Maternal Success Sexuality, Fertility, and Genetics

18. The nurse is providing counseling to a group of sexually active single women. Most of the women have expressed a desire to have children in the future, but not within the next few years. Which of the following actions should the nurse suggest the women take to protect their fertility for the future? Select all that apply. 1. Use condoms during intercourse. 2. Refrain from smoking cigarettes. 3. Maintain an appropriate weight for height. 4. Exercise in moderation. 5. Refrain from drinking carbonated beverages.

1 2 3 4 There are a number of factors that can affect fertility. Some of the factors are beyond a woman's control. For example, a woman may not marry until she is in her 30s and, consequently, may delay conception. Other factors, such as smoking cigarettes and exercising, are controllable.

A Roman Catholic couple is infertile. Their health care practitioner advises them that their best chance of getting pregnant is via in vitro fertilization with a mixture of the man's sperm and donor sperm. Which of the following issues, related to this procedure, should the nurse realize may be in conflict with the couple's religious beliefs? Select all that apply. 1. The man will ejaculate by masturbation into a specially designed condom. 2. The woman may become pregnant with donor sperm. 3. Fertilization is occurring in the artificial environment of the laboratory. 4. More embryos will be created than will be used to inseminate the woman. 5. The woman will receive medications to facilitate the ripening of her ova.

1 2 3 4 This is an alternateform question. It is critical to heed the notation, "Select all that apply." When discussing reproductive rights and practices, religious imperatives are often important issues to consider.

During a genetic evaluation, it is discovered that the woman is carrying one autosomal dominant gene for a serious late adult-onset disease, while her partner's history is unremarkable. Based on this information, which of the following family members and in need of genetic counseling? Select all that apply. 1. The woman's fetus. 2. The woman's sisters. 3. The woman's brothers. 4. The woman's parents. 5. The woman's partner.

1 2 3 4 This question requires the test taker to do a reverse genetic analysis. If a woman is carrying one autosomal dominant gene, then her genotype is Aa. She received the affected gene from one of her parents and a normal gene from her other parent. One of her parents, therefore, definitely carries the gene. Because one of her parents carries the gene, each of her siblings has a 50/50 probability of carrying the gene. Because she carries the gene, her fetus has a 50/50 probability of carrying the gene. Since the woman's partner's history is unremarkable, it is unlikely that he carries the gene.

A couple that has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? Select all that apply. 1. Anger at others who have babies. 2. Feelings of failure because they can't make a baby. 3. Sexual excitement because they want so desperately to conceive a baby. 4. Sadness because of the perceived loss of being a parent. 5. Guilt on the part of one partner because he or she is not able to give the other a baby.

1 2 4 5 Couples who are experiencing infertility express many emotions. One common thread that connects all of the emotions is grief. Infertile couples grieve their inability to conceive. They experience all of the stages of grief including denial, anger, bargaining, and depression. Acceptance, if it is ever reached, often takes many years.

A couple who has sought fertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occurs? 1. The testes are overheated. 2. The vas deferens is ligated. 3. The prostate gland is enlarged. 4. The flagella are segmented.

1 A knowledge of language will help the test taker to answer this question. The suffix "genesis" means "the beginning of, origin of, or the creation of." Therefore, the question is asking which of the factors listed will affect the creation of sperm.

A woman, whose menstrual cycle is 35 days long, states that she often has a slight pain on one side of her lower abdomen on day 21 of her cycle. She wonders whether she has ovarian cancer. Which of the following is the nurse's best response? 1. "Women often feel a slight twinge when ovulation occurs." 2. "You should seek medical attention as soon as possible since ovarian cancer is definitely a possibility." 3. "Ovarian cancer is unlikely because the pain is not a constant pain." 4. "It is more likely that such pain indicates an ovarian cyst because pain is more common with that problem."

1 Although the stem includes the fact that the woman is concerned about ovarian cancer, this question is actually testing what the test taker knows about ovulation. The test taker should try not to be confused by extraneous information included in a stem.

A pregnant woman and her husband are both heterozygous for achondroplastic dwarfism, an autosomal dominant disease. The nurse advises the couple that their unborn child has which of the following probabilities of being of normal stature? 1. 25% probability. 2. 50% probability. 3. 75% probability. 4. 100% probability.

1 Because both parents are heterozygous ("hetero" meaning "different"), they each have one dominant gene or allele (A) and one recessive gene or allele (a). Therefore, the genotype of each parent is Aa. Because achondroplasia is a dominant disease, the recessive allele in this scenario is the normal gene. Only 1 of the 4 boxes contains 2 recessive (normal) genes; therefore, their child has a 1 in 4, or 25%, chance of being of normal stature.

A client complaining of secondary amenorrhea is seeking care from her gynecologist. Which of the following may have contributed to her problem? 1. Athletic activities. 2. Vaccination history. 3. Pet ownership. 4. History of asthma.

1 If unsure of the definition, the test taker should be able to deduce what is meant by secondary amenorrhea. The prefix "a" means "not" and the remainder of the word refers to the menses. A problem that is labeled "primary" is one that occurs initially. A secondary problem occurs later. A client with primary amenorrhea, therefore, is a young woman who has never had a period. A client with secondary amenorrhea is a young woman who did have periods, but whose periods have stopped. The most common cause of secondary amenorrhea is pregnancy. Many other causes, including a low body fat index, such as can result from excessive or very strenuous exercises, can also lead to amenorrhea.

