Chapter 10 Fetal Development and Genetics
The fluid-filled, inner membrane sac surrounding the fetus is which structure? decidua endometrium chorion amnion
D The fluid-filled, inner membrane sac surrounding the fetus is the amnion. The chorion is the outer membrane surrounding the fetus. The endometrium is the inner lining of the uterus. The decidua is the name used for the endometrium during pregnancy.
A young couple who underwent preconceptual genetic testing is at high risk for having a child with Down syndrome and have decided not to have children. Which response by the nurse is most appropriate? "If you would like to discuss this further, here is the contact information for the genetic counseling center." "You always have the option to adopt a child if you are really wanting to become parents." "The health care provider can refer you for a second opinion if you are not happy with these results." "To still have a child of your own, you should consider asking a friend or family member to be a surrogate."
A Even if a couple decides not to have more children, the nurse should be certain they know genetic counseling is available for them should their decision change. It is not appropriate for the nurse to discuss adoption or surrogacy at this time. The couple needs time to process this information first. The nurse should avoid using terms such as "always" as the couple may have barriers that would prevent them from being able to adopt. The nurse should not state the client should approach family or friends for surrogacy at this time. If the couple would request information, the nurse would list all potential possibilities for surrogacy and not place emphasis/pressure on a certain group. Being referred for a second opinion is providing the couple with false hope. If the couple would request a referral, it would not be denied.
When describing the characteristics of the amniotic fluid to a pregnant woman, the nurse would include which information? The amount gradually fluctuates during pregnancy. It limits fetal movement in utero. It is composed primarily of organic substances. It is usually an acidic fluid.
A 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.
A nurse is describing what happens at fertilization as the zygote begins life. Which statement is most accurate? The zygote begins life with the diploid number of chromosomes The zygote begins life with the haploid number of chromosomes The zygote begins life with its first meiotic division before ovulation. The zygote begins life with its second meiotic division just before ovulation.
A Because each nucleus contains a haploid number of chromosomes (23), this union restores the diploid number of (46). Because each nucleus contains a haploid number of chromosomes (23), this union restores the diploid number (46). The primary oocyte completes its first meiotic division before ovulation. The secondary oocyte begins its second meiotic division just before ovulation.
A pregnant client asks the nurse if the fetus can be tested for Down syndrome. Which statement by the nurse is most appropriate? "Yes, a chromosomal analysis can be done to assess for Down syndrome." "Of course. The primary health care provider can prescribe a DNA analysis for this." "You need to be sure you want to know this information before you think about being tested." "When you have ultrasounds done, they look for signs of Down syndrome."
A Chromosomal analysis is part of the genetic testing for Down syndrome. The nurse would state this for the client to directly answer the client's question. A DNA analysis may be used in the detection of genetic diseases. The nurse should not avoid answering the client's question. While features of Down syndrome may be seen on ultrasound, the client asked if testing could be completed and the nurse should address this question.
The nurse is conducting an initial history and assessment on a client at 10 weeks' gestation who is pregnant with her first child. Which question is a priority for the nurse to ask the client at this time? "Does anyone in your or the father's family have any genetic disorders?" "Do you plan to breastfeed or bottle feed your new baby?" "Are you planning to develop a birth plan for use during the birthing process?" "Was your mother or grandmother diagnosed with gestational diabetes?"
A Due to the timing of the client's pregnancy, it is a priority for the nurse to assess for potential risk factors for genetic abnormalities. The client is in the appropriate time frame to begin genetic testing if desired. The nurse will determine the client's feeding preference and plans to have a birth plan closer to birth to allow the client time to research these topics and make an informed decision about both. Gestational diabetes is not thought to be genetic in nature. The client will be tested for gestational diabetes regardless of family history during her second trimester.
