likely consider pathological rather than age-related changes?

If a male has a history of impaired blood flow in his vascular system, he may be prone to develop

A 68-year-old man has revealed to his care provider that he is distraught over his increasingly frequent inability to maintain an erection. Which of the following teaching points is most warranted?