A woman is a carrier for hemophilia A, an X-linked recessive illness. Her husband has a normal genotype. The nurse can advise the couple that the probability that their daughter will have the disease is: 1. 0% probability. 2. 25% probability. 3. 50% probability. 4. 75% probability.

1 It is essential when discussing X-linked recessive inheritance that the probability of boys and girls be assessed separately. Because males carry only one X, they only need one affected "x" to exhibit the X-linked recessive disease. The four offspring depicted in the Punnett square include one unaffected girl (XX), one girl who carries the gene but does not have the disease since the gene is recessive (X"x"), one normal boy (XY), and one boy who has the affected gene and therefore the disease ("x"Y). Girls must carry the affected gene on two "x" chromosomes to exhibit the disease. Thus, the probability of a girl having the disease is 0. It is important to note, however, that the probability of the daughters being carriers is 1 in 2, or 50%.

A 10-week gravid states that her sister's son has been diagnosed with an X-linked recessive disease, Duchenne muscular dystrophy. She questions the nurse about the disease. Which of the following responses is appropriate for the nurse to make? 1. "Because Duchenne muscular dystrophy is inherited through the woman, it is advisable for you to see a genetic counselor." 2. "Duchenne muscular dystrophy usually occurs as a spontaneous mutation. It is very unlikely that your fetus is affected." 3. "Your child could acquire Duchenne muscular dystrophy only if both you and your husband carried the gene. You need to check your husband's family history." 4. "If you were to have an amniocentesis and it were to be positive for Duchenne muscular dystrophy, I could recommend you to an excellent abortion counselor."

1 It is important for the test taker to realize that clients who find out that their child has a genetic disease through amniocentesis do not learn of the results until well into the second trimester. These clients, therefore, may be deciding whether to abort when they are able to feel fetal movement. Even for clients who are pro-choice, the decision to abort so late in the pregnancy can be a very difficult one.

Which statement by a gravid client who is a carrier for Duchenne muscular dystrophy, an X-linked recessive disease, indicates that she understands the implications of her status? 1. "If I have a girl, she will be healthy." 2. "None of my children will be at risk of the disease." 3. "If I have a boy, he will be a carrier." 4. "I am going to abort my fetus because it will be affected."

1 It is often especially difficult for women who carry X-linked diseases. While they, as females, are always healthy, it is their bodies that transmit the defective genes to their sons. As a result, the mothers often express a great deal of guilt.

A 25-year-old woman, G0 P0000, enters the infertility clinic stating that she has just learned she is positive for the BRCA1 and the BRCA2 genes. She asks the nurse what her options are for getting pregnant and breastfeeding her baby. The nurse should base her reply on which of the following? 1. Fertility of women who carry the BRCA1 and BRCA2 genes is similar to that of unaffected women. 2. Women with these genes should be advised not to have children because the children could inherit the defective genes. 3. Women with these genes should have their ovaries removed as soon as possible to prevent ovarian cancer. 4. Lactation is contraindicated for women who carry the BRCA1 and BRCA 2 genes.

1 Many women who have been found to carry a BRCA gene decide to have mastectomies and/or oophorectomies. Other women choose to have children and then have the procedures and still others choose to have frequent diagnostic tests to monitor for the development of cancer. Whichever path the client takes must be her decision based on accurate information provided by health care professionals.

A client is being interviewed prior to becoming pregnant. She states that she has a disease that is transmitted by mitochondrial inheritance. Which of the following statements is consistent with the client's disease? 1. 100% of her children will be affected. 2. Only her female children will be affected. 3. Each fetus will have a 50% probability of being affected. 4. A fetus will be affected only if it inherits a similar gene from its father.

1 Mitochondrial DNA is inherited through the mother only. Since all of the woman's gametes contain her mitochondrial DNA, all of her offspring will be affected.

A client asks the nurse about the gamete intrafallopian transfer (GIFT) procedure. Which of the following responses would be appropriate for the nurse to make? 1. Fertilization takes place in the woman's body. 2. Zygotes are placed in the fallopian tubes. 3. Donor sperm are placed in a medium with donor eggs. 4. A surrogate carries the infertile woman's fetus.

1 The best way for the test taker to remember the various forms of infertility therapies is to remember the definitions of the components. For example, when GIFT is being discussed, the term "gamete" (G) refers to the male or female reproductive cell—that is, the sperm or ovum. When ZIFT is being considered, the term "zygote" (Z) refers to the fertilized ovum. The prefix "intra" means "within" and the term "fallopian" refers to the fallopian tube. When GIFT (or ZIFT) is discussed, the method of transfer into the fallopian tube is via laparoscope

At her first prenatal visit, a woman relates that her maternal aunt has cystic fibrosis (CF), an autosomal recessive illness. Which of the following comments is appropriate for the nurse to make at this time? 1. "We can check to see whether or not you are a carrier for cystic fibrosis." 2. "It is unnecessary for you to worry since your aunt is not a direct relation." 3. "You should have an amniocentesis to see whether or not your child has the disease." 4. "Please ask your mother whether she has ever had any symptoms of cystic fibrosis."