A 25-year-old woman who underwent genetic testing has learned that she is heterozygous dominant for Huntington disease. Her male partner, however, who also underwent the testing, is free from the trait. What statement by the woman would indicate an understanding of the risk of their child developing Huntington disease? "Since my partner does not carry the trait and I do, there is a 50% chance that each of our children will either carry the trait or develop the disease." "Since one of us carries the trait and the other does not, there is a 25% chance each of our children will be a carrier of the trait." "Because I am heterozygous dominant and my partner is not, each of our children will not develop or be a carrier of the disease." "Each of our children has a 75% chance of developing Huntington disease."
A Huntington disease is inherited in an autosomal dominant manner. This means that a person with the mutation in only one of the two copies of the gene will have the condition. This client is heterozygous dominant. Her male partner has no copies of the mutated gene. Thus, each of the couple's children has a 50% chance to have Huntington disease and a 50% chance to be a carrier of the disease.
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? If the fetus becomes stressed, the meconium is released into the amniotic fluid, placing the fetus at risk for pneumonia. Meconium-stained fluids cause an increased risk of jaundice. Abdominal distension occurs and infection can set in. The fetus can become constipated following birth.
A 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.
The nurse is performing a newborn examination. What assessment finding by the nurse may identify potential chromosomal anomalies? ears set below the level of the eyes two creases of the palms flexed muscle tone presence of acrocyanosis
A Low-set ears may be associated with trisomy 13 or trisomy 18 and is an abnormal finding. Acrocyanosis is a normal finding on newborn assessment in the first 24 hours and is not associated with chromosomal anomalies. Two creases on the palms is a normal finding; a single palmar crease may be associated with trisomy 21. Flexed muscle tone is a normal finding; decreased muscle tone may be associated with trisomy 21.
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? Many spontaneous abortions (miscarriages) occur due to chromosomal disorders and this testing may determine if this is the cause. This testing will help to determine if your hormone levels are causing the recurrent spontaneous abortions (miscarriages). It will reassure you to find out if the baby had anomalies that were not compatible with life. If you do not want to have this testing done, we will respect that decision.
A 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.
A woman at 15 weeks' gestation is about to undergo amniocentesis. Which nursing intervention should be made first? Obtain a signed consent form. Have the client void. Place the client in supine position. Observe the fetal heart rate monitor.
A Nursing responsibilities for assessment procedures include seeing a signed consent form has been obtained as needed (necessary if the procedure poses any risk to the mother or fetus that would not otherwise be present, as is the case with amniocentesis). All of the answers are nursing interventions that should be made before or during amniocentesis, but having the client sign a consent form should be completed before the others.
The term that describes the percentage of individuals known to carry the gene for a trait and who actually manifest the condition is: penetrance. pedigree. genotype. variable expression.
A Penetrance is the percentage of persons known to have a particular gene mutation and who actually show the trait. Pedigree is a first step in establishing the pattern of inheritance. A genotype consists of the genes and variations therein that a person inherits from his or her parents. Variable expression is the variation in the degree to which a trait is manifested.
A woman is taking vaginal progesterone suppositories during her first trimester because her body does not produce enough of it naturally. She asks the nurse what function this hormone has in her pregnancy. What should the nurse explain is the primary function of progesterone? maintains the endometrial lining of the uterus during pregnancy ensures the corpus luteum of the ovary continues to produce estrogen contributes to mammary gland development regulates maternal glucose, protein, and fat levels
A Progesterone is necessary to maintain the endometrial lining of the uterus during pregnancy. It is human chorionic gonadotropin (hCG) that acts to ensure the corpus luteum of the ovary continues to produce estrogen and progesterone. Estrogen contributes to mammary gland development, and human placental lactogen regulates maternal glucose, protein, and fat levels.
A nurse is conducting a presentation at a community health center about congenital malformations. The nurse describes that some common congenital malformations can occur and are recognized to be caused by multiple genetic and environmental factors. Which example would the nurse most likely cite? spina bifida color blindness hemophilia cystic fibrosis
A Spina bifida is a multifactorial inherited disorder thought to be due to multiple genetic and environmental factors. Cystic fibrosis is considered an autosomal recessive inherited disorder, while color blindness and hemophilia are considered X-linked inheritance disorders.
