ABGC: General Genetic Counseling Ethics and Research Ethics

A patient's insurance company requests access to their genetic test results before approving coverage. What should the genetic counselor do? A) Provide the results since the insurer is paying for testing B) Request the patient's written consent before releasing results C) Refuse to release results since insurance companies cannot access genetic data D) Inform the insurer that genetic counselors are not authorized to release results

Answer: B) Request the patient's written consent before releasing results Explanation: Patient consent is required before sharing genetic information with third parties.

A hospital implements a new genomic data storage system. To ensure compliance with security standards, what is the first step a genetic counselor should take? A) Encrypt patient records B) Review HIPAA and institutional policies C) Notify patients of possible breaches D) Restrict all access to genetic counselors only

Answer: B) Review HIPAA and institutional policies Explanation: Compliance with regulations, such as HIPAA, is essential before implementing new security measures.

Which law protects against genetic discrimination in health insurance and employment? A) The Americans with Disabilities Act (ADA) B) The Genetic Information Nondiscrimination Act (GINA) C) The Health Insurance Portability and Accountability Act (HIPAA) D) The Affordable Care Act (ACA)

Answer: B) The Genetic Information Nondiscrimination Act (GINA) Explanation:GINA protects individuals from genetic discrimination in employment and health insurance

Which of the following is a primary goal of public genetic education? A) To increase demand for direct-to-consumer genetic testing B) To empower individuals with knowledge about genetics and health C) To replace medical professionals in genetic counseling roles D) To ensure that all individuals undergo genetic testing

Answer: B) To empower individuals with knowledge about genetics and health Explanation: Public education aims to promote awareness and informed decision-making about genetics.

Which of the following is NOT one of the four primary ethical principles guiding genetic counseling? A) Beneficence B) Veracity C) Autonomy D) Justice

Answer: B) Veracity Explanation: While veracity (truthfulness) is an important professional principle, the four primary ethical principles are autonomy, beneficence, nonmaleficence, and justice.

14. A genetic counselor receives a request from a patient's sibling for the patient's genetic test results. What should the counselor do first? A) Release the results since they are first-degree relatives B) Verify if the patient provided written consent for release C) Inform the sibling that test results are always confidential D) Discuss the ethical obligation to disclose genetic risk

Answer: B) Verify if the patient provided written consent for release Explanation: Confidentiality regulations require patient authorization before releasing genetic information.

A genetic counselor is asked to provide risk calculations for a rare condition they have not encountered before. What should they do? A) Perform the calculation and provide counseling B) Decline the request as it falls outside their expertise C) Consult with a specialist or refer the patient D) Ask a colleague to sign off on the calculation without review

Answer: C) Consult with a specialist or refer the patient Explanation: Genetic counselors should recognize the limits of their expertise and seek appropriate consultation.

A pregnant patient requests genetic testing for a condition that is not actionable prenatally. The counselor believes the test may cause unnecessary anxiety. What is the most ethical response? A) Decline testing because it is not medically actionable B) Proceed with testing without further discussion C) Discuss potential benefits and limitations, allowing the patient to decide D) Request that the patient's physician make the decision

Answer: C) Discuss potential benefits and limitations, allowing the patient to decide Explanation: Respecting autonomy means providing balanced information and allowing informed decision-making.

A patient agrees to participate in a genetic research study but later changes their mind. What must the genetic counselor do? A) Inform the patient that withdrawal is not allowed once the study begins B) Allow the patient to withdraw at any time without consequences C) Require the patient to provide a written justification for withdrawal D) Notify the research sponsor before permitting withdrawal

Answer: B) Allow the patient to withdraw at any time without consequences Explanation: Voluntary participation is a core principle of ethical research, and participants can withdraw freely.

13. Under HIPAA, which of the following is considered protected health information (PHI)? A) A patient's genetic test results B) The name of the laboratory performing the test C) A researcher's publication on a genetic disorder D) A publicly available gene sequence

Answer: A) A patient's genetic test results Explanation: PHI includes any individually identifiable health information, such as genetic test results.

Under HIPAA regulations, patients have the right to: A) Access their genetic test results directly from the testing laboratory B) Request modifications to their genetic test results C) Prevent their provider from seeing their genetic test results D) Have unlimited access to all healthcare provider notes

Answer: A) Access their genetic test results directly from the testing laboratory Explanation: HIPAA ensures that patients have direct access to their own genetic test results.

A genetic counselor is approached by a pharmaceutical company offering compensation for referring patients to a clinical trial. What is the ethical concern? A) Conflict of interest B) Informed consent C) Genetic discrimination D) Duty to warn

Answer: A) Conflict of interest Explanation: Accepting compensation could influence the counselor's recommendations, creating a conflict between patient care and financial gain.

A genetic counselor is asked to enroll a patient in a research study. The patient is unsure about participating. What should the counselor do? A) Explain the risks and benefits, allowing the patient to decide B) Encourage participation to support scientific advancement C) Obtain consent from the patient's physician D) Proceed with enrollment since the study has IRB approval

Answer: A) Explain the risks and benefits, allowing the patient to decide Explanation: Informed consent must be voluntary and include an unbiased explanation of risks and benefits.

A patient is hesitant to undergo genetic testing due to fear of discrimination. What should the genetic counselor emphasize? A) GINA prohibits genetic discrimination in health insurance and employment B) Genetic testing is mandatory under new healthcare laws C) Life and disability insurance companies cannot use genetic test results D) Employers can legally request genetic test results for hiring decisions

Answer: A) GINA prohibits genetic discrimination in health insurance and employment Explanation: GINA provides some protections, particularly in health insurance and employment, but not in all areas.

Which entity is responsible for reviewing and approving genetic research involving human participants? A) Institutional Review Board (IRB) B) American Board of Genetic Counseling (ABGC) C) National Society of Genetic Counselors (NSGC) D) Food and Drug Administration (FDA)

Answer: A) Institutional Review Board (IRB) Explanation: The IRB ensures that research involving human participants meets ethical and legal standards.

What is the primary purpose of using evidence-based practice in genetic counseling? A) To ensure personal opinions do not influence patient care B) To reduce patient autonomy in decision-making C) To increase genetic testing rates D) To maximize financial gain for the institution

Answer: A) To ensure personal opinions do not influence patient care Explanation: Evidence-based practice ensures that genetic counseling recommendations are based on scientific research rather than personal beliefs.

A genetic counselor receives an email requesting patient genomic data from an unknown researcher. What should the counselor do first? A) Verify the researcher's credentials and institutional affiliation B) Share the requested data after removing patient names C) Report the request as a potential data breach D) Delete the email without responding

Answer: A) Verify the researcher's credentials and institutional affiliation Explanation: Data sharing should follow ethical guidelines and security protocols to protect patient privacy.

Which of the following should always be included in a genetic counseling session note? A) The patient's complete family history B) A record of informed consent discussions C) The genetic counselor's personal opinions on testing D) All genetic conditions discussed, even if unrelated to the case

Answer: B) A record of informed consent discussions Explanation: Documenting informed consent ensures that the patient was fully informed before testing.

A genetic counselor realizes they accidentally documented incorrect medical information in a patient's chart. What is the best course of action? A) Delete the incorrect entry and replace it with accurate information B) Add an addendum with the correction while maintaining the original entry C) Ask a colleague to modify the entry for them D) Ignore the error since it does not affect patient care

Answer: B) Add an addendum with the correction while maintaining the original entry Explanation: Medical documentation rules require maintaining original entries while adding corrections transparently.

A genetic counselor is asked by a colleague to disclose the genetic test results of a mutual patient. The counselor is unsure if the patient has consented to sharing this information. What should the counselor do first? A) Release the information if the colleague is a licensed medical professional B) Check the patient's consent documentation C) Assume implied consent since the patient is under the same medical institution D) Decline the request and inform the colleague that patient confidentiality laws prohibit sharing

Answer: B) Check the patient's consent documentation Explanation: The principle of confidentiality requires that a counselor confirm that the patient has consented before sharing genetic information.

A genetic counselor owns stock in a private genetic testing company. The counselor's clinic is considering switching to that company's services. What is the most ethical action? A) Advocate for the company without disclosure B) Disclose the financial interest and recuse from the decision C) Privately recommend the company to colleagues D) Proceed as usual since stock ownership is common

Answer: B) Disclose the financial interest and recuse from the decision Explanation: Conflict of interest should be disclosed, and the counselor should remove themselves from the decision-making process.