1 The test taker must remember that just because there is a history of a genetic disease in the family, it does not mean that every member of the family will be affected. It is much less invasive, as well as much less expensive, to do a test on the client's blood to see whether she is carrying the CF gene than to do an amniocentesis to see whether the baby is affected. If both the father and the mother were found to be carriers, then it would be advisable to offer fetal genetic counseling to the couple.

When a nurse is teaching a woman about her menstrual cycle, which of the following is the most important change that happens during the follicular phase of the menstrual cycle? 1. Maturation of the graafian follicle. 2. Multiplication of the fimbriae. 3. Secretion of human chorionic gonadotropin. 4. Proliferation of the endometrium.

1 The test taker should always try to find a clue in the stem for the answer to the question. In this question, the test taker is requested to choose "the most important change that happens during the follicular phase." In general, things are named logically, and this case is no different. The follicular phase is the period of the menstrual cycle when the follicle matures.

12. The nurse is teaching a class on reproduction. When asked about the development of the ova, the nurse would include which of the following? 1. Meiotic divisions begin during puberty. 2. At the end of meiosis, four ova are created. 3. Each ovum contains the diploid number of chromosomes. 4. Like sperm, ova have the ability to propel themselves.

1 The test taker should be familiar with the fact that meiosis begins during puberty and that the ova age during the following years. This is the likely reason women who attempt to become pregnant after 35 years of age have an increased incidence of infertility as well as an increased probability of becoming pregnant with a Down syndrome fetus.

Once oogenesis is complete, the resultant gamete cell contains how many chromosomes? 1. 23. 2. 46. 3. 47. 4. 92.

1 The test taker should use his or her understanding of language to answer the question. Oogenesis is the development of the female egg, or ovum. (Spermatogenesis is the development of the male sperm.) In order for the fertilized egg (which is created once the ovum and sperm combine) to have the diploid or normal number of chromosomes, the ovum and sperm must each have the haploid number of chromosomes, or 23 in each.

A 54-year-old client calls her health care practitioner complaining of frequency and burning when she urinates. Which of the following factors that occurred within the preceding 3 days likely contributed to this client's problem? 1. She had intercourse with her partner. 2. She returned from a trip abroad. 3. She stopped taking hormone replacement therapy. 4. She started a weight-lifting exercise program.

1 The urinary meatus is often manipulated during foreplay and rubbed against during intercourse. To prevent a UTI, women are encouraged to urinate immediately after having intercourse to flush any bacteria from the urethral opening.

A couple is seeking infertility counseling. The practitioner has identified the factors listed below in the woman's health history. Which of these findings may be contributing to the couple's infertility? 1. The client is 36 years old. 2. The client was 13 years old when she started to menstruate. 3. The client works as a dental hygienist 3 days a week. 4. The client jogs 2 miles every day.

1 The woman was 13 years old at menarche, an age that is well within normal limits. Working as a dental hygienist has not been shown to increase one's chances of developing infertility. An excessive exercise schedule is a problem, but jogging 2 miles a day is well within the definition of moderate exercise. When women are over 35 years of age, however, their fertility often drop

It is day 17 of a woman's menstrual cycle. She is complaining of breast tenderness and pain in her lower left quadrant. The woman states that her cycle is usually 31 days long. Which of the following is an appropriate reply by the nurse? 1. "You are probably ovulating." 2. "Your hormone levels should be checked." 3. "You will probably menstruate early." 4. "Your breast changes are a worrisome sign."

1 There are two hints to the answer in this question. First, the woman has a 31-day cycle and it is day 17. It is, therefore, 14 days before the woman usually menstruates. Women usually ovulate 14 days before their menstrual periods begin. The one-sided lower quadrant pain is also a clue. Women often feel a twinge, called mittelschmerz, near the site of the ovary at the time of ovulation.

A client has just had an amniocentesis to determine whether her baby has an inheritable genetic disease. Which of the following interventions is highest priority at this time? 1. Assess the fetal heart rate. 2. Check the client's temperature. 3. Acknowledge the client's anxiety about the possible findings. 4. Answer questions regarding the genetic abnormality.

1 This is a prioritizing question. All answers, therefore, are correct. It is the test taker's responsibility to determine which response is of highest priority. The test taker should remember Maslow's Hierarchy of Needs and established procedures for providing first aid and CPR when answering prioritizing questions.

A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? 1. The couple has established a set schedule for their sexual encounters. 2. The couple has been married for more than eight years. 3. The couple lives with one set of parents. 4. The couple has close friends who gave birth to a baby within the past year.

1 When answering questions about the nursing process, it is important for the test taker to make sure that each diagnosis is independent. For example, when the nurse identifies sexual dysfunction related to decreased libido as a diagnosis, then the assessments, as well as the goals, interventions, and evaluations, must relate directly to that problem.

An infertility specialist is evaluating whether a woman's cervical mucus contains enough estrogen to support sperm motility. Which of the following tests is the physician conducting? 1. Ferning capacity. 2. Basal body temperature. 3. Culposcopy. 4. Hysterotomy.