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? chorion and amnion chorion and endoderm ectoderm and amnion amnion and mesoderm
A The chorion and amnion are the two fetal membranes. The ectoderm, mesoderm, and endoderm are layers in the developing blastocyst.
A nurse overhears a colleague tell a client that based on the genetic testing results she should terminate the pregnancy. Which action is most appropriate for the nurse to take? Immediately stop the nurse. Tell the unlicensed assistive personnel Call the client later and apologize. Contact the health care provider.
A The nurse should interrupt the nurse and remind him or her that it is important not to impose personal values onto the client.
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? 16 weeks 30 weeks 10 weeks 24 weeks
A The nurse should tell the client that an amniocentesis is typically scheduled between 15 and 18 weeks' gestation.
A client who is 37 years of age presents to the health care clinic for her first prenatal checkup. Due to her advanced age, the nurse should prepare to talk with the client about her increased risk for what complication? genetic disorders preterm labor gestational diabetes cervical insufficiency
A Women over the age of 35 are at increased risk of having a fetus with an abnormal karyotype or other genetic disorders. Gestational diabetes, cervical insufficiency, and preterm labor are risks for any pregnant woman.
A 40-year-old client is in her 10th week of pregnancy. So far, her pregnancy appears to be healthy, with no abnormal results from standard diagnostic tests. Because of her age, however, the nurse would anticipate that the client is a candidate for which diagnostic tests? Select all that apply. cell-free DNA testing chorionic villus sampling amniocentesis maternal serum screening nuchal translucency screening
A, B, C Chorionic villus sampling (CVS), amniocentesis, and cell-free DNA testing are all techniques that may be offered to women who are older than 35 years of age, or to those whose triple/quadruple screen is abnormal, to further screen for genetic disorders. CVS is generally performed 10 to 13 weeks after the LMP. Women of all ages are offered routine sonogram screening (a nuchal translucency scan) and analysis of maternal serum levels of alpha-fetoprotein (MSAFP) by a quadruple screen early in pregnancy to evaluate for neural tube, abdominal wall, or chromosomal disorders in the fetus.
When describing to parents at a genetic counseling session the probability of their newborn inheriting cystic fibrosis, the nurse would include which statement? Select all that apply. "There is a 50% chance of inheriting one normal gene and one abnormal gene." "Children of two carriers of the disorder have a 25% chance of inheriting two normal genes." "Cystic fibrosis is an X-linked inheritance when the male is a carrier." "Cystic fibrosis is a multifactorial inherited disorder mainly caused by the environment." "Cystic fibrosis is an inherited disorder where two abnormal genes are needed."
A, B, E Autosomal recessive inherited disorders occur when two copies of the abnormal gene are necessary to demonstrate signs and symptoms of the disorder. Both parents of the affected person must be carriers of the gene. Offspring of two carriers of the abnormal gene have a 25% chance of inheriting two normal genes, a 50% chance of inheriting one normal gene and one abnormal gene (carrier), and a 25% chance of inheriting two abnormal genes. Common types of genetic disorders that follow the autosomal recessive inheritance pattern include cystic fibrosis. The X-link and multifactorial inheritance disorders do not correlate to cystic fibrosis.
During a clinical rotation at a prenatal clinic, a client asks a nurse what causes certain birth defects. The nurse replies that they can be caused by teratogens. What does the severity of the defects depend on? Select all that apply. when during development the conceptus is exposed to the teratogen the age of the father the particular teratogen to which the fetus is exposed the age of any siblings the food preferences of the father
A, C A teratogen is a substance that causes birth defects. The severity of the defect depends on when during development the conceptus is exposed to the teratogen and the particular teratogenic agent to which the fetus is exposed.
The nurse prepares a couple to have a karyotype performed. What describes a karyotype? a blood test that will reveal an individual's homozygous tendencies a visual presentation of the chromosome pattern of an individual the gene carried on the X or Y chromosome the dominant gene that will exert influence over a correspondingly located recessive gene
B A karyotype is a photograph of a person's chromosomes aligned in order.
