PREPU- Chapter 10: Fetal Development and Genetics - ML6

A pregnant client who is planning to have genetic testing asks the nurse when she should schedule her amniocentesis. What should the nurse tell the client? A. 10 weeks B. 24 weeks C. 30 weeks D. 16 weeks

ANSWER: D. 16 weeks EXPLANATION: The nurse should tell the client that an amniocentesis is typically scheduled between 15 and 18 weeks' gestation. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 345

A woman at 15 weeks' gestation who works at a daycare center thinks she may have just been exposed to rubella at work. The client asks how this may affect her fetus. What is the best response the nurse can give? A. "By the end of the eighth week all of the organ systems and major structures are present, so exposure to any teratogen can lead to birth defects. More assessments are needed." B. "Your health care provider will let you know if there are any problems with your baby." C. "We will have to see what gestational age your baby was at exposure." D. "We will need to perform some additional tests."

ANSWER: A. "By the end of the eighth week all of the organ systems and major structures are present, so exposure to any teratogen can lead to birth defects. More assessments are needed." EXPLANATION: All organ systems are complete at 8 weeks gestation. During this time of organogenesis the growing structure is most vulnerable to invasion by teratogens. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 331

After completing an assessment, the nurse suspects a woman has confused implantation bleeding with her period. The nurse predicts the woman is at which week in her pregnancy? A. 4 weeks B. 3 weeks C. 2 weeks D. 1 week

ANSWER: A. 4 weeks EXPLANATION: It is important to ask about the date of the last normal period. If a woman confuses implantation bleeding with her period, the pregnancy is 4 weeks older than she thinks. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 326

The nurse is assessing a young female who just found out she is pregnant. She is now reporting vague abdominal discomfort. After noting the client has a history of PID, the nurse predicts the health care provider will give priority to ruling out which situation? A. Ectopic pregnancy B. Repeat PID C. UTI D. Endometriosis

ANSWER: A. Ectopic pregnancy EXPLANATION: An ectopic pregnancy or tubal pregnancy can result when there is blockage or scarring of the fallopian tubes due to infection (PID) or trauma (tubal ligation reversal). Ectopic pregnancy may present with vague signs and symptoms but is the leading cause of maternal death in the first trimester and should be given priority when determining the cause of abdominal complaints. The other choices would be ruled out after the ectopic pregnancy is ruled out. REFERENCE: (none given)

Which situation increases the risk of the fetal age being miscalculated? A. The woman noted bleeding during implantation. B. The woman took antibiotics during the week of conception. C. The woman was told there was an inadequate amount of Wharton jelly noted during an ultrasound. D. The woman was diagnosed with an excessive amount of amniotic fluid.

ANSWER: A. The woman noted bleeding during implantation. EXPLANATION: The woman may mistake the scant bleeding noted during implantation as a period and would therefore have a miscalculated fetal age. Wharton jelly is the substance around the umbilical cord that prevents compression of the cord and would not have a bearing on fetal age. Amniotic fluid serves several purposes, but the amount would not cause the fetal age to be miscalculated. Antibiotics taken during the week of conception would have no bearing on the calculated fetal age. REFERENCE: (none given)

A nurse is caring for a 37-year-old pregnant client who is expecting twin boys. The client smoked prior to conception but has stopped during the pregnancy. A relative of the client has Klinefelter syndrome, and the client wants to find out more about the disorder. Which information will the nurse provide to the client during genetic counseling? A. There is a greater risk of Klinefelter syndrome due to the client's age. B. Klinefelter syndrome occurs only in girls and not boys. C. Having twins increases the risk of Klinefelter syndrome. D. The client's previous smoking habit will increase the risk of a genetic disorder.

ANSWER: A. There is a greater risk of Klinefelter syndrome due to the client's age. EXPLANATION: The risk of trisomies such as Klinefelter syndrome increases with the age of the mother at the time of pregnancy. Klinefelter syndrome occurs only in males. Having twins does not increase the risk of Klinefelter syndrome for the babies, nor does the client's previous smoking habit have any bearing on the risk for Klinefelter syndrome. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 342

A couple desires to undergo genetic testing for Huntington disease. The nurse recognizes that this is which type of genetic disorder? A. autosomal dominant inherited disorder B. autosomal recessive inherited disorder C. X-linked inherited disorder D. X-linked dominant inherited disorder

ANSWER: A. autosomal dominant inherited disorder EXPLANATION: Autosomal dominant inherited disorders occur when a single gene in the heterozygous state is capable of producing the phenotype. Huntington's is a type of this genetic disorder. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 338

A woman is undergoing testing that provides a picture-like analysis of the number, form, and size of the woman's chromosomes. The nurse identifies this as: A. karyotyping B. genome C. genotype D. phenotype

ANSWER: A. karyotyping EXPLANATION: Karyotyping is a pictorial analysis of the number, form, and size of an individual's chromosomes. Genome is a representation of a person's genetic blueprint. Genotype refers to the specific genetic makeup or gene pairs inherited from one's parents. Phenotype refers to the observed outward characteristics of an individual. REFERENCE: (none given)

The nurse is conducting a health history for an infant with a presumed genetic disorder. On which family members will the nurse gather information? Select all that apply. A. siblings B. parents C. great-grandparents D. grandparents E. in-laws

ANSWER: A. siblings B. parents D. grandparents EXPLANATION: The nurse should obtain information for three generations of family members related to health history. This would need to include half-brothers and half-sisters as well. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 343

A pregnant client asks the nurse how the fetus breathes if it is floating in the amniotic fluid. The best explanation by the nurse is: A. the fetus receives oxygen through the umbilical vein. B. the fetus breathes by exchanging gases in the lungs. C. the fetus breathes by receiving blood from the maternal circulation. D. the fetus receives oxygen through the umbilical artery.

ANSWER: A. the fetus receives oxygen through the umbilical vein. EXPLANATION: The fetal lungs are non-functional and are an organ of oxygenation during intrauterine life. There is no gas exchange occurring in the lungs. The fetus receives oxygenated blood through the umbilical vein. The umbilical artery removes carbon dioxide from the fetus. Oxygen from the maternal system diffuses across the placenta, but the maternal circulation is not responsible for fetal breathing. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 332

Genetic testing has revealed that a couple's unborn child shows the possibility of mosaicism. When counseling this couple, the nurse explains this means that: A. the genetic abnormality occurred after fertilization and during the mitotic cell division. B. this genetic abnormality is a recessive trait that is familial. C. this genetic trait is generally passed from the mother to the child. D. this genetic trait generally occurs when both parents have the recessive trait in their DNA and pass it to their offspring.

ANSWER: A. the genetic abnormality occurred after fertilization and during the mitotic cell division. EXPLANATION: Mosaicism refers to when the chromosomal abnormalities do not show up in every cell and only some cells or tissues carry the abnormality. It occurs after fertilization and during the mitotic cell division. The symptoms are usually less severe. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 341

The placenta is the site where antibodies in the mother's blood pass into the fetal circulation. These antibodies give passive immunity to the fetus for several common childhood diseases. There are some infections for which the mother does not provide antibodies to the fetus. What infection is the fetus not protected from? A. diphtheria B. smallpox C. rubeola D. rubella

ANSWER: D. rubella EXPLANATION: The fetus does not receive immunity to rubella, cytomegalovirus (CMV), varicella, or measles. If the woman encounters these pathogens during her pregnancy, fetal infection may ensue. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 331

A 25-year-old client with a newborn male asks if the newborn is at risk for Down syndrome because the client's distant relative was diagnosed with Down syndrome. Which information will the nurse share with the client? A. Instances of Down syndrome in the family greatly increase the risk for the newborn to be diagnosed with Down syndrome. B. All newborns are at risk because Down syndrome occurs from extra genetic material created during development of the sperm or egg. C. Down syndrome occurs only in females, thus there is no risk because the newborn is male. D. The risk for your newborn to have Down syndrome is increased because of the mother's young age.