1 When estrogen levels are high, a woman's cervical mucus is most receptive to a man's sperm. At that time, the pH of the vaginal and cervical environments is most conducive to the sperm's successful migration into the uterus and into the fallopian tubes.

The nurse is creating a pedigree from a client's family history. Which of the following symbols should the nurse use to represent a female? 1. Circle. 2. Square. 3. Triangle. 4. Diamond.

1 When the same symbols are used in all pedigrees, readers are able to analyze the results easily. Symbols that are light colored or completely uncolored depict healthy individuals. Those that are dark colored depict individuals with disease.

A nurse working in an infertility clinic should include which of the following in her discussions with the couple? 1. Adoption as an alternative to infertility treatments. 2. The legal controversy surrounding artificial insemination. 3. The need to seek marriage counseling before undergoing infertility treatments. 4. Statistics regarding the number of couples who never learn why they are infertile.

1 Whenever clients seek assistance from health care professionals, it is the obligation of the professional to provide the clients with all options of care. In the case of infertility, clients should be advised regarding infertility counseling, testing, and interventions as well as adoption strategies. The couple should determine for themselves which route(s) they wish to pursue

An infertile woman has been diagnosed with endometriosis. She asks the nurse why that diagnosis has made her infertile. Which of the following explanations is appropriate for the nurse to make? 1. "Scarring surrounds the ends of your tubes, preventing your eggs from being fertilized by your partner's sperm." 2. "You are producing insufficient quantities of follicle-stimulating hormone that is needed to mature an egg every month." 3. "Inside your uterus is a benign tumor that makes it impossible for the fertilized egg to implant." 4. "You have a chronic infection of the vaginal tract that makes the secretions hostile to your partner's sperm."

1 not caused by an infection. TEST-TAKING TIP: This question is essentially a knowledge-level question. All of the answer options relate to infertility problems, but only one is specifically related to endometriosis. It is important to have an understanding of gynecological issues since many do affect a woman's fertility.

A nurse is explaining to a client about monthly hormonal changes. Starting with day 1 of the menstrual cycle, please place the following four hormones in the chronological order in which they elevate during the menstrual cycle. 1. Follicle-stimulating hormone. 2. Gonadotropin-releasing hormone. 3. Luteinizing hormone. 4. Progesterone.

2 1 3 4 To remember the hormones of the female menstrual cycle, it is important to know definitions, especially of prefixes and suffixes. Gonadotropin is a hormone that stimulates the gonads—that is, the ovaries or the testes. Follicle-stimulating hormone stimulates the follicle, or ovum sac, to mature, while luteinizing hormone stimulates the release of the ovum from the ovary and heralds the luteal phase of the menstrual cycle (when the corpus luteum is functioning). Finally, progesterone, which is produced by the corpus luteum, rises in the woman's bloodstream.

A female client seeks care at an infertility clinic. Which of the following tests may the client undergo to determine what, if any, infertility problem she may have? Select all that apply. 1. Chorionic villus sampling. 2. Endometrial biopsy. 3. Hysterosalpingogram. 4. Serum progesterone assay. 5. Postcoital test.

2 3 4 5 There are a number of tests that are performed to assess fertility in couples. It is important to remember that many of the assessments are invasive, painful, embarrassing, and, depending on the results, may label one of the partners as the cause of the infertility. The knowledge of who is responsible for the infertility can be very difficult for some clients to learn.

Nurses working in a midwifery office have attended a conference to learn about factors that increase a woman's risk of becoming infertile. To evaluate the nurses' learning, the conference coordinator tested the nurses' knowledge at the conclusion of the seminar. Which of the following problems should the nurses state increase a client's risk of developing infertility problems? Select all that apply. 1. Women who have menstrual cycles that are up to 30 days long. 2. Women who experience pain during intercourse. 3. Women who have had pelvic inflammatory disease. 4. Women who have excess facial hair. 5. Women who have menstrual periods that are over 5 days long.

2 3 4 Women with PCOS have many symptoms: hirsutism, insulin resistance, high levels of circulating testosterone, and infertility, to name a few. To improve the chances of a woman with PCOS becoming pregnant, she is frequently prescribed Clomid (clomiphene) for the infertility and Glucophage (metformin) for the insulin resistance. Sexually transmitted infections and endometriosis may also impair a woman's fertility.

40 Which instruction by the nurse should be included in the teaching plan for an infertile woman who has been shown to have a 28-day biphasic menstrual cycle? 1. Douche with a cider vinegar solution immediately before having intercourse. 2. Schedule intercourse every day from day 8 to day 14 of the menstrual cycle. 3. Be placed on follicle-stimulating hormone therapy by the fertility specialist. 4. Assess the basal body temperature pattern for at least 6 more months.

2 A biphasic cycle on a BBT chart is evidenced by a relatively stable temperature at the beginning of the cycle, a slight dip in temperature at the time of ovulation, and a sustained rise in temperature—of at least 0.4°F for the remainder of the cycle.

Most children born into families look similar but are not exactly the same. The children appear different because homologous chromosomes exchange genetic material at which of the following? 1. Centromere. 2. Chiasma. 3. Chromatid. 4. Codon.

2 Crossing over at the chiasmata is an essential process during meiosis. DNA is exchanged between nonsister chromatids—one from the mother and one from the father. This results in the genetic variance of the species.

