Maternal & Child Health Nursing Chapter 8

Which question would be most important for a nurse to ask a G2 P1 client who has a child with sickle cell anemia? A) "Did you and your partner get genetic testing?" B) "Have you done well to control your stress?" C) "Do you know the sex of your baby?" D) "When was your last exacerbation?"

A) "Did you and your partner get genetic testing?" The nurse should assess whether the client has had genetic testing completed. If not, the client should be referred for testing.

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) Tay-Sachs B) sickle cell anemia C) b-thalassemia D) Down syndrome

A) Tay-Sachs Sickle cell anemia occurs most often in African Americans, Tay-Sachs disease occurs most often in people of Jewish ancestry. B-thalassemia is a blood dyscrasia that occurs frequently in families of Greek or Italian heritage. Down syndrome is not attributed to Jewish ancestry.

A recently married couple come to the prenatal clinic because they are concerned about genetic testing. The husband is of Jewish heritage. What testing should the nurse recommend to the couple? A) Tay-Sachs disease B) Turner syndrome C) cystic fibrosis D) Down syndrome

A) Tay-Sachs disease Tays-Sachs disease is a autosomal recessive disorder that occurs primarily in Ashkenazi Jews.

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? A) The child is enrolled in kindergarten. B) The child stays at home with a parent. C) The child is placed in a home facility. D) The child is kept in a daycare setting.

A) The child is enrolled in kindergarten. 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.

Prenatal testing is used to assess for genetic risks and to identify genetic disorders. In explaining to a couple about an elevated alpha-fetoprotein screening test result, the nurse would discuss the need for: A) further, more definitive evaluations to conclude anything. B) special care needed for a Down syndrome infant. C) a more specific determination of the acid-base status. D) immediate termination of the pregnancy based on results.

A) further, more definitive evaluations to conclude anything. Increased maternal serum alpha fetoprotein levels may indicate a neural tube defect, Turner syndrome, tetralogy of Fallot, multiple gestation, omphalocele, gastroschisis, or hydrocephaly. Therefore, additional information and more specific determinations need to be done before any conclusion can be made. Down syndrome is associated with decreased maternal serum alpha fetoprotein levels. This type of testing provides no information about the acid-base status of the fetus. Immediate termination is not warranted; more information is needed.

A nurse is interviewing a couple at a preconception counseling session. The couple is of Greek heritage and are concerned about the possibility of their children being born with a genetic disorder. Based on the nurse's understanding of genetic disorders, the nurse would identify this couple as being at risk for which conditon? A) β-thalassemia B) sickle cell anemia C) α-thalassemia D) Tay-Sachs disease

A) β-thalassemia Different ancestry backgrounds cause different genetic disorders to be more common in some ethnic groups than in others. The blood disorder β-thalassemia, for example, occurs most frequently in families of Greek or Mediterranean heritage, whereas α-thalassemia occurs most often in persons from the Philippines or southeast Asia. Sickle-cell anemia occurs most often in people with an African ancestry. Tay-Sachs disease, a deterioration of muscle and mental facilities, occurs most often in people of eastern Jewish ancestry.

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) Decisional conflict related to continuation of pregnancy C) Situational low self-esteem D) Deficient knowledge related to inheritance pattern

B) Decisional conflict related to continuation of pregnancy The client is unsure as to whether to continue the pregnancy or terminate it as evidenced by the question she asked the nurse.

A Spanish-speaking couple comes in for genetic testing. They are planning to start a family and are concerned because the wife's sister has a genetic disorder. The clinic's consent form is in English and the husband is speaks only Spanish. The nurse does not speak Spanish. What should the nurse do? A) Inform the couple they just needed to sign so the testing could be done B) Informing the geneticist that the couple cannot give informed consent C) Explain the form to the patient in English and have them sign it D) Let the wife translate for her husband

B) Informing the geneticist that the couple cannot give informed consent Nurses assess the patient's capacity and ability to give voluntary consent. This includes assessment of factors that may interfere with informed consent, such as hearing loss, language differences, cognitive impairment, and the effects of medication. The nurse's best action is to inform the geneticist that the couple cannot give informed consent until a translator is available. The other answers are incorrect because just having the couple sign the form or explaining it in English and then having them sign the form does not allow you to know that the husband understands what he is signing. The wife cannot translate for her husband because you do not know it she is translating the document correctly.

To screen for chromosomal disorders, a 39-year-old woman is scheduled for a circulating cell-free DNA test. What type of test is this? A) skin biopsy B) blood specimen collection C) ultrasound D) urine specimen collection

B) blood specimen collection Women over the age of 35 may be offered a more accurate, noninvasive blood test, circulating cell-free DNA (cfDNA) testing, to screen for chromosomal disorders.

Girls with Turner syndrome will usually exhibit: A) painful joints. B) short stature. C) progressive dementia. D) chorealike movements.

B) short stature. Girls with Turner syndrome usually have a single X chromosome, causing them to have short stature and infertility. Persons with sickle cell anemia have painful joints. Color blindness occurs in persons diagnosed with Huntington disease, and they may exhibit chorealike movements. Progressive dementia occurs in early-onset familial Alzheimer disease.