ANSWER: B. All newborns are at risk because Down syndrome occurs from extra genetic material created during development of the sperm or egg. EXPLANATION: Down syndrome occurs because of the presence of an extra chromosome in the body that is in either the sperm or the egg. Down syndrome is not genetically inherited except in incidences of translocation, which are very rare. Both male and female newborns are equally at risk for Down syndrome. The risk for a newborn to have Down syndrome increases if the mother's age is 35 years or older. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 1821

The nursing student correctly identifies what information about oogenesis? A. It begins at puberty in the male. B. It is the process by which gametes undergo two sequential cellular divisions of the nucleus. C. It begins in the ovaries before birth but is not fully complete until the childbearing years. D. It is the process by which somatic cells give birth to daughter cells.

ANSWER: C. It begins in the ovaries before birth but is not fully complete until the childbearing years. EXPLANATION: Mitosis is the process by which somatic cells give birth to daughter cells. Meiosis is the process by which gametes undergo two cellular divisions of the nucleus. Spermatogenesis begins at puberty in the male, and oogenesis begins in the ovaries before birth but is not fully complete until the childbearing years. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 324

A client is confused concerning her fertile period each month. The nurse would educate the client by providing which information? A. The female fertility period is from Day 12 to Day 21 of her menstrual cycle. B. Fertilization can occur only if intercourse occurs on the day of ovulation. C. The window of opportunity for conception is from 3 days before to 2 days following ovulation. D. Since a sperm can only live 12 to 24 hours after ejaculation, fertility is limited to 1 day before to 1 day after ovulation.

ANSWER: C. The window of opportunity for conception is from 3 days before to 2 days following ovulation. EXPLANATION: Since sperm are viable for 24 to 72 hours after ejaculation and the ovum remains fertile for a maximum of 48 hours after ovulation, the window is from 3 days before to 2 days after ovulation. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 324

A female client has the Huntington's disease gene. She and her husband want to have a child but are apprehensive about possibly transmitting the disease to their newborn child. They have strong views against abortion (elective termination of pregnancy). They would also like to have their "own" child and would consider adopting only as a last resort. Which action would be most appropriate in this situation? A. undergoing prenatal diagnosis with prenatal choice of continuing pregnancy B. using donor gametes for conception of a child C. opting for a preimplantation genetic diagnosis D. chancing the conception and birth of a child

ANSWER: C. opting for a preimplantation genetic diagnosis EXPLANATION: The most appropriate choice would be opting for a preimplantation genetic diagnosis (PGD). A PGD is a genetic evaluation of the embryo created through IVF which will reveal whether the Huntington's disease gene is present in the embryo. Undergoing prenatal diagnosis with prenatal choice of continuing pregnancy is not an option because the client and her husband are against abortion (elective termination of pregnancy). Chancing the conception and birth of a child involves the risk of passing the gene to the newborn child. Using donor gametes may reduce the risk, but it is against the client's preferences. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 345

A nurse is caring for a client who has just been told that her unborn baby carries a genetic disorder associated with significant health related issues. The client asks, "Should I kill the baby?" What is the most appropriate nursing diagnosis for this client? A. Fear related to birth of a baby B. Situational low self-esteem C. Deficient knowledge related to inheritance pattern D. Decisional conflict related to continuation of pregnancy

ANSWER: D. Decisional conflict related to continuation of pregnancy EXPLANATION: The client is unsure as to whether to continue the pregnancy or terminate it as evidenced by the question she asked the nurse. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 343

A group of nursing students are preparing a presentation depicting the fetal circulation. The instructor determines the presentation is successful when the students correctly illustrate which route for the ductus arteriosus? A. The left to right heart atria B. The aorta to the pulmonary veins C. The right ventricle to the aorta D. The pulmonary artery to the aorta

ANSWER: D. The pulmonary artery to the aorta EXPLANATION: Because the fetal lungs are not inflated, blood must be diverted past them. The ductus arteriosus helps to do this by shunting blood from the pulmonary artery to the aorta. The foramen ovale diverts blood from the right atrium to the left atrium, bypassing the lungs. The ductus venosus diverts a portion of blood from the umbilicus to the inferior vena cava instead of passing through the liver first. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 331-332

What is the best indicator that the client is experiencing an ectopic pregnancy? A. increasing hematocrit and hemoglobin levels B. amenorrhea C. nausea D. adnexal tenderness

ANSWER: D. adnexal tenderness EXPLANATION: Ectopic pregnancy occurs when the fertilized ovum is slowed or prevented passage through the fallopian tube and implants before it reaches the uterus, usually in the adnexa (ovaries/fallopian tubes). When the embryo outgrows space, the area ruptures and there is bleeding. This bleeding irritates the peritoneum causing sharp, one-sided adnexal tenderness or pain. Laboratory tests reveal decreased hematocrit and hemoglobin levels and rising leukocyte levels. Initially symptoms of pregnancy may be present, including amenorrhea, breast tenderness, and nausea. REFERENCE: (none given)

The health care provider prescribes 50 mg daily by mouth of clomiphene for a client having fertility problems. The client cannot swallow pills. Available is 200 mg/5 ml elixir. How many milliliters of the medication would the nurse administer? Record your answer using two decimal points.

ANSWER: 1.25 EXPLANATION: The order is for 50 mg. There are 200 mg in 5 mL. Thus, there are 40 mg per mL. The problem is solved by: 50 mg/X ml = 40 mg/1mL X= 1.25 mL REFERENCE: (none given)

A nursing instructor is discussing the various events that occur during a pregnancy. The instructor determines the session is successful after the students put the following events in the correct chronological order. Use all the options. 1. Formation of the placenta 2. Heart begins beating 3. Union of an ovum and sperm 4. Fetus ready to be born 5. Fetus kicks actively 6. Implantation of the zygote

ANSWER: 3. Union of an ovum and sperm 6. Implantation of the zygote 1. Formation of the placenta 2. Heart begins beating 5. Fetus kicks actively 4. Fetus ready to be born EXPLANATION: The correct order is as follows: 1) union of an ovum and sperm (fertilization); 2) implantation of the zygote; 3) formation of the placenta; 4) heart begins beating; 5) fetus kicks actively; 6) fetus ready for birth. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 324-326

A nurse is describing fetal growth to a group of newly pregnant clients. Place the structures below in the order from ovulation to term. Use all options. 1. fetus 2. embryo 3. zygote 4. ovum

ANSWER: 4. ovum 3. zygote 2. embryo 1. fetus EXPLANATION: Fetal growth begins with the ovum (from ovulation to fertilization) and then continues as follows: zygote (fertilization to implantation), embryo (implantation from 5 to 8 weeks) and fetus (from 5 to 8 weeks to term). REFERENCE: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 9: Nursing Care of the Growing Fetus.

A pregnant woman undergoing amniocentesis asks her nurse why the baby needs this fluid. What would be an accurate response from the nurse? A. "Amniotic fluid cushions your baby to prevent injury." B. "Amniotic fluid provides fetal blood circulation." C. "Amniotic fluid supplies the food your baby needs to grow." D. "Amniotic fluid keeps the fetus from moving freely inside it to prevent injury."