23. A genetic counselor is invited to speak at a conference sponsored by a genetic testing company. The company offers compensation. What should the counselor do? A) Accept the offer and promote the company's products B) Disclose the financial relationship to the audience C) Decline the offer to avoid any potential bias D) Request that the company write the presentation

Answer: B) Disclose the financial relationship to the audience Explanation: Transparency about potential conflicts of interest is essential in professional ethics.

A genetic counselor is invited to present a lecture on genetic risk assessment to healthcare providers. What should be the main goal of the lecture? A) Promoting a single commercial genetic testing company B) Educating providers on risk assessment and appropriate test ordering C) Convincing providers to refer all patients for genetic counseling D) Sharing personal anecdotes from past cases

Answer: B) Educating providers on risk assessment and appropriate test ordering Explanation: Professional education should focus on evidence-based information to enhance healthcare provider knowledge.

10. The Genetic Information Nondiscrimination Act (GINA) prohibits discrimination in which areas? A) Life insurance and mortgages B) Employment and health insurance C) Disability insurance and education D) Criminal justice and military service

Answer: B) Employment and health insurance Explanation: GINA protects individuals from genetic discrimination in employment and health insurance, but not in life, disability, or long-term care insurance.

Which of the following is the best way to protect patient genomic data? A) Storing files in an unsecured email system B) Encrypting all genetic data before transmission C) Using patient names in genetic research databases D) Sharing data only with pharmaceutical companies

Answer: B) Encrypting all genetic data before transmission Explanation: Encryption ensures data confidentiality and security, reducing the risk of breaches.

Which of the following is an essential security measure for storing genomic data? A) Storing files on personal USB drives B) Encrypting genetic data before storage or transmission C) Keeping all genetic information in paper files only D) Allowing open access to all researchers

Answer: B) Encrypting genetic data before storage or transmission Explanation: Encryption protects sensitive genetic data from unauthorized access.

What is a key responsibility of a genetic counselor supervising a student? A) Allowing students to provide independent counseling after one week B) Ensuring that students understand their limitations and seek guidance C) Assigning complex cases to students to test their abilities D) Requiring students to make all patient decisions without oversight

Answer: B) Ensuring that students understand their limitations and seek guidance Explanation: Supervisors must ensure safe and effective training while monitoring students' competencies.

The Genetic Information Nondiscrimination Act (GINA) applies to: A) Life and disability insurance B) Health insurance and employment C) Mortgage and housing discrimination D) Law enforcement and military service

Answer: B) Health insurance and employment Explanation: GINA protects individuals from genetic discrimination in employment and health insurance but not in life, disability, or long-term care insurance.

A patient reports that their employer requested a copy of their genetic test results. What is the most appropriate response from the genetic counselor? A) Provide the results since GINA does not apply to employers B) Inform the patient that GINA prohibits employers from requesting genetic information C) Advise the patient to provide the test results to their employer D) Notify the employer that they have legal rights to request genetic data

Answer: B) Inform the patient that GINA prohibits employers from requesting genetic information Explanation: Employers cannot request genetic test results under GINA protections.

Why is professional education important for genetic counselors? A) It allows them to bypass state licensure requirements B) It ensures they remain current with advancements in genetics C) It guarantees job promotions D) It is only required for newly certified counselors

Answer: B) It ensures they remain current with advancements in genetics Explanation: Ongoing education ensures competency and up-to-date knowledge in genetics and counseling practices.

A genetic counseling student expresses discomfort with discussing psychosocial issues. What is the best way for the supervisor to address this? A) Assign more psychosocial cases to the student for practice B) Provide structured guidance and role-playing exercises C) Advise the student to focus solely on medical aspects of counseling D) Allow the student to avoid psychosocial discussions

Answer: B) Provide structured guidance and role-playing exercises Explanation: Students should be supported and trained to develop well-rounded counseling skills.

A patient requests a copy of their genetic counseling notes, but the genetic counselor is concerned that the information may cause distress. What is the most appropriate course of action? A) Refuse to release the notes due to potential psychological harm B) Provide the notes and offer to discuss their contents C) Require the patient's physician to review the notes before release D) Modify the notes to remove potentially distressing content

Answer: B) Provide the notes and offer to discuss their contents Explanation: Patients have the right to access their medical records, and the counselor can provide support and context.

A genetic counselor working in a hospital setting is asked by a physician to order a genetic test. The hospital policy states that only physicians can place genetic test orders. What should the counselor do? A) Decline the request and refer the physician to hospital policy B) Order the test since the physician has verbally approved it C) Discuss the request with hospital administration to clarify the policy D) Proceed with ordering the test, documenting the physician's approval

Answer: C) Discuss the request with hospital administration to clarify the policy Explanation: Scope of practice varies by institutional policy and should be followed to ensure compliance and ethical practice.

A patient with Huntington's disease asks their genetic counselor not to disclose their diagnosis to their adult children, even though they may be at risk. What is the most ethical course of action for the counselor? A) Respect the patient's confidentiality and take no further action B) Inform the patient's children directly due to the genetic risks involved C) Encourage the patient to disclose the information and provide resources for support D) Disclose the information to the children's primary care providers for risk assessment

Answer: C) Encourage the patient to disclose the information and provide resources for support Explanation: While respecting confidentiality, the counselor has an ethical obligation to promote informed decision-making and provide guidance.

Which of the following is a key responsibility of a clinical supervisor in genetic counseling? A) Providing emotional therapy to students B) Assigning all clinical cases to students without oversight C) Ensuring students work within their competence level D) Allowing students to function independently after two weeks of training

Answer: C) Ensuring students work within their competence level Explanation: Supervisors must monitor students and ensure that their responsibilities match their level of training.

Which ethical principle emphasizes the responsibility of a genetic counselor to avoid harming clients? A) Autonomy B) Justice C) Nonmaleficence D) Fidelity

Answer: C) Nonmaleficence Explanation: Nonmaleficence is the principle of "do no harm," ensuring that a genetic counselor avoids actions that may cause harm to clients.

Which of the following tasks falls within the standard scope of practice for a certified genetic counselor? A) Prescribing medication for a genetic disorder B) Conducting physical examinations to diagnose genetic conditions C) Providing psychosocial support and risk assessment for genetic conditions D) Performing surgical procedures for genetic anomalies

Answer: C) Providing psychosocial support and risk assessment for genetic conditions Explanation: Genetic counselors do not prescribe medication or conduct physical exams but play a key role in risk assessment and counseling.

A genetic counselor is asked to give a community lecture on hereditary cancer. What should be the primary focus? A) Convincing attendees to undergo genetic testing B) Discussing ethical concerns in research genetics C) Providing unbiased, evidence-based information on cancer risk D) Sharing personal experiences from past patients

Answer: C) Providing unbiased, evidence-based information on cancer risk Explanation: Public education should be informative and evidence-based without coercing individuals.

What is a certificate of confidentiality in genetic research used for? A) To prevent forced disclosure of identifiable research data B) To ensure participants pay for their genetic tests C) To protect researchers from lawsuits related to their findings D) To allow researchers to sell de-identified genetic data

Correct Answer: A Explanation: A certificate of confidentiality protects identifiable research data from being disclosed in legal proceedings, helping ensure participant privacy and encouraging study participation.

In research, what is a p-value used to determine? A) The likelihood that an observed result is due to chance B) The clinical significance of a genetic test result C) The ethical validity of a study design D) The effect size of a genetic association

Correct Answer: A Explanation: A p-value assesses statistical significance, indicating whether an observed result is likely due to chance.

Under IRB regulations, what qualifies research as "minimal risk"? A) The risk level is no greater than that encountered in daily life or routine medical procedures B) The study involves only healthy adults with no pre-existing conditions C) Any study that includes genetic testing is automatically above minimal risk D) A study with potential psychological distress for participants

Correct Answer: A Explanation: Minimal risk research is defined as presenting no greater risk than what is encountered in everyday life. Genetic studies may be considered minimal risk if they involve noninvasive methods and no significant psychological or medical consequences.