Which of the following is an attainable short-term goal for an 8-week gravid client who has a family history of cystic fibrosis? 1. Have a sweat chloride test done. 2. Seek out genetic counseling. 3. Undergo chorionic villus sampling. 4. Be seen by a pulmonologist.

2 Cystic fibrosis is an autosomal-recessive disease. If the woman has a family history of CF, she may be a carrier for the disease. If her partner also is a carrier, there would be a 1 in 4, or 25%, probability of the fetus having the disease and a 1 in 2, or 50%, chance of the child being a carrier. It is important for the woman to seek genetic counseling.

A woman who has had multiple miscarriages is advised to go through genetic testing. The client asks the nurse the rationale for this recommendation. The nurse should base his or her response on which of the following? 1. The woman's pedigree may exhibit a mitochondrial inheritance pattern. 2. The majority of miscarriages are caused by genetic defects. 3. A woman's chromosomal pattern determines her fertility. 4. There is a genetic marker that detects the presence of an incompetent cervix.

2 If a client has had more than two miscarriages, she and her partner should be referred to a genetic counselor. Either one of the couple may have a genetic anomaly that is affecting the viability of the fetus. In addition, a DNA sample of the products of each miscarriage should be sent for genetic analysis. Often a diagnosis can be made from the analyses.

A client is to receive Pergonal (menotropins) injections for infertility prior to in vitro fertilization. Which of the following is the expected action of this medication? 1. Prolongation of the luteal phase. 2. Stimulation of ovulation. 3. Suppression of menstruation. 4. Promotion of cervical mucus production.

2 It is possible that the test taker would not know the action of Pergonal. When the generic name is seen, however, an educated guess can be made. A "tropin" is a substance that stimulates an organ to do something. The only answer that states that an organ is being stimulated is choice 2.

60. A genetic counselor's report states, "The genetic nomenclature for this fetus is 46, XX." How should the nurse who reads this report interpret the cytogenetic results? 1. The baby is female with a normal number of chromosomes. 2. The baby is hermaphroditic male with female chromosomes. 3. The baby is male with an undisclosed genetic anomaly. 4. There is insufficient information to answer this question.

2 Karyotypes that show translocations, deletions, and other abnormalities can be very difficult to interpret, but it is relatively easy to discern monosomy and trisomy defects. The test taker must simply count the number of chromosomal pairs. If any chromosome is missing its mate or if there are 3 of any of the chromosomes, the fetus will usually exhibit a distinct syndrome. One exception to the rule is the fetus that carries multiple Y chromosomes with 1 X—for example, XYY or XYYY. In that situation, the baby will appear and, in the vast majority of cases, act normally

The nurse discusses the results of a 3-generation pedigree with the proband who has breast cancer. Which of the following information must the nurse consider? 1. The proband should have a complete genetic analysis done. 2. The proband is the first member of the family to be diagnosed. 3. The proband's first degree relatives should be included in the discussion. 4. The proband's sisters will likely develop breast cancer during their lives.

2 Per HIPAA (Health Insurance and Portability Accountability Act of 1996), a nurse who works for a health care organization must not discuss any information about a client's health information unless given express permission to do so by the patient. A patient's right to privacy includes the right to keep information confidential from relatives as well as strangers. In addition, anyone who has a genetic disease is further covered by GINA (Genetic Information Nondiscrimination Act of 2008), which requires that insurance companies and employers not discriminate against those with genetic illnesses (see http://hhs.gov/ ocr/privacy/hipaa/understanding/index. html). It is important to remember that the genetic information of one family member may affect others in the family since they, too, may carry defective genes. This knowledge can be very difficult for some family members as well as for the proband. In essence, the nurse must remember that client information must be kept confidential.

A client, G4 P4004, states that her husband has just been diagnosed with polycystic kidney disease (PKD), an autosomal dominant disease. The husband is heterozygous for PKD, while the client has no PKD genes. The client states, "I have not had our children tested because they have such a slim chance of inheriting the disease. We intend to wait until they are teenagers to do the testing." The nurse should base her reply on which of the following? 1. Because affected individuals rarely exhibit symptoms before age 60, the children should be allowed to wait until they are adults to be tested. 2. The woman may be exhibiting signs of denial since each of the couple's children has a 50/50 chance of developing the disease. 3. Because the majority of the renal cysts that develop in affected individuals are harmless, it is completely unnecessary to have the children tested. 4. The woman's husband should be seen by a genetic specialist since he is the person who is carrying the affected gene.

2 Remember to look to see which inheritance pattern is being discussed in the stem and ALWAYS complete a Punnett square before answering a question. It is very easy to become confused when being asked about Mendelian inheritance patterns.

A client's amniocentesis results were reported as 46, XY. Her obstetrician informed her at the time that everything "looks good." Shortly after birth the baby is diagnosed with cerebral palsy. Which of the following responses will explain this result? 1. It is likely that the client received the wrong amniocentesis results. 2. Cerebral palsy is not a genetic disease. 3. The genes that cause cerebral palsy have not yet been discovered. 4. The genetics lab failed to test for cerebral palsy.