ANSWER: A. "Amniotic fluid cushions your baby to prevent injury." EXPLANATION: The amniotic fluid, kept inside the amnion, cushions the fetus against injury, regulates temperature, and allows the fetus to move freely inside it, which allows normal musculoskeletal development of the fetus. The woman's blood supplies food to—and carries wastes away from—the fetus. The placenta supplies the developing organism with food and oxygen; then the umbilical cord connects the fetal blood vessels contained in the villi of the placenta with those found within the fetal body. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 329

A client has had a biophysical profile done and receives a score of 9. The client asks the nurse, "What does this mean?" Which response by the nurse would be appropriate? A. "Based on your results, your baby is doing well." B. "Your score is a little low so we need to do more testing." C. "Your score means that you are likely to go into preterm labor." D. "We'll have to watch you closely because your baby may be in jeopardy."

ANSWER: A. "Based on your results, your baby is doing well." EXPLANATION: Biophysical profiles may be done as often as daily during a high-risk pregnancy. A score of 8 to 10 means the fetus is considered to be doing well. A score of 6 is considered suspicious and a score of 4 denotes a fetus potentially in jeopardy. A score of 9 does not indicate the need for additional testing, a greater risk for preterm labor, or a fetus in jeopardy. REFERENCE: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 9: Nursing Care of the Growing Fetus.

A pregnant client has received results of genetic testing that show the fetus has trisomy 13. The health care provider has discussed options for care, including termination of the pregnancy. How does the nurse best respond to support this family's decision-making? A. "Can you tell me about your beliefs and values related to this decision?" B. "Would you like to meet other families who have a child with trisomy 13?" C. "I can refer you to pastoral care for help in making this decision." D. "How do you feel about your ability to care for a child with an impairment?"

ANSWER: A. "Can you tell me about your beliefs and values related to this decision?" EXPLANATION: Children affected by trisomy 13 are often severely cognitively impaired and most do not survive early childhood, so termination of pregnancy is often offered to families with an affected pregnancy. This entails very difficult decision-making for the family, and the nurse can best support the process by first clarifying the family's values related to this option. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 403, 1828-1829

A client at a preconception screening appointment indicates to the nurse that she is a carrier of muscular dystrophy, an X-linked recessive trait. Her partner does not have the trait. Which statement made by the client indicates an understanding of the implications? A. "Each time I have a child, there is a 25% chance a female child will be a carrier." B. "Because this is an X-linked recessive trait, any male children will not be affected." C. "There are more affected females than males with this particular trait." D. "There is a good chance all my future children will be affected with this trait."

ANSWER: A. "Each time I have a child, there is a 25% chance a female child will be a carrier." EXPLANATION: X-linked recessive inheritance affects more males than females. There is no male-to-male transmission but any man who is affected with an X-linked recessive disorder will have carrier daughters. If a woman is a carrier, there is a 25% chance she will have an "affected son," a 25% chance that her daughter will be a "carrier," a 25% chance that she will have an "unaffected" son, and a 25% chance her daughter will be a "noncarrier." REFERENCE: Chapter 10: Fetal Development and Genetics - Page 339

The nurse prepares a couple to have a karyotype performed. What describes a karyotype? A. a blood test that will reveal an individual's homozygous tendencies B. a visual presentation of the chromosome pattern of an individual C. the gene carried on the X or Y chromosome D. the dominant gene that will exert influence over a correspondingly located recessive gene

ANSWER: A. a visual presentation of the chromosome pattern of an individual EXPLANATION: A karyotype is a photograph of a person's chromosomes aligned in order. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 337

A nurse working in the newborn nursery hears an innocent murmur on auscultation of a 24-hour-old infant's chest. The nurse recognizes this as most likely the result of which condition? A. delayed fetal shunt closure B. dysfunctional foramen ovale C. congenital defect D. attached umbilical cord stump

ANSWER: A. delayed fetal shunt closure EXPLANATION: Functional closure of all fetal shunts usually occurs anywhere from the first hour to three to four weeks after birth. These delayed fetal shunt closures are usually not associated with a heart lesion. If they are still present at a later date, evaluation may be warranted. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 331

A healthy 25-year-old pregnant client with no family history of or risk factors for genetic disorders requests cell-free DNA testing. The client states wanting to be certain of any genetic disorders in the fetus and does not feel that the hormonal screening is accurate enough. What should the nurse explain to this client? A. "This is an option, but for young healthy clients, cell-free DNA testing is often not covered by insurance." B. "You should have the screening first, and only need cell-free DNA testing if the screen is positive." C. "This testing is not necessary if you would not terminate a pregnancy based on results." D. "The hormonal screening is highly accurate, and it is less invasive than the cell-free DNA test."

ANSWER: A. "This is an option, but for young healthy clients, cell-free DNA testing is often not covered by insurance." EXPLANATION: Low-risk pregnant clients in the first trimester are routinely offered hormonal screening (analysis of maternal serum alpha-fetoprotein (MSAFP), pregnancy-associated plasma protein A (PAPP-A), and free β-human chorionic gonadotropin (hCG) to evaluate for chromosomal disorders in the fetus. Cell-free DNA testing may be offered based on a positive screen or to pregnant clients at higher risk, such as those 35 years and older. Cell-free DNA testing is more accurate and may be obtained by all pregnant clients, but often must be paid for out of pocket. The nurse should provide the client with information about all of the screening and testing options, but allow the client to make the decision that fits best with values and desires. Clients who would not terminate a pregnancy may wish to know a diagnosis to prepare in advance. The hormonal screening is less accurate and is not less invasive than cell-free DNA testing. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 400

A nurse is counseling a couple who have a 5-year-old daughter with Down syndrome. The nurse recognizes that their daughter's genome is represented by which chromosome combination? A. 47XX21+ B. 47XY21+ C. 46XX D. 46XX5p-

ANSWER: A. 47XX21+ EXPLANATION: In Down syndrome, the person has an extra chromosome 21, so this is abbreviated as 47XX21+ (for a female) or 47XY21+ (for a male). 46XX is a normal genome for a female. The abbreviation 46XX5p- is the abbreviation for a female with 46 total chromosomes but with the short arm of chromosome 5 missing (Cri-du-chat syndrome). REFERENCE: Chapter 10: Fetal Development and Genetics - Page 341

A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function? A. Amniotic fluid volume B. Fetal heart rate C. Fetal breathing record D. Fetal reactivity

ANSWER: A. Amniotic fluid volume EXPLANATION: A biophysical profile combines five parameters (fetal reactivity, fetal breathing movements, fetal body movement, fetal tone, and amniotic fluid volume) into one assessment. The fetal heart and breathing record measures short-term central nervous system function; the amniotic fluid volume helps measure long-term adequacy of placental function. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 329

A client asks about a child inheriting an autosomal recessive disorder. What must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? A. Both parents must be carriers. B. One parent must have the disease. C. One parent, usually the mother, must be a carrier. D. One parent, usually the father, must not be a carrier or have the disease.

ANSWER: A. Both parents must be carriers. EXPLANATION: Autosomal recessive inheritance occurs when two copies of the mutant or abnormal gene in the homozygous state are necessary to produce the phenotype. In other words, two abnormal genes are needed for the individual to demonstrate signs and symptoms of the disorder. Both parents of the affected person must be carriers of the gene, either clinically normal or expresses the disorder. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 338

A client is undergoing genetic testing and counseling. What is the responsibility of the nurses during this process? A. Clarify values and goals for the couple. B. Notify insurance companies of test results. C. Share with the client the nurse's opinion when asked. D. Explain the results of the testing to the client.