A genetic counseling clinic is updating its patient handouts and protocols for screening and prevention based on the latest research. Which of the following is the best approach to ensure the updates are evidence-based? A. Use guidelines and recommendations from reputable professional organizations (like NSGC or ACMG) that summarize current evidence. B. Base the updates on what the majority of the clinic's patients say they prefer. C. Ask each counselor at the clinic to use their personal judgment to rewrite the handouts. D. Adopt the practices of a popular genetic counseling blog found online.

Correct Answer: A Explanation: Professional guidelines (from organizations such as NSGC, ACMG, etc.) are typically developed through extensive review of current evidence and expert consensus. Option A is correct because it ensures that the clinic's materials align with proven and accepted standards. While understanding patient preferences is important (Option B), educational content should first be scientifically accurate. Option C, relying solely on individual judgment, risks inconsistency and personal bias. Option D may not be reliable, as a blog might not be evidence-based or peer-reviewed.

What is the primary advantage of a randomized controlled trial (RCT) in genetic research? A) It establishes causal relationships between genetic variants and disease outcomes B) It minimizes ethical concerns related to human subject research C) It is the easiest study design to conduct D) It requires fewer participants than other study designs

Correct Answer: A Explanation: RCTs use randomization to reduce bias and establish causal links between genetic factors and disease outcomes, making them a gold standard in clinical research.

A researcher receives an email request from an unknown source asking for access to de-identified genetic data. What should the researcher do first? A) Verify the requestor's credentials and institutional affiliation B) Share the requested data since it is de-identified C) Report the request as a potential data breach D) Delete the email without responding

Correct Answer: A Explanation: Researchers must ensure that data sharing complies with institutional policies and ethical standards before granting access.

Which of the following is an example of selection bias in genetic research? A) Including only individuals with a family history of disease in a prevalence study B) Randomly assigning participants to study groups C) Using a large, diverse sample representative of the general population D) Applying standardized diagnostic criteria to all study participants

Correct Answer: A Explanation: Selection bias occurs when participants are not representative of the general population, leading to skewed results.

What is the primary purpose of an Institutional Review Board (IRB) in genetic research? A) To review and approve research protocols for ethical and regulatory compliance B) To recruit participants for clinical studies C) To ensure that researchers achieve their intended scientific goals D) To interpret genetic test results for study participants

Correct Answer: A Explanation: The IRB's primary role is to protect the rights and welfare of human research participants by reviewing research protocols to ensure they adhere to ethical and legal guidelines.

During a counseling session for a pregnancy at risk for a genetic condition, the genetic counselor strongly feels the couple should pursue prenatal testing. The counselor says, "I think most responsible parents would want to know this information and be prepared to make hard choices." Which ethical principle is the counselor potentially violating? A. Respect for the clients' autonomy, by pressuring them and not remaining nondirective. B. Beneficence, by not acting in the best interest of the unborn child. C. Fidelity, by not being truthful with the clients. D. Justice, by not treating the clients fairly.

Correct Answer: A Explanation: The counselor is risking a violation of the principle of respecting client autonomy and the practice of nondirectiveness. Option A is correct because the counselor's statement is coercive; it imposes a value judgment that could pressure the couple into a decision (like testing or even termination) rather than supporting them in making their own informed choice. This isn't an issue of beneficence toward the child (B) or truth-telling (C), and justice (D) is not relevant here. The key issue is that the counselor should provide information and support without steering the clients toward the counselor's preferred decision.

A genetic counseling student, during a session, provides a couple with an incorrect recurrence risk for a genetic condition. The supervising counselor realizes the mistake. What is the best immediate action by the supervisor? A. Interrupt gently and correct the information in the moment, clarifying the accurate risk to the couple, then discuss the error with the student privately after the session. B. Let the session proceed and correct the error only in the written report later. C. Wait until after the session to tell the student about the mistake, and have the student call the couple later to correct it. D. Do nothing; making mistakes is part of learning and the error is the student's responsibility to manage.

Correct Answer: A Explanation: The supervisor's primary responsibility is to the patient's accurate understanding and then to the student's learning. Option A is correct: the supervisor should ensure the couple receives correct information as soon as possible (ideally during the session, to prevent misunderstanding) and then use the situation as a teaching moment with the student in private. This protects the patient from acting on wrong information and helps the student learn. Option B delays correction and risks the couple leaving with incorrect information. Option C is not ideal because the error should be corrected before the couple leaves, and the supervisor should guide the correction rather than leaving it solely to the student. Option D neglects both the patient's need for correct information and the student's need for guidance.

A genetic counselor's spouse is a sales representative for a laboratory that performs expanded carrier screening, and the counselor's clinic is considering which lab to use for their carrier screening panel. What is the best way for the counselor to handle this situation? A. Refrain from participating in the decision-making process and disclose the relationship to her colleagues to avoid a conflict of interest. B. Advocate strongly for her spouse's lab since she has insider knowledge that it's the best. C. Keep the spousal relationship secret to avoid influencing her colleagues' opinions. D. Automatically reject her spouse's lab from consideration to prove she's unbiased.

Correct Answer: A Explanation: When a personal relationship could influence professional decisions, transparency and recusal from decision-making are key. Option A is correct: the counselor should disclose her spouse's affiliation and avoid involvement in choosing the lab to prevent any bias or appearance of bias. Option B would be improperly influenced by her personal connection. Option C is wrong because hiding the relationship could lead to an undisclosed conflict of interest if her opinion (even unspoken) influences others. Option D, outright rejecting the lab solely to appear unbiased, might deprive the clinic of a good option; the better approach is to step back and let others evaluate the choices on their merits.

Evidence-based practice in genetic counseling is best described by which statement? A. Using personal intuition and past experience as the sole basis for counseling decisions. B. Integrating the latest research findings, clinical expertise, and the patient's values and preferences into counseling and care decisions. C. Relying only on established clinical protocols and never deviating, even if new research emerges. D. Deferring to whichever approach the patient requests, regardless of what research or guidelines suggest.

Correct Answer: B Explanation: Evidence-based practice involves a combination of the best available evidence, the clinician's expertise, and the patient's preferences. Option B is correct because it captures this balanced approach. Option A ignores scientific evidence. Option C ignores the need to update practices when new evidence is available and also ignores patient individuality. Option D puts patient preference above all, but good practice means informing those preferences with evidence and expertise

A genetic counselor is considering adopting a new genetic test for use in her clinic after a single small study reported that it improved patient outcomes. What should the counselor do to practice in an evidence-based manner? A. Immediately start using the new test for all relevant patients, since one study showed benefit. B. Wait until larger studies or consensus guidelines confirm the test's benefits and accuracy before incorporating it into routine practice. C. Adopt the test but only for a few hand-picked patients to see if the outcomes match the study. D. Reject the test entirely because new tests are too risky, regardless of the study's results.

Correct Answer: B Explanation: Evidence-based practice means integrating the best available research evidence. Option B is correct: one small study is not enough to change practice widely. The counselor should look for more robust evidence or professional guidelines to ensure the test is truly beneficial and accurate. Option A would be premature implementation without sufficient evidence. Option C is like doing an unofficial trial without appropriate rigor or oversight. Option D dismisses the test outright; instead of rejecting new advances categorically, the counselor should rely on strong evidence before adoption.

A researcher wants to study the long-term effects of a gene therapy intervention in children with a rare disorder. What type of study design is most appropriate? A) Cross-sectional study B) Longitudinal cohort study C) Case-control study D) Systematic review

Correct Answer: B Explanation: A longitudinal cohort study follows participants over time, making it ideal for assessing long-term effects.

Midway through a rotation, a genetic counseling student confides in her supervisor that she finds counseling cancer genetics patients very upsetting because her own mother recently died of cancer. She feels this is affecting her performance. What is the most appropriate response by the supervisor? A. Tell the student that she needs to separate personal issues from work and continue with her assignments as usual. B. Acknowledge the student's feelings and discuss possible adjustments, such as providing additional support, temporarily shifting some cancer cases away from her if possible, and encouraging her to seek counseling or support resources. C. Remove the student from the rotation immediately and report her to the program for inability to handle stress. D. Ignore the disclosure, as it's the student's personal issue and not the supervisor's concern.