At a prenatal checkup with a client at 7 weeks' gestation, the nurse would identify what as a normal finding? Quickening is detected by the mother. Fetal heart sounds are heard. Gender identity is determined with ultrasound. The fetus would have a startle reflex.
B Although the heart is not fully developed, it begins to beat at week 5, and a regular rhythm and can be heard at week 7. Quickening is felt around week 13. Gender identity can be determined at weeks 9 to 12. The startle reflex can be seen around weeks 21 to 24.
A nurse is conducting a presentation for a group of nurses at the prenatal clinic on basic genetic information. After teaching the group about genetics, the nurse determines that the teaching was effective based on which statement by the group? "A secondary goal of determining my genome is to find new treatments." "My genome is my genetic blueprint." "My parents gave me good phenotypes." "Your outward characteristics show some interesting genotypes."
B An individual's genome represents his or her genetic blueprint, which determines genotype (the gene pairs inherited from parents) and phenotype (observed outward characteristics of an individual). A primary goal of human genome project (HGP) is to translate the findings into new strategies for the prevention, diagnosis, and treatment of genetic diseases and disorders.
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? "I can refer you to pastoral care for help in making this decision." "Can you tell me about your beliefs and values related to this decision?" "How do you feel about your ability to care for a child with an impairment?" "Would you like to meet other families who have a child with trisomy 13?"
B 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.
A number of inherited diseases can be detected in utero by amniocentesis. Which disease can be detected by this method? diabetes mellitus trisomy 21 (Down syndrome) phenylketonuria impetigo
B Karyotyping for chromosomal defects can be carried out using amniocentesis.
A client at 38 weeks' gestation is diagnosed with placental insufficiency. Which prescription from the health care provider will the nurse anticipate? Assess the client's blood pressure every 2 hours. Prepare the client for an induction of labor. Administer one dose of betamethasone. Discharge the client home with daily nonstress testing.
B 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.
A couple has just been notified that their unborn child carries a genetic disorder. The couple expresses concern that the insurance company will not cover the costs associated with the medical bills for the child. What is the most appropriate response by the nurse? "The insurance company may consider it a preexisting condition since you know." "There are laws in place that prohibit that from happening." "The insurance company may ask you to change policies once the baby is born." "They will charge you a higher premium every month."
B The Genetic Information Nondiscrimination Act of 2008 prohibits insurance companies from denying coverage or charging higher premiums based solely on genetic predisposition.
The nursing instructor is illustrating the fetal circulation to a group of nursing students. The instructor determines the session is successful after the students correctly choose which main structure is most responsible for providing nutrition and removing waste from the fetus? placenta mother's blood amniotic fluid umbilical cord
B The mother's blood is the structure most responsible for providing nutrition and removing waste from the fetus. The placenta and umbilical cord provide the passage for the blood to move back and forth. Without the mother's blood, the fetus would not be able to survive or get nutrition or send its waste products away. The amniotic fluid provides various functions but is not mainly responsible for providing nutrition or removing waste.
The nurse is caring for four pregnant clients. Which client will the nurse highlight for the health care provider as being at highest risk for carrying a child with a genetic abnormality? 38-year-old client whose partner is 43 years of age and who have a child diagnosed with hypoplastic left heart syndrome 36-year-old client with thalassemia whose partner is 55 years of age and who have a son with Duchenne muscular dystrophy 28-year-old client diagnosed with hemophilia whose partner is 38 years of age and has hypertension 17-year-old client diagnosed with schizophrenia whose partner is 15 years of age and has type 2 diabetes
B The nurse knows the 36-year-old client with thalassemia whose partner is 55 years of age and have a son with Duchenne muscular dystrophy is at highest risk with 3 risk factors. Maternal age of 35 or older, paternal age 50 or older, having a genetic disorder (such as thalassemia or hemophilia) already having a child with a genetic disorder (such as Duchenne muscular dystrophy), family history of genetic disorders, and exposure to a known risk factor (such as certain drugs or infections) are all known risk factors. Nongenetic disorders which are not risk factors include type 2 diabetes, hypoplastic left heart syndrome, hypertension, and schizophrenia.