ANSWER: A. Clarify values and goals for the couple. EXPLANATION: Nurses can help clients clarify values and goals, assess understanding of information, protect clients' rights, and support a client's decisions. Notifying insurance companies of test results and giving the client a personal opinion, even when asked, is unethical on the part of the nurse. The nurse can ensure the client understands the results, but the nurse should not explain the results of the test to the client; this is the primary health care provider's role. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 346

A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage? A. From fertilization to the end of the second week after fertilization B. Approximately 2 weeks after fertilization to the end of the eighth week C. Approximately 9 weeks after fertilization to birth D. Approximately 6 weeks after fertilization to the end of 8 weeks

ANSWER: A. From fertilization to the end of the second week after fertilization EXPLANATION: The pre-embryonic stage begins at fertilization and lasts through the end of the second week after fertilization. The embryonic stage begins approximately 2 weeks after fertilization and ends at the conclusion of the eighth week after fertilization. The fetal stage begins at 9 weeks after fertilization and ends at birth. There is no distinct stage recognized approximately 6 to 8 weeks after fertilization. This is part of the embryonic stage period. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 324

A nurse is providing genetic counseling to a pregnant client. Which are nursing responsibilities related to counseling the client? Select all that apply. A. explaining basic concepts of probability and disorder susceptibility B. ensuring complete informed consent to facilitate decisions about genetic testing C. instructing the client on the appropriate decision to be taken D. knowing basic genetic terminology and inheritance patterns E. avoiding explanation of ethical or legal issues and concentrating on genetic issues

ANSWER: A. explaining basic concepts of probability and disorder susceptibility B. ensuring complete informed consent to facilitate decisions about genetic testing D. knowing basic genetic terminology and inheritance patterns EXPLANATION: The responsibilities of the nurse while counseling the client include knowing basic genetic terminology and inheritance patterns and explaining basic concepts of probability and disorder susceptibility. The nurse should ensure complete informed consent to facilitate decisions about genetic testing. The nurse should explain ethical and legal issues related to genetics as well. The nurse should never instruct the client on which decision to make and should let the client make the decision. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 344

A client presents to the hospital experiencing a spontaneous abortion (miscarriage) at 8 weeks' gestation, which is the third spontaneous abortion (miscarriage) in 2 years. The health care provider offers to send the products of conception for genetic testing. The client expresses not understanding the reason for this action. How does the nurse explain? A. Many spontaneous abortions (miscarriages) occur due to chromosomal disorders and this testing may determine if this is the cause. B. This testing will help to determine if your hormone levels are causing the recurrent spontaneous abortions (miscarriages). C. It will reassure you to find out if the baby had anomalies that were not compatible with life. D. If you do not want to have this testing done, we will respect that decision.

ANSWER: A. Many spontaneous abortions (miscarriages) occur due to chromosomal disorders and this testing may determine if this is the cause. EXPLANATION: Many spontaneous abortions (miscarriages) occur due to chromosomal disorders, and genetic testing may be completed to find out if this was the cause of this spontaneous abortion (miscarriage). The testing will not determine hormone levels, and the client may need further testing to determine the cause of recurrent spontaneous abortions (miscarriages). If the client declines testing the decision will be respected, but the client should be provided with information to make an informed decision first. The nurse should not assume how the client will feel or respond to learning if there were or were not genetic abnormalities. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 341

The nurse is reviewing the results of a woman's maternal serum alpha fetoprotein (AFP) blood test. The results are positive, in the high range. Which action will the nurse complete next? A. Notify the primary health care provider of the results. B. Place the results in the client's medical records. C. Notify the woman of the results of the test. D. Obtain instructions on how to lower the blood levels.

ANSWER: A. Notify the primary health care provider of the results. EXPLANATION: The maternal serum alpha-fetoprotein (AFP) blood test is performed on pregnant clients to screen for fetal neural tube defects. When reviewing the results and recognizing the high level in the maternal blood, the nurse would notify the primary health care provider. Further screening may be recommended or the health care provider may ask the client to come in for a consultation. It is not appropriate to place the results on the chart without primary health care provider notification. The primary health care provider, not the nurse, will discuss the results of the test with the woman. The woman does not have the ability to alter the alpha-fetoprotein levels in the blood. REFERENCE: (none given)

A client at 38 weeks' gestation is diagnosed with placental insufficiency. Which prescription from the health care provider will the nurse anticipate? A. Prepare the client for an induction of labor. B. Discharge the client home with daily nonstress testing. C. Assess the client's blood pressure every 2 hours. D. Administer one dose of betamethasone.

ANSWER: A. Prepare the client for an induction of labor. EXPLANATION: Placental insufficiency is a serious complication where the placenta no longer works properly to provide nutrition and oxygen to the fetus, nor remove waste products from the fetus. Because this client's fetus is at full term, the nurse would anticipate an induction of labor or a cesarean birth. The client is not stable enough to be sent home for monitoring. Hypertension can be a cause of placental insufficiency; however, at this point in the pregnancy, birth is the best option. Betamethasone is a steroid given to clients to hasten preterm fetal lung development. This client is at term and does not need betamethasone. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 330

A recently married couple come to the prenatal clinic because they are concerned about genetic testing. The husband is of Jewish heritage. The nurse should recommend the couple undergo genetic testing to determine if the fetus has which disorder common among Ashkenazi Jews (Jews of Eastern European lineage)? A. Tay-Sachs disease B. Down syndrome C. cystic fibrosis D. Turner syndrome

ANSWER: A. Tay-Sachs disease EXPLANATION: Tays-Sachs disease is a autosomal recessive disorder that occurs primarily in Ashkenazi Jews. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 338

A multigravida client is concerned that she may deliver early. When asking the nurse what is the earliest her baby can be delivered and survive, which time frame would the nurse point out? A. The end of the second trimester B. The end of the first trimester C. The end of the third trimester D. The end of the fourth trimester

ANSWER: A. The end of the second trimester EXPLANATION: During the second trimester, fetal growth is significant. The fetus begins this trimester 3 inches long and weighing less than 1 oz (0.8 gm). By the end of the second trimester, the fetus is about 15 inches long and weighs more than 2 lbs (1000 gm). Major organs develop to the point that the fetus may survive (with help) outside the womb. The fetus would not be able to survive at the end of the first trimester. The end of the third trimester is the expected time of deliver. The fourth trimester involves the time after delivery. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 331

A multigravida client is concerned that she may deliver early. When asking the nurse what is the earliest her baby can be delivered and survive, which time frame would the nurse point out? A. The end of the second trimester B. The end of the first trimester C. The end of the third trimester D. The end of the fourth trimester

ANSWER: A. The end of the second trimester EXPLANATION: During the second trimester, fetal growth is significant. The fetus begins this trimester 3 inches long and weighing less than 1 oz (0.8 gm). By the end of the second trimester, the fetus is about 15 inches long and weighs more than 2 lbs (1000 gm). Major organs develop to the point that the fetus may survive (with help) outside the womb. The fetus would not be able to survive at the end of the first trimester. The end of the third trimester is the expected time of deliver. The fourth trimester involves the time after delivery. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 331

A woman with both heart disease and osteoarthritis has come to the genetics clinic for genetic screening. What would the nurse know about these two diseases? A. They are multifactorial. B. They are a direct result of the client's lifestyle. C. They are caused by a single gene. D. They do not have a genetic basis.

