Newborn Pt2

A mother who is holding her 2-hour-old newborn says, "I don't think she likes breastfeeding, but last time, when we were in the delivery room, she did really well." Which is the nurse's best response?

"After birth, babies go into a deep sleep, but when she wakes up, she'll be hungry."

What is the difference between nevus simplex and erythema toxicum?

- Nevus simplex - "stork bites" are capillary defects that are superficial and blanchable. They are usually present on the eyelids, nose, upper lip and nape of the neck - Erythema toxicum - "newborn rash" is an area of redness with papules that appears within 72 hours and can appear anywhere on the body

What are some causes of hyperthermia in infants?

- Sepsis - Overuse of warmers, phototherapy or sunlight - Hot environment - Excessive clothing or blankets

What are some non-pharmacological ways to control pain in a newborn?

- Swaddling - Sucking (non-nutritive) - Oral Glucose - Skin to skin contact - Breastfeeding

Choice Multiple question - Select all answer choices that apply. The nurse is determining if a pregnant patient is an appropriate candidate for a genetics referral. The nurse makes the referral based on which of the following findings? Select all that apply. a) Child with Down syndrome b) Previous miscarriage c) Positive alpha-fetoprotein test d) Maternal age of 30

-Positive alpha-fetoprotein test -Child with down syndrome

What are the 2 types of predictive testing?

-presymptomatic (development of disease is certain if mutation present ie Huntington's Disease) -predispostional (development of disease is possible if mutation present ie BRCA1 for breast cancer)

Preemie dose for vitamin k

0.5 mg IM

The nurse is caring for a healthy caucasian neonate who was born at 37 weeks of gestation. What does the nurse find while performing the skin assessment of the newborn immediately after the birth? 1. Bluish-black areas on the body 2. Desquamation of the epidermis 3. Vernix caseosa covering the body 4. Dark red-colored swellings on the body

3. Vernix caseosa covering the body

normal RR for newborn

30-60 breaths per min

A nurse is assessing a newborn's temperature. Which reading would the nurse document as normal? 36.0° C (96.8° F) 35.0° C (95.0° F) 38.0° C (100.4° F) 37.0° C (98.6° F)

37.0° C (98.6° F)

The nurse is caring for a neonate during the first hour after birth. Which observation by the nurse is a cause for concern? 1. Rise of the abdomen with each inspiration 2. Bluish discoloration of hands and feet 3. Transient periods of duskiness while crying 4. Discoloration of the mucous membranes

4. Discoloration of the mucous membranes

While caring for an infant, which method should the nurse adapt to prevent heat loss due to evaporation? 1. Wrap the infant in a cloth. 2. Place the infant in a warm crib. 3. Place the crib away from the windows. 4. Dry the infant immediately after the bath.

4. Dry the infant immediately after the bath.

The nurse is examining the external genitalia of a female infant. What finding must the nurse report? 1. Slight bloody spotting 2. Presence of hymenal tag 3. Mucoid vaginal discharge 4. Fecal discharge from vagina

4. Fecal discharge from vagina

While reviewing the blood labs of a 3-day-old infant, the nurse finds that the infant has neutrophilia. What might be the cause of the neutrophilia? 1. Epispadias. 2. Polydactyly. 3. cephalhematoma. 4. Meconium aspiration syndrome.

4. Meconium aspiration syndrome.

The nurse is caring for a patient who is breastfeeding a term newborn. What does the nurse teach the patient about how normal stool should appear on the fourth day after birth? 1. Greenish-black stool 2. Greenish-brown stool 3. Pale yellow to brown stool 4. Pasty yellow to golden stool

4. Pasty yellow to golden stool

While evaluating the reflexes of a male newborn, the nurse notes that with a loud noise, the newborn symmetrically abducts and extends his arms, his fingers fan out and form a "C" with the thumb and forefinger, and he has a slight tremor. What finding does the nurse document? 1. Positive tonic neck reflex 2. Positive Glabellar (Myerson) reflex 3. Positive Babinski reflex 4. Positive Moro reflex

4. Positive Moro reflex

The nurse is caring for a male infant who has been circumcised. Which is the most important detail for the nurse to be aware of? 1. The infant has effective feeding. 2. The infant has passed adequate urine. 3. The infant has passed normal stool. 4. The infant has excessive bleeding.

4. The infant has excessive bleeding.

The nurse is caring for a neonate immediately after birth. Which finding would require the nurse to notify the primary health care provider during the first 2 days after birth? 1. The neonate's diaper has pink-tinged stains. 2. The neonate's urine is cloudy after the first voiding. 3. The neonate voids eight times during the day. 4. The neonate has not voided for 24 hours.

4. The neonate has not voided for 24 hours.

n most healthy newborns, blood glucose levels stabilize at _________ mg/dL during the first hours after birth.

50 to 60 In most healthy term newborns, blood glucose levels stabilize at 50 to 60 mg/dL during the first several hours after birth. A blood sugar level less than 40 mg/dL in the newborn is considered abnormal and warrants intervention. This infant can display classic symptoms of jitteriness, lethargy, apnea, feeding problems, or seizures. By the third day of life, the blood glucose levels should be approximately 60 to 70 mg/dL.

A patient understands that her diagnosis of ovarian cancer syndrome is an autosomal-dominant inherited condition. What is the chance that her daughter will inherit the gene mutation for this disease? a) 80% b) 10% c) 25% d) 50%

50%

What is a normal glucose level in a newborn?

50-60 within the first few hours and 60-80 within the first week

Heritability estimate for addiction to alcohol in bot males and females

50-60%

A newborn is born and, at 1 minute of life, is acrocyanotic, HR is 110, is floppy with some flexion, has a weak cry and grimaces. What Apgar score would the nurse assign this infant? 7 8 9 6

6

When should the newborn be bathed?

6-24 hours keep vernix on (bath should be short)

What is the relationship among genes, DNA and proteins

A gene is a section of DNA that provided the directions for synthesizing a specific protein

What are modes of heat loss in the newborn (Select all that apply)? a. Perspiration b. Convection c. Radiation d. Conduction e. Urination

B, C, D

A nurse is assessing a patient with an autosomal-dominant inherited condition. When discussing the risk of transmission to the patient's offspring, which of the following would the nurse include? a) The patient's partner must also have the genetic mutation. b) Females will be carriers for the condition. c) Each child has a 50% risk of inheriting the gene. d) The risk for inheritance depends on the presence of other gene mutations.

Each child has a 50% risk of inheriting the gene.

Which birth is likely to have more retained fluid in the lungs, vaginal or c-section?

C-section since the chest is not compressed in the birth canal

Vitamin K is given to the newborn to: A. Reduce bilirubin levels. B. Increase the production of red blood cells. C. Enhance ability of blood to clot. D. Stimulate the formation of surfactant.

C. Enhance ability of blood to clot. Vitamin K does not reduce bilirubin levels. Vitamin K does not increase the production of red blood cells. Newborns have a deficiency of vitamin K until intestinal bacteria that produce vitamin K are formed. Vitamin K is required for the production of certain clotting factors. Vitamin K does not stimulate the formation of surfactant.

Which statement about cancer is true

Cancer cells arise from normal cells

Pt states that the origin of most cancer is genetic. What is the best response

Cancers arise in cells that have alteration in the genes

A client is at risk for breast cancer. Which of the following would reflect the client's genotype for this disorder? a) Evidence of a lump in the breast b) Positive breast biopsy c) Carrier of BRCA1 mutation d) Family history of breast cancer

Carrier of BRCA 1 mutation

What type of genetic test process information about as a symptomatic person's risk for having a child with a specific autosomal recessive disorder in the future

Carrier test

What is the stimulus that initiated breathing?

Change in sensory environment from womb to birth

What is the liver's job related to bilirubin?

Changing unconjugated bilirubin to conjugated bilirubin

When caring for a newborn born by Cesarean section, the nurse recognizes the increased risk for respiratory distress because the baby did not experience which external stimuli?

Chest squeeze

The LPN assists the RN while performing the Ortolani maneuver on a newborn. When asked by the mother the reason for this maneuver, which is the best response from the nurse? Spinal column movement Shoulder movement Hip for dislocation Clavicles for dislocation

Hip for dislocation Ortolani maneuver is used to assess the possibility of a dislocated hip in an infant. Ortolani maneuver does not assess for spinal column movement, shoulder movement, nor does it assess the clavicles for dislocation. There is no specific movement to assess for spinal column movement, shoulder movement, or clavicle dislocation.

What is the first intervention when a decreasing heart rate is noticed?

Manage the airway

Caucasian take more warfarin than asia

Many Asian do not breath down warfarin as fast as caucasians, so the drug is more effective at lower dosages

The daughter of a patient with Huntington disease has requested that she be tested for the disease even though she has no symptoms at this time. What type of test does the nurse anticipate the physician will order? a) Prenatal testing b) Presymptomatic testing c) A family pedigree d) Predisposition testing

Presymptomatic testing

Skin to skin functions to (3)

Provide ample external stimulation for first breaths, decrease heat loss, promotes mother infant bonding (improves BF)

Why is pharmacokinetics of particular interest in treating pt with psychiatric health problems

Psychiatric meds may be effective in only a small group of Pts.

At risk for hypoglycemia

SGA, IUGR, preterm and IDM

Characteristics of breast fed stool

Seedy, yellow, mustard gold, soft to liquidity, frequent

brown fat

Source of heat unique to neonates that is capable of greater thermogenic activity than ordinary fat; deposits are found around the adrenals, kidneys, and neck; between the scapulae; and behind the sternum for several weeks after birth

The nurse admits a newborn to the admission nursery and prepares to bathe the baby for the first time after assessing what?

Stable temperature for 2 hours

A client has an autosomal-dominant disorder. His wife is unaffected. When explaining the risk for inheritance of the disorder in their offspring, which statement by the nurse would be most appropriate? a) "There is a 50% chance that each of your children will have the condition." b) "The female determines whether your children will have the disorder." c) "Any child you have would most likely have the disorder." d) "You have a 1 in 4 chance of a child being affected by the disorder."

There is a 50% chance that each of your children will have the condition

Why do genetic counseling programs include extensive courses on laboratory methods in genetics

To help patients understand testing procedures and results

Lethal cardiac arrhythmia with long QT

Torsade de Pointes

What is the most common trisomy abnormality?

Trisomy 21 (causes Down's syndrome)

Which statement best describes the role of tumor suppressor genes in CA development

Tumor suppressor genes control or modify the activity of oncogenes, reducing the risk for CA development

Juliet tells a nurse that she has 3 aunts who were diagnosed with great cancer. She asks if she should have genetic testing.

Your family history may indicate an increased risk for breath cancer and a genetic counselor could help determine whether you could benefit from genetic testing

The nurse should immediately alert the physician when: a. The infant is dusky and turns cyanotic when crying. b. Acrocyanosis is present at age 1 hour. c. The infant's blood glucose level is 45 mg/dL. d. The infant goes into a deep sleep at age 1 hour.

a. The infant is dusky and turns cyanotic when crying.

As related to the normal functioning of the renal system in newborns, nurses should be aware that: a. The pediatrician should be notified if the newborn has not voided in 24 hours. b. Breastfed infants likely will void more often during the first days after birth. c. "Brick dust" or blood on a diaper is always cause to notify the physician. d. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.

a. The pediatrician should be notified if the newborn has not voided in 24 hours.

The cheeselike, whitish substance that fuses with the epidermis and serves as a protective coating is called: a. Vernix caseosa. b. Surfactant. c. Caput succedaneum. d. Acrocyanosis.

a. Vernix caseosa.

The nurse caring for the newborn should be aware that the sensory system least mature at the time of birth is: a. Vision. b. Hearing. c. Smell. d. Taste.

a. Vision.

found only in NB, highly vascular, cannot be replenished once used, premature, SGA and LGA have inadequate stores

brown fat

A first-time dad is concerned that his 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice, what fact should be included? a. Physiologic jaundice occurs during the first 24 hours of life. b. Physiologic jaundice is caused by blood incompatibilities between the mother and infant blood types. c. The bilirubin levels of physiologic jaundice peak between the second and fourth days of life. d. This condition is also known as "breast milk jaundice."

c. The bilirubin levels of physiologic jaundice peak between the second and fourth days of life.

non-shivering, increased RR, hypothermia, low birth weight, s&s hypoglycemia, bluish

cold stress

Heat loss due to baby being born wet, births, baths

evaporation

Normal BP ranges for newborn

normal ranges 70-50/45-30

Where should you do blood sugar checks on a NB?

outer heels

Infants lose weight directly after birth due to

passage of meconium, low fluid intake and loss of extracellular fluid

Which of the following is the first step in establishing the pattern of inheritance? a) Pedigree b) Mutation c) Genotype d) Transcription

pedigree

A nurse working in the neonatal nursery anticipates the primary care provider to prescribe which medication for a premature newborn having difficulty breathing? albuteral surfactant norepinephrine epinephrine

surfactant Surfactant is a protein that keeps small air sacs in the lungs from collapsing. Its use was introduced in 1990 and continues today, especially for premature babies and those who have respiratory distress syndrome. The other medications are not given to help premature babies breathe.

What variable in a person with CAD increase the likelihood of a strong influence in its expression

the problems is severe before age 50

What are expected findings in a newborn within the first 30 minutes of life?

- HR: 160-180 BPM then 100-120 BPM within 30 minutes - RR: irregular, 60-80 breaths per minute, fine crackles in lungs - Grunting, nasal flaring and retractions are normal, but should stop within an hour of birth - Bowel sounds present, meconium may be passed

What are some contraindications for circumcision?

- Hypospadias/Epispadias - Prematurity - Ambiguous genitalia - Buried penis - Chordee

What are some risks of genetic testing?

- Discrimination (insurance or employers) - False positives (may lead to termination of otherwise healthy pregnancies) - False negatives (mother may not undergo needed screening/monitoring) - Increased anxiety/altered family dynamics

What are some ways to decrease regurgitation in newborns?

- Feed smaller amounts more frequently - Frequent burping - Position the head elevated

A mother says, "I changed his diaper, fed him, burped him, and he won't stop crying. I even tried playing music for him and shaking this toy for him. What am I doing wrong?" Which is the nurse's best response?

"He may be overstimulated. Try snuggling him close."

A mother is concerned because her 2-day-old newborn's birth weight was 8 lb (3584 g) and his current weight is 7 lb 8 oz (3360 g). What would be the nurse's response to the mother's concern? "The newborn needs to be fed more frequently to stop this weight loss pattern." "The weight loss is a normal finding, since newborns lose 5% to10% of their birth weight in the first few days after birth." "Although newborns lose some weight after birth due to poor nutrition, this amount is concerning." "The weight loss may be indicative of some underlying health problem. I need to notify the doctor."