Correct Answer: B Explanation: A supervisor should respond with empathy and support while ensuring patient care and the student's learning aren't compromised. Option B is correct: it demonstrates understanding and proactively addresses the issue by adjusting responsibilities if needed and guiding the student to appropriate resources. This helps the student cope and learn without being overwhelmed. Option A lacks compassion and could worsen the student's distress. Option C is punitive and premature; there may be ways to support the student rather than removing her entirely. Option D neglects the supervisor's responsibility to guide and assist the student in a difficult situation

A genetic counselor in a prenatal clinic is asked by a physician to perform a detailed fetal ultrasound because the clinic is short-staffed that day. The counselor has observed many ultrasounds but is not clinically trained to conduct them. What is the appropriate response? A. Perform the ultrasound; since the counselor has seen many done, she can likely manage it. B. Decline to perform the ultrasound, explaining it is outside her scope of practice and ensure a qualified professional conducts it. C. Agree to try, but if unsure of findings, call the physician later. D. Perform the ultrasound only if the patient signs an extra consent acknowledging the counselor is not certified in this procedure.

Correct Answer: B Explanation: Conducting medical procedures like detailed ultrasounds is not within the training or scope of a genetic counselor (unless they have specific additional qualifications). Option B is correct: the counselor should politely decline and ensure the patient is seen by someone properly trained, maintaining quality of care. Option A would be irresponsible and potentially harmful. Option C is also inappropriate because attempting a procedure beyond one's competence is risky, even with a plan to consult later. Option D does not make it acceptable; a consent form doesn't justify practicing outside one's scope.

Which of the following is the most appropriate method for storing genomic data securely? A) Storing files on a personal USB drive without encryption B) Encrypting all genetic data before storage or transmission C) Keeping all genetic information in paper files only D) Allowing open access to all

Correct Answer: B Explanation: Encrypting genetic data ensures confidentiality and security, reducing the risk of unauthorized access or data breaches.

A genetic counselor inadvertently discovers that she provided a patient with incorrect information about a genetic test due to a lab report mix-up. The patient may have made a medical decision based on that incorrect information. What is the most ethical immediate action for the counselor? A. Do nothing unless the patient contacts you, since correcting the error might cause distress and undermine trust. B. Inform the patient as soon as possible about the mistake, apologize, and provide the correct information and appropriate guidance. C. Wait until the patient's next scheduled appointment to discuss the error face-to-face to avoid a difficult phone conversation now. D. Try to quietly correct the error behind the scenes (e.g., have the lab reissue the report) without telling the patient, to spare them confusion.

Correct Answer: B Explanation: Ethical practice demands honesty with patients, especially when an error has occurred. Option B is correct: the counselor should promptly disclose the mistake, apologize, and correct the information. This transparency is crucial for maintaining trust and allowing the patient to make informed decisions going forward. Option A is wrong because failing to inform the patient could lead to harm or continued misconceptions. Option C unnecessarily delays disclosure and leaves the patient in the dark longer than needed. Option D is unethical because it hides the truth; even if the error is fixed internally, the patient has a right to know what happened.

One of the genetic counselors in a team meeting insists on continuing to recommend a particular screening test that recent studies have shown is ineffective, because "I've seen it help at least one family." What is the most appropriate response grounded in evidence-based practice? A. Agree with her, because personal clinical experience is more important than published data. B. Suggest reviewing the current research together and consider updating recommendations for patients, since current evidence indicates the test is not effective. C. Continue recommending the test to be on the safe side, even if evidence is weak, because it might help someone. D. Vote to remove that counselor from the team decisions since she doesn't follow evidence.

Correct Answer: B Explanation: Evidence-based practice requires that counseling recommendations reflect the best available research. Option B is correct: it encourages reviewing data and potentially changing practice if the evidence no longer supports the test's efficacy. Personal experiences (as noted in A) can be misleading, especially if contradicted by larger studies. Option C is not ideal because offering ineffective tests can lead to unnecessary cost, stress, or false reassurance. Option D is extreme; the goal is to educate and align on evidence, not punish a colleague for raising an opinion.

A genome-wide association study (GWAS) is primarily used to: A) Diagnose single-gene disorders B) Identify common genetic variants associated with complex diseases C) Determine the effectiveness of a genetic counseling intervention D) Perform whole-genome sequencing on every participant

Correct Answer: B Explanation: GWAS identify genetic variants that may contribute to common diseases by comparing large populations. They are not used for single-gene disorder diagnosis or treatment evaluation.

A genetic counselor has been using the same genetic risk data and testing practices for many years. He has not attended any professional development or training on new genomic technologies. As a result, he occasionally provides outdated information. This behavior conflicts with which ethical obligation of genetic counselors? A. The obligation to respect patient autonomy. B. The obligation to continue education and maintain competence in the field. C. The obligation to ensure confidentiality of patient information. D. The obligation to avoid conflicts of interest.

Correct Answer: B Explanation: Genetic counseling ethics emphasize that counselors should keep their knowledge and skills up-to-date through continuing education. Option B is correct because failing to stay current can compromise the quality of information and care provided to clients. This scenario is not about patient autonomy (A), confidentiality (C), or conflicts of interest (D). It's fundamentally about maintaining professional competence to provide the best evidence-based information and counseling.

A patient being seen for genetic counseling reveals intense anxiety and depression related to her risk of familial cancer. She asks the genetic counselor if they can provide therapy or prescribe anti-anxiety medication. What is within the genetic counselor's scope of practice in this scenario? A. Prescribe a mild anti-anxiety medication to help the patient cope. B. Offer supportive counseling for her concerns and refer her to a mental health professional for ongoing therapy or medication evaluation. C. Initiate a full course of psychotherapy focusing on her childhood, since that might be affecting her anxiety. D. Tell her that anxiety is not something you address and only talk about the genetics.

Correct Answer: B Explanation: Genetic counselors are trained to provide psychosocial support related to genetic issues, but they are not licensed to prescribe medication or provide long-term psychotherapy (unless they have additional credentials). Option B is correct: the counselor can and should provide empathetic listening, short-term coping strategies, and then refer the patient to appropriate mental health care for specialized treatment. Option A is outside the scope (prescribing is for medical providers like physicians or psychiatrists). Option C is also outside the typical genetic counseling scope and expertise. Option D neglects the important psychosocial aspect of genetic counseling; while GCs don't treat psychiatric conditions, they should address emotional concerns within the session and facilitate further help.

A state legislation committee asks a seasoned genetic counselor to provide expert testimony on a proposed law that would allow insurers access to patients' genetic test results. According to the Code of Ethics, how should the counselor approach this request? A. Decline to participate, as involvement in politics is outside the counselor's professional role. B. Accept the invitation and provide factual, evidence-based information on genetics, advocating against genetic discrimination to uphold the welfare of individuals with genetic risks. C. Participate but only share personal stories of clients without any data or broader context, to make an emotional appeal. D. Agree to testify as a representative of all genetic counselors without consulting professional organizations, since she was invited as an expert.

Correct Answer: B Explanation: Genetic counselors have an ethical responsibility to society to promote policies that prevent genetic discrimination and to serve as reliable sources of information on genetics. Option B is correct because the counselor would be using her expertise to inform policy in a way that protects patients (against insurance genetic discrimination), consistent with professional ethics. Option A forfeits an important opportunity to advocate for patients. Option C relies only on anecdotal evidence rather than the counselor's professional expertise and evidence-based knowledge. Option D is incorrect because while counselors can speak as experts, they should clarify whether they speak as individuals or on behalf of an organization; claiming to represent all genetic counselors without authorization would be inappropriate.

A patient comes for genetic counseling and is introduced to a genetic counseling student who is observing the session. Partway through, the patient seems uncomfortable and asks if the student can step out because she prefers to talk privately with the certified counselor. What is the appropriate response? A. Explain to the patient that the student is a professional in training and insist that the student stay, as this is important for the student's learning. B. Respect the patient's wishes and have the student leave the room, then continue the session one-on-one with the patient. C. Tell the patient that the student will leave, but first have the student explain why their presence is valuable. D. End the session entirely if the student cannot stay, since the student needs to observe.

Correct Answer: B Explanation: Patient autonomy and comfort are priorities. Option B is correct: the counselor should honor the patient's request without making the patient feel guilty. While involving students is important for training, patients have the right to decline a student observer. Option A disregards the patient's comfort and could damage trust. Option C is also not appropriate; it's better to simply respect the request without pressuring the patient. Option D is unacceptable, as it sacrifices patient care for the student's experience.