ANSWER: A. They are multifactorial. EXPLANATION: Genomic or multifactorial influences involve interactions among several genes (gene-gene interactions) and between genes and the environment (gene-environment interactions), as well as the individual's lifestyle. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 339

An expectant mother is on heparin for previous blood clots and voicing concerns about how her medications will affect her baby. The nurse would inform the mother that: A. heparin does not cross the placenta and is safe for her to take. B. any medication that an expectant mother takes can cause sequelae for the infant. C. she should discontinue the heparin and change to another anticoagulant. D. it is recommended to stop taking the heparin while she is pregnant.

ANSWER: A. heparin does not cross the placenta and is safe for her to take. EXPLANATION: Heparin is a medication that does not cross the placenta and therefore is safe to use during pregnancy. Not all medications cause fetal sequelae. It is not recommended to abruptly discontinue any medication without consulting the mother's health care provider. Heparin is the safest anticoagulant for a pregnant woman to take. REFERENCE: (none given)

A child is diagnosed with Turner syndrome. The nurse understands that this condition is associated with which genetic problem? A. only 1 functional X chromosome B. missing portion of chromosome 5 C. three copies of chromosome 18 D. extra chromosome 13

ANSWER: A. only 1 functional X chromosome EXPLANATION: The child with Turner syndrome (gonadal dysgenesis) has only one functioning X chromosome. Cri-du-chat syndrome is the result of a missing portion of chromosome 5. Children with trisomy 18 syndrome (Edwards syndrome) have three copies of chromosome 18. In trisomy 13 syndrome (Patau syndrome), the child has an extra chromosome 1. REFERENCE: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 8: The Nursing Role in Genetic Assessment and Counseling.

The nurse is reviewing the note (above) for a woman hoping to become pregnant in the near future. What concerns the nurse most when reviewing the note? A. past medical history B. allergies C. family dynamics D. maternal age

ANSWER: A. past medical history EXPLANATION: All of the data obtained in the note is important. The nurse would recognize the client's history of abdominal surgery and tubal ligation reversal as concerning due to the risk of an ectopic pregnancy. The nurse would be aware of the allergies to aspirin and sunscreens would to be need noted but would not be most concerning. Maternal age is not a concern. The family dynamics do not appear to be at risk for violence or increased stress. REFERENCE: (none given)

The nurse is providing prenatal education in the community. The nurse advises the pregnant women to check with their health care provider before what activity(ies)? Select all that apply. A. receiving immunizations B. taking over-the-counter herbs C. taking "natural" medications D. eating spicy foods E. drinking bottled water

ANSWER: A. receiving immunizations B. taking over-the-counter herbs C. taking "natural" medications EXPLANATION: The pregnant woman is taught to consider that substances she takes into her body may pass to the fetus. These include immunizations, over-the-counter herbs, and all medications, even the ones labeled as "natural." The woman should verify with her health care provider before any of those things are taken. Eating spicy food and drinking specific brands of bottled water would not need to be cleared with the provider unless the woman experienced gastrointestinal symptoms following ingestion. REFERENCE: (none given)

In order for conception to take place, it is most common for a woman to get pregnant: A. two weeks after her normal menstrual period. B. one week before her normal menstrual period. C. immediately after a normal menstrual period. D. during her menstrual period.

ANSWER: A. two weeks after her normal menstrual period. EXPLANATION: Menstruation is a constant cycle that normally occurs over a 28-day cycle. Fertilization is the union of ovum and sperm, which is the starting point of pregnancy. Fertilization typically happens around 2 weeks (or day 14) after the last normal menstrual period. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 324

A 45-year-old man has just been diagnosed with Huntington disease. He and his spouse are concerned about their four children. Based on the knowledge of patterns of inheritance, how will the nurse respond? A. "This disorder is carried on the X chromosome so only your female children would be affected." B. "Each of your children will have a 50% chance of inheriting the disease." C. "Both genes of a pair must be abnormal for the disorder to occur in your children." D. "Your male children are more likely to be affected than your female children."

ANSWER: B. "Each of your children will have a 50% chance of inheriting the disease." EXPLANATION: Huntington disease is an autosomal dominant disorder. A single gene in the heterozygous state is capable of producing the phenotype. In these cases, the abnormal or mutant gene overshadows the normal gene and the individual will demonstrate signs and symptoms of the disorder. The affected person usually has one affected parent. The defect occurs on the autosome not on the X chromosome; therefore, autosomal dominant inherited conditions affect female and male family members equally and follow a vertical pattern of inheritance in families. A person who has an autosomal dominant inherited condition carries a gene mutation for that condition on one chromosome pair. Each of that person's offspring has a 50% chance of inheriting the gene mutation for the condition and a 50% chance of inheriting the normal version of the gene. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 337

A pregnant client arrives at the community health center for a routine check-up. She informs the nurse that a relative on her mother's side has hemophilia, and she wants to know the chances of her child acquiring hemophilia. Which characteristics of hemophilia should the nurse explain to the client to help her understand the odds of acquiring the disease? Select all that apply. A. Affected individuals will have affected parents. B. Affected individuals are usually males. C. Daughters of an affected male are unaffected and are not carriers. D. Female carriers have a 50% chance of transmitting the disorder to their sons. E. Females are affected by the condition if it is a dominant X-linked disorder.

ANSWER: B. Affected individuals are usually males. D. Female carriers have a 50% chance of transmitting the disorder to their sons. E. Females are affected by the condition if it is a dominant X-linked disorder. EXPLANATION: The nurse should explain to the client that individuals with hemophilia are usually males. Female carriers have a 50% chance of transmitting the disorder to their sons, and females are affected by the condition if it is a dominant X-linked disorder. Offspring of nonhemophilic parents may be hemophilic. Daughters of an affected male are usually carriers. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 339

During the initial assessment of a preterm infant, it is noted that the infant has a heart murmur. Which shunt from fetal life most likely remains open? A. Foramen ovale B. Ductus arteriosus C. Umbilical vein D. Ductus venosus

ANSWER: B. Ductus arteriosus EXPLANATION: There are three shunts in the fetal circulation: the foramen ovale, the ductus venosus and the ductus arteriosus. Additionally, there are two umbilical arteries and one umbilical vein, which close following birth and form ligaments. In a preterm infant, there is a higher likelihood of the ductus arteriosus remaining open, so a murmur heard in a preterm infant shortly after birth would be suspected to be ductal murmur. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 332

While in utero, a fetus swallows many substances that are deposited in the fetal intestinal system as meconium. What problem can arise from this occurrence? A. The fetus can become constipated following birth. B. If the fetus becomes stressed, the meconium is released into the amniotic fluid, placing the fetus at risk for pneumonia. C. Abdominal distension occurs and infection can set in. D. Meconium-stained fluids cause an increased risk of jaundice.