"The weight loss is a normal finding, since newborns lose 5% to10% of their birth weight in the first few days after birth."

What are some physiologic adjustments that facilitate breathing immediately postpartum?

- Clamping the umbilical cord causes a rise in blood pressure - Stimulation of chemoreceptors in the carotid and aorta that detect hypoxia - Compression of the chest during vaginal delivery forcing fluid out - Crying - Profound temperature change from intrauterine life to outside - Catecholamine surge prior to labor that promotes lung fluid clearance

Term dose for vitamin k

1 mg IM

What is a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge? 1. Apical heart rate of 90 beats/minute, slightly irregular, when awake and active 2. Acrocyanosis 3. Harlequin color sign 4. Weight loss representing 5% of the newborn's birth weight

1. Apical heart rate of 90 beats/minute, slightly irregular, when awake and active

The nurse is assessing the heart rate of a term infant. Which finding would require the nurse to evaluate further? 1. Heart rate of 85 beats/minute while asleep 2. Heart rate of 90 beats/minute before feeding 3. Heart rate of 140 beats/minute while awake 4. Heart rate of 170 beats/minute when crying

2. Heart rate of 90 beats/minute before feeding

While caring for the newborn, the nurse must be alert for any signs of cold stress. This would include which symptom? 1. Decreased activity level 2. Increased respiratory rate 3. Hyperglycemia 4. Shivering

2. Increased respiratory rate

Sometimes health-care providers with information about family members' genetic risk are confronted by conflicting ethical principles. Which principle is LEAST likely to conflict with the health-care providers' "duty to Warn"?

Genetic discrimination

The nurse is assessing a neonate immediately after birth. How does the nurse document the presence of bluish-black pigmentation on the neonate's buttocks? 1. Mongolian spots 2. Nevus simplex 3. Nevus flammeus 4. Erythema toxicum

1. Mongolian spots

The nurse is caring for a full-term neonate born by cesarean. What is the effect of cesarean birth on the respiratory function of the neonate? 1. Retention of fluid in the lungs 2. Incidence of transient bradypnea 3. Exhaustion from the effort of breathing 4. Episodes of periodic breathing

1. Retention of fluid in the lungs

The nurse notices that a newborn has difficulty breathing. What infant behavior might have led to the nurse to this conclusion? 1. The infant did not cry after birth. 2. The infant had improper bowel sounds. 3. The infant moved its head from side to side. 4. The infant had increased blood pressure (BP).

1. The infant did not cry after birth.

The nurse performs nasal and oral suctioning of a newborn immediately after birth. What is the reason for this nursing intervention? 1. To stimulate respiration 2. Assist in stimulating cardiac activity 3. Removal of fluid from the lungs 4. To increase pulmonary blood flow

1. To stimulate respiration

What is the normal heart rate of an infant?

110-160 BPM

The average HR in the first week of life is

110-160 up to 180 when crying, may drop 80-100 when sleeping

What is the normal urine output of a term infant?

15-60 ml/kg/day

Begins when awakened from deep sleep, lasts 4-6 hours, first poop, look for apnea, cyanosis, mottling, increases mucus, gagging, choking, regurgitation

2nd period of reactivity

A nurse is obtaining a genetic family history of a client. The nurse collects information about family members going back at least how many generations? a) 3 b) 2 c) 4 d) 5

3

The nurse is assessing an infant for plantar reflex. What action by the nurse elicits the plantar reflex? 1. Touch the corner of the infant's mouth with a finger. 2. Tap over the bridge of the infant's nose when awake. 3. Place a finger at the base of the infant's toes. 4. Place a finger in the palm of the infant's hand.

3. Place a finger at the base of the infant's toes.

After birth how soon should an infant eat?

3-5 hours, bf immediately

In most healthy newborns, blood glucose levels stabilize at what mg/dl during the first hours after birth? 1. 80 to 100 2. Less than 40 3. 50 to 60 4. 60 to 70

3. 50 to 60

Upon assessment, the nurse finds that the infant has a sunken abdomen, bowel sounds heard in the chest, nasal flaring, and grunting. What clinical condition does the nurse suspect the infant has based on these findings? 1. Epispadias. 2. A ruptured viscus. 3. A diaphragmatic hernia. 4. Hirschsprung's disease.

3. A diaphragmatic hernia.

The nurse is caring for an infant after a forceps-assisted birth. Which feature does the nurse attribute to a forceps-assisted birth? 1. Erythematous skin 2. Blotchy or mottled skin 3. Edema and ecchymosis 4. Cyanotic discoloration

3. Edema and ecchymosis

The nurse is caring for a baby who is 4 weeks old. The nurse finds that the newborn is breathing through the mouth. What does the nurse expect to be the most likely clinical condition for this observation? 1. Hypoxemia. 2. Cardiac disorder. 3. Nasal obstruction. 4. Laryngeal obstruction.

3. Nasal obstruction.

When will the newborn regain the weight lost the first few days after birth?

7-10 days

A 32-year-old patient has just been told that she has the BRCA1 hereditary breast cancer gene mutation. What is her risk of developing cancer by the age of 65 years? a) 25% b) 50% c) 100% d) 80%

80%

What is the heritability estimate for schizophrenia in the general populations

80%

What is the Apgar score and how is it interpreted?

A quick way to assess a newborn immediately (done at 1 and 5 minute intervals postpartum) - 0-3 - severe distress - 4-6 - moderate distress - 7-10 - minimal to no problems

Which statement AFib is true

A variety of different genes contribute to its expession

The nurse is planning the care of a 1-day-old infant. Which of the following nursing interventions would protect the newborn from heat loss by convection? A. Placing the newborn away from air currents B. Pre-warming the examination table C. Drying the newborn thoroughly D. Removing wet linens from the isolette

A. Placing the newborn away from air currents Placing the newborn away from air currents reduces heat loss by convection. Pre-warming the examination table reduces heat loss by conduction. Drying the newborn thoroughly immediately after birth or after a bath will prevent heat loss by evaporation. Removing wet linens that are not in direct contact with the newborn from the isolette reduces heat loss by radiation.

Cystic fibrosis is an example of which type of inheritance? a) Autosomal dominant b) Autosomal recessive c) Multifactorial d) X-linked recessive

Autosomal recessive

The nurse, planning an educational program on cystic fibrosis, should include information explaining that cystic fibrosis is an example of which of the following types of inherited conditions? a) Autosomal dominant b) Multifactorial c) Autosomal recessive d) X-linked recessive

Autosomal recessive

What are the respiration rates for an infant?

Average of 40, but between 30-60

Where should an infants temperature be taken and what should it be?

Axillary and it should be 97.7-99.5 F

An 85 yr old pt stress that she does not perform breast self-exam because there is not history of breast cancer in her family. What is the best response.

Breast cancer can be found more frequently in some families however the risk for general non-familiar breast cancer increases with age.

When caring for a newborn, the nurse must be alert for signs of cold stress, including: A. Decreased activity level. B. Increased respiratory rate. C. Hyperglycemia. D. Shivering.

B. Increased respiratory rate. Infants experiencing cold stress would have an increased activity level. An increased respiratory rate is a sign of cold stress in the newborn. Hypoglycemia would occur with cold stress. Newborns are unable to shiver as a means of increasing heat production; they increase their activity level instead.

What is the most accurate classification of the common forms of CAD and HTN

Complex disorders resulting from gene environment interactions

Which condition provided the greatest support for a strong genetic contribution to autism spectrum disorder

Concordance among dizygotic twins is 10 %

Direct bilirubin

Conjugated with glucuronic acid, water soluble

The nurse is obtaining health history from a client with a genetic disorder. Which of the following would be most appropriate for the nurse to establish the pattern of inheritance? a) Obtain information about the client's parents. b) Investigate for possible signs and symptoms of the disorder. c) Determine if the condition is dominant or recessive. d) Construct a pedigree of the client's family.

Construct a pedigree of the client's family.

Which type of genetic testing is the more sensitive method for detecting any mutation in a specific gene

Direct DNA sequencing

What are milia?

Distended, white, small sebaceous glands on the face

The nurse is assisting new parents adjust to the birth of their first child. The parents appear hesitant to pick up the baby, stating they are afraid they will make the baby cry. What is the best response if the nurse discovers the infant is lying relatively still with eyes wide open, looking at the parents? Encourage the mother to breastfeed Suggest they rock the baby to sleep Commend the parents for making the right choice Encourage the parents to pick up the baby

Encourage the parents to pick up the baby

Which intervention is most effective for the nurse to perform to promote elimination of conjugated bilirubin?

Encouraging frequent feeding

Which action reflects promoting of genomic care as part of comprehension health care

Ensuring that genomic issues potentially influencing a person health are incorporated into routing care

The nurse is conducting a community education program on genetics/genomics. The nurse determines that participants are understanding the information when the class states that diagnostic test used to detect small chromosomal abnormalities and characterizing chromosomal rearrangement is which of the following? a) DNA analysis b) Hemoglobin electrophoresis c) Fluorescent in situ hybridization (FISH) d) Hexosaminidase A activity testing

Fluorescent in situ hybridization (FISH)

Increase vascular resistance leads to the closure of the

Foramen ovale, ductus arteriosus, ductous venosus

Woman as 3 aunts with breast cancer. Which genetic professional would be most appropriate for assistance in helping her understand the health risk

Genetic counsler

During a community education program on genetics and genomics, the nurse uses which of the following as an example of a small gene mutation that affects protein structure-producing hemoglobin S? a) Marfan syndrome b) Tay-Sachs disease c) Hemophilia d) Sickle cell anemia

Hemophilia

Vitamin k is given in the left leg for what reason?

Increase production of blood clotting factors, vitamin k comes from gut flora which NB don't have at birth

A pt whose mom has huntington's disease is considering genetic testing but is not sure whether she really wants to know if she has the mutation. She asks you why you would do if your mom had the disease

I can only tell you the benefits and the risk of testing, you must make this decision yourself

What is a carrier screen test looking for?

If a parent has a genetic disease, but is asymptotic (Tay-Sachs, CF, Sickle Cell)

A pt with a very high concentration of insulin receptors on cells that require insulin for glucose to enter. How should insulin dosages be adjusted for this patient to have blood glucose levels with the normal range

Insulin dosages should be decreased because the drug will exert its action at lower concentrations

Who is at greatest risk of having a child with Down's Syndrome?

Mothers older than age 35

What is the most cost effective piece of genetic information?

Obtaining a family history from both sides of the family

Characteristics of formula fed stool

Pale yellow, formed, firmer

Maternal antibodies IgG are transferred to the fetus via placenta this is

Passive acquired immunity

Differentiate between pathologic and physiologic jaundice.

Pathologic - Appears within 24 hours, serum bilirubin increases more than 6mg/dL in a day or is greater than 15 at any point - Usually caused by hemolytic reactions Physiologic - Appears after 24 hours and usually resolves without treatment

Which normal cell characteristic is represented by the production of insulin in the beta cells of the pancreas

Performance of a differentiated function

While assessing a client, the nurse notes that the client has numerous freckles on his skin. The nurse interprets this finding as which of the following? a) Genotype b) Genome c) Variable expression d) Phenotype

Phenotype

The nurse working in the labor and delivery unit prepares to test for which of the following as a part normal newborn screening? a) Phenylketonuria b) Sickle cell anemia c) Cystic fibrosis d) Down syndrome

Phenylketonuria

How do genetic issues influence individual variation of the response to a specific drug

Polymorphism of genes encoding metabolizing enzymes

Upon physical examination, the nurse notes the liver of a newborn is palpable 2-3 cm below the right costal margin. The nurse recognizes this finding and should consider the following? Recognize this as a normal physical finding. Check the results of the newborn neonatal screen. Notify physician. Request liver enzyme testing.

Recognize this as a normal physical finding. Rationale: In the newborn, the liver is palpable 2-3 cm below the right costal margin. It is relatively large and occupies 40% of the abdominal cavity. This is a completely normal finding. Assessment; Health Promotion and Maintenance; Application

Normal physiological jaundice is assessed when the nurse observes what?

Serum total bilirubin of 7.2 mg/dL on day 4 of life

After assessing a client's family history, the nurse determines the need for a genetic referral based on which of the following? a) Absence of consanguinity of family members b) Sister infertility problems due to spouse's low sperm count c) History of an unexplained miscarriage d) Several relatives diagnosed with colon cancer

Several relatives diagnosed with colon cancer

What is the normal respiration pattern of a newborn?

Shallow, irregular and 30-60 breaths per minute. Periods of apnea are normal, but should not last for longer than 20 seconds

Why are general physician and surgeons NOT considered to be genetics professionals

The focus on their professional education is the study of Medicine rather than genetics

A client gives birth to a baby at a local health care facility. The nurse observes that the infant is fussy and begins to move her hands to her mouth and suck on her hand and fingers. How should the nurse interpret these findings? The infant is attempting self-consoling maneuvers. The infant is entering the habituation state. The infant is in a state of hyperactivity. The infant is displaying a state of alertness.

The infant is attempting self-consoling maneuvers.

Pts response to normal drug dose that because of a genetic variation in an enzyme that prepares the drug for elimination results in a blood drug level that is below the minimum effective concentration

The intended response fails to be produced

After a newborn has been bathed, which action performed by the nurse indicates a need for further teaching about maintaining the baby's thermoregulation?

The newborn is placed in a clean bassinet.

What statement regardignn general cancer development is true

The risk for CA development increase with age

Which statement is true regarding fetal and newborn senses? A newborn does not have the ability to discriminate between tastes. The rooting reflex is an example that the newborn has a sense of touch. A newborn cannot experience pain. A newborn cannot see until several hours after birth. A fetus is unable to hear in utero.

The rooting reflex is an example that the newborn has a sense of touch.

Why is a newborn's specific gravity lower than that of an adult?

Their kidneys are immature and can not concentrate urine

Why are people who have poor DNA repair mechanism at greater risk for CA development

Their somatic mutations are more likely to be permanent

A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, "What is this black, sticky stuff in her diaper?" The nurse's best response is: a. "That's meconium, which is your baby's first stool. It's normal." b. "That's transitional stool." c. "That means your baby is bleeding internally." d. "Oh, don't worry about that. It's okay."

a. "That's meconium, which is your baby's first stool. It's normal."

Part of the health assessment of a newborn is observing the infant's breathing pattern. A full-term newborn's breathing pattern is predominantly: a. Abdominal with synchronous chest movements. b. Chest breathing with nasal flaring. c. Diaphragmatic with chest retraction. d. Deep with a regular rhythm.

a. Abdominal with synchronous chest movements.

A new mother states that her infant must be cold because the baby's hands and feet are blue. The nurse explains that this is a common and temporary condition called: a. Acrocyanosis. b. Erythema neonatorum. c. Harlequin color. d. Vernix caseosa.

a. Acrocyanosis.