During a session, a patient with a genetic predisposition to cancer asks the genetic counselor, "Should I go ahead and have preventative surgery to remove my ovaries?" Making this decision involves complex medical considerations. What is the most appropriate response from the genetic counselor within their scope of practice? A. Decide for the patient and tell her to proceed with the surgery as it's the safest option. B. Explain the genetic risks and options in detail, and encourage her to discuss the surgical decision with her physician who can address the medical/surgical aspects and overall health context. C. Provide her with a medical second opinion on surgery, since as a genetic counselor you are qualified to give surgical recommendations. D. Refuse to discuss anything about surgery, stating that it's not your job at all.

Correct Answer: B Explanation: Genetic counselors provide information and support decision-making but do not make medical management decisions like whether to have surgery. Option B is correct: it keeps the counselor within scope by explaining genetic risk and available options (their expertise), while appropriately referring the patient to her physician for the definitive surgical decision and medical guidance. Option A is outside the counselor's role (counselors should not unilaterally tell patients to have surgery). Option C oversteps the counselor's qualifications by acting as a medical decision-maker. Option D is too rigid; the counselor should still discuss the genetic implications and options, but not the final medical management decision alone.

A genetic counseling student in her final internship feels frustrated because her supervisor never lets her lead any part of the session, even though she has demonstrated competence. The student mostly just observes silently. What would be the best approach for the supervisor to take in this situation? A. Continue the same approach; the student should be grateful for the learning opportunity even if it's passive. B. Allow the student to take on more responsibilities, such as leading parts of sessions or drafting patient letters, while the supervisor observes and provides feedback. C. Let the student run an entire clinic day completely alone to prove she can handle it. D. Tell the student that observation is the only way to learn and she will get to counsel only after she graduates.

Correct Answer: B Explanation: In supervising students, it's important to gradually increase their responsibilities in line with their growing skills. Option B is correct: the supervisor should provide opportunities for the competent student to actively practice counseling tasks, under supervision, to prepare her for independent practice. Option A dismisses the student's readiness and limits her learning. Option C swings too far by removing supervision entirely (which could compromise patient care and student support). Option D is simply incorrect; practical counseling experience during training is essential and should not be withheld when the student is capable of more.

Which of the following sources provides the highest level of evidence to inform genetic counseling practice? A. A single case report published by a physician about one patient's outcome. B. A systematic review or meta-analysis of multiple well-designed studies on the topic. C. An expert opinion from a respected geneticist shared in a conference presentation. D. A small study with no control group reported in a news article.

Correct Answer: B Explanation: In the hierarchy of evidence, systematic reviews or meta-analyses of multiple studies provide very high-level evidence because they synthesize data from many patients and settings. Option B is correct. Case reports (Option A) and small uncontrolled studies (Option D) are very low levels of evidence and may not be generalizable. Expert opinion (Option C) can be valuable, especially if evidence is lacking, but it is not as robust as well-conducted research that has been systematically reviewed.

An insurance company denies coverage for a genetic test that could be beneficial for a patient. The physician asks the genetic counselor to "use a different diagnosis code that will get the test approved," essentially suggesting a misrepresentation to trick the insurance. What is the most ethical response by the counselor? A. Go along with the physician's suggestion to help the patient get the needed test covered. B. Refuse to falsify any information and instead assist in a legitimate appeal to the insurance company or explore alternative options for the patient. C. Avoid the situation by asking another staff member to handle the insurance paperwork. D. Inform the patient that their physician suggested cheating the insurance, to distance yourself from the decision.

Correct Answer: B Explanation: It is unethical and potentially illegal to misrepresent clinical information for insurance purposes. The counselor should maintain honesty and integrity. Option B is correct: the counselor should refuse to provide false information and instead pursue proper channels (like an appeal or patient assistance programs) to obtain coverage. While the intention in A (helping the patient) is sympathetic, it violates ethical and legal standards. Option C shirks responsibility, and Option D could unnecessarily inflame the situation; the key is to handle the matter professionally by doing the right thing, as in B.

Which measure is commonly used to express the strength of an association in a case-control study? A) Relative risk B) Odds ratio C) Confidence interval D) Hazard ratio

Correct Answer: B Explanation: Odds ratios are used in case-control studies to quantify the association between exposure and disease.

A genetic counselor runs a private genealogy consulting business on weekends. She has started offering her clinic patients a "special discount" if they sign up for her private service after their genetic counseling sessions. What ethical concern does this situation raise? A. None - she is providing patients with additional resources. B. Conflict of interest - because she is mixing her personal business with her clinical role, potentially influencing her professional advice for personal gain. C. Confidentiality - because patient information might be shared between the clinic and her private business. D. Informed consent - because patients did not consent to being recruited for outside services.

Correct Answer: B Explanation: Offering her own paid services to patients she sees in a clinic creates a conflict of interest and a potential exploitation of the counselor-client relationship for personal gain. The counselor might be biased in her clinical recommendations to promote her business. This violates ethical guidelines about avoiding exploitation of clients and managing conflicts of interest. While confidentiality (Option C) and consent (Option D) are important in other contexts, the primary issue here is the counselor's financial interest influencing her professional role, making Option B the correct answer.

During a genetic counseling session, you realize that the patient is the daughter of a close family friend. You did not know this before the appointment. What is the best way to handle this potential conflict of interest? A. Continue with the session as normal; there's no need to mention the personal connection. B. Immediately inform the patient of the connection and offer to refer her to a different genetic counselor if she prefers, to maintain objectivity and her comfort. C. Ask the patient for more personal details about the family friend to satisfy your curiosity, since you have a connection. D. Proceed with the counseling but make sure to share updates about the patient's results with your family friend (the patient's parent) since you know them.

Correct Answer: B Explanation: Recognizing a personal relationship with a patient can create a dual relationship that may affect professional objectivity or the patient's comfort in sharing information. The best approach is transparency and giving the patient a choice. Option B is correct: disclose the connection and offer an alternative provider if the patient or you feel it could be a conflict. Option A ignores the issue, which might be fine if the patient truly doesn't mind, but it's important to offer the choice. Option C is inappropriate and unprofessional. Option D violates confidentiality and exploits the connection in an unethical way.

Which of the following research activities typically requires full IRB review? A) A retrospective chart review of de-identified genetic data B) A study involving genetic testing of minors with potential psychosocial risks C) An anonymous online survey about genetic knowledge D) Analyzing publicly available genomic data

Correct Answer: B Explanation: Research involving genetic testing of minors, particularly if it presents psychological or medical risks, requires full IRB review due to the potential for harm and the need for parental consent. Studies with de-identified or publicly available data often qualify for exemption or expedited review.

A researcher conducting a genetic study finds an incidental finding that may have serious health implications for a participant. What is the most appropriate action? A) Immediately disclose the finding to the participant's family B) Follow the study's pre-established policy on incidental findings and consult the IRB if necessary C) Ignore the finding since it was not the primary purpose of the study D) Report the result to the participant's primary care provider without informing the participant

Correct Answer: B Explanation: Researchers must follow their study's protocol regarding incidental findings, which should be defined in advance. IRB guidance may be needed for cases where there is no clear policy.

A first-year genetic counseling student just started their clinical rotation. On the first day, the supervisor assigns the student to independently counsel a family about a new diagnosis, including delivering difficult news, without any prior observation or preparation. Which statement best reflects the ethical concern in this scenario? A. It's acceptable because students learn best by jumping into real cases immediately. B. It may be inappropriate because the task is not commensurate with the student's current training and experience. C. It's unethical to ever allow students to counsel patients directly. D. The supervisor should have the student handle it to test whether the student is capable under pressure.

Correct Answer: B Explanation: Responsibilities given to trainees should match their level of training. On a first day with no preparation, expecting a student to handle a complex counseling session alone is likely beyond their competence. Option B is correct as it highlights that the supervisor's assignment is inappropriate for the student's experience level. Students should observe and gradually take on responsibility under supervision. Option A and D ignore the potential harm to both patient and student from an overwhelming assignment. Option C is incorrect because students do need direct experience, but it should be incremental and supervised.

A researcher wants to use genomic data from a prior study for a new project. What must they do before proceeding? A) Use the data freely, since it has already been collected B) Obtain IRB approval and ensure the new use aligns with the original consent form C) Share the data with commercial companies to increase research funding D) Obtain additional funding before proceeding

Correct Answer: B Explanation: Reusing genomic data often requires IRB approval and must align with the original consent provided by participants.