A nurse working as a member of a genetic counseling team understands that her careful assessment of which body areas in a newborn may provide important indications for structural genetic disorders? A) Length, weight, and head circumference B) Presence or absence of primitive reflexes C) Space between the eyes, the shape of the ears, and the numbers of fingers and toes D) Color of the eyes, skin color, and parent's race

C) Space between the eyes, the shape of the ears, and the numbers of fingers and toes Genetic disorders vary in their degree of representation. Therefore, assessment of body areas such as the space between the eyes, the shape of the ears and the number of digits may provide findings that indicate a genetic defect such as low set ears in Trisomy 18 or 13. Length, weight, and head circumference are standard measures of any newborn. Presence or absence of primitive reflexes provides information about the neurological status of a newborn not about structural disorders, and the color of the patient's eyes, skin color, and parent's race, may give information about the child's ethnicity but not are not structural in nature.

Parents of a newborn have recently found out that their infant has a genetic disorder. The parents say to the nurse, "It's not fair that this is happening to us." The nurse interprets this statement as reflecting which stage of grief? A) shock and denial B) reorganization C) anger D) acceptance E) bargaining

C) anger Parental reactions to the knowledge their child has a possible genetic disorder or to the birth of a child with a genetically inherited disorder usually involves a grief reaction, similar to that experienced by parents whose child has died at birth (their "perfect" child is gone). Both parents may pass through stages of shock and denial ("This cannot be true"), anger ("It's not fair this happened to us"), and bargaining ("If only this would go away") before they reach reorganization and acceptance ("It has happened to us, and it is all right").

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

C) gathering relevant family and medical history information The nurse's role in genetic counseling is to provide information, collect relevant data, offer support, and coordinate resources. The other answers are incorrect because the nurse does not provide advice or influence the client to make choices. The nurse also does not identify genetic markers.

An African American couple presents for a genetic counseling appointment. They are pregnant and are concerned about their child. This couple would have genetic testing for what condition? A) Meckel's diverticulum B) rubella C) sickle cell anemia D) asthma

C) sickle cell anemia Assessing ancestry and ethnicity is important to help identify individuals and groups who could benefit from genetic testing for carrier identification, such as African Americans routinely offered testing for sickle cell anemia. The other answers are incorrect because they are not identified with the African American race.

Which condition is the most commonly occurring chromosomal disorder? A) Turner syndrome B) fragile X C) trisomy 21 D) Klinefelter syndrome

C) trisomy 21 Trisomy 21, the most frequently occurring chromosomal disorder, occurs in about 1 in 800 pregnancies. In women who are older than 35 years of age, the incidence is as high as 1 in 100 live births. Fragile X syndrome is the most common cause of intellectual disability in males. Children with Klinefelter syndrome are males with an extra X chromosome; the child with Turner syndrome (gonadal dysgenesis) has only one functional X chromosome. Neither disorder is considered the most common chromosomal disorder.

While talking with a pregnant woman who has undergone genetic testing, the woman informs the nurse that her baby will be born with Down syndrome. The nurse understands that Down syndrome is an example of: A) X-linked recessive inheritance. B) multifactorial inheritance. C) trisomy numeric abnormality. D) chromosomal deletion.

C) trisomy numeric abnormality. Down syndrome is an example of a chromosomal abnormality involving the number of chromosomes, in particular chromosome 21, in which the individual has three copies of that chromosome. Multifactorial inheritance gives rise to disorders such as cleft lip, congenital heart disease, neural tube defects, and pyloric stenosis. X-linked recessive inheritance is associated with disorders such as hemophilia. Chromosomal deletion is involved with disorders such as cri du chat syndrome.

A couple has just learned that their son will be born with Down syndrome. The nurse shows a lack of understanding when making which statement? A) "We have counseling services available, and I recommend them to everyone facing these circumstances." B) "I will support you in any decision that you make." C) "I will give you as much information as I can about this condition." D) "I will alert your entire family about this so you don't have to."

D) "I will alert your entire family about this so you don't have to." It is necessary to maintain confidentiality at all times, which prevents health care providers from alerting family members about any inherited characteristic unless the family member has given consent for the information to be revealed.

A couple is discussing starting a family with the nurse. When should the nurse suggest genetic counseling? A) in the second trimester B) after conception C) before the second child D) before they conceive

D) before they conceive The best time for genetic testing is prior to conception. This allows for the couple to discuss risks and plan appropriately.

The nurse is developing a presentation for a community group of young adults discussing fetal development and pregnancy. The nurse would identify that the sex of offspring is determined at the time of: A) formation of morula. B) meiosis. C) oogenesis. D) fertilization.

D) fertilization. Sex determination occurs at the time of fertilization. Meiosis refers to cell division resulting in the formation of an ovum or sperm with half the number of chromosomes. The morula develops after a series of four cleavages following the formation of the zygote. Oogenesis refers to the development of a mature ovum, which has half the number of chromosomes.

Women having in vitro fertilization (IVF) can have both the egg and sperm examined for genetic disorders of single gene or chromosome concerns before implantation. False True

True