Conductive heat loss prevention

prewarming objects that come into contact with the infant such as mattress, towels, stethoscope and blankets. placing a prewarmed blanket on the scale before weighing the infant.

Heat loss due to cold walls of the room, walls of bed and ice for blood gasses (indirect contact)

radiation

Heat loss transferred from warm body to cool objects not in direct contact with the baby

radiation

A nurse working at a clinic interprets which of the following treatment plans as a sign that clinic has transitioned to a genomic approach for personalized medicine? a) Trial and error approach to disease treatment b) Treatment of presenting disease symptoms c) Treatment of underlying genetic cause of disease d) Waiting to treat until disease symptoms appear

treatment of underlying genetic cause of disease

At what point should the nurse expect a healthy newborn to pass meconium? before birth by 12 to 18 hours of life within 1 to 2 hours of birth within 24 hours after birth

within 24 hours after birth

A newborn develops physiologic jaundice, and the mother asks the nurse why this happened. Which response by the nurse would be most accurate? "We really don't know why jaundice develops in some babies and not in others. We just know how to treat it." "There is some type of blood incompatibility between you and your baby that's causing the problem." "Because his liver is a bit immature, the baby can't break down the bilirubin as fast as needed." "Your baby must have a blocked duct near his liver that's preventing the bilirubin from being excreted."

"Because his liver is a bit immature, the baby can't break down the bilirubin as fast as needed." The newborn has physiologic jaundice, which is related to decreased bilirubin conjugation. Newborns have relatively immature livers and cannot conjugate (break down) bilirubin as fast as needed. Bilirubin overproduction is responsible for causing jaundice associated with a blood incompatibility. Impaired bilirubin excretion, such as from an obstruction in the biliary tree, also can lead to jaundice. The causes of newborn jaundice are known; jaundice usually results from one of these three mechanisms.

The nurse is assessng a newborn male in the presence of the parents and notes that he has a hypospadias. How should the nurse respond when questioned by the parents as to what this means? "His testicles have not descended into the scrotal sac." "His urinary meatus in located on the under surface of the glans." "He has fluid in the scrotal sac." "He has normal male genitalia."

"His urinary meatus in located on the under surface of the glans." The term "hypospadias" refers to the urinary meatus being abnormally located on the ventral (under) surface of the glans. There are no special terms to indicate normal genitalia. Cryptorchidism refers to undescended testes. Hydrocele refers to the collection of fluid in the scrotal sac.

What are the kinds of heat loss that infants may experience?

- Convection - baby to air - Radiation - baby to distant object - Evaporation - water evaporation from skin carrying away heat - Conduction - baby to direct contact with a cold object

What are the structures unique to fetal circulation?

- Foramen Ovale - shunts blood between atria - Ductus arteriosis - Diverts blood away from lungs between aorta and pulmonary artery - Ductus venosis - Diverts blood around the liver

What are some signs/symptoms of hypoglycemia in a newborn?

- Glu less than 40 - Jitteriness - Lethargy - Apnea - Feeding problems - Seizures

How does an infant create more body heat in response to cold stress?

- Metabolism of brown fat - Increasing metabolism of glucose in the brain, liver and heart

Immediately after birth what is the NB RR?

60-70

What is the normal blood pressure of an infant?

60-80/30-50

The nurse is assisting a client during delivery. What measures does the nurse take to protect the infant from heat loss? Select all that apply. 1. Ensure the infant is dried immediately after birth. 2. Place the naked infant on bare scales for accuracy. 3. Place the naked infant on the mother's bare chest and cover with a blanket. 4. Ensure the nursery temperature is 27° C (80.6° F). 5. Wrap the infant and cover the head with a cap.

1. Ensure the infant is dried immediately after birth. 3. Place the naked infant on the mother's bare chest and cover with a blanket. 5. Wrap the infant and cover the head with a cap.

The heart rate of the newborn in the first few minutes after birth will be in which range? 120 to 130 bpm 120 to 180 bpm 80 to 120 bpm 180 to 220 bpm

120 to 180 bpm During the first few minutes after birth, the newborn's heart rate is approximately 120 to 180 bpm. Thereafter, it begins to decrease to an average of 120 to 130 bpm.

What is the distance that a newborn's vision is best?

17-20 cm (8-12")

baby is awake and active, signs of hunger/sucking, increases HR and RR, transient retractions and nasal flaring, lasts 30 minutes after birth

1st period of reactivity

The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick, sticky stool is very dark green, almost black in color. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by: 1. telling the mother not to worry because breastfed babies have this type of stool. 2. explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements. 3. asking the mother what she ate at her last meal. 4. suggesting that the mother ask her pediatrician to explain newborn stool patterns to her.

2. explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements.

Students are reviewing information about genes and chromosomes. They demonstrate understanding of this information when they identify each person as having how many pairs of chromosomes in each cell? a) 47 b) 18 c) 23 d) 46

23

A mother of a newborn reports to the nurse that the child has bluish pigmentation on the back. What could be the reason for this condition? 1. Infection 2. Hypothermia 3. Polycythemia 4. Mongolian spots

4. Mongolian spots

Which condition suggests attention ADHD

9 yr old does not focuse on a favorite story for longer than 3 min

What is a euploid cell?

A cell with the correct number of chromosomes (23 for haploid and 46 for diploid)

What is a scaphoid abdomen with bowel sounds in the chest indicative of?

A diaphragmatic hernia (scaphoid abdomen means sunken)

What statement regarding behavioral genetic is accurate

A genetic predisposition toward a specific behavior can be modified by altering environment influence

The mother of a 2-day-old male has been informed that her child has sepsis. The mother is distraught and says, "I should have known that something was wrong. Why didn't I see that he was so sick?" The best reply is: A. "Newborns have immature immune function at birth, and illness is very hard to detect." B. "Your mothering skills will improve with time. You should take the newborn class." C. "Your baby didn't get enough active acquired immunity from you during the pregnancy." D. "The immunity your baby gets in utero doesn't start to function until he is 4 to 8 weeks of age."

A. "Newborns have immature immune function at birth, and illness is very hard to detect." The immune system of a newborn lacks response to pyrogens and presents a limited inflammatory response; thus, the signs and symptoms of infection are often subtle and nonspecific in the newborn. This response does not address the physiology of neonatal infection and is not therapeutic because it is blaming. The mother develops active acquired immunity, which is passed to the newborn transplacentally as passive acquired immunity. This immunity is to the illnesses and infections she has had or been immunized against. The passive acquired immunity a newborn receives from its mother is effective at birth and lasts from four weeks to eight months, depending on the specific antibody.

The parents of a newborn are receiving discharge teaching. The nurse explains that the infant should have several wet diapers per day. Which statement by the parents indicates that further education is necessary? A. "Our baby was born with kidneys that are too small." B. "A baby's kidneys don't concentrate urine well for several months." C. "Feeding our baby frequently will help the kidneys function." D. "Kidney function in an infant is very different from in an adult."

A. "Our baby was born with kidneys that are too small." Size of the kidneys is rarely an issue. Counting wet diapers indicates urine output in relation to fluid intake. Frequent feeding helps maintain the fluid volume. The ability to concentrate urine develops by 3-4 months of age. The inability to concentrate urine due to limited tubular reabsorption and lower glomerular filtration rate are the main differences between kidney function in a newborn and normal adult kidney function.

The home care nurse is examining a 3-day-old infant. The skin on the child's sternum is yellow when blanched with a finger. The parents ask the nurse why jaundice occurs. The best response from the nurse is: A. "The liver of an infant is not fully mature and doesn't conjugate the bilirubin for excretion." B. "The infant received too many red blood cells after delivery because the cord was not clamped immediately." C. "The yellow color of your baby's skin indicates that you are breastfeeding too often." D. "This is an abnormal finding related to your baby's bowels not excreting bilirubin as they should."

A. "The liver of an infant is not fully mature and doesn't conjugate the bilirubin for excretion." Physiologic jaundice is a common occurrence and peaks on day 3 or 4. It happens in part because of the RBC destruction that infants experience combined with liver immaturity, which leads to less efficient conjugation of bilirubin for excretion. Frequent feeding, therefore, will decrease jaundice. Bilirubin binds to the proteins in breast milk and formula for excretion through the bowels.

During a community health class, the nurse is educating prenatal patients and their partners about normal newborn behavior. Which attendee's statement indicates that teaching was effective? "I can expect that my newborn baby: A. "Will be able to hear very well immediately after she is born." B. "Should be trained to breastfeed by being encouraged to suck on a pacifier before feedings." C. "Will have difficulty seeing me close up in the hours right after delivery." D. "Should be discouraged form sucking on a pacifier if he is bottle feeding."

A. "Will be able to hear very well immediately after she is born." Newborns have very acute hearing immediately after birth. Pacifiers should be offered to breastfed infants only after breastfeeding is well established or during prolonged times away from the mother, or when stressful or painful procedures are required. The newborn is nearsighted and has best vision at a distance of 8 to 15 inches. For bottle-fed infants, there is no reason to discourage nonnutritive sucking with a pacifier.

1. New discoveries in molecular genetics will have the greatest effect on nursing practice in the area of: a. collection and use of health histories. b. counseling clients. c. identification of gene mutations. d. use of new therapies.

ANS: A The profession of nursing will be impacted by new discoveries in molecular genetics in the areas of education, practice, and public health debates. The practice arena impacts are collection and use of health histories, learning and applying innovative biotechnologies, prevention and health education roles, and administration of new therapies.

What would be a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge? A. Apical heart rate of 90 beats/min, slightly irregular, when awake and active B. Acrocyanosis C. Harlequin color sign D. Weight loss representing 5% of the newborn's birth weight

A. Apical heart rate of 90 beats/min, slightly irregular, when awake and active The heart rate of a newborn should range from 120 to 140 beats/min, especially when active. The rate should be regular with sharp, strong sounds. Acrocyanosis is a normal finding in a newborn at 24 hours of age. A harlequin sign is a normal finding related to the immature neurologic system of a newborn. A 5% weight loss is acceptable in the newborn.

The newborn at 24 hours of age has a red blood cell count of 5.4 million per ml. Which of the following entries would the nurse expect to find in the newborn's chart? A. Cord clamping delayed until pulsation ceased B. CBC drawn from the anterior surface of the left hand C. Placental abruption noted to be 80% at time of delivery D. Infant is breastfed 15-20 minutes every three hours

A. Cord clamping delayed until pulsation ceased Delayed cord clamping can cause an increase of RBC up to 61%, resulting in a slightly higher-than-average red blood cell count. Venous blood has lower red cell counts than do capillary blood samples. Maternal or fetal blood loss cause hypovolemia and low red blood cell counts (less than 5.2 million per ml). Breastfeeding does not impact red cell counts in the first day of life.

A nurse is counseling a client who is considering having genetic testing completed to determine whether she is a carrier of the gene linked to Huntingtons disease. What is the first step the nurse would take when assessing this client? a. Assess vital signs. b. Assess family history of this disorder. c. Assess clients past medical history. d. Assess current medications.

ANS: B Taking a family history is a useful place to begin when considering a genetic connection and prior to the onset of testing.

When reviewing laboratory results for a 1-day-old infant, the nurse notes that the infant's IgM antibodies are elevated. Which is the least likely cause of the infant's IgM antibody level elevation? A. Maternal-fetal transfer of IgM while in utero B. Placental leakage C. Intrauterine exposure to syphilis D. Intrauterine exposure to TORCH syndrome

A. Maternal-fetal transfer of IgM while in utero Because IgM does not normally cross the placenta, most or all of it is produced by the fetus beginning at 10 to 15 weeks' gestation. Elevated levels of IgM at birth may indicate placental leaks or, more commonly, antigenic stimulation in utero. Elevated levels of IgM at birth may indicate placental leaks. Elevations in IgM may be due to newborn exposure to an intrauterine infection such as syphilis. Elevations in IgM at birth may be due to newborn exposure to an intrauterine infection such as syphilis or TORCH syndrome (toxoplasmosis, rubella, cytomegalovirus, herpesvirus hominis type 2 infection).

A nurse is working as part of a genetic counseling team. Which of the following tasks would the nurse most likely perform? a) Complete a physical examination. b) Identify the client's support systems. c) Prepare a written summary for the client. d) Discuss the specific test findings.

Identify the client's support systems

A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is: A. Vision. B. Hearing. C. Smell. D. Taste.

A. Vision. The visual system continues to develop for the first 6 months. As soon as the amniotic fluid drains from the ear (minutes), the infant's hearing is similar to that of an adult. Newborns have a highly developed sense of smell. The newborn can distinguish and react to various tastes.

A nurse applies genetic and genomic knowledge when completing a client assessment by: a. Constructing a pedigree from a collected family history b. Identifying a client who may benefit from genetic counseling c. Referring a client to specialized genetic services d. Incorporating knowledge of genomic risk factors

ANS: A Constructing a pedigree from a collected family history demonstrates assessment in the nursing process. Identification is demonstrated by identifying a client who may benefit from genetic counseling. Referral is demonstrated by referring a client to specialized genetic services. Provision of education, care, and support is demonstrated by incorporating knowledge of genomic risk factors.

The Genetic Information Nondiscrimination Act (GINA): a. Protects individuals from discrimination based on their genetic information b. Allows health insurance companies to deny coverage for pre-existing conditions c. States employers may collect genetic information from employees as needed d. Requires employees to report genetic disorders to their employer

ANS: A GINA was designed to prohibit the improper use of genetic information in health insurance and employment. It protects individuals from discrimination based on their genetic information, prevents denial of coverage based solely on genetic predisposition to disease, and limits disclosure of genetic information.

The increasing knowledge about genetics and genomics will influence nursing practice by changing how: a. Nurses collect and use health histories b. Nursing students complete clinical experiences c. Referrals to other disciplines are made d. Ethical dilemmas are solved

ANS: A Genetics and genomics will change future practice in several areas including: how students are educated, how nurses collect and use health histories, how nurses learn and apply innovative biotechnology, how prevention and health education is provided, administration of new therapies, and public health debates.

A nurse working in the 1970s would have applied genetic concepts by: a. Providing genetic counseling to those with genetic disorders b. Educating clients about using genetic testing for risk identification c. Explaining the purposes of the Human Genome Project to clients d. Facilitating referrals for specialized genetic services for clients

ANS: A In the 1970s, nurses working in genetics provided genetic counseling to persons with genetic diseases or risk factors for such disorders. The other activities performed by the nurse did not occur until the 1990s.