2 Some couples believe that if an amniocentesis result shows that the chromosomes and genes are normal, then the baby will be normal. This is not true. Some problems are caused by teratogens, some are caused by birth injuries, and some genetic diseases are not tested for. Indeed, only a discreet number of defects can be assessed during amniocentesis. It would be financially impossible to test every fetus for every one of the thousands of genetic defects.

A client is receiving Pergonal (menotropins) intramuscularly for ovarian stimulation. Which of the following is a common side effect of this therapy? 1. Piercing rectal pain. 2. Mood swings. 3. Visual disturbances. 4. Jerky tremors.

2 The test taker must be aware that not only is infertility itself a psychological stressor but the therapy used to treat it is also a stressor. The client is given daily injections of Pergonal (a mixture of FSH and LH) for 10 days to 2 weeks. The impact of the hormonal injections can be very disruptive to the woman's psyche, leading to mood swings and, in some cases, severe depression.

A 3-month-old baby has been diagnosed with cystic fibrosis (CF). The mother says, "How could this happen? I had an amniocentesis during my pregnancy and everything was supposed to be normal!" What must the nurse understand about this situation? 1. Cystic fibrosis cannot be diagnosed by amniocentesis. 2. The baby may have an uncommon genetic variant of the disease. 3. It is possible that the laboratory technician made an error. 4. Instead of obtaining fetal cells the doctor probably harvested maternal cells.

2 There are more than 1000 genetic variants of CF. It is impossible to test for all the variants. Unfortunately, clients do not realize that amniocentesis is not 100% reliable in identifying genetic problems. In addition, not all variants are tested on the newborn screen.

A woman's temperature has just risen 0.4°F and will remain elevated during the remainder of her cycle. She expects to menstruate in about 2 weeks. Which of the following hormones is responsible for the change? 1. Estrogen. 2. Progesterone. 3. Luteinizing hormone (LH). 4. Follicle-stimulating hormone (FSH).

2 This question asks the test taker to explain a temperature rise that occurs 2 weeks prior to menstruation. It is essential for the test taker to know that ovulation usually takes place approximately 14 days before the onset of the menses. That eliminates estrogen and FSH since the temperature would have been elevated much earlier in the cycle if those hormones were responsible. LH spikes and then drops at the time of ovulation; that hormone, too, can be eliminated as a possible answer. The only hormone that becomes elevated during the latter part of the menstrual cycle is progesterone.

A woman asks the obstetrician's nurse about cord blood banking. Which of the following responses by the nurse would be best? 1. "I think it would be best to ask the doctor to tell you about that." 2. "The cord blood is frozen in case your baby develops a serious illness in the future." 3. "The doctors could transfuse anyone who gets into a bad accident with the blood." 4. "Cord blood banking is very expensive and the blood is rarely ever used."

2 Umbilical cord blood contains stem cells that are used to treat cancers and other catastrophic illnesses, like sickle cell anemia. It is administered in the same way that a bone marrow transplant is administered.

An infertile man is being treated with Viagra (sildenafil citrate) for erectile dysfunction (ED). Which of the following is a contraindication for this medication? 1. Preexisting diagnosis of herpes simplex 2. 2. Nitroglycerin ingestion for angina pectoris. 3. Retinal damage from type I diabetes mellitus. 4. Postsurgical care for resection of the prostate.

2 Viagra has been shown to increase the hypotensive effects of nitrate-containing medications. It should not be taken in conjunction with any medication that contains nitrates, including nitroglycerin.

A woman, who has undergone amniocentesis, has been notified that her baby is XX with a 14/21 robertsonian chromosomal translocation. The nurse helps the woman to understand which of the following? 1. The baby will have a number of serious genetic defects. 2. It is likely that the baby will be unable to have children when she grows up. 3. Chromosomal translocations are common and rarely problematic. 4. An abortion will probably be the best decision under the circumstances.

2 When a reciprocal translocation has occurred, part of the chromosomal material from one chro - mosome improperly attaches to another chromosome and vice versa. In the case of a robertsonian translocation, the affected individual is aneuploid since the centromeres of two chromosomes fuse while the genetic material from the short arms of the chromosomes is lost. Affected individuals usually appear normal and will develop normally even, as in the case of the robertsonian translocation, some genetic material is lost. When the child's gametes develop via meiosis, however, each of the eggs will contain an abnormal quantity of genetic material.

What is the rationale for testing all neonates for maple syrup urine disease (MSUD) when only 1 in 100,000-300,000 children will be born with the disease? 1. To encourage the parents to have genetic testing done. 2. To prevent neurological disease in affected children. 3. To reduce the amount of money insurance companies must pay for sick MSUD children. 4. To persuade pharmaceutical companies to develop medications to treat children with MSUD.

2 When children with inborn metabolic diseases follow strict diets they have the potential to grow into normal adulthood. It is essential that the tests be performed during the neonatal period because the children's diets must be altered as quickly as possible to prevent the adverse affects. When children with MSUD eat restricted foods, their brains are severely affected, leading to mental retardation, coma, and death.

A man has inherited the gene for familial adenomatous polyposis (FAP), an autosomal dominant disease. He and his wife wish to have a baby. Which of the following would provide the couple with the highest probability of conceiving a healthy child? 1. Amniocentesis. 2. Chorionic villus sampling. 3. Pre-implantation genetic diagnosis. 4. Gamete intrafallopian transfer.