A 33-year-old pregnant client asks the nurse about testing for birth defects that are safe for both her and her fetus. Which test would the nurse state as being safe and noninvasive? amniocentesis ultrasound chorionic villus sampling percutaneous umbilical cord sampling
B The nurse would state that an ultrasound is a noninvasive test that is completely safe for both mother and child. Amniocentesis, chorionic villus sampling, and percutaneous umbilical cord sampling are invasive tests that are associated with maternal and fetal risk.
A nurse is discussing the importance of good nutrition to a young pregnant client. The nurse would point out that the growing fetus is getting nutrition from the mother via which structure? decidua placenta amniotic fluid umbilical arteries
B The placenta is a flat, round structure which forms on the decidua and attaches to the fetus by the umbilical cord. The placenta is the organ responsible for supplying nutrients and oxygenated blood to the fetus. The amniotic fluid surrounds the fetus and provides protection, temperature regulation, allows movement, and symmetric growth. It collects urine and other waste products from the fetus. The decidua is the name given to the endometrium after the pregnancy starts. The umbilical arteries carry waste products away from the fetus to the placenta, where they are filtered out into the maternal body for proper disposal.
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? Identify the best decision to be taken for the client. Refer the client to another specialist for a second opinion. Review what has been discussed with the specialist. Refer the client for further diagnostic and screening tests.
C 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.
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: is a screening test for placental function. measures the fetal liver function. may reveal chromosomal abnormalities. tests the ability of her heart to accommodate the pregnancy.
C An alpha-fetoprotein analysis is a cost-effective screening test to detect chromosomal and open-body-cavity disorders.
A nurse is conducting a class for nursing students on genetic inheritance and is focusing specifically on X-linked recessive disorders. Which statement by a nursing student would indicate appropriate learning has occurred? "If the male does not have it, the children will not either." "If the female is the carrier, the sons may have the disorder." "If the female is the carrier, the daughter can be too." "Males cannot be carriers if they do not have the disorder."
C Because females have two X chromosomes, if they receive an X-linked recessive disorder from the mother, they can be a carrier of the disorder just like the mother.
The nurse is caring for a child with Down syndrome (trisomy 21). This is an example of which type of inheritance? Mendelian recessive Mendelian dominant chromosome nondisjunction phase 2 atrophy
C Down syndrome occurs when an ovum or sperm cell does not divide evenly, permitting an extra 21st chromosome to cross to a new cell.
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? "This disorder is carried on the X chromosome so only your female children would be affected." "Both genes of a pair must be abnormal for the disorder to occur in your children." "Each of your children will have a 50% chance of inheriting the disease." "Your male children are more likely to be affected than your female children."
C 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.
A nurse is teaching a class on genetic disorders for pregnant couples who have recently been told their unborn child has a genetic disorder. Which statement would be important for the nurse to include? "Genetic disorders occur when you expose yourself to harmful chemicals." "Genetic disorders occur during proliferation of cell growth. "Genetic disorders occur at the moment an ovum and sperm fuse." "Genetic disorders occur because you were predestined for it."
C Many parents blame themselves for genetic disorders and try to identify ways in which they could have prevented the disorder from occurring. The nurse should teach the parents that genetic disorders occur at the moment the ovum and sperm fuse or in some instances before that occurs.
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? sickle cell anemia beta-thalassemia Tay-Sachs disease Down syndrome
C 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.
A client who has one child with a genetic disorder tells the nurse, "I told my husband I was ready to have another baby and now he does not want to be intimate with me." What is the most appropriate nursing diagnosis for this client's husband? Hopelessness related to increased tension Risk for loneliness related to lack of communication Altered sexuality pattern related to fear Ineffective coping related to personal issues
C The client's husband may be not engaging in intercourse because he is afraid of conceiving a second child with a genetic disorder. The nurse should identify resources for the client that allow for increased communication and education for the couple.