A nurse uses the Codes of Ethics developed by the International Council of Nurses and the American Nurses Association when: a. Providing confidential genetic testing for a client b. Advocating for the inclusion of genetic content in a nursing curriculum c. Considering the pros and cons of an ethical dilemma d. Becoming competent in genomics

ANS: A The Codes of Ethics include in this mandate the right that people have to seek and receive genomic heath care that is nondiscriminatory, confidential, private, and that enables those served to make informed decisions.

The blueprint or code that is used to construct other components of cells is called the: a. DNA b. Gene c. Chromosome d. Base

ANS: A The DNA is the chemical inside the nucleus of the cell that has the genetic instructions for making living organisms. This can be compared to a blueprint or code that is used to construct other components of cells.

When a nurse understands the significant impact that genetic testing can have on an individual and family, the nurse is meeting a competency identified by the: a. National Coalition of Health Professional Education in Genetics (NCHPEG) b. Centers for Disease Control and Prevention c. American Nurses Association d. International Council of Nurses

ANS: A The NCHPEG identifies one competency of health care professionals as being able to understand that health-related genetic information can have social and psychological implications for individuals and families.

According to the CDCs Genomic competencies for the public health workforce, all public health workers should be able to (select all that apply): a. Demonstrate basic knowledge of the role that genomics play in disorders. b. Make appropriate referrals to those with more genomic experience. c. Counsel individuals about their genetic susceptibility for particular disorders. d. Recommend appropriate genetic screening tests for clients.

ANS: A, B The CDCs Genomic competencies for the public health workforce apply to all public health professionals. All public health workers should demonstrate basic knowledge and be able to make appropriate referrals. The other statements would not be true of competencies of all public health workers.

When delivering safe and effective nursing care, the nurse must consider the significance of which factor(s) in the development of disease? Select all that apply. a. Genetics b. Lifestyle c. Environment d. Technology

ANS: A, B, C The knowledge of human genetics can improve the safety, quality, and effectiveness of care for clients. It is important for nurses to understand the predisposition to disease as well as the impact of behavior and social conditions on overall community health and well-being. Many genetic disorders have an environmental link.

1. Genes that carry genetic instructions for making living organisms are subject to alterations in: (Select all that apply.) a. changes in chromosomal structure. b. changes in deoxyribonucleic acid. c. changes in ribonucleic acid. d. sequences of bases.

ANS: A, B, C, D Alterations in the usual sequence of bases [adenine (A), guanine (G), cytosine (C), and thymine (T)] that form a gene, changes in DNA or chromosomal structures are called mutations. A large number of agents are known to cause mutations. Despite three billion DNA base pairs that must be replicated in each cell division and the large number of mutagens we are exposed to, DNA replication is quite accurate because of the mechanism known as DNA repair that corrects 99.9% of initial errors.

A public health nurse is demonstrating one of the minimum competencies set forth by the National Coalition of Health Professional Education in Genetics (NCHPEG) when: a. Organizing a meeting to discuss the care of cystic fibrosis clients b. Making a referral to a genetics specialist c. Advocating for legislation to support stem cell research d. Educating a client about the results of genetic testing

ANS: B The minimum competencies for health care professionals set forth by NCHPEG are: be able to examine competence of practice, understand the social and psychological implications of health-related genetic information, and know how and when to make referrals to a genetics professional. Making a referral is the only example that is described in these competencies.

The aim of genomic medicine is a) improving predictions about individuals' susceptibility to diseases. b) cure of disease. c) cloning. d) reproduction.

Improving predictions about individuals' susceptibility to diseases

2. The National Coalition of Health Professional Education in Genetics (NCHPEG) created a red-flag tool for determining risk in closely related individuals for the most common diseases that includes: (Select all that apply.) a. close biologic relationship between parents. b. condition occurs in the gender that is least expected. c. ethnic predisposition to certain genetic disorders. d. multiple affected family members. e. onset at an earlier or later than expected age

ANS: A, B, C, D The genetic red flags developed by the NCHPEG provide an excellent tool to determine if an individual or family might be at risk. The primary red flag for the most common diseases is a large number of affected relatives who are closely related. Some of the red flags are family history of multiple affected family members with the same or related disorders, which may or may not follow an identifiable pattern in the family; onset at an early age; condition occurs in the gender that is least expected to have it; disease occurs in the absence of known risk factors; ethnic predisposition to certain genetic disorders; and a close biological relationship between parents.

A nurse is counseling a client who has just learned that she is a carrier of the BRCA-2 gene. What are potential reactions by this client? (Select all that apply) a. Feelings of guilt b. Fear of loss of insurance coverage c. Feelings of anxiety d. Fear for children

ANS: A, C, D Feelings of guilt, anxiety, and fear for future susceptibility for children are all potential reactions this client may have. The Genetic Information Nondiscrimination Act (GINA) protects clients from losing insurance benefits based upon genetic information.

4. A young female client is concerned about her risk for developing ovarian cancer and needs information that might affect her health decisions. She requests that her elderly grandmother be tested for genetic mutations. One significant challenge faced by a family member in responding to such a request is: a. anxiety about the future. b. carrier guilt. c. decreased quality of life. d. fear of blood draws.

ANS: B Genomics has influenced the availability of genetic tests which has implications for families. Individuals, families, and communities need to understand the purpose, limitations, and potential benefits and risks of a test before submitting samples for analysis. Genetic testing is now used to predict the development of genetic disorders, screening populations, confirming diagnoses, prenatal testing, and DNA testing to develop and apply individualized medical treatment.

6. A middle-aged woman, with a history of breast and ovarian cancer in her family, is concerned that a positive finding for BRACA2 gene may result in loss of her insurance coverage. The nurse should discuss protections under: a. the Affordable Care Act. b. the Genetic Information Nondiscrimination Act (GINA). c. Healthy People 2020. d. the Human Genome Project.

ANS: B The GINA of 2009 protects the public from genetic discrimination by employers or insurers. The act prevents group health plans and health insurers from denying coverage to a healthy individual or charging higher premiums based solely on genetic predisposition to disease. The legislation also prohibits employers from using an individual's genetic information when hiring, firing, or making job placement or promotion decisions.

3. The overarching themes conceptualized in the vision for the Human Genome Project embrace the relationship of genomes to: a. biology, chemistry, and medicine. b. biology, health, and society. c. ethics, medicine, and heredity. d. medicine, technology, and ethics.

ANS: B The stated goals of the Human Genome Project were determining the sequence of the three billion chemical pairs that make up human DNA; storing this information in databases; improving tools for data analysis; transferring related technologies to the private sector; and addressing the ethical, legal, and social issues (ELSI) that may arise from the genome mapping project completed in 2003 that identified 25,000 genes in human DNA.

2. In the late 1950s, Down syndrome was discovered to be caused by an extra copy of chromosome 21. This early breakthrough best describes: a. double-helix structure. b. genetics. c. genomics. d. mutation carrier.

ANS: B The term genetics is used to mean the study of the function and effect of single genes that are inherited by children from their parents—in other words, the cause of certain diseases, the genetic link.

When a nurse learns more about the Human Genome Project to better counsel families about the process of genetic testing, the nurse is learning about: a. Genetics b. Genomics c. Genes d. Genetic susceptibility

ANS: B Genomics refers to the study of individual genes to understand the structure of the genome, including the mapping of genes and sequencing the DNA.

The father of genetics is: a. Charles Darwin b. Gregor Mendel c. James Watson d. Francis Galton

ANS: B Gregor Mendel is considered to be the father of genetics. Charles Darwin expounded on theories of evolution. Francis Galton performed family studies using twins to understand the influence of heredity on various human characteristics. James Watson was the co-discoverer of DNA.

When a nurse considers that clients may not want to have genetic testing done because of the impact that it may have on future life decisions, the nurse is incorporating genetics/genomics into practice using: a. Assessment b. Identification c. Referral d. Provision of education, care, and support

ANS: B One of the ways that a nurse uses identification is by identifying ethical, cultural, and societal issues related to genetic and genomic information and technologies. Assessment is not being performed here because the nurse is not assessing a particular clients needs or history. Referral is not taking place, nor is education, care, or support of a patient.

A nurse is counseling a client whose genetic test results show a genetic susceptibility for breast cancer. The most appropriate statement by the nurse would be: a. You should discuss hormone replacement therapy with your physician. b. You are at an increased risk to develop breast cancer. c. You should have a bilateral mastectomy as soon as possible. d. You should tell all of your siblings and children to get tested.

ANS: B Persons with a genetic susceptibility are at increased risk for developing the disease. Although the client may choose to have a bilateral mastectomy and recommend genetic testing to other family members, the most important thing to relay to the client is that having a genetic susceptibility does not mean that one will automatically have the disease.

Which type of body tissue have the highest risk for cancer development

Any tissue that retains the ability to divide

What are the scores for an Apgar score?

Appearance 0=blue 1=pink with blue extremities 2=completely pink Pulse 0=none 1= <100 BPM 2= >100 BPM Grimace 0=none 1=grimacing 2=vigorous cry Activity 0=flaccid 1=some flexion 2=well flexed Respiratory 0=Absent 1=Slow 2=Crying with normal RR

The best response from a nurse when counseling a client who is considering purchasing a genetic testing kit from a vendor advertised on the Internet would be: a. It is illegal to purchase genetic testing kits from Internet vendors. b. It will be important to follow up with a health care provider after receiving your results. c. Many times online vendors experience inaccuracies with their results. d. Internet vendors use the latest technology to perform these tests.

ANS: B The most important aspect of genetic testing is the counseling that occurs with the testing. Purchasing genetic testing kits on the Internet makes it easy for the public to access, but leaves a health care professional out of the testing process. Meeting with a health care professional is important to counsel a client about the implications and indications for such testing.

3. A client's concern about hereditary cancer syndrome can be influenced by the limitations of current testing methods and factors related to: (Select all that apply.) a. absolute risk. b. adoption. c. family size. d. family interest. e. GINA.

ANS: B, C Current methods of testing do not detect all of the mutations that can occur in some diseases including hereditary cancer syndrome-related genes. If a mutation is detected, it does not confirm an absolute risk of cancer but a need for high-risk management. Additionally, an inherited syndrome may not be evident for someone from a small family; someone who is adopted; or someone who is not informed about their family's history of disease or cause of death. Most hereditary cancer syndromes are inherited in an autosomal dominant pattern with variable expression and incomplete penetrance (mutation in one member of the gene pair). Both men and women carry, pass on to children, and inherit these mutations. For mutation carriers, the hereditary cancer syndrome can be mild or more severe. Whether cancer ever develops, the site at which it develops, or the seriousness of the cancer can vary among different people with the same mutation, even within the same family.

7. A nurse in a community health clinic reviews a client's health history and includes a family health history across three generations, noting any diseases with a genetic basis. The nurse is detecting or defining risk in low-risk groups for potential referral for diagnostic testing. This is an example of: a. genetic testing. b. primary prevention. c. secondary prevention. d. tertiary prevention

ANS: C When a nurse reviews the health history, the nurse observes for any disease that may have a genetic basis and if found, immediately refers the person or family to the appropriate health care provider. The goal of screening is to detect or define risk in low-risk groups and identify those people who should have diagnostic testing.

Which question would be the most appropriate for the nurse to ask when eliciting information about a clients genetic history? a. Have any of your family members ever completed genetic testing? b. Do any of your family members have a genetic disorder? c. What medical problems have your parents and grandparents experienced? d. What environmental exposures have you had?

ANS: C A clients family medical history is important to obtain in order to consider the clients potential risk for genetic diseases and disorders. The best way to obtain this information is to ask an open-ended question about past medical history of parents and grandparents.

. Which statement regarding mutations is true? a. Mutations in the DNA sequence occur on a regular basis. b. Mutagens are a result of a mutation. c. Environmental factors can be linked to many mutations. d. Spontaneous mutations occur because of environmental exposure.

ANS: C A large number of agents are known to cause mutations. These mutations are attributed to known environmental causes. DNA replication is very accurate, thus, mutations do not occur on a regular basis. Mutagens are the factors that cause mutations. Spontaneous mutations occur naturally during DNA replication.

Which role of the nurse will be most important in the future practice of providing genomic nursing care? a. Direct caregiver b. Educator c. Advocate d. Referral agent

ANS: C Although the nurse will use all of these roles when providing genomic nursing care, the most important role will be that of advocate. Nurses will increasingly provide guidance on policy discussions and ethical issues that relate to confidentiality, privacy, and commercialization. This is the nursing role of advocate.

One of the main goals of the Human Genome Project was: a. Providing physicians with a national database for information related to genetic disorders b. Developing new medications that can be used in genetics research c. Addressing ethical, legal, and social issues related to this research d. Improving the ability to accurately test for genetic disorders

ANS: C The goals of the Human Genome Project were to determine the sequences of the base pairs in human DNA; improve tools for data analysis; transfer related technologies to the private sector; and address the ethical, legal, and social issues that may arise.

5. Cleft lip and/or palate, a common congenital malformation, is often inherited and influenced by environmental factors, therefore it is referred to as a(n): a. extra chromosome expression. b. gene mutation. c. lifetime exposure phenomenon. d. multifactorial disease.

ANS: D Multifactorial diseases or those caused by gene and environment interaction influence disease risk, health conditions, and the therapies used to treat disease. Multifactorial disorders tend to occur in families and include such common inherited congenital malformations as cleft lip and palate, neural tube defects, and congenital heart disease.

Which statement would be most appropriate for the nurse to make when assisting a family in compiling a family health history? a. When you have completed this history, it will not need to be updated. b. Looking back at two generations of biological relatives will be sufficient. c. The purpose of completing a family history is to decrease genetic susceptibility. d. A family history is a useful tool when considering your future health risks.

ANS: D A family history is a useful tool to help families know about their health risks and prevent disease in themselves and their close relatives. It is recommended that families develop a three generation history and update it on a regular basis. Completion of a family history will not decrease genetic susceptibility; rather it will make families more aware of what that susceptibility may be.

What should an infants mean arterial pressure be?

Approximately equal to the age in gestational weeks

Julia age 32 is BRCA1 +, which is known to greatly increase the risk for breast and ovarian CA. She was tested because her mom who had ovarian CA was BRCA1 + . Julia has decided to have both her ovaries removed because she believes that in her family, being BRCA1+ increases the risk for ovarian CA only. How should a genetic counselor respond

Clarify that a BRCA1 mutation does not preferentially express ovarian CA over breast CAin any given family

While collecting a medical history, a client reports having a family history positive for Huntingtons disease. However, the client states he does not want to have genetic testing performed. The nurse recognizes that one reason a client may refuse genetic testing is because of the: a. Impact it may have on obtaining health insurance in the future b. Legal consequences that may result c. Inaccuracy of the results that are obtained d. Decreased quality of life that may occur if the results are positive

ANS: D Barriers to genetic testing are: some individuals do not have an insurance carrier that reimburses for genetic testing, a high-deductible insurance policy, and feelings that testing may decrease the quality of life and increase anxiety for the future if the results were positive. Others may also feel guilty about passing along a disease to children and grandchildren.