A genetic counselor is writing a research paper and wants to acknowledge all contributors. However, her colleague suggests leaving out the clinic's genetic counseling assistant who helped gather data, arguing that only professionals should be authors. According to the Code of Ethics, what should the counselor do? A. Follow the colleague's advice and omit the assistant to maintain professional-only authorship. B. Acknowledge the genetic counseling assistant's contributions appropriately, such as in the acknowledgments or authorship if warranted, to give credit for their work. C. List the assistant as the primary author to reward the effort, even if the assistant did not write the paper. D. Keep the assistant's contribution secret to avoid potential conflict with the colleague.

Correct Answer: B Explanation: The NSGC Code of Ethics emphasizes appropriately acknowledging the work and contributions of others. Option B is correct because it reflects honesty and fairness by giving credit to the assistant who contributed. Omitting the assistant (Option A) fails to recognize their work, and Option D is similarly unethical. Option C is inappropriate because authorship should reflect actual contribution level; gratuitously making the assistant primary author if they did not fulfill that role is not a truthful representation either.

What is the primary ethical concern when conducting genetic research involving children? A) Ensuring children receive a financial benefit for participation B) The potential for unintended disclosure of genetic risk to the family C) The inability of minors to provide informed consent independently D) The increased cost of genetic testing for minors

Correct Answer: C Explanation: Because minors are not legally able to provide informed consent, researchers must obtain parental consent and, when appropriate, child assent. Ethical concerns also include the potential for unintended harm and family implications.

A pregnant patient at 20 weeks gestation has a fetus diagnosed with a serious congenital heart defect via ultrasound. The obstetrician strongly recommends amniocentesis for genetic testing, but the patient says, "I wouldn't end this pregnancy no matter what, so I don't want any invasive tests." The doctor insists that knowing the cause is important and pressures her to do the amnio. The patient asks the genetic counselor for advice. What should the counselor do? A. Urge the patient to follow the obstetrician's recommendation because doctors know what is best medically. B. Support the patient's decision to decline further testing, and help communicate her wishes and reasoning to the obstetrician. C. Encourage the patient to reconsider because more information could be useful, siding with the physician's view. D. Remain neutral and refuse to discuss the pros and cons of amniocentesis since the patient already said no.

Correct Answer: B Explanation: The counselor should respect and advocate for the patient's autonomy. Option B is correct: supporting the patient's informed decision and helping her communicate with her physician respects her values and right to refuse a test she doesn't want. While providing full information about pros and cons is important (and presumably the patient understands them since she made an informed choice), the counselor's role is not to coerce but to support whatever the patient decides. Option A undermines patient autonomy and is paternalistic. Option C also leans toward coercion by aligning with the physician's pressure. Option D is incorrect because while the counselor should respect the decision, part of support can include ensuring the patient understands consequences—remaining silent or disengaged isn't helpful.

Which of the following scenarios best illustrates the ethical principle of justice in genetic counseling? A. A counselor spends extra time ensuring a patient understands all testing options before making a decision. B. A counselor arranges for a sign language interpreter for a deaf client so that the client receives the same quality of information as hearing clients. C. A counselor respects a client's wish not to share a genetic risk with family members, even though others could be at risk. D. A counselor double-checks a genetic test result to prevent any harm from a possible error.

Correct Answer: B Explanation: The principle of justice relates to fairness and equal access to services and resources. Option B is correct because by arranging an interpreter, the counselor is ensuring equitable access to information for a client with hearing impairment, treating them fairly. Option A reflects beneficence (going above and beyond for the patient's understanding) or good patient care, but not specifically about fairness among individuals. Option C relates to autonomy and confidentiality. Option D is about nonmaleficence (avoiding harm through errors). Only B specifically exemplifies justice by providing equal service regardless of a client's disability or needs.

A genetic counselor is offered an all-expenses-paid trip to a genetics conference by a genetic testing company, on the condition that she refer a certain number of patient samples to that company's lab for testing. What is the most ethical response to this offer? A. Accept the offer because attending conferences improves her knowledge, which will ultimately help her patients. B. Decline the offer or any quid pro quo arrangements, as it creates a conflict of interest that could bias (or appear to bias) her test referrals. C. Accept the trip but disclose to patients that she went to the conference courtesy of the lab. D. Refer only the easiest cases to that lab to fulfill the quota, but send complicated cases elsewhere.

Correct Answer: B Explanation: The scenario describes a clear conflict of interest: a personal benefit (a paid trip) tied to referring patients to a particular lab. The ethical course is to avoid such arrangements. Option B is correct because the counselor should not allow or appear to allow personal incentives to influence her clinical decisions. Accepting the offer (Option A) could compromise her objectivity, even if she gains knowledge at the conference. Option C, mere disclosure after accepting, does not remove the conflict — it's better not to enter the arrangement at all. Option D still engages in the quid pro quo scheme and is unethical.

A genetic counselor supervising a student realizes that the student has significant knowledge gaps and poor skills even near the end of the rotation. The student is likable and trying hard, but not yet competent to counsel independently. What is the supervisor's ethical responsibility in evaluating and handling this situation? A. Pass the student on the rotation to avoid hurting their feelings or causing trouble with their program. B. Give honest feedback about the student's weaknesses and provide a fair but truthful evaluation to the training program, possibly recommending additional training or supervision. C. Avoid providing any critique and let the program figure out the student's abilities on its own. D. Allow the student to counsel independently for the last few sessions to see if they "sink or swim."

Correct Answer: B Explanation: The supervisor owes it to the profession, the student, and future patients to accurately assess the student's competence. Option B is correct: giving honest feedback (ideally both during the rotation and in the evaluation) and suggesting further improvement measures if needed. This ensures the student receives appropriate remediation or extra training before practicing independently. Option A, passing the student without merit, would be unethical and could put future patients at risk. Option C abdicates the supervisor's duty to teach and evaluate. Option D could compromise patient care and is not an effective or fair way to address competence issues at the last minute.

A genetic counselor is caring for a 12-year-old girl who has just been diagnosed with a hereditary condition. The girl's parents instruct the counselor not to tell the child anything about the genetic diagnosis, fearing it will upset her. During a follow-up appointment, the child asks the counselor, "Is something wrong with me?" What is the most ethical way for the counselor to handle this situation? A. Respect the parents' wishes completely and tell the girl, "No, everything is fine," to avoid causing her distress. B. Gently explain to the girl in age-appropriate terms that she has a genetic condition, while also working with the parents to help them understand the importance of honesty. C. Tell the girl to ask her parents for information, deflecting the question. D. Refuse to see the child as a patient until the parents agree that she can be informed about her condition.

Correct Answer: B Explanation: This scenario is challenging because it involves the child's right to know and the parents' protective instincts. Ethically, children who are old enough to ask and understand have a right to some information about their health. Option B is correct: the counselor should strive to be truthful with the child in a compassionate, developmentally appropriate way, and counsel the parents on why openness (to an appropriate degree) is beneficial. This balances respect for the parents with beneficence toward the child. Option A, simply lying, undermines trust and could harm the child if she senses something is wrong. Option C avoids addressing the child's legitimate concern and breaks the therapeutic relationship. Option D is extreme and not helpful; it's better to work with the family toward an ethical solution.

A 45-year-old patient has been diagnosed with a hereditary cancer syndrome that gives her a 50% chance of developing cancer. She refuses to share this information with her adult children, who each have a 25% risk of having inherited the same mutation. The genetic counselor knows the children could benefit from this information. What is the most appropriate action for the counselor regarding this ethical dilemma? A. Break confidentiality and directly inform the patient's children, since their health is at stake. B. Respect the patient's confidentiality but continue to encourage and support her in sharing this information with her children herself. C. Inform the patient that you cannot continue working with her unless she agrees to tell her children. D. Anonymously send the children information about their possible risk without revealing the source.

Correct Answer: B Explanation: This scenario pits the patient's confidentiality against potential benefit to her children. The counselor's primary obligation is to the patient, so maintaining confidentiality is essential. Option B is correct: the counselor should respect the patient's decision (not directly informing the children without consent) while encouraging and helping her understand the importance of sharing genetic risk information. This approach honors autonomy and confidentiality but also promotes beneficence by trying to protect the children's health through the patient's own action. Option A would violate confidentiality (no law mandates disclosure in this case), Option C is coercive and breaks trust, and Option D is unethical and breaches confidentiality covertly.