3 Pre-implantation genetic diagnosis (PGD) is a form of genetic assessment. The assessment is performed prior to the transfer of the embryo into the woman's fallopian tubes. The embryos that are assessed via PGD are conceived via assisted reproductive technology. Since only healthy embryos are implanted, a couple will not have to decide whether or not to terminate affected pregnancies

A nurse is teaching an infertile couple about how the sperm travel through the man's body during ejaculation. Please put the following five major structures in order, beginning with the place where spermatogenesis occurs and continuing through the path that the sperm and semen travel until ejaculation. 1. Epididymis. 2. Prostate. 3. Testes. 4. Urethra. 5. Vas deferens.

3 1 5 2 4 This is an alternateform question. The test taker is required to place the items in the required sequence. It is essential that the test taker knows and understands normal anatomy and physiology. If the normal functioning of the body is not understood, it will be very difficult for the test taker to learn and remember abnormalities. Although maternity is often viewed as a topic in women's health, it must be remembered that the male's contribution to the embryo is as important to a healthy pregnancy outcome as the woman's. Understanding the male reproductive system is, therefore, a necessary requirement.

62. A woman is seeking genetic counseling during her pregnancy. She has a strong family history of diabetes mellitus. She wishes to have an amniocentesis to determine whether she is carrying a baby who will "develop diabetes." Which of the following replies would be most appropriate for the nurse to make? 1. "Doctors don't do amniocenteses to detect diabetes." 2. "Diabetes cannot be diagnosed by looking at the genes." 3. "Although diabetes does have a genetic component, diet and exercise also determine whether or not someone is diabetic." 4. "Even if the baby doesn't carry the genes for diabetes, the baby could still develop the disease."

3 Although virtually 100% of some diseases are genetically determined, most diseases have both genetic and environmental components. In other words, they have multifactorial etiologies. Diabetes mellitus, cancer, asthma, and the like are examples of diseases with multifactorial etiologies.

80. The nurse is counseling a pregnant couple who are both carriers for phenylketonuria (PKU), an autosomal recessive disease. Which of the following comments by the nurse is appropriate? 1. "I wish I could give you good news, but because this is your first pregnancy, your child will definitely have PKU." 2. "Congratulations, you must feel relieved that the odds of having a sick child are so small." 3. "There is a 2 out of 4 chance that your child will be a carrier like both of you." 4. "There is a 2 out of 4 chance that your child will have PKU."

3 As can be seen by the Punnett square, there is a 3 out of 4 probability that their child will be healthy (AA and Aa)—a 1 out of 4 probability that their child with carry no abnormal genes for PKU (AA), a 2 out of 4 probability that their child will be a carrier (Aa)—and a 1 out of 4 probability that their child will have the disease (aa).

In analyzing the need for teaching regarding sexual health in a client who is sexually active, which of the following questions is the most important for a nurse to ask? 1. "How old are your children?" 2. "Did you have intercourse last evening?" 3. "With whom do you have intercourse?" 4. "Do you use vaginal lubricant?"

3 Clients who engage in sex with multiple sex partners are high risk for infection and pregnancy. Women who have intercourse with same-sex partners are high risk for some sexually transmitted infections (STIs), especially bacterial vaginosis. And because there is no risk of pregnancy, women in lesbian relationships may be less likely to protect themselves from infection.

A woman has been advised that the reason she has had a number of spontaneous abortions is because she has an inheritable mutation. Which of the following situations is consistent with this statement? 1. A client developed skin cancer after being exposed to the sun. 2. A client developed colon cancer from an inherited dominant gene. 3. A reciprocal translocation was reported on a client's genetic analysis. 4. A client's left arm failed to develop when she was a fetus.

3 Clients who have reciprocal translocations are usually phenotypically normal. When they produce gametes, however, the eggs (or sperm) have nuclei that are composed of an unbalanced amount of genetic material. Because their offspring are often nonviable, their pregnancies end in miscarriage.

A couple has been told that the male partner, who is healthy, is producing no sperm "because he has cystic fibrosis." Which of the following explanations is accurate in relation to this statement? 1. Since the man is healthy, he could not possibly have cystic fibrosis. 2. Men with cystic fibrosis often have no epididymis. 3. The expressivity of cystic fibrosis is variable. 4. Cystic fibrosis is a respiratory illness having nothing to do with reproduction.

3 Infertility and genetics are often related. In this situation, the genetic disease cystic fibrosis has resulted in aspermia. In addition, many miscarriages are caused by inborn genetic defects. In general, clients who are infertile should be referred for genetic counseling.

A nurse is discussing sexual arousal during a preadolescent boys' sex education class. Which of the following should the nurse base her reply on when a boy asks, "What exactly happens when my body gets aroused, anyway?" 1. The vas deferens thickens and expands. 2. The sympathetic nerves of the penis are stimulated. 3. The corpora of the penis become engorged. 4. The prepuce of the penis elongates.

3 It is unlikely that the nurse would use some of the terminology included in the responses when speaking with the boys. For example, she might replace the term "prepuce" with the word "foreskin." The test taker should not choose the incorrect response simply because he or she does not understand or disagrees with the terminology in the response. Note that the responses are not direct quotes since they are not surrounded by quotation marks and the stem states, "Which of the following should the nurse base her reply on?"