ANSWER: B. If the fetus becomes stressed, the meconium is released into the amniotic fluid, placing the fetus at risk for pneumonia. EXPLANATION: Infants develop meconium in their intestines; if they are stressed or hypoxic, the anal sphincter relaxes and meconium is passed into the amniotic fluid. This poses a danger to the fetus since they breathe in this fluid and swallow it. The meconium lines the lungs and respiratory passages, making it difficult for the infant to breathe once it is born. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 329

After teaching a class about conception, the nursing instructor asks the attendees to explain the process of fertilization. Which statements indicate the students need additional teaching? Select all that apply. A. The ovum is receptive to conception 12 to 23 hours after ovulation. B. Sperm are viable for only about 48 hours after ejaculation. C. Sperm are able to fertilize the ovum from 3 days before until 2 days after ovulation. D. Sperm are able to fertilize the ovum up to 12 hours after ejaculation, and the ovum remains fertile for at least 24 hours after ovulation. E. This activity usually occurs in the ampulla of the fallopian tube.

ANSWER: B. Sperm are viable for only about 48 hours after ejaculation. D. Sperm are able to fertilize the ovum up to 12 hours after ejaculation, and the ovum remains fertile for at least 24 hours after ovulation. EXPLANATION: Once the mature ovum is released (i.e., ovulation), fertilization must occur fairly quickly because an ovum is capable of fertilization for only about 24 to 48 hours. After that time, it atrophies and becomes nonfunctional. Because the functional life of a spermatozoon is also about 24 to 72 hours, the total critical time span during which sexual relations must occur for fertilization to be successful is from 3 days (72 hours) before until 2 days (48 hours) after ovulation. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 324

A baby is born with what the primary care provider believes is a diagnosis of trisomy 21. This means that the infant has three number 21 chromosomes. What factor describes this genetic change? A. The mother also has genetic mutation of chromosome 21. B. The client has a nondisjunction occurring during meiosis. C. During meiosis, a reduction of chromosomes resulted in 23. D. The client will have a single X chromosome and infertility.

ANSWER: B. The client has a nondisjunction occurring during meiosis. EXPLANATION: During meiosis, a pair of chromosomes may fail to separate completely, creating a sperm or oocyte that contains either two copies or no copy of a particular chromosome. This sporadic event, called nondisjunction, can lead to trisomy. Down syndrome is an example of trisomy. The mother does not have a mutation of chromosome 21, which is indicated in the question. Also, trisomy does not produce a single X chromosome and infertility. Genes are packaged and arranged in a linear order within chromosomes, which are located in the cell nucleus. In humans, 46 chromosomes occur in pairs in all body cells except oocytes and sperm, which contain only 23 chromosomes. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 341

Cystic fibrosis is an example of which type of inheritance? A. autosomal dominant B. autosomal recessive C. X-linked recessive D. multifactorial

ANSWER: B. autosomal recessive EXPLANATION: Cystic fibrosis is an autosomal recessive inherited condition. Huntington disease would be an example of an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Cleft lip is a multifactorial inherited condition. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 338

The nursing student is preparing a presentation that will illustrate the various stages of fetal development. The student will label which stage as the time when the various tissues of the growing embryo begin to assume specific functions? A. pre-embryonic B. embryonic C. fetal D. post-embryonic

ANSWER: B. embryonic EXPLANATION: During the embryonic period, the cells multiply and tissues begin to assume specific functions, a process known as differentiation. This stage lasts from the end of the second week after fertilization until the end of the eighth week. The pre-embryonic stage begins with fertilization and lasts for 2 weeks. Cellular division and implantation occur during this stage of development. The fetal stage is from the beginning of the ninth week after fertilization and continues until birth. There is additional growth and maturation of the organs and body systems during this time. There is no post-embryonic stage. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 326

During which stage of fetal development is exposure to teratogens most damaging? A. pre-embryonic stage B. embryonic stage C. fetal stage D. mitosis stage

ANSWER: B. embryonic stage EXPLANATION: The most sensitive period of fetal development related to teratogens is during the embryonic period when the different body systems are developing. During the pre-embryonic stage, the fetal stage, and the mitosis stage, the risk of teratogenic exposure is not as influential on the fetus. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 331

Genetics-related health care is basic to the holistic practice of nursing. What should nursing practice in genetics include? A. identifying genetic markers B. gathering relevant family and medical history information C. providing advice on termination of pregnancy D. discouraging females to conceive after the age of 40 years

ANSWER: B. gathering relevant family and medical history information EXPLANATION: The nurse's role in genetic counseling is to provide information, collect relevant data, offer support, and coordinate resources. The nurse should not provide advice on terminating a pregnancy, nor attempt to discourage women 40+ from trying to conceive. The nurse also does not identify genetic markers. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 344

A woman is confused after finding out the ultrasound results predict a different due date for the birth of her baby. Which factor should the nurse point out is most likely the reason for the miscalculation of the fetal age? A. an error in math when calculating B. mistaking implantation bleeding for last menstrual period (LMP) C. amount of weight gain of mother in early weeks of pregnancy D. not seeking prenatal care in the beginning

ANSWER: B. mistaking implantation bleeding for last menstrual period (LMP) EXPLANATION: The most common cause is implantation bleeding, which can occur as the blastocyst implants itself into the endometrium. This bleeding can be mistaken for a scanty menstrual period and can lead to miscalculation of fetal age by 2 weeks. The other choices might also contribute, especially the math miscalculation, but are not the primary reason. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 326

The nurse is reviewing prenatal charts in the clinic and notes some clients report infections during their pregnancies. Which maternal infection(s) places the fetus at high risk for developmental abnormalities? Select all that apply. A. urinary tract infections B. rubella C. sinus infections D. varicella E. Zika virus

ANSWER: B. rubella D. varicella E. Zika virus EXPLANATION: The Zika virus, varicella, and rubella are known as infectious teratogens. A urinary tract infection and a sinus infection would likely not alone cause fetal abnormalities. REFERENCE: (none given)

A fertilized ovum is known as which structure? A. fetus B. zygote C. embryo D. chorion

ANSWER: B. zygote EXPLANATION: A fertilized ovum is known as a zygote and is the beginning of potential individual human development. The developing human organism is known as an embryo from the time it implants on the uterine wall until the eighth week after inception and as a fetus from the beginning of the ninth week after fertilization through birth. The chorion is the outermost cell layer that surrounds the embryo and fluid cavity. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 324

The pregnant client at 6 weeks' gestation asks the nurse if an ultrasound will reveal the sex of the fetus yet. What is the best response by the nurse? A. "We will be able to determine the sex of the baby today with transvaginal ultrasound." B. "We will have to wait until the baby is 8 weeks' gestation to be able to determine what the sex is." C. "We will have to wait until the baby is 16 weeks' gestation to determine what the sex is." D. "We will have to wait until the baby is 20 weeks' gestation to determine the sex of the baby."

ANSWER: C. "We will have to wait until the baby is 16 weeks' gestation to determine what the sex is." EXPLANATION: The sex of the baby can be determined by ultrasound at 16 weeks' gestation. An ultrasound at 6 and 8 weeks would be too early to determine the sex. An ultrasound at 20 weeks should confirm what was found at 16 weeks. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 345

A pregnant client and her husband have had a session with a genetic specialist. What is the role of the nurse after the client has seen a specialist? A. Identify the best decision to be taken for the client. B. Refer the client to another specialist for a second opinion. C. Review what has been discussed with the specialist. D. Refer the client for further diagnostic and screening tests.