A long-term patient is extremely grateful for the support her genetic counselor provided through a difficult diagnosis. At the final session, the patient gives the counselor an envelope with $1,000 in cash as a thank-you gift. What is the most appropriate action for the counselor to take? A. Accept the cash gift, as refusing it would offend the patient. B. Politely decline the very generous gift, explaining that while you appreciate the gesture, it's against professional policy to accept such a large gift. C. Accept the money but donate it to a charity of the patient's choice later. D. Ask the patient if she can instead publicly endorse the counselor's services, as that would be more valuable than cash.

Correct Answer: B Explanation: While small tokens of appreciation can sometimes be accepted, a large cash gift presents a conflict of interest and professional boundary concern. Option B is correct: the counselor should kindly decline and explain that professional ethics or workplace policies prevent accepting substantial monetary gifts. This maintains professional boundaries and avoids any perception of favoritism or indebtedness. Option A is incorrect as accepting such a large gift is not appropriate. Option C, even with good intentions, still involves taking the money initially and could be problematic without institutional guidance. Option D inappropriately solicits something in return (an endorsement), which is not an appropriate response either.

Which study design is best suited for determining the prevalence of a genetic disorder in a population? A) Case-control study B) Cohort study C) Cross-sectional study D) Randomized controlled trial

Correct Answer: C Explanation: A cross-sectional study examines a population at a single point in time to determine the prevalence of a disorder.

During a session, a genetic counselor receives results of a carrier test for a 16-year-old female patient and discovers an unexpected finding - the tested father is not biologically related to the patient (non-paternity). The mother and the presumed father are in the room awaiting results. What is the most ethical course of action for the counselor? A. Disclose the non-paternity to both the mother and the presumed father immediately, as they have a right to know. B. Inform the mother privately about the non-paternity but not the father. C. Focus on the original purpose of the test (carrier status) and report those results to the family, without mentioning the incidental non-paternity finding. D. Refuse to provide any results to avoid getting involved in a sensitive family issue.

Correct Answer: C Explanation: In genetic counseling, unexpected sensitive information like misattributed paternity is typically handled by not disclosing it if it's not relevant to the medical question, unless there is a compelling reason. Option C is correct because the counselor should report on the genetic test's intended results (e.g., carrier status) and not volunteer the non-paternity finding, which is a social issue outside the test's scope. Disclosing non-paternity (Options A or B) can cause significant harm and breaches the trust that such incidental findings will be handled carefully. Option D is inappropriate because the family deserves the relevant results they came for; the counselor should not withhold the legitimate test results.

What is the primary goal of informed consent in genetic research? A) To ensure participants comply with study protocols B) To protect researchers from liability C) To provide participants with the necessary information to make an autonomous decision about participation D) To standardize data collection across studies

Correct Answer: C Explanation: Informed consent ensures that participants fully understand the risks, benefits, and purpose of the research before deciding whether to participate. It is a fundamental ethical requirement in human research.

Parents of a healthy 10-year-old request genetic testing for an adult-onset cancer predisposition gene that runs in the family. There is no medical intervention in childhood that would change management for this condition; the parents say they "just want to know." What is the most appropriate ethical response from the genetic counselor? A. Proceed with testing since the parents consent for their minor child and have a right to the information. B. Refuse to order the test and dismiss the family from the clinic for an inappropriate request. C. Explain to the parents that testing a child for an adult-onset condition is not recommended, and counsel them on waiting until the child is old enough to make his own informed decision about testing. D. Agree to test the child but keep the results confidential until the child turns 18.

Correct Answer: C Explanation: Professional guidelines advise against genetic testing of minors for adult-onset conditions that have no immediate medical benefit, to preserve the child's future autonomy and avoid potential psychosocial harm. Option C is correct: the counselor should educate the parents about these ethical considerations and recommend deferring testing. Option A ignores the ethical implications and the child's future rights. Option B is inappropriate and punitive; the request can be managed through counseling rather than dismissing the family. Option D is not practical or ethical; performing the test and hiding results would violate transparency and could still impact the child if parents know testing was done.

A genetic counseling research study uses de-identified genetic data. What type of IRB review is this study most likely to require? A) Full board review B) Expedited review C) Exemption from IRB review D) HIPAA waiver

Correct Answer: C Explanation: Research using de-identified data often qualifies for exemption since no identifiable information is collected.

A genetics clinic has a limited number of free whole-exome sequencing slots available through a research grant, and many patients could potentially benefit. The clinic develops criteria to decide who gets these slots, prioritizing patients with the most urgent medical needs and no other means to obtain testing. This approach is an example of applying which ethical principle? A. Autonomy B. Nonmaleficence C. Justice D. Fidelity

Correct Answer: C Explanation: Setting fair criteria to allocate limited resources reflects the principle of justice, which is about fairness and equitable distribution of resources. By prioritizing based on medical need and lack of alternatives, the clinic is trying to be fair in who benefits from the free testing. Autonomy (A) isn't directly relevant here since it's not about individual decision-making. Nonmaleficence (B) involves avoiding harm and isn't about resource distribution. Fidelity (D) usually refers to loyalty or keeping commitments, also not applicable. The scenario is fundamentally about justice in healthcare.

Over the past year, a genetic counselor has been working extended hours and handling a very large caseload. Lately, he feels emotionally exhausted and notices he is becoming less patient and empathetic with clients. According to the Code of Ethics, what is the best step for him to take? A. Continue working as usual; his personal feelings should not interfere with patient care and he must push through. B. Immediately take a leave of absence without telling anyone the reason, to avoid risking any further burnout. C. Acknowledge the impact of burnout on his professional performance and seek appropriate help or adjustments, such as reducing caseload, seeking counseling or supervision, to maintain his effectiveness with clients. D. Start referring all patients to colleagues because he feels he can no longer handle counseling at all.

Correct Answer: C Explanation: The Code of Ethics advises counselors to be responsible for their own well-being as it affects professional performance. Option C is correct because recognizing burnout and taking proactive steps to address it (through self-care, professional support, or workload management) will help ensure he provides competent, compassionate care. Option A is incorrect as ignoring burnout can lead to poor client care or ethical lapses. Option B may be too abrupt and not coordinated with patient care needs or employer support. Option D overreacts by abandoning his role entirely rather than addressing the issue; a measured approach as in C is preferred.

A genetic counselor with strong personal beliefs against pregnancy termination is counseling a woman who received a prenatal diagnosis of a condition associated with severe disability. The patient is considering termination and asks for guidance. The counselor feels unable to discuss termination objectively due to her beliefs. According to the NSGC Code of Ethics, what is the most appropriate action for the counselor to take? A. Inform the patient that she cannot discuss termination and end the session immediately. B. Provide only minimal information about termination due to her discomfort, steering the patient away from that option. C. Explain to the patient that she will arrange for another genetic counselor who can discuss all options, including termination, in an unbiased manner. D. Proceed with counseling about all options including termination, but emphasize her personal moral opposition to that choice.

Correct Answer: C Explanation: The NSGC Code of Ethics requires counselors to recognize when their personal values impede their ability to counsel a patient objectively. In such cases, the counselor should refer the patient to another qualified professional to ensure the patient receives unbiased, nonjudgmental information. Option C is correct because it upholds the patient's right to full, unbiased information by transferring care to someone without that conflict. Options A and B would leave the patient without adequate support or information, and Option D injects the counselor's personal bias into the session, which is unethical.

33. If a genetic counselor finds themselves in a situation that could be a real or perceived conflict of interest, what is the best first step they should take? A. Immediately remove themselves from the situation without explaining anything to anyone. B. Proceed as usual but try to make sure no one finds out about the conflict. C. Disclose the conflict of interest to the relevant parties (such as employers, patients, or colleagues) and discuss appropriate ways to manage or eliminate it. D. Ignore it unless someone else points it out, since a "perceived" conflict isn't a real conflict.