An example of a multifactorial disorder is: a. Measles b. Hepatitis B c. Eczema d. Type I diabetes

ANS: D Disorders that are influenced by multiple factors including genetics/genomics, environment, lifestyle, and other factors are considered to be multifactorial.

A nurse implements the principles of the Personalized Health Care Initiative in practice by: a. Educating clients that multiple factors influence the development of disease b. Counseling clients about the results of genetic testing c. Lobbying for legislation to support genetic research d. Protecting clients from discrimination based on the results of genetic testing

ANS: D The goals of the Personal Health Care Initiative are to link clinical and genomic information to support personalized health care, protect individuals from discrimination-based or unauthorized use of genetic information, ensure the accuracy and clinical validity of genetic tests performed for medical application purposes, and develop common policies for access to genomic databases for federally-sponsored programs.

Which factor would demonstrate physiologic respiratory adaptation to extrauterine life in a newborn infant? Rapid respirations following a cesarean birth to eliminate fetal fluids Abrupt temperature change upon delivery, causing a cry Increase in oxygen levels and decrease in CO2 levels, stimulating respirations Taking a breath within 3 minutes of delivery with stimulation

Abrupt temperature change upon delivery, causing a cry Respiratory adaptation following birth is seen in an infant that responds with a strong cry following thermal changes, such as those the newborn experiences going from the warm uterus to the cold outside air. The first breath should occur within the first few moments after birth, not after 3 minutes. The rapid decrease in oxygen and increase in the CO2 levels, not the reverse, serves as stimulation for respirations. Tachypnea following a cesarean birth does not demonstrate respiratory adaptation but may indicate fluid retention and complications.

Which of the following physical assessment findings indicates a need for further evaluation? Hypertonia Absence of the rooting reflex Brisk knee jerk Plantar flexion

Absence of the rooting reflex Rationale: Absence or delayed disappearance of reflexes will always be a concern and a reason to refer for developmental screening. Newborns tend to have more hypertonia than hypotonia. Hypotonia would be a definite need for a referral. Brisk knee jerk and plantar flexion should be found upon exam of the newborn. Evaluation; Physiological Integrity; Analysis

During pregnancy the fetus has protection through moms vaccinations which form antibodies. This is what type of immunity

Active acquired immunity

Activity decreases, decreases HR and RR, deep sleep 2-4 hours, difficult to arouse, no interest in feeding, likely not to void or stool, 30 minutes after delivery

Activity to sleep phase

What target cultural population is a priority for the nurse to educate about prevention of hypertension? a) African Americans b) Hispanics c) Native Americans d) Italian Americans

African Americans

The nurse encourages bonding when a baby is in which stage of the sleep-wake cycle?

Alert

A patient born at 27 weeks gestation develops grunting, nasal flaring, and decreased oxygenation. Based on the patient's gestational age, there is more than likely a deficiency in surfactant. Surfactant is critical for: Development of the bronchi or bronchioles in the lungs. Absorption and reabsorption of additional lung secretions. Preventing the exchange of oxygen and carbon dioxide. Alveolar stability.

Alveolar stability. Rationale: Surfactant prevents the alveoli from completely collapsing with each expiration, thus promoting lung expansion. Other options are important for inspiratory and expiratory cycles, but are not pertinent in the discussion of functioning alveoli of the lung. Diagnosis; Physiological Integrity; Analysis

Birth does what to systemic vascular resistance and what to pulmonary resistance?

Increases systemic vascular resistance and decreases pulmonary vascular resistance

The nurse is teaching new parents how to dress their newborn. Which statements indicate that teaching has been effective? (Select all that apply.) A. "We should make sure that we keep our home air-conditioned so the baby doesn't overheat." B. "It is important that we dry the baby off as soon as we give him a bath or shampoo his hair." C. "When we change the baby's diaper, we should change any wet clothing or blankets, too." D. "If the baby's body temperature gets too low, he will warm himself up without any shivering." E. "Our baby will have a much faster rate of breathing if he is not dressed warmly enough."

B. "It is important that we dry the baby off as soon as we give him a bath or shampoo his hair." C. "When we change the baby's diaper, we should change any wet clothing or blankets, too." D. "If the baby's body temperature gets too low, he will warm himself up without any shivering." E. "Our baby will have a much faster rate of breathing if he is not dressed warmly enough." Babies need to be kept warm. Cold ambient temperatures will increase the oxygen consumption of a newborn and can lead to respiratory distress. Drying a wet baby prevents evaporation, one mechanism of heat loss. Changing wet clothing or blankets immediately prevents evaporation, one mechanism of heat loss. Non-shivering thermogenesis is the mechanism used by newborns to warm themselves. A neonate with a low body temperature will increase oxygen consumption, which can lead to respiratory distress.

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver: A. Tells the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. B. Alerts the physician that the infant has a dislocated hip. C. Informs the parents and physician that molding has not taken place. D. Suggests that if the condition does not change, surgery to correct vision problems might be needed.

B. Alerts the physician that the infant has a dislocated hip. This is an inappropriate statement that may result in unnecessary anxiety for the new parents. The Ortolani maneuver is a technique for checking hip integrity. Unequal movement suggests that the hip is dislocated. The physician should be notified. Molding refers to movement of the cranial bones and has nothing to do with the infant's hips. The Ortolani maneuver is not a technique used to evaluate visual acuity in the newborn. This maneuver checks hip integrity.

The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern since the large amount of thick, sticky stool is very dark green, almost black in color. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by: A. Telling the mother not to worry since all breastfed babies have this type of stool. B. Explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements. C. Asking the mother what she ate at her last meal. D. Suggesting that the mother ask her pediatrician to explain newborn stool patterns to her.

B. Explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements. This type of stool is the first stool that all newborns, not just breastfed babies, have. At this early age this type of stool (meconium) is typical of both bottle-fed and breastfed newborns. The mother's nutritional intake is not responsible for the appearance of meconium stool. The nurse is fully capable of and responsible for teaching a new mother about the characteristics of her newborn, including expected stool patterns.

The nurse notes that, when placed on the scale, the newborn immediately abducts and extends the arms, and the fingers fan out with the thumb and forefinger forming a "C." This response is known as a: A. Tonic neck reflex. B. Moro reflex. C. Cremasteric reflex. D. Babinski reflex.

B. Moro reflex. Tonic neck reflex refers to the "fencing posture" a newborn assumes when supine and turns the head to the side. These actions show the Moro reflex. The cremasteric reflex refers to retraction of testes when chilled. The Babinski reflex refers to the flaring of the toes when the sole is stroked.

The newborn's nurse should alert the health care provider when which newborn reflex assessment findings are seen? (Select all that apply.) A. Newborn turns head toward stimulus when eliciting rooting reflex. B. Newborn's fingers fan out when palmar reflex checked. C. Newborn forces tongue outward when tongue touched. D. Newborn exhibits symmetric abduction and extension of arms, and fingers form "C" when Moro reflex elicited. E. Newborn's toes hyperextend with dorsiflexion of big toe when sole of foot stroked upward along lateral aspect.

B. Newborn's fingers fan out when palmar reflex checked. The baby's fingers should curl around the examiner's fingers when eliciting the palmar reflex. When eliciting rooting reflex, the characteristic response is for the baby to turn head toward stimulus and open mouth. Extrusion is elicited by touching tongue, and newborn's tongue is forced outward. The newborn should elicit symmetric abduction and extension of the arms and fingers form a "C" with the Moro reflex. The Babinski reflex is elicited by stroking upward along the lateral aspect on the sole of the feet. The expected response is hyperextension of the toes with dorsiflexion of the big toe.

A newborn male, estimated to be 39 weeks of gestation, would exhibit: A. Extended posture when at rest. B. Testes descended into scrotum. C. Abundant lanugo over his entire body. D. Ability to move his elbow past his sternum.

B. Testes descended into scrotum. The newborn's good muscle tone will result in a more flexed posture when at rest. A full-term male infant will have both testes in his scrotum and rugae on his scrotum. The newborn will exhibit only a moderate amount of lanugo, usually on his shoulders and back. The newborn would have the inability to move his elbow past midline.

Which intervention would be the best way for the nurse to prevent heat loss in a newborn while bathing? Limit the bathing time to 5 minutes. Bathe the baby in water between 90 and 93 degrees. Bathe the baby under a radiant warmer. Postpone breastfeeding until after the initial bath.

Bathe the baby under a radiant warmer. Bathing a newborn under a radiant warmer helps to prevent heat loss. To minimize the effects of cold stress during the bath, the nurse should also prewarm blankets, dry the child completely to prevent heat loss from evaporation, encourage skin-to-skin contact with the mother, promote early breastfeeding, used heated and humidified oxygen, and defer bathing until the newborn is medically stable. Limiting the length of time spent bathing the baby is secondary to maintaining the baby's body temperature. Having warm water is also important but is irrelevant if the baby is not kept warm under a warmer.

A nurse working as part of a genetics counseling team is preparing a presentation for a career day discussion at a local college of nursing. When describing the genomic framework for nursing, which of the following would the nurse include as being most important? a) Experiencing first-hand providing care for a wide range of genetic conditions b) Having a thorough understanding of the various technologies available c) Being keenly aware of one's own attitudes and assumptions about genetics and genomics d) Obtaining in-depth knowledge about the variety of cultural beliefs related to the causes of illness

Being keenly aware of one's own attitudes and assumptions about genetics and genomics

How are malignant rumors different from benign tumors

Benign tumors have totally normal features, and malignant tumors have totally abnormal features

What are mongolian spots?

Bluish discoloration over buttocks and base of spine. Benign and will usually fade in 1-2 years. Document this to avoid later confusion with bruises.

The nurse needs to draw blood via heel stick for a newborn screening examination. How can the nurse use understanding of the newborn's heat production physiology to promote blood collection?

By applying a warm pack to the heel before attempting to draw blood

The nurse manager of the neonatal intensive care unit is preparing a handout for parents of ill newborns. Which statement should the nurse include? A. Newborns can eliminate excess fluid as quickly as an adult. B. The kidneys are fully functional by 30 weeks' gestation. C. Neonates have a tendency to become dehydrated. D. Sugar is rarely present in the urine of a newborn.

C. Neonates have a tendency to become dehydrated. Neonates cannot concentrate their urine or pull water back into the vascular volume, and thus can become dehydrated easily. Newborns have difficulty eliminating excess fluid because of their relatively low glomerular filtration rate. Full nephron function doesn't develop until 34-36 weeks. Tubular reabsorption of glucose, sodium, amino acids, and bicarbonate is limited in newborns. Glucosuria therefore develops.

A new grandfather is marveling over his 12-hour-old newborn grandson. Which statement indicates that the grandfather needs additional education? A. "I can't believe he can already digest fats, carbohydrates, and proteins." B. "It is amazing that his whole digestive tract moves things along at birth." C. "Incredibly, his stomach capacity is already a cupful when he was born." D. "He will lose some weight but then miraculously regain it by about 10 days."

C. "Incredibly, his stomach capacity is already a cupful when he was born." A newborn's stomach capacity is only 20-40 ml; overfeeding of bottle-fed infants tends to cause regurgitation and abdominal discomfort, exhibited by crying. At birth, neonates can digest fats, simple carbohydrates, and proteins. Gastric emptying and intestinal peristalsis occur during in utero life; the first bowel movement usually occurs in the first day of life. Neonates lose 5-10 % of their birth weight in the first days after life, especially if they are breastfed. They should have regained the lost weight and should be back to their birth weight by 10 days of age.

The new father asks the nurse to describe what his baby will experience while sleeping and awake. The best response is: A. "Babies have several sleep and alert states. Keep watching and you'll notice them." B. "You may have noticed that your child was in an alert awake state for an hour after his birth." C. "Newborns have two stages of sleep: deep or quiet sleep and rapid eye movement sleep." D. "Birth is hard work for babies; it takes them a week or two to recover and become more awake."

C. "Newborns have two stages of sleep: deep or quiet sleep and rapid eye movement sleep." This statement is true. Teaching the parents how to detect the two sleep stages helps them tune in to their infant's behavioral states. Although it is true that babies have several sleep and alert states, the wording of this response is condescending and not therapeutic. This is not the best response. Although this statement is true, it does not respond to the father's question about sleeping now. Recovery from the birth process only takes a day or two. During that time, feedings should take place when the baby is in an alert state.

A telephone triage nurse gets a call from a postpartum patient who is concerned about jaundice. The patient's newborn is 37 hours old. What data should the nurse gather first? A. Stool characteristics B. Fluid intake C. Skin color D. Bilirubin level

C. Skin color Yellow coloration of the skin and sclera is a sign of physiologic jaundice that appears after the first 24 hours postnatally. Inspection of the skin would be the first step in assessing for jaundice. The stool characteristic of green coloration indicates excretion of bilirubin. Inadequate fluid intake can predispose an infant toward becoming jaundiced and is best determined by the number of wet diapers per day. Skin color begins to appear yellow once the serum levels of bilirubin are about 4-6 mg/dL.

The nurse is planning an educational presentation on hyperbilirubinemia for nursery nurses. Which statement is most important to include in the presentation? A. Conjugated bilirubin is eliminated in the conjugated state. B. Unconjugated bilirubin is neurotoxic and cannot cross the placenta. C. Total bilirubin is the sum of the direct and indirect levels. D. Antibiotics decrease the incidence of hyperbilirubinemia.

C. Total bilirubin is the sum of the direct and indirect levels. This is true. Conjugated bilirubin is also referred to as direct, while unconjugated bilirubin is also referred to as indirect. Conjugated bilirubin can be transformed back into unconjugated bilirubin prior to excretion by β-glucuronidase enzyme if gut bacteria have not transformed it into urobilinogen. Unconjugated bilirubin is neurotoxic but crosses the placenta during fetal life for the maternal GI system to conjugate and excrete. Because of the role of gut bacteria in converting conjugated bilirubin into urobilinogen, neonates who have been administered antibiotics have an increased incidence of hyperbilirubinemia.

Which type of genetic test would be used to detect the possibility of Down syndrome? a) DNA analysis b) Complete blood count (CBC) c) Chromosomal analysis d) Hemoglobin electrophoresis

Chromosomal analysis

The nurse is working with a mother whose unborn child was diagnosed as having Down syndrome. The nurse explains to the mother that Down syndrome occurs due to which of the following? a) Germ-line mutation b) Structural gene mutation c) Chromosome nondisjunction d) Phenotype nondisjunction

Chromosome nondisjunction

Which changes in newborn circulation does the nurse anticipate immediately after the first lusty cry, prior to clamping of the umbilical cord? (Select all that apply.)