ANSWER: C. Review what has been discussed with the specialist. EXPLANATION: After the client has seen the specialist, the nurse should review what the specialist has discussed with the family and clarify any doubts the couple may have. The nurse should never make the decision for the client but rather should present all the relevant information and aid the couple in making an informed decision. There is no need for the nurse to refer the client to another specialist or for further diagnostic and screening tests unless instructed to do so by the specialist. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 346

A pregnant woman of Jewish descent comes to the clinic for counseling and tells the nurse that she is worried her baby may be born with a genetic disorder. Which disease does the nurse identify to be a risk for this client's baby based on the family's ancestry? A. sickle cell anemia B. beta-thalassemia C. Tay-Sachs disease D. Down syndrome

ANSWER: C. Tay-Sachs disease EXPLANATION: Sickle cell anemia occurs most often in African Americans. Tay-Sachs disease occurs most often in people of Jewish ancestry. Beta-thalassemia is a blood dyscrasia that occurs frequently in families of Greek or Italian heritage. Down syndrome is not attributed to Jewish ancestry. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 334

When describing the characteristics of the amniotic fluid to a pregnant woman, the nurse would include which information? A. It is usually an acidic fluid. B. It is composed primarily of organic substances. C. The amount gradually fluctuates during pregnancy. D. It limits fetal movement in utero.

ANSWER: C. The amount gradually fluctuates during pregnancy. EXPLANATION: Amniotic fluid is alkaline. Amniotic fluid is composed of 98% water and 2% organic matter. Amniotic fluid volume gradually fluctuates throughout pregnancy. Sufficient amounts promote fetal movement to enhance musculoskeletal development. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 329

The health care provider has prescribed a karyotype for a newborn. The mother questions the type of information that will be provided by the test. What information should be included in the nurse's response? A. The karyotype will provide information about the severity of your baby's condition. B. A karyotype is useful in determining the potential complications the baby may face as a result of its condition. C. The karyotype will assess the baby's chromosomal makeup. D. The karyotype will determine the treatment needed for the infant.

ANSWER: C. The karyotype will assess the baby's chromosomal makeup. EXPLANATION: The pictorial analysis of the number, form, and size of an individual's chromosomes is referred to as a karyotype. This analysis commonly uses white blood cells and fetal cells in amniotic fluid. The chromosomes are numbered from the largest to the smallest, 1 to 22, and the sex chromosomes are designated by the letter X or the letter Y. The severity and related complications of a disorder are not determined by the karyotype. Condition management is not determined by the karyotype. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 337

The nurse is preparing a presentation for a health fair which will illustrate the development of a baby. The nurse should point out the fertilized egg is implanted in the endometrium by which day? A. 4 B. 6 C. 8 D. 10

ANSWER: D. 10 EXPLANATION: By day 10 after fertilization, the blastocyst has completely buried itself in the endometrial lining. Prior to day 10, the attachment is much looser. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 326

The nursing instructor is illustrating the circulatory flow between the mother and fetus. The instructor determines the session is successful when the class correctly chooses which structure with which route? A. The one umbilical artery carries oxygen-rich blood to the fetus from the placenta. B. The two umbilical arteries carry waste products from the placenta to the fetus. C. The one umbilical vein carries oxygen-rich blood to the fetus from the placenta. D. The two umbilical veins carry waste products from the fetus to the placenta.

ANSWER: C. The one umbilical vein carries oxygen-rich blood to the fetus from the placenta. EXPLANATION: There are two umbilical arteries and one umbilical vein. The arteries carry waste from the fetus to the placenta; the vein carries oxygenated blood to the fetus from the placenta. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 332

A client is offered preconception genetic testing but reports being worried about the results preventing access to health insurance in the future. How does the nurse respond? A. This is a good concern to discuss with your genetic counselor. B. Your employer is not allowed to know about your genetic test results, so this cannot influence your health insurance. C. There are laws that prevent discrimination related to genetic information for health insurance. D. It would be best to arrange for health and life insurance before getting your genetics results.

ANSWER: C. There are laws that prevent discrimination related to genetic information for health insurance. EXPLANATION: The Genetic Information Nondiscrimination Act prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future. REFERENCE: Ricci Chapter 10: Fetal Development and Genetics - Page 335

A pregnant woman indicates taking prescribed tetracycline during pregnancy, without realizing it was a concern. What infant assessments will the nurse recommend be checked on an ongoing basis? A. hearing acuity B. cardiac function C. bone development D. nerve conduction

ANSWER: C. bone development EXPLANATION: Tetracycline is an antibiotic that may cause dental and osseous concerns for the fetus/infant when taken during pregnancy. Nervous system deficits may be experienced when the fetus is exposed to mercury. When exposed to rubella, deafness and cardiac abnormalities may occur. REFERENCE: (none given)

A group of nursing students are preparing a presentation for a health fair illustrating the structures found during a pregnancy. Which structures should the students point out form a protective barrier around the developing fetus? A. ectoderm and amnion B. amnion and mesoderm C. chorion and amnion D. chorion and endoderm

ANSWER: C. chorion and amnion EXPLANATION: The chorion and amnion are the two fetal membranes. The ectoderm, mesoderm, and endoderm are layers in the developing blastocyst. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 326

For which client is preimplantation genetic diagnosis (PGD) a viable option? A. client who is currently 32 years of age B. client who had a miscarriage at 15 weeks' gestation C. client whose partner has cystic fibrosis D. client in the second week of pregnancy

ANSWER: C. client whose partner has cystic fibrosis EXPLANATION: Preimplantation genetic diagnosis (PGD) is a viable option when either parent is a carrier of a genetic disorder. It is also an option when the mother is of advanced maternal age or has a history of multiple miscarriages. PGD is not a viable option for pregnant clients. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 345

An 18-year-old pregnant woman asks the nurse why she has to have a routine alpha-fetoprotein serum level drawn. The nurse explains that this: A. is a screening test for placental function. B. tests the ability of her heart to accommodate the pregnancy. C. may reveal chromosomal abnormalities. D. measures the fetal liver function.

ANSWER: C. may reveal chromosomal abnormalities. EXPLANATION: An alpha-fetoprotein analysis is a cost-effective screening test to detect chromosomal and open-body-cavity disorders. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 345

The nurse is caring for a client and her partner who are considering a future pregnancy. The client reports her last two pregnancies ended in stillbirth related to an underlying genetic disorder. What response by the nurse is most appropriate? A. "You should contact a geneticist after you become pregnant to closely watch your condition." B. "Your risk of repeated occurrences likely increases with future pregnancies." C. "You are strong to consider such an undertaking." D. "Consultation with a genetic counselor before you become pregnant would likely be beneficial."

ANSWER: D. "Consultation with a genetic counselor before you become pregnant would likely be beneficial." EXPLANATION: Prepregnancy screening with a genetic counselor would be helpful to the client who has a history of fetal loss as a result of a genetic disorder. The screening would allow the family to closely be evaluated for risk factors and have access to potential screening options. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 343

Which question would be most important for a nurse to ask a G2P1 client who has a child with sickle cell anemia? A. "When was your last exacerbation?" B. "Have you done well to control your stress?" C. "Do you know the sex of your baby?" D. "Did you and your partner get genetic testing?"

ANSWER: D. "Did you and your partner get genetic testing?" EXPLANATION: The nurse should assess whether the client has had genetic testing completed. If not, the client should be referred for testing. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 342

The nurse is caring for several pregnant clients in the office setting. Which client's statement would be of most concern to the nurse? A. "A few weeks before I knew I was pregnant, I took acetaminophen for a headache." B. "I smoked cigarettes daily until a few years ago, and I was able to quit." C. "I take heparin every day since I have a history of blood clots." D. "I forgot to tell you at my first prenatal appointment that I take phenytoin for seizures."

