Unit4: Ch 42- Structure and Function of the Male Reproductive System (Porch's 5th ed)

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

Answer 1

Ans: C
Feedback:
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).

Answer 2

Ans: B, C
Feedback:
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.

Answer 3

Ans: A
Feedback:
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 genital ducts.
D) move sperm from the ampulla to the penis

Answer 4

Ans: B
Feedback:
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

Answer 5

Ans: A, B, C
Feedback:
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%

Answer 6

Ans: C
Feedback:
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

Answer 7

Ans: B
Feedback:
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

Answer 8

Ans: E, A, F, B, C, D
Feedback:
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.

Answer 9

Ans: B
Feedback:
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

Answer 10

Ans: D
Feedback:
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.

Answer 11

Ans: D
Feedback:
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

Answer 12

Ans: A, D
Feedback:
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)

Answer 13

Ans: A, C, F
Feedback:
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

Answer 14

Ans: D
Feedback:
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.

Answer 15

Ans: C
Feedback:
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.”

Answer 16

Ans: C
Feedback:
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

Answer 17

Ans: C
Feedback:
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

Answer 18

Ans: B
Feedback:
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.”

Answer 19

Ans: C
Feedback:
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.”

Answer 20

Ans: A
Feedback:
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.