Closure of the ductus arteriosus Closure of the foramen ovale Increased blood flow to the lungs

A pt with fox elbow in ER states that he named MS for pain rather than codiene because the last time he had a painful injury codeine was not effective in managing he's pain. What is the nurse's best response

Communicate this information to the admitting physician

Fact about schizophrenia

Copy number variants appear to play the most important role in genetic risk for schizophrenia

What is the CRIES scale for pain?

Crying: 0=No 1=high pitched 2=Inconsolable Requiring O2 to maintain 95%: 0=No 1=<30% 2=>30% Increase in vitals: 0=normal 1=<20% of normal 2=>20% of normal Expression: 0=none 1=grimace 2=grimace and grunt Sleeplessness: 0=none 1=frequent awakening 2=constantly awake

A patient has an autosomal recessive inherited condition. For what type of disorder does the nurse anticipate the patient will be treated? a) Huntington disease b) Familial hypercholesterolemia c) Hereditary breast cancer d) Cystic fibrosis

Cystic fibrosis

The nurse is working with a 40-year-old pregnant woman about to undergo amniocentesis. The nurse provides appropriate education by stating that amniocentesis is performed for a prenatal diagnosis of which of the following? a) Thalassemia b) Cystic fibrosis c) Diabetes d) Cleft palate

Cystic fibrosis

Which assessment findings indicate the newborn is cold stressed and burning brown fat to produce heat? (Select all that apply.)

Hypoglycemia Metabolic acidosis Respiratory distress

During a post conference, nursing students are simulating physical assessment of the newborn using a model. Throughout the simulated assessment, students describe each of their actions. Which nursing student's statement indicates the need for further teaching? A. "I measured the newborn's blood pressure using the Doppler technique." B. "I auscultated the infant's heart tones for one minute." C. "I palpated peripheral pulses in all the newborn's extremities." D. "I obtained the infant's heart rate by observing the cardiac monitor."

D. "I obtained the infant's heart rate by observing the cardiac monitor." Physical assessment of the newborn's heart rate requires auscultation of the apical pulse for a full minute. The measurement of blood pressure is best accomplished by using the Doppler technique with a size- and weight-appropriate cuff over the brachial artery. Apical pulse rates should be obtained by auscultation for a full minute, preferably when the newborn is asleep. Peripheral pulses of all extremities should also be evaluated to detect any inequalities or unusual characteristics.

A postpartum patient calls the nursery to report that her 3-day-old newborn has passed a bright green stool. The nurse's best response is: A. "Take your newborn to the pediatrician." B. "There may be a possible food allergy." C. "Your newborn has diarrhea." D. "This is a normal occurrence."

D. "This is a normal occurrence." By the third day of life, the newborn's stools appear brown to green in color. It is not necessary for the patient to take her newborn to the pediatrician. The green color of stool is not due to food allergies. The green color of stool is not characterized as diarrhea, but is a transitional stool that consists of part meconium and part fecal material.

The nurse is reviewing charts of newborns. Which infant requires immediate intervention? A. 24-hour-old term male with total bilirubin level of 2.0 B. 3-day-old term bottle-fed female with bilirubin of 11.0 C. 2-week-old post-term breastfed male with bilirubin of 10.0 D. 12-hour-old preterm female exhibiting icterus and lethargy

D. 12-hour-old preterm female exhibiting icterus and lethargy Jaundice is an indication of hyperbilirubinemia and is not an expected finding in the first day of life. Lethargy can be a sign of kernicterus developing. Preterm infants are more likely to develop jaundice. Total bilirubin levels under 3.0 are expected in the first 24 hours of life. Physiologic jaundice peaks between days 3 and 5; a total bilirubin level of 11.0 is not treated with phototherapy, regardless of feeding method. Breast milk jaundice peaks at 2-3 weeks of age and commonly presents with a total bilirubin level of 5.0-10.0.

The nurse is assessing a newborn at 1 hour of age. Which finding requires an immediate intervention? A. Respiratory rate 60, crackles present bilaterally B. Pulse rate 145, systolic murmur heard C. Mean blood pressure 55 mm Hg D. Pauses in respiration lasting 30 seconds

D. Pauses in respiration lasting 30 seconds Pauses in respirations greater than 20 seconds are considered episodes of apnea and require further intervention. Respiratory rate is normal; crackles are commonly heard in the first few hours after birth as the infant reabsorbs the fluid in the lungs present at birth. This pulse rate is normal. Systolic murmurs are very unlikely to indicate serious pathology and are usually caused by incomplete closure of the ductus arteriosus or foramen ovale. This is a normal blood pressure finding in an infant at 1 hour of life.

When weighing a newborn, the nurse should: A. Leave its diaper on for comfort. B. Place a sterile scale paper on the scale for infection control. C. Keep hand on the newborn's abdomen for safety. D. Weigh the newborn at the same time each day for accuracy.

D. Weigh the newborn at the same time each day for accuracy. The baby should be weighed without a diaper or clothes. Clean scale paper is acceptable; it does not need to be sterile. The nurse's hand should be above, not on, the abdomen for safety. Weighing a newborn at the same time each day allows for accurate weights.

Treat hypoglycemia in an infant with

D10W bolus 2-3 mL/kg IVP

When does meconium start to transition?

Day 5

Pink or dry spots not resolved by the 3rd-4th day of life may indicate

Dehydration

A routine hematocrit level is drawn on a newborn immediately after delivery and is found to be 68%. What may have contributed to this abnormally high hematocrit level? Delayed cord clamping Leukocytosis Hypovolemia Congenital heart defect

Delayed cord clamping Correct answer: Blood volume increases by approximately 50% with delayed cord clamping; this increase is reflected by a rise in hematocrit level to about 65%. Congenital heart defects, leukocytosis, and hypovolemia are not related at all to high hematocrit levels. Diagnosis; Physiological Integrity; Analysis

The nurse is caring for an 18-hour-old newborn who has not voided for the first time yet. Which is the nurse's priority action?

Documenting and continuing monitoring

Nondisjunction of a chromosome results in which of the following diagnoses? a) Duchenne muscular dystrophy b) Marfan syndrome c) Huntington disease d) Down syndrome

Down syndrome

The nurse observes a mother bottle feeding her newborn and recognizes further teaching is needed when the mother does what?

Holds the baby flat in her arms after the feeding

Which action does the nurse take to reduce the newborn's evaporative heat loss?

Drying the infant thoroughly after birth

The nurse accepts a newborn from the provider after delivery. Which is the priority intervention?

Drying the newborn

Immediately after the umbilical cord is cut, the newborn has a weak, shallow cry. Which is the nurse's priority action to promote breathing?

Drying the newborn vigorously

When do the vast majority of trisomies occur?

During oogenesis

How does early feeding lower the newborn's risk of developing jaundice?

Early feeding promotes peristalsis and passing of meconium. Meconium is high in unconjugated bilirubin, so the longer it is in the intestines, the more bilirubin is absorbed back into circulation

The nurse reviews the laboratory results of a 1-hour-old newborn. Which finding does the nurse need to report to the provider immediately?

Elevated bilirubin

The nurse notes a newborn's skin and sclera have taken on a yellow hue. Which finding does the nurse expect to see when reviewing the laboratory values?

Elevated unconjugated bilirubin

The infants first breath serves to (3)

Empty the airway of fluid, establish volume and function of the newborns lungs, cause the change from fetal circulation to neonatal circulation

Gene-to-gene interaction in which that action of one gene modified the expression of a different gene

Epistasis

Which of the following would be least appropriate to include when conducting the psychosocial component of the genetics health assessment? a) Family's educational level b) Family rules about information disclosure c) Informed decision making ability d) Ethnic background of all family members

Ethnic background of all family members

How often should a NB eat after the initial feed?

Every 2-4 hours

What would be the expected response to a skin injury if the involved tissue has lost the normal cell characteristic of contact inhibition

Excessive growth fof replacement tissue

A pt 34 yrs old is concerned about being HNPCC carrier, cause his dad died of colon CA at age 39, his dad sister died of colon CA at age 41, and brother age 37 now has colon cancer. the brother's testing is negative for all the known mutation associated with inherited forms of colon cancer. How should the pt be counseled another his risk of colon CA

Explain that testing for him would e of no benefits because of the current test limitation by that his family history does place him a high risk.

What can a term baby digest?

Fats, carbs, proteins

Which of the following best reflects the interpretation of the Health Insurance Portability and Accountability Act (HIPAA) and genetic information. a) Employers are not allowed to use a client's genetic information for hiring decisions. b) Group insurance plans can increase premiums for clients with a genetic condition. c) A lifetime cap on benefits cannot be instituted for a specific genetic disorder. d) Genetic information cannot be used to establish insurance eligibility.

Genetic information cannot be used to establish insurance eligibility.

A nurse is working with a client who is undergoing genetic testing. The nurse would least likely be responsible for which of the following? a) Advocating for confidentiality of the results b) Obtaining the client's family history c) Educating the client about the testing procedures d) Informing the client about the testing results

Informing the client about the testing results

When does the mucosal barrier mature in infants and what is the significance?

It is mature by 4-6 months. Before this, the barrier is very permeable and can allow bacteria and other harmful substances into systemic circulation

A nurse does an initial assessment on a newborn and notes a pulsation over the anterior fontanelle that corresponds with the newborn's heart rate. How would the nurse interpret this? This finding is normal if the pulsation can also be palpated in the posterior fontanelle. If the fontanelle feels full, then this is normal. This is an abnormal finding and needs to be reported immediately. It is normal to feel pulsations that correlate with the newborn's heart rate over the anterior fontanelle.

It is normal to feel pulsations that correlate with the newborn's heart rate over the anterior fontanelle.

What should be told to the pt who have been found to have genetic mutation that increase the risk of colon cancer and says he does not want any of his family to know about their result

It is not required that you tell anyone about this Renault, However because your sibling and children may also be at risk for common cancer, you should think about how this information might help them

The nursing instructor is teaching a class on the physiologic properities involved with the birthing process. The instructor determines the session is successful when the students correctly match surfactant with which function? It expands the lungs with breaths. It keeps alveoli from collapsing with breaths. It allows oxygen to move in the lungs. It removes fluid from the lungs.

It keeps alveoli from collapsing with breaths.

Best description of the genetic contribution to onset of autism

Known causes of autism spectrum include copy number variants and chromosomal problems

Which objective data best indicates that the ductus arteriosus of a newborn has not closed? Temperature instability ranging from 36.5°C to 38.5°C. Rapid heart rates between 180 and 220 beats per minute. Labile oxygen saturations with occasional apnea/bradycardia spells. Low blood pressure and blood pressure means.

Labile oxygen saturations with occasional apnea/bradycardia spells. Correct answer: Closing of the ductus arteriosus does not directly affect heart rate, blood pressure, or body temperature. It does affect shunting of the blood, causing unstable oxygen saturations and resulting in possible apneic and bradycardic episodes. Assessment; Physiological Integrity; Analysis

What is the result of mutation occurring in a suppressor gene

Loss of an existing function

Your pt Maggie insist that her mother have genetic testing to determine if her breast cancer is connected to a mutation in the BRCA1/2 genes. Maggie is concerned about her own risk for getting breast cancer and that of her children, but Maggie's mom does not want to be tested. What ethical principle is on of several that must be considered in evaluation this case

Maggie's mother right to pricaxy

An adult daughter whose mother gas bipolar disease because she engages in all of the following behaviors. Which behavior should be explored further as a manifestation of bipolar disease

Making frequent purchases of expensive clothing that she never wears

Which partner dictates the gender of the fetus?

Male partners because only they carry the Y gene,

After teaching nursing students about autosomal-dominant and autosomal-recessive inherited disorders, the instructor determines that the teaching was successful when the class identifies which of the following as true about autosomal-dominant inherited conditions? a) The percentage of people with a trait who manifest it is variable. b) The severity of the manifestations often varies in degrees. c) Horizontal transmission is more commonly seen in families. d) Males and females are equally affected by this pattern of inheritance.

Males and females are equally affected by this pattern of inheritance.

What is the end result of hypothermia in infants?

Metabolic acidosis

To create a neutral thermal environment for a newborn immediately after delivery, the nurse should consider: Minimal stimulation, and place under the radiant warmer bed. Place newborn with extremities extended and relaxed, and place hat over newborn's head. Deep suction every hour while under the radiant warmer bed. Place newborn with extremities extended and relaxed under the radiant warmer bed.

Minimal stimulation, and place under the radiant warmer bed. Correct answer: A newborn should never be suctioned hourly. Minimal stimulation is suggested to conserve heat and energy (perform grouped cares). The newborn should be placed in a flexed position to decrease exposed surface tension, decreasing amount of heat lost. Implementation; Health Promotion and Maintenance; Application

The nurse is assisting with the admission of a newborn boy to the nursery. The nurse notes what appears to be bruising on the left upper outer thigh of htis dark-skinned infant. Which documentation should the nurse provide? Mongolian spot noted on left upper outer thigh Harlequin sign noted on left upper outer thigh Birth trauma noted on left upper outer thigh Mottling noted on left upper outer thigh

Mongolian spot noted on left upper outer thigh A mongolian spot is bluish-black areas of discoloration on the back and buttocks or extremities of dark-skinned newborns. The Harlequin sign refers to the dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit. Mottling occurs when the lips, hands, and feet appear blue from immature peripheral circulation. Birth trauma is a possibility, however, there would be notations of an incident and the possibly other injuries would be noted.

The nurse is conducting an assessment on a newborn and witnesses a startled response with the extension of the arms and legs. The nurse should document this as which response? Tonic neck Fencing Moro Rooting

Moro The Moro reflex is also known as the startle reflex. When the infant is startled, they extend their arms and legs away from the body. The fencing reflex is also called the tonic neck reflex and is a total body assessment. The rooting reflex assesses the infant's ability to "look" for food.

A nurse is preparing a presentation for a local community group about familial Alzheimer's disease. As part of the presentation, the nurse is planning to discuss the possible genetic basis for this condition. The nurse would describe the inheritance as which of the following? a) X-linked b) Autosomal dominant c) Multifactoral d) Autosomal recessive

Multifactoral

A nurse is preparing a presentation for a local community group about familial Alzheimer's disease. As part of the presentation, the nurse is planning to discuss the possible genetic basis for this condition. The nurse would describe the inheritance as which of the following? a) X-linked b) Multifactoral c) Autosomal recessive d) Autosomal dominant

Multifactoral

The nurse is reviewing the chart of a client who was diagnosed with a cleft lip and palate at birth. The nurse demonstrates understanding of this disorder, identifying it as involving which type of inheritance pattern? a) Multifactorial b) X-linked recessive c) Autosomal dominant d) Autosomal recessive

Multifactorial

What tissue is most likely to provide an adequate DNA sample for genetic testing

Nasal epithelial cells

A nursing student is preparing a class for new mothers about adaptations they can expect in their newborns. Which information about newborn vision should the student include in the presentation? Newborns cannot focus on any objects. Newborns have the ability to focus on objects in midline. Newborns have the ability to focus only on objects far away. Newborns have the ability to focus only on objects in close proximity.