A nurse is present when a health care provider tells a couple that the results of their genetic testing came back normal. Later, the nurse notes that the completed genetic report identifies the couple positive for a genetic disorder. What is the most appropriate action by the nurse? Call the couple and tell them the truth. Do nothing; it is not the nurse's decision. Report it to the nursing supervisor. Call the medical review board.
C The nurse has an obligation to report unethical behavior and should report the discrepancy to the nursing supervisor.
A pregnant client is undergoing an amniocentesis in her third trimester and is worried why she is undergoing this procedure. Which statement by the nurse would best alleviate this client's anxieties? "This procedure is not very dangerous and you should not worry about it." "The doctor can explain everything to you when we are done with the procedure." "We want to be sure your baby's lungs are mature and this measures the development of the baby's lungs. "We are concerned that your baby may have some genetic disorder."
C The purpose of an amniocentesis is to determine if the lungs of the fetus are mature enough to support respirations outside the womb. Additionally, an amniocentesis is done for genetic testing for a variety of disorders. Telling the client that there might be a genetic disorder would only escalate the mother's concerns, not alleviate them. Telling the client the procedure is not dangerous or that the doctor will explain things after the amniocentesis does not address her concerns; rather, it minimizes them.
When educating parents on recessive genetic disease statistics, the nurse understands that which statement by the parents indicates an accurate understanding of genetic inheritance? "With each child the odds of inheritance decrease significantly." "My children will have a 50/50 chance of having a genetic disease." "Each child will have a 25% chance of developing the disease." "If I have four children, only one will have the disease."
C The statistics of inheritance are reset with each pregnancy; therefore, each pregnancy has the same statistical probability of displaying the genetic disease.
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? fetal pre-embryonic post-embryonic embryonic
D 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.
In developing a plan of care for a 5-year-old child with Down syndrome, what should be a priority for the nurse in meeting the expected growth and development outcomes for this child? The child is placed in a home facility. The child stays at home with a parent. The child is kept in a day care setting. The child is enrolled in kindergarten.
D All children are granted the opportunity to learn in the public school system regardless of their intellectual ability. To meet the child's growth and development outcomes, the child should be enrolled in kindergarten so that he or she has an opportunity to learn and play with others of the same age.
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? "Your health care provider will let you know if there are any problems with your baby." "We will have to see what gestational age your baby was at exposure." "We will need to perform some additional tests." "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."
D All organ systems are complete at 8 weeks gestation. During this time of organogenesis the growing structure is most vulnerable to invasion by teratogens.
A client's older child has sickle-cell anemia, an autosomal recessive disorder. The client is now pregnant with a new partner and asks about the chances of this child having sickle-cell anemia. How does the nurse respond? Because this child is female, the child will not be affected by sickle-cell anemia. You will need to check with your health care provider about this question. Because you are a sickle-cell gene carrier, the child has a 50% chance of being affected. Sickle-cell anemia is a recessive gene, so the child will be affected only if your new partner also carries this gene.
D Autosomal recessive disorders, such as sickle-cell anemia, are inherited when both parents are carriers of the gene. They are not sex-linked. Because this pregnancy is with a new partner, inheritance of the disorder is only possible if the new partner is also a carrier of this gene.
The nurse is creating an educational pamphlet for pregnant mothers. Which is the best description of fetal development for the nurse to emphasize? length, weight, sex age in weeks and systems developed sex and systems developed gestational age, length, weight, and systems developed
D Client education is a major component of maternal-child nursing. During pregnancy, nurses provide anticipatory guidance to prepare the woman and her significant other for the changes each month brings. Clients most often want to know gestational age in weeks, length, weight, and systems developed; the client is then able to visualize what the fetus looks like.
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? The end of the first trimester The end of the fourth trimester The end of the third trimester The end of the second trimester
D 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.
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? Explain that there is only a 25% chance of this pregnancy being affected. Refer the family to grief counseling for support during this pregnancy. Ensure they are aware that, if this child is affected, they can terminate the pregnancy. Discuss options for genetic screening in this pregnancy to determine if the fetus is affected.