Correct Answer: C Explanation: The best initial step in addressing a conflict of interest is transparency. Option C is correct: the counselor should disclose any potential conflict to those who need to know and work out a plan to manage it (which might include recusal or other adjustments). Option A might be necessary in some severe cases, but abruptly leaving without explanation is not ideal; a proper handoff or plan should be made. Option B and D involve concealment or inaction, which are unethical because they allow the conflict to potentially influence professional behavior without accountability. Being open about the situation ensures trust and integrity in the counselor's professional role

A senior genetic counselor supervises a graduate student intern. The counselor begins to ask the student for personal favors outside of training—such as babysitting the counselor's children—offering the student extra clinic hours in return. Which aspect of the Code of Ethics is the counselor most clearly violating? A. There is no violation; this is a mutually beneficial arrangement. B. Privacy and confidentiality, because personal life and work life are being mixed. C. Professional boundaries, as she is exploiting her supervisory position for personal benefit, which is unethical. D. Informed consent, since the student did not formally consent to these extra duties.

Correct Answer: C Explanation: The counselor is violating ethical standards by not maintaining appropriate professional boundaries with a trainee. Option C is correct: using a supervisory relationship to obtain personal favors is exploitative and unprofessional. The Code of Ethics for relationships with colleagues and trainees emphasizes avoiding exploitation. Option A is incorrect — even if the student agrees, the power imbalance makes it ethically problematic. Options B and D are not directly relevant to this scenario; the key issue is the abuse of the supervisor's position.

A patient comes in with an article from the internet about a new herbal supplement that supposedly "cures" a genetic disorder. The supplement has not been studied in any clinical trials. The patient is eager to try it. How should the genetic counselor respond from an evidence-based perspective? A. Encourage the patient to try the supplement immediately since it might help and is readily available. B. Dismiss the patient's interest and tell them only pharmaceuticals can treat genetic conditions. C. Acknowledge the patient's desire for treatment but explain that there is no scientific evidence yet to support the supplement's effectiveness or safety, and discuss any proven medical options or clinical trials that are available. D. Tell the patient that if they believe in it strongly, they should go ahead, as placebo effect might make it work.

Correct Answer: C Explanation: The counselor should neither immediately endorse an unproven remedy nor disrespect the patient's interest. Option C is correct: it balances empathy for the patient's hopes with an explanation that the supplement lacks scientific evidence, which is necessary before recommending any treatment. The counselor can guide the patient toward evidence-based options, including mentioning that clinical trials or standard treatments exist. Option A would be irresponsible without evidence of safety or efficacy. Option B is dismissive and could alienate the patient. Option D relies on placebo effect and ignores the principle of recommending based on evidence.

A new genetic counselor has not yet passed the ABGC certification exam, but her clinic's brochure lists her as a "board-certified genetic counselor." Which ethical principle is being violated in this scenario? A. Confidentiality - because her exam status is private information. B. Justice - because this misrepresentation gives her an unfair advantage. C. Veracity - because she is not accurately representing her credentials and qualifications. D. Autonomy - because patients aren't given a choice in selecting a certified counselor.

Correct Answer: C Explanation: The scenario violates the principle of veracity (truthfulness) and integrity in professional representation. Genetic counselors must accurately represent their qualifications and credentials. Listing an uncertified individual as "board-certified" is dishonest and misleads patients and colleagues. It doesn't directly involve patient confidentiality or autonomy, and while it could be seen as unfair, the core issue is the lack of honesty about credentials, making Option C the correct answer.

A supervising counselor overhears her student excitedly discussing a patient's case with another friend in a public cafeteria, mentioning the patient by name and details of the mutation. What should the supervisor do? A. Wait to see if the student realizes the mistake on her own; if not, mention it in the end-of-rotation evaluation. B. Immediately interrupt and scold the student in front of the friend to drive the point home. C. Later, in private, remind and educate the student that discussing identifiable patient information in public violates patient confidentiality and is unacceptable, and ensure the student understands privacy rules. D. Report the student to the genetic counseling program's director and ban them from seeing patients for breaching confidentiality.

Correct Answer: C Explanation: The student has breached confidentiality, likely out of enthusiasm and lack of experience. The supervisor should address it as a serious teaching moment. Option C is correct: a private conversation to explain why this behavior is unethical and how to protect patient privacy in the future. This approach corrects the behavior and reinforces professional standards. Publicly scolding the student (Option B) could humiliate them without necessarily improving understanding. Option A is too passive; the breach needs prompt addressing. Option D may be warranted only if the student shows a pattern of disregard for confidentiality; a single incident is better handled with education and a warning.

A genetic counselor is also part of a research team for a new genetic test. She stands to be listed as an author on a publication if enough patients enroll in the study. When seeing an eligible patient in clinic, what is the most ethical approach? A. Recommend the patient join the study without disclosing her role in it, to increase enrollment. B. Avoid discussing the study at all to prevent any conflict of interest. C. Inform the patient about the study as an option, including explaining her role as a researcher and making clear that the patient's decision will not affect their clinical care. D. Strongly push the patient to participate because the study needs participants, but mention her involvement after they agree.

Correct Answer: C Explanation: When a counselor has a dual role as a researcher, transparency is crucial. Option C is correct: the counselor should disclose her involvement in the study and present the research as an optional opportunity, ensuring the patient knows their care will not be impacted by their choice to participate or not. This manages the conflict of interest by being honest and not pressuring the patient. Option A hides important information and is coercive. Option B might deprive the patient of a potentially beneficial opportunity and isn't necessary if the conflict can be managed with disclosure. Option D is coercive and only discloses the conflict after influencing the patient, which is unethical.

Which of the following scenarios is NOT a conflict of interest for a genetic counselor? A. The counselor receives a commission for each patient she refers to a particular genetic testing company. B. The counselor owns stock in a biotechnology firm whose products she frequently recommends. C. The counselor's performance review and bonus are tied to how many patients she sees per day, potentially impacting the quality of counseling. D. The counselor volunteers for a genetic disorder advocacy group and sometimes refers patients to the group for support.

Correct Answer: D Explanation: Options A, B, and C all describe situations where personal or financial interests could unduly influence the counselor's professional decisions or behavior (receiving commissions, having a financial stake in recommendations, or being pressured to prioritize quantity over quality of care). These are conflicts of interest or at least pose a risk of conflict. Option D, volunteering for an advocacy group, generally is not a conflict of interest; referring patients to a support group where the counselor volunteers doesn't typically result in personal gain or bias (assuming the counselor isn't gaining financially). It's generally considered part of good patient care to connect clients with support resources. Therefore, D is not a conflict of interest.

A genetic counselor is reading a new research article to determine if its findings should change her practice. Which factor is LEAST important in evaluating the quality of the study's evidence? A. The study's sample size and whether it included appropriate controls. B. Whether the journal that published the study is peer-reviewed. C. The funding source of the study and any potential conflicts of interest. D. The popularity of the lead researcher on social media

Correct Answer: D Explanation: When critically appraising evidence, factors like methodology (sample size, controls), peer-review status, and possible conflicts of interest are important to determine reliability. Option D is correct as the least important factor — a researcher's social media popularity has no bearing on the scientific quality of the study. Options A, B, and C are all important considerations in evaluating evidence quality and potential bias.

An adult genetic counselor who specializes in cancer genetics is asked to counsel a family about a rare pediatric metabolic disorder, a topic she is unfamiliar with. What is the most ethical response according to the Code of Ethics? A. Accept the case and provide general genetic information, hoping it will be sufficient. B. Decline to see the family, telling them she only does cancer cases and they should find someone else. C. Quickly self-study the metabolic condition the night before and handle the session without mentioning her limited knowledge. D. Refer the family to or consult with a genetic counselor or specialist in metabolic disorders to ensure the family receives accurate and informed counseling.

Correct Answer: D Explanation: Genetic counselors are expected to work within their scope of practice and recognize the limits of their expertise. Option D is correct because it ensures the family is guided by someone with appropriate expertise, either through referral or consultation, aligning with the counselor's duty to provide competent, informed services. Options A and C risk providing inaccurate or incomplete information, and Option B abandons the family without guidance instead of facilitating a proper referral.

Under HIPAA regulations, which of the following constitutes protected health information (PHI)? A) A patient's de-identified genetic test results B) The name of the laboratory performing the genetic test C) A researcher's publication on a genetic disorder D) A patient's whole-genome sequencing data with identifiers

Correct Answer: D Explanation: Genetic test results linked to identifiable patient information are considered PHI under HIPAA and must be protected.