Newborns have the ability to focus only on objects in close proximity.

On a newborn's initial assessment, it is noted that the newborn's head is misshapen and elongated with swelling of the soft tissue of the skull. What nursing intervention is needed? Have the mother massage the scalp twice daily to reduce the swelling. An ice pack should be placed on the edematous scalp. No interventions are needed. This will resolve on its own over the next several days. Place a snug cap on the newborn's head to compress the swelling.

No interventions are needed. This will resolve on its own over the next several days.

A certified family nurse practitioner with an MSN degree in family practice who works in a clinic serving patients who have connective tissue disorders refers to himself as a clinical geneticist. is this title appropriate

No, a clinical geneticist is a physician who have completed a fellowship in clinical genetics

What should you monitor as a sign of infection in a NB?

Not fever (temp instability) assess for hypothermia

In which body or cell area are most genes in the humans located

Nucleus

A group of students are reviewing information about genomics and how things are changing toward a genomic era of personalized medicine. The students demonstrate understanding of this information when they identify which of the following as a characteristic? a) Treatment of the symptoms of the presenting disease b) Evaluation of a single gene as responsible for a disease c) Optimization of risk reduction related to genetic predisposition d) Strategy of waiting for disease symptoms to appear

Optimization of risk reduction related to genetic predisposition

A breast-feeding patient is attempting to soothe a 2-day-old crying newborn. The patient finds a pacifier and places it in the newborn's mouth. What is the nurse's best response? Coating the pacifier with honey will make the pacifier more desirable to the infant. Pacifiers are discouraged completely because of difficulties noted weaning infants after one year of life. Discuss different styles and shapes of pacifiers with the patient to determine which pacifier works best for the infant. Pacifiers are discouraged due to a phenomenon called nipple confusion.

Pacifiers are discouraged due to a phenomenon called nipple confusion. Rationale: Pacifiers should be offered to breast-fed infants only after breast-feeding is well established. If the pacifier is offered too soon, a phenomenon called nipple confusion may occur in the breast-fed infant. Never coat the pacifier with sugary substances. Pacifiers are encouraged once breast-feeding is well established. Planning; Health Promotion and Maintenance; Application

During a class, a student asks the instructor, "I read something that said that in some conditions, the presence of a gene mutation may not actually lead the person to actually show the trait. How can this be?" The instructor interprets the student's statement as reflecting which of the following? a) Translocation b) Penetrance c) Deletion d) Variable expression

Penetrance

Generic names for vitamin k

Phytonadione/aquamephyton

Pink or dry dust spots in the first few days of life are caused by

Pink or orange iris acid crystals

A newborn has developed physiologic jaundice as verified by high bilirubin levels found in the blood. What appropriate interventions would a nurse expect to perform in this scenario? (Select all that apply.) Make newborn NPO. Increase IV fluids. Draw a blood gas to check for metabolic alkalosis. Place newborn under bili-lights, protecting eyes and genitalia.

Place newborn under bili-lights, protecting eyes and genitalia. Increase IV fluids. Rationale: The combination of increasing IV fluids and placing under bili-lights is the best intervention to perform to decrease a bilirubin level. Check for metabolic acidosis rather than alkalosis; making newborn NPO will increase bilirubin levels. Implementation; Physiological Integrity; Application

A nurse is assessing a couple of Ashkenazi Jewish descent. The nurse understands that carrier testing for which condition would be least appropriate for this couple? a) Cystic fibrosis b) Tay-Sachs disease c) Canavan disease d) Sickle-cell disease

Sickle-cell disease

A group of nursing students are reviewing information about issues associated with genetic counseling throughout the lifespan. The students demonstrate understanding of the issues when they identify which of the following as an issue related to the newborn period? a) Potential for disrupted bonding b) Potential for social stigmatization c) Possible decreased self-esteem d) Implications of reproductive choices

Potential for disrupted bonding

Parents request that a test be done to determine if the fetus has Down syndrome. What type of test does the nurse anticipate the physician will order? a) Presymptomatic testing b) Prenatal screening c) Predisposition testing d) A family pedigree

Prenatal screening

How do genetic counselors provide genetic information to pt and families in a nondirective manner

Presenting all fact as and available options in a manner that neither promotes nor excludes an legally permitted decision or action

How do genetic counselors provide emetic information to pts and families in a no directive manner

Presenting all facts and available options in a manner that neither promotes nor excludes any legally permitted decision or action

The nurse is assessing a newborn by auscultating the heart and lungs. Which natural phenomenon will the nurse explain to the parents is happening in the cardiovascular system? Fluid is removed from the alveoli and replaced with air. The oxygen in the blood decreases. Oxygen is exchanged in the lungs. Pressure changes occur and result in closure of the ductus arteriosus.

Pressure changes occur and result in closure of the ductus arteriosus.

Which of the following is an example of convection heat loss in the newborn? Removal from an incubator for procedures Giving a bath Placing cold objects, such as ice, onto the radiant warmer bed Using a cold stethoscope

Removal from an incubator for procedures Correct answer: Convection is defined as loss of heat from the warm body surface to the cooler air currents. The other options are examples of radiation, evaporation, and conduction. Planning; Health Promotion and Maintenance; Application

The nurse is conducting a prenatal class for expectant parents on conception. The nurse provides additional teaching when a parent states which of the following? a) Meiosis is the result of haploid cells. b) The result of mitosis is diploid cells. c) Meiosis involves chromosome recombination. d) Reproductive cells are formed through mitosis.

Reproductive cells are formed through mitosis

To ensure ethical nursing care when dealing with genetic and genomic information, which principle would the nurse integrate as the foundation for all nursing care? a) Justice b) Fidelity c) Veracity d) Respect for people

Respect for people

The new mother is holding her infant, speaking softly and gently stroking the baby's face. She giggles and asks the nurse why the baby turns toward her finger when she strokes the cheeks. The nurse should explain that this is which common newborn reflex? Tonic neck Sucking Moro Rooting

Rooting This is the rooting reflex and is used to encourage the infant to feed. This reflex and the sucking reflex work together to assist the infant with cues for feeding at the breast. The tonic neck (or fencing) reflex and the Moro (or startle) reflex are total body reflexes and assess neurologic function in the newborn.

A woman whose sister tested + for a specific mutation in the BRCA1 gene, which increases the risk of breath and ovarian cancer, is found not th have mutation but does have a mutation of unknown significance near the known mutation site. How should this woman be counseled?

She should be informed that she does not have the specific mutation but that because another mutation is present she should be vigilant about screening.

The nurse is assessing a child with Turner syndrome. The nurse anticipates which of the following findings? a) Short stature b) Progressive dementia c) Painful joints d) Chorealike movements

Short stature

Characteristics of NB urine

Sterile, odorless, straw colored, cloudy (mucous)

A nurse is teaching a new mother about what to expect for bowel elimination in her newborn. Because the mother is breastfeeding, what should the nurse tell her about the newborn's stools? Stools should be yellow-green and loose. Stools should be yellow-gold, loose, and stringy to pasty. Stools should be brown and loose. Stools should be greenish and formed in consistency.

Stools should be yellow-gold, loose, and stringy to pasty. The stools of a breast-fed newborn are yellow-gold, loose, and stringy to pasty in consistency. The stools of the formula-fed newborn vary depending on the type of formula ingested. They may be yellow, yellow-green, or greenish and loose, pasty, or formed in consistency, and they have an unpleasant odor.

Why is determining the genetic contribution important to assess in stroke pt

Stroke calcification and phenotype remain heterogeneous

The nurse is evaluating a patient's drug blood level for a medication. The patient is identified as a cytochrome P450 (CYP) ultrarapid metabolizer. The nurse anticipates that the patient's drug blood level will be which of the following? a) Subtherapeutic b) Therapeutic c) High d) Toxic

Subtherapeutic

Which rationale best describes the priority intervention of suctioning a baby's mouth and nares immediately after delivery? Suctioning assists with increasing the pulmonary vascular resistance in the lungs, resulting in a decrease in blood flow to the pulmonary bed. Suctioning removes 80-110 ml of fluid that remains in the respiratory passages, permitting adequate movement of air. Suctioning assists with the opening of the glottis, creating negative intrathoracic pressure. Suctioning decreases intrathoracic pressure, decreasing the respiratory rate to 30-60 breaths per minute.

Suctioning removes 80-110 ml of fluid that remains in the respiratory passages, permitting adequate movement of air. Rationale: It is stated that 80-110 ml remains in the respiratory passages that must be removed to permit adequate movement of air. Suctioning increases intrathoracic pressure, decreases pulmonary vascular resistance, and creates a positive intrathoracic pressure. Implementation; Safe, Effective Care Environment; Application

For pt who have familial hypercholestrolemia,what should be the focus of teaching for blood cholesterol reduction

Taking the lipid-lowering drug as prescribed

Which newborn is at lowest risk for elevated unconjugated bilirubin levels?

The baby born at 41 weeks' gestation

What is kernicterus?

The build-up of bilirubin in the brain causing neurological dysfunctions

What is the concern if a newborn's urine is pink tinged and tests positive for uric acid?

There is no concern in the first week of life. If it continues, it could be a sign of inadequate fluid intake

How do newborns breathe?

They are obligate nose breathers and use the abdominal muscles to draw in breath

Why should lotions and creams be avoided while using phototherapy?

They can absorb heat and cause burns

A patient has been identified as a poor metabolizer for a drug that undergoes CYP 450 metabolism. The nurse interprets this information as indicating which of the following? a) The patient will need a higher dosage of medication. b) The therapeutic response would be less. c) Drug absorption would be more rapid. d) The patient is at increased risk for toxicity.

The patient is at increased risk for toxicity

A client has an autosomal-dominant disorder. His wife is unaffected. When explaining the risk for inheritance of the disorder in their offspring, which statement by the nurse would be most appropriate? a) "The female determines whether your children will have the disorder." b) "You have a 1 in 4 chance of a child being affected by the disorder." c) "Any child you have would most likely have the disorder." d) "There is a 50% chance that each of your children will have the condition."

There is a 50% chance that each of your children will have the condition

Nursing students are reviewing legislation about the use of genetic information. The students demonstrate a need for additional review when they identify which of the following as being prohibited by the Genetic Information Nondiscrimination Act (GINA)? a) Use of genetic information to establish insurance eligibility b) Employers from using genetic information to make a decision about promotions c) Health insurers from charging higher rates for people at risk for a genetic condition d) Health insurers from denying coverage to a healthy person at risk for a genetic condition

Use of genetic information to establish insurance eligibility

what is the genetic contributing to the development of the most common forms of atherosclerosis

Variation in a verity of genes each exertion a small effect

How often should a NB void/eliminate

Wet and dirty for every day of life

Under which condition would genetic testing for predisposition to an inherited disorder in a miner be considered reasonable

When the risk is high and prophylaxis to reduce disorder severity is available.

A 40 yr old man has a mom dx with breats CA at age 45, a dad dx smoking related lung CA at age 55, 33 yr old sister with breast CA and 38 yr old sister with ovarian cancer, ask if he should be concerned for his cancer risk. What is the best response

Your risk for breast CA may be increased and required nor investigation, however, your risk for lung cancer is not affected by this history

When should a NB void?

Within 24-48 hours

How soon should a NB pass meconium?

Within 24-48 hours of life

Which type of Mendelian inherited condition results in both genders being affected equally in a vertical pattern? a) X-linked inheritance b) Multifactorial genetic inheritance c) Automosomal dominant inheritance d) Automosomal recessive inheritance

X-linked inheritance

A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on "high." The nurse instructs the mother that the fan should not be directed toward the newborn and the newborn should be wrapped in a blanket. The mother asks why. The nurse's best response is: a. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." b. "Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." c. "Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." d. "Your baby will get cold stressed easily and needs to be bundled up at all times."

a. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him."

Which newborn reflex is elicited by stroking the lateral sole of the infant's foot from the heel to the ball of the foot? a. Babinski b. Tonic neck c. Stepping d. Plantar grasp

a. Babinski

Nurses can prevent evaporative heat loss in the newborn by: a. Drying the baby after birth and wrapping the baby in a dry blanket. b. Keeping the baby out of drafts and away from air conditioners. c. Placing the baby away from the outside wall and the windows. d. Warming the stethoscope and the nurse's hands before touching the baby.

a. Drying the baby after birth and wrapping the baby in a dry blanket.

A collection of blood between the skull bone and its periosteum is known as a cephalhematoma. To reassure the new parents whose infant develops such a soft bulge, it is important that the nurse be aware that this condition: a. May occur with spontaneous vaginal birth. b. Happens only as the result of a forceps or vacuum delivery. c. Is present immediately after birth. d. Will gradually absorb over the first few months of life.

a. May occur with spontaneous vaginal birth.

With regard to the respiratory development of the newborn, nurses should be aware that: a. The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth. b. Newborns must expel the fluid from the respiratory system within a few minutes of birth. c. Newborns are instinctive mouth breathers. d. Seesaw respirations are no cause for concern in the first hour after birth.

a. The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth.

Who should be offered screening for aneuploidy?

all women regardless of age or risks

signs and symptoms of hypoglycemia in the NB

lethargy, sleepiness, limp, poor feedings, apnea, irregular respirations, hypotonia, tremors, jerkiness, respiratory distress, vomiting, inadequate suck, jitteriness, cynaosis, tachy, temp instability, pallor, loss of suck/swallow coordination

The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. The nurse responds to the parents by telling them: a. "Infants can see very little until about 3 months of age." b. "Infants can track their parent's eyes and distinguish patterns; they prefer complex patterns." c. "The infant's eyes must be protected. Infants enjoy looking at brightly colored stripes." d. "It's important to shield the newborn's eyes. Overhead lights help them see better."

b. "Infants can track their parent's eyes and distinguish patterns; they prefer complex patterns."

An examiner who discovers unequal movement or uneven gluteal skin folds during the Ortolani maneuver would then: a. Tell the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. b. Alert the physician that the infant has a dislocated hip. c. Inform the parents and physician that molding has not taken place. d. Suggest that, if the condition does not change, surgery to correct vision problems may be needed.

b. Alert the physician that the infant has a dislocated hip

Plantar creases should be evaluated within a few hours of birth because: a. The newborn has to be footprinted. b. As the skin dries, the creases will become more prominent. c. Heel sticks may be required. d. Creases will be less prominent after 24 hours.

b. As the skin dries, the creases will become more prominent.