ANSWER: D. "I forgot to tell you at my first prenatal appointment that I take phenytoin for seizures." EXPLANATION: Phenytoin is a teratogen and the provider would consider an alternate seizure medication if indicated. Ideally, the client would have alerted the health care provider as early as possible. Acetaminophen is not considered a teratogen when taken as directed and heparin does not cross the placental barrier and is considered safe during pregnancy. Smoking during pregnancy can cause intrauterine growth restriction, but this client stopped smoking before the pregnancy. REFERENCE: (none given)

A nurse is caring for a pregnant client at 6 weeks' gestation whose previous child had trisomy 13 and died shortly after birth. The family expresses concern that this child will also be affected. How should the nurse advise this family? A. Ensure they are aware that, if this child is affected, they can terminate the pregnancy. B. Refer the family to grief counseling for support during this pregnancy. C. Explain that there is only a 25% chance of this pregnancy being affected. D. Discuss options for genetic screening in this pregnancy to determine if the fetus is affected.

ANSWER: D. Discuss options for genetic screening in this pregnancy to determine if the fetus is affected. EXPLANATION: Genetic testing will be offered to this family to determine if this fetus is affected. Termination may be an option if the fetus is affected and termination is desired, but the family should initially be informed of screening/testing options. Trisomy 13 is a spontaneous, not a heritable, genetic anomaly that results from three copies of the 13th chromosome. Grief counseling may be provided if needed, but the nurse should first address the current pregnancy. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 341

Nondisjunction of a chromosome results in which diagnosis? A. Huntington disease B. Duchenne muscular dystrophy C. Marfan syndrome D. Down syndrome

ANSWER: D. Down syndrome EXPLANATION: When a pair of chromosomes fails to separate completely (nondisjunction), the resulting sperm or oocyte contains two copies of a particular chromosome. Nondisjunction can result in a fertilized egg having trisomy 21 or Down syndrome. Huntington disease is one example of a germ-line mutation. Duchenne muscular dystrophy, an inherited form of muscular dystrophy, is an example of a genetic disease caused by structural gene mutations. Marfan syndrome is a genetic condition that may occur in a single family member as a result of spontaneous mutation. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 353

A couple wants to start a family. They are concerned that their child will be at risk for cystic fibrosis because they each have a cousin with cystic fibrosis. They are seeing a nurse practitioner for preconceptual counseling. What would the nurse practitioner tell them about cystic fibrosis? A. It is an autosomal dominant disorder. B. It is passed by mitochondrial inheritance. C. It is an X-linked inherited disorder. D. It is an autosomal recessive disorder.

ANSWER: D. It is an autosomal recessive disorder. EXPLANATION: Cystic fibrosis is autosomal recessive. Nurses also consider other issues when assessing the risk for genetic conditions in couples and families. For example, when obtaining a preconception or prenatal family history, the nurse asks if the prospective parents have common ancestors. This is important to know because people who are related have more genes in common than those who are unrelated, thus increasing their chance for having children with autosomal recessive inherited condition such as cystic fibrosis. Mitochondrial inheritance occurs with defects in energy conversion and affects the nervous system, kidney, muscle, and liver. X-linked inheritance, which has been inherited from a mutant allele of the mother, affects males. Autosomal dominant is an X-linked dominant genetic disease. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 338

A nurse is caring for a couple during a prenatal clinic visit. Which assessment finding would lead the nurse to suggest genetic counseling for the couple? A. The mother is from a larger family, including seven brothers and three sisters. B. This is the second marriage for the 48-year old father. C. The mother expresses concern about her stepchildren accepting the baby. D. The mother just turned 39 years of age.

ANSWER: D. The mother just turned 39 years of age. EXPLANATION: Genetic counseling is indicated for any woman older than 35 years of age and any man older than 55 years of age. This is directly related to the association between advanced parental age and the occurrence of Down syndrome. The mother's family history would be significant if there were indications of inherited diseases, congenital anomalies, or other such disorders. The father's age would not be a concern at 48 years old. The family may benefit from family counseling to assure the blended family is healthy, but genetic counseling cannot help with that issue. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 342

A nurse is caring for a 32-year-old Jewish client who is pregnant with a female baby. The parents are not directly related by blood. The mother reports that her husband's cousin had an infant born with Tay-Sachs disease that died two years ago and she is concerned about her baby. Which information should the nurse need to give this client regarding her baby having the same disease? A. Tay-Sachs disease affects only male infants so there is no problem with her baby. B. The age of the client increases the susceptibility of the baby to Tay-Sachs disease. C. There is no risk of Tay-Sachs disease because the parents are not related by blood. D. There is a risk to the baby based upon the Jewish background, so genetic testing would be recommended.

ANSWER: D. There is a risk to the baby based upon the Jewish background, so genetic testing would be recommended. EXPLANATION: Tay-Sachs disease affects both male and female babies. The age of the client does not significantly increase the risk of Tay-Sachs disease. Even though the client and her husband are not related by blood, their Jewish background/heritage places their baby at a greater risk. There is a chance that the offspring may have Tay-Sachs disease even if both parents don't have it because they could be carriers, so genetic testing would be advisable. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 334

A client and partner are excited to discover they are expecting twins. The nurse is prepared to monitor the twins for which potential situation after noting they share an amniotic sac? A. increased teratogenic effects B. conjoined twins C. twin-to-twin transfusion syndrome D. cord entanglement

ANSWER: D. cord entanglement EXPLANATION: The greatest risk for monoamniotic monochorionic twins is cord entanglement as they share the same amnio and chorion and are contained in the amniotic fluid together. Conjoined is a possibility but not the greatest risk. Twin-to-twin transfusion syndrome is also a possibility but is a greater risk for diamniotic monochorionic as they share either placenta or vessels. Fraternal (dizygotic) twins with two placentas, two amnions, and two chorions are diamniotic dichorionic and would not be at risk for the cord entanglement. REFERENCE: (none given)

A nursing student is explaining to a newly pregnant woman what happens during each stage of fetal development. At which stage does the nurse inform the woman that the lungs are fully shaped? A. end of 4 weeks B. end of 8 weeks C. end of 12 weeks D. end of 16 weeks

ANSWER: D. end of 16 weeks EXPLANATION: At the end of 16 weeks, the lungs are fully shaped, fetus swallows amniotic fluid, skeletal structure is identifiable, downy lanugo hair is present on the body, and sex can be determined using ultrasound. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 328

A student nurse is preparing an illustration for a health fair depicting the various types of twins. Which format will the student use to depict identical twins? A. two separate eggs and different sperm B. two separate eggs and one sperm C. one egg and two different sperm D. one egg and one sperm

ANSWER: D. one egg and one sperm EXPLANATION: Identical twins develop from the fertilization of one egg by one sperm, and this divides into two zygotes shortly after fertilization, resulting in two babies who share identical genetic material and are termed identical twins. With two separate eggs and two separate sperm, the twins would be fraternal dizygotic. One sperm cannot fertilize two eggs, and two sperm cannot fertilize one egg. REFERENCE: (none given)

Which genetic condition is caused by a small gene mutation that affects protein structure, producing hemoglobin S? A. Marfan syndrome B. hemophilia C. Tay-Sachs disease D. sickle cell anemia

ANSWER: D. sickle cell anemia EXPLANATION: Sickle cell anemia is an example of a genetic condition caused by a small gene mutation that affects protein structure, producing hemoglobin S. Marfan syndrome is an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Tay-Sachs disease is an autosomal recessive inherited condition. REFERENCE: Chapter 10: Fetal Development and Genetics - Page 338