D 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.
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? They do not have a genetic basis. They are caused by a single gene. They are a direct result of the client's lifestyle. They are multifactorial.
D 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.
A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as the: genotype. genome. allele. phenotype.
D Phenotype refers to a person's outward appearance or the expression of genes. Alleles are two like genes. Genotype refers to his or her actual gene composition. Genome is the complete set of genes present in a person.
For which client is preimplantation genetic diagnosis (PGD) a viable option? client who had a miscarriage at 15 weeks' gestation client who is currently 32 years of age client in the second week of pregnancy client whose partner has cystic fibrosis
D 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.
Which genetic condition is caused by a small gene mutation that affects protein structure, producing hemoglobin S? Marfan syndrome hemophilia Tay-Sachs disease sickle cell anemia
D 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.
The parents are questioning why their newborn was born deaf when there are no other deaf family members. The nurse could explore possible exposure to a teratogenic agent at which stage of the pregnancy? 12 weeks at fertilization 18 weeks 6 weeks
D Teratogenic agents ingested during the embryonic stage (2 to 8 weeks) can affect the neurologic system of the fetus, including the hearing. During weeks 6 through 8, the ear is most vulnerable to teratogenic agents. From the preembryonic stage of fertilization to the beginning of week 2, there is decreased risk due to no implantation or transfer of substances from the mother to the developing blastocyte. During the fetal stage (9 weeks to birth), the fetus is fully formed and is now concentrating on increasing in size. There is a decreased risk from teratogenics during this time period.
Which question would be most important for a nurse to ask a G2P1 client who has a child with sickle cell anemia? "When was your last exacerbation?" "Have you done well to control your stress?" "Do you know the sex of your baby?" "Did you and your partner get genetic testing?"
D The nurse should assess whether the client has had genetic testing completed. If not, the client should be referred for testing.
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? The karyotype will provide information about the severity of your baby's condition. The karyotype will determine the treatment needed for the infant. A karyotype is useful in determining the potential complications the baby may face as a result of its condition. The karyotype will assess the baby's chromosomal makeup.
D 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.
A mother has come to the clinic with her 13-year-old daughter to find out why she has not started her menses. After a thorough examination and history, genetic testing is prescribed to rule out which abnormality? cri du chat syndrome fragile X syndrome Klinefelter's syndrome Turner syndrome
D Turner syndrome is a common abnormality of the sex chromosome in which a portion or all of the X chromosome is missing. Only about one third of the cases are diagnosed as newborns; the remaining two thirds are diagnosed in early adolescence when they experience primary amenorrhea. No cure exists for this syndrome. Hormone replacement therapy may be used to induce puberty.
A nurse is interviewing the family members of a pregnant client to obtain a genetic history. While asking questions, which information would be most important? avoidance of questions on race or ethnic background socioeconomic status of the family members specific physical characteristics of family members if couples are related to each other or have blood ties
D While obtaining the genetic history of the client, the nurse should find out if the members of the couple are related to each other or have blood ties, as this increases the risk of many genetic disorders. The socioeconomic status or the physical characteristics of family members do not have any significant bearing on the risk of genetic disorders. The nurse should ask questions about race or ethnic background because some races are more susceptible to certain disorders than others.
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? "Because this is an X-linked recessive trait, any male children will not be affected." "There are more affected females than males with this particular trait." "There is a good chance all my future children will be affected with this trait." "Each time I have a child, there is a 25% chance a female child will be a carrier."
D 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."
A client with symptoms of pregnancy is having an ultrasound is to determine the gestation of the pregnancy. The nurse explains that the visualization of different developmental milestones correlates with the gestation of the pregnancy. Place the following developmental milestones in order, from earliest to latest, as they appear during the first trimester. Use all options. Gestational sac Spine formation Cardiac pulsation Formation of limb buds
Gestational sac Cardiac pulsation Spine formation Formation of limb buds