A newborn is placed under a radiant heat warmer, and the nurse evaluates the infant's body temperature every hour. Maintaining the newborn's body temperature is important for preventing: a. Respiratory depression. b. Cold stress. c. Tachycardia. d. Vasoconstriction.

b. Cold stress.

The process in which bilirubin is changed from a fat-soluble product to a water-soluble product is known as: a. Enterohepatic circuit. b. Conjugation of bilirubin. c. Unconjugation of bilirubin. d. Albumin binding.

b. Conjugation of bilirubin.

A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the: a. Transition period. b. First period of reactivity. c. Organizational stage. d. Second period of reactivity.

b. First period of reactivity.

Cardiovascular changes that cause the foramen ovale to close at birth are a direct result of: a. Increased pressure in the right atrium. b. Increased pressure in the left atrium. c. Decreased blood flow to the left ventricle. d. Changes in the hepatic blood flow.

b. Increased pressure in the left atrium.

Infants in whom cephalhematomas develop are at increased risk for: a. Infection. b. Jaundice. c. Caput succedaneum. d. Erythema toxicum.

b. Jaundice.

The transition period between intrauterine and extrauterine existence for the newborn: a. Consists of four phases, two reactive and two of decreased responses. b. Lasts from birth to day 28 of life. c. Applies to full-term births only. d. Varies by socioeconomic status and the mother's age.

b. Lasts from birth to day 28 of life.

By knowing about variations in infants' blood count, nurses can explain to their clients that: a. A somewhat lower than expected red blood cell count could be the result of delay in clamping the umbilical cord. b. The early high white blood cell (WBC) count is normal at birth and should decrease rapidly. c. Platelet counts are higher than in adults for a few months. d. Even a modest vitamin K deficiency means a problem with the ability of the blood to clot properly.

b. The early high white blood cell (WBC) count is normal at birth and should decrease rapidly.

A nurse receives the shift report on four infants. Baby A is 16 hours old, HR 117, RR 32, axillary temperature 98oF (36.6oC), BP 72/43 mm Hg, bilirubin 3.5 mg/dL rooming in with mother; baby B is 8 hours old, HR 152, RR 48, axillary temperature 97.7oF (36.5oC), BP 60/40 mm Hg, bilirubin 3 mg/dL, returning to nursery for night; baby C is 19 hours old, HR 140, RR 45, axillary temperature 98.6oF (37oC), BP 68/45 mm Hg, bilirubin 4 mg/dL, rooming in with mother; baby D is 4 hours old, HR 160, RR 60, axillary temperature 98.6oF (37oC), BP 80/45 mm Hg, bilirubin 2 mg/dL, returning to nursery for night. Which baby would the nurse assess first? baby C baby A baby B baby D

baby C Hyperbilirubinemia, high levels of unconjugated bilirubin in the bloodstream (serum levels of 4 to 6 mg/dL and greater), can lead to jaundice, a yellow staining of the skin. Only baby C has hyperbilirubinemia. All the vital signs are within normal limits: Heart rate 110 to 160 beats per minute; respiratory rate 30 to 60 breaths per minute; axillary temperature 97.7°F to 98.6°F (36.5°C to 37°C); and blood pressure 60-80/40-45 mm Hg.

A nurse is assessing a newborn during the first 24 hours after birth. Which findings would the nurse recognize as normal? positive Ortolani sign rounded, symmetrical abdomen heart rate of 90 to 100 bpm enlarged labia with pseudomenstruation body temperature of 97.9° to 99.7° F (36.5° to 37.5° C)

body temperature of 97.9° to 99.7° F (36.5° to 37.5° C)

While assessing the newborn, the nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is: a. 80 to 100 beats/min. b. 100 to 120 beats/min. c. 120 to 160 beats/min. d. 150 to 180 beats/min.

c. 120 to 160 beats/min.

While assessing the integument of a 24-hour-old newborn, the nurse notes a pink, papular rash with vesicles superimposed on the thorax, back, and abdomen. The nurse should: a. Notify the physician immediately. b. Move the newborn to an isolation nursery. c. Document the finding as erythema toxicum. d. Take the newborn's temperature and obtain a culture of one of the vesicles.

c. Document the finding as erythema toxicum.

While examining a newborn, the nurse notes uneven skin folds on the buttocks and a click when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has: a. Polydactyly. b. Clubfoot. c. Hip dysplasia. d. Webbing

c. Hip dysplasia.

In administering vitamin K to the infant shortly after birth, the nurse understands that vitamin K is: a. Important in the production of red blood cells. b. Necessary in the production of platelets. c. Not initially synthesized because of a sterile bowel at birth. d. Responsible for the breakdown of bilirubin and prevention of jaundice.

c. Not initially synthesized because of a sterile bowel at birth.

A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is: a. Seen at age 3 days. b. The residue of a milk curd. c. Passed in the first 12 hours of life. d. Lighter in color and looser in consistency.

c. Passed in the first 12 hours of life.

What marks on a baby's skin may indicate an underlying problem that requires notification of a physician? a. Mongolian spots on the back b. Telangiectatic nevi on the nose or nape of the neck c. Petechiae scattered over the infant's body d. Erythema toxicum anywhere on the body

c. Petechiae scattered over the infant's body

With regard to the gastrointestinal (GI) system of the newborn, nurses should be aware that: a. The newborn's cheeks are full because of normal fluid retention. b. The nipple of the bottle or breast must be placed well inside the baby's mouth because teeth have been developing in utero, and one or more may even be through. c. Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the baby's head. d. Bacteria are already present in the infant's GI tract at birth because they traveled through the placenta.

c. Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the baby's head.

With regard to the newborn's developing cardiovascular system, nurses should be aware that: a. The heart rate of a crying infant may rise to 120 beats/min. b. Heart murmurs heard after the first few hours are cause for concern. c. The point of maximal impulse (PMI) often is visible on the chest wall. d. Persistent bradycardia may indicate respiratory distress syndrome (RDS).

c. The point of maximal impulse (PMI) often is visible on the chest wall.

A client is at risk for breast cancer. Which of the following would reflect the client's genotype for this disorder? a) Evidence of a lump in the breast b) Family history of breast cancer c) Positive breast biopsy d) Carrier of BRCA1 mutation

carrier of BRCA1 mutation

The nurse notices that a newborn has a white discharge from his breasts. The nurse would explain to his parents that this is: a sign that he has a pituitary tumor. a suggestion he may need chromosomal studies. caused by his mother's hormones. caused by exposure to cool air.

caused by his mother's hormones.

Surfactant

chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing

Heat loss due to cold hands, cool scales, cold exam tables, cold stethoscopes

conduction

loss due to direct contact of warm body to cool object

conduction

Heat loss due to AC, unwarmed O2 and removal from the incubator

convection

heat loss from baby to cooler air currents, amount of heat transferred depends on the velocity of the moving air

convection

Which statement describing physiologic jaundice is incorrect? a. Neonatal jaundice is common, but kernicterus is rare. b. The appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process. c. Because jaundice may not appear before discharge, parents need instruction on how to assess it and when to call for medical help. d. Breastfed babies have a lower incidence of jaundice.

d. Breastfed babies have a lower incidence of jaundice.

One reason the brain is vulnerable to nutritional deficiencies and trauma in early infancy is the: a. Incompletely developed neuromuscular system. b. Primitive reflex system. c. Presence of various sleep-wake states. d. Cerebellum growth spurt.

d. Cerebellum growth spurt.

The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is: a. Closure of fetal shunts in the circulatory system. b. Full function of the immune defense system at birth. c. Maintenance of a stable temperature. d. Initiation and maintenance of respirations.

d. Initiation and maintenance of respirations.

Which statement describing the first phase of the transition period is inaccurate? a. It lasts no longer than 30 minutes. b. It is marked by spontaneous tremors, crying, and head movements. c. It includes the passage of meconium. d. It may involve the infant's suddenly sleeping briefly.

d. It may involve the infant's suddenly sleeping briefly.

An African-American woman noticed some bruises on her newborn girl's buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called: a. Lanugo. b. Vascular nevi. c. Nevus flammeus. d. Mongolian spots

d. Mongolian spots

While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, his fingers fan out and form a "C" with the thumb and forefinger, and he has a slight tremor. The nurse would document this finding as a positive: a. Tonic neck reflex. b. Glabellar (Myerson) reflex. c. Babinski reflex. d. Moro reflex.

d. Moro reflex.

During life in utero, oxygenation of the fetus occurs through transplacental gas exchange. When birth occurs, four factors combine to stimulate the respiratory center in the medulla. The initiation of respiration then follows. Which is not one of these essential factors? a. Chemical b. Mechanical c. Thermal d. Psychologic

d. Psychologic

A nursing student is helping the nursery nurses with morning vital signs. A baby born 10 hours ago by cesarean section is found to have moist lung sounds. What is the best interpretation of these data? a. The nurse should notify the pediatrician stat for this emergency situation. b. The neonate must have aspirated surfactant. c. If this baby was born vaginally, it could indicate a pneumothorax. d. The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth.

d. The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth.

What infant response to cool environmental conditions is either not effective or not available to them? a. Constriction of peripheral blood vessels b. Metabolism of brown fat c. Increased respiratory rates d. Unflexing from the normal position

d. Unflexing from the normal position

Characteristics of initial respirations in a NB

diaphragmatic, shallow and irregular in depth and rhythm, abdomen and chest movements are synchronous

Heat loss due to wet baby

evaporation

A nurse is working with a couple who will be undergoing genetic testing. Which of the following would the nurse prepare the couple for as the first genetic test? a) DNA analysis b) Chromosomal analysis c) Family history d) Carrier testing

family history

What do newborns do to respond to a cooler environment?

flexed posture reduces heat loss, brown fat stores increase temperature, activity increases temperature

A 12-hour-old infant is receiving IV fluids for polycythemia. For which complication should a nurse monitor this client? hypotension decreased level of consciousness tachycardia fluid overload

fluid overload

When does the foramen ovale normally close?

functional closure 1-2 hours

When does the ductus arteriosus close?

functional closure within 18 hours after birth

When do we worry about weight loss in a NB

greater than 10% of birth weight

Why are NB nose breathers?

high position of the epiglottis and soft palate

Blood pressure changes in the NB

highest at birth, descends to lowest level at 3 hours of age, crying can elevate BP

Why does hypoglycemia occur in NB

infant continues to produce high levels of insulin

The nurse is explaining to new parents that a potential complication of a cesarean birth is transient tachypnea. The nurse explains that this is due to which occurrence? lack of thoracic compressions during birth prolonged unsuccessful vaginal birth loss of blood volume due to hemorrhage inadequate suctioning of the mouth and nose of the newborn

lack of thoracic compressions during birth

Why do NB's have to regulate their temp differently than adults?

large body surface in relation to mass and limited subq fat

Lung expansion and compliance in the newborn is reduced for what reasons?

large heart reduces space, weak intercostal muscles, rigid rib cage, horizontal ribs, high diaphragm

The nurse is preparing a teaching plan for new parents about why newborns experience heat loss. Which information about newborns would the nurse include? expanded stores of glucose and glycogen limited voluntary muscle activity enhanced shivering ability thick skin with deep lying blood vessels

limited voluntary muscle activity Newborns have limited voluntary muscle activity or movement to produce heat. They have thin skin with blood vessels close to the surface. They cannot shiver to generate heat. They have limited stores of metabolic substances such as glucose and glycogen.

At birth glucose levels are in

low 30s (normal 40-45)

Why would blood appear in a NB's diaper

male: due to circumcision, female: pseudomenstration (maternal hormonal withdrawal) should resolve in 2 weeks

When does the ductus venosus close?

minutes of birth...3-7 days functionally

Upon assessment, the nurse determines that all four children in a family are known to carry a gene for a particular condition. Two of the children actually manifest the condition. Which of the following terms should the nurse use to document the percentage of family members that manifest the condition? a) Variable expression b) Pedigree c) Penetrance d) Genotype

penetrance

In utero, what is the organ responsible for gas exchange?

placenta

A nurse is assessing a newborn with the parents. The nurse explains that which aspect of newborn behavior is an important indication of neurologic development and function? orientation to surroundings crying response reflex voluntary movements

reflex

Interventions for cold stress

remove wet/damp clothing, place newborn in warmer, wrap in warm blanket with warm tshirt, hat hold infant, place temp probe on abdomen of infant with attachment to radiant warmer, watch for S&S of hypoglycemia, recheck axillary temp, monitor frequently

A nursing student observing newborns in the nursery is amazed that a crying infant put her fingers in her mouth, instantly stops crying, and then falls asleep. This behavior can best be explained as: social behavior. self-quieting ability. motor maturity. the sleep state.

self-quieting ability. Self-quieting ability refers to newborns' ability to quiet and comfort themselves. Assisting parents to identify consoling behaviors also helps. The sleep state is noted as an infant becoming drowsy and less attentive to the parents and his surroundings. Social behaviors are things such as cuddling and snuggling into the arms of the parents when the newborn is held. Motor maturity refers to posture, tone, coordination, and movements of the newborn.

Catecholamines (epinephrine and norepinephrine)

stimulates by sympathetic NS; increases heart rate, blood pressure, blood glucose levels and dilates lung passageways

A female client is a carrier for a gene mutation on one of her X chromosomes. Her spouse is unaffected. The nurse understands that which of the following is most likely? a) The risk of transmitting the disorder is negligible. b) Any daughters of the client would be carriers for the disorder. c) The client's sons have a 50% chance of being affected. d) The client has signs and symptoms of the condition.

the client's sons have a 0% chance of being affected

A mother points out to the nurse that following three meconium stools, her newborn has had a bright green stool. The nurse would explain to her that: her child may be developing an allergy to breast milk. this is most likely a symptom of impending diarrhea. her child will need to be isolated until the stool can be cultured. this is a normal finding.

this is a normal finding. Newborn stools typically pass through a pattern of meconium, green transitional, and then yellow.

Choice Multiple question - Select all answer choices that apply. A client has hypercholesterolemia. The nurse understands that which of the following reflects the phenotype of the disease? Select all that apply. a) Family history of heart disease b) Early onset of cardiovascular disease c) Mutations in low-density lipoprotein (LDL) receptors d) Low levels of low-density lipoproteins (LDLs) e) Skin xanthoma

• Early onset of cardiovascular disease • Skin xanthoma • Family history of heart disease

Choice Multiple question - Select all answer choices that apply. Students are reviewing information about genetic tests and associated conditions. They demonstrate understanding of this information when they identify which conditions as being identified by DNA analysis? Select all that apply. a) Fragile X syndrome b) Sickle-cell anemia c) Down syndrome d) Huntington disease e) Cystic fibrosis

• Huntington disease • Cystic fibrosis • Fragile X syndrome