77. A woman who is a carrier for sickle cell anemia is advised that if her baby has two recessive genes, the penetrance of the disease is 100%, but the expressivity is variable. Which of the following explanations will clarify this communication for the mother? All babies with 2 recessive sickle cell genes will: 1. Develop painful vaso-occlusive crises during their first year of life. 2. Exhibit at least some signs of the disease while in the neonatal nursery. 3. Show some symptoms of the disease but the severity of the symptoms will be individual. 4. Be diagnosed with sickle cell trait but will be healthy and disease-free throughout their lives.

3 The test taker must be familiar with common terms used to describe genetic diseases, like penetrance and expressivity. Penetrance: When a disease is 100% penetrant, 100% of the individuals who have the gene(s) for the disease will exhibit the disease. Similarly, if a disease is 80% penetrant, only 80% of the individuals who have the gene(s) for the disease will exhibit the disease. Expressivity: This term refers to the range of severity—or phenotypes—of a particular genetic disease.

A woman asks a nurse about presymptomatic genetic testing for Huntington's disease. The nurse should base her response on which of the following? 1. There is no genetic marker for Huntington's disease. 2. Presymptomatic testing cannot predict whether or not the gene will be expressed. 3. If the woman is positive for the gene for Huntington's, she will develop the disease later in life. 4. If the woman is negative for the gene, her children should be tested to see whether or not they are carriers.

3 The test taker must understand the difference between recessive and dominant illnesses. There is a carrier state in recessive illnesses because two affected genes must be present in the genome for the disease to be expressed. Only one affected gene must be present for a dominant disease to be expressed.

15. A couple is seeking infertility counseling. During the history, it is noted that the man is a cancer survivor, drinks one beer every night with dinner, and takes a sauna every day after work. Which of the following is an appropriate response by the nurse? 1. It is unlikely that any of these factors is affecting his fertility. 2. Daily alcohol consumption could be causing his infertility problems. 3. Sperm may be malformed when exposed to the heat of the sauna. 4. Cancer survivors have the same fertility rates as healthy males.

3 The test taker should try not to be fooled by quantities and numbers when they are included in the stem or answer options. The stem states that the male consumes one beer each evening. That quantity has not been shown to affect fertility.

Which of the following client responses indicates that the nurse's teaching about care following chorionic villus sampling (CVS) has been successful? 1. If the baby stops moving, the woman should immediately go to the hospital. 2. The woman should take oral terbutaline every 2 hours for the next day. 3. If the woman starts to bleed or to contract, she should call her physician. 4. The woman should stay on complete bed rest for the next 48 hours.

3 The test taker, if familiar with normal pregnancy changes, can immediately eliminate choice 1 since CVS is performed between 10 and 12 weeks' gestation and quickening rarely occurs before 16 weeks' gestation, even in multiparous pregnancies. Spontaneous abortion is the most common complication of CVS; therefore, the woman should report any bleeding or contractions.

A couple is seeking advice regarding actions that they can take to increase their potential of becoming pregnant. Which of the following recommendations should the nurse give to the couple? 1. The couple should use vaginal lubricants during intercourse. 2. The couple should delay having intercourse until the day of ovulation. 3. The woman should refrain from douching. 4. The man should be on top during intercourse.

3 There is a great deal of false information in the community regarding ways to maximize one's ability to become pregnant. For example, some couples believe that they should have intercourse less frequently when trying to become pregnant because sperm potency drops with frequent ejaculations. This notion has not been shown to be true. Clients need fact-based information regarding ways to maximize their ability to conceive.

A client who is undergoing ovarian stimulation for infertility calls the infertility nurse and states, "My abdomen feels very bloated, my clothes are very tight, and my urine is very dark." Which of the following is the appropriate statement for the nurse to make at this time? 1. "Please take a urine sample to the lab so they can check it for an infection." 2. "Those changes indicate that you are likely already pregnant." 3. "It is important for you to come into the office to be examined today." 4. "Abdominal bloating is an expected response to the medications."

3 This client is exhibiting signs of ovarian hyperstimulation. This is a serious complication. The client is likely third spacing her fluids (the fluids in her body are shifting into her interstitial spaces), resulting in abdominal distention, oliguria, and concentrated urine. The client should be evaluated by her physician.

68. A woman is informed that she is a carrier for Tay-Sachs disease, an autosomal recessive illness. What is her phenotype? 1. She has one recessive gene and one normal gene. 2. She has two recessive genes. 3. She exhibits all symptoms of the disease. 4. She exhibits no symptoms of the disease.

4 A person's genotype refers to a person's genetic code. A person who is a carrier for an autosomal recessive disease will have a heterozygous genotype—Aa. A person's phenotype refers to the person's observable characteristics. A person who is a carrier for an autosomal recessive disease will have a normal phenotype. Only persons who have a genotype of aa would express the disease.

A woman whose blood type is O- (negative) states, "My husband is AB+ (positive)." The mother queries the nurse about what blood type the baby will have. Which of the following blood types should the nurse advise the mother that the baby may have? Select all that apply. 1. "Your baby could be type O+ (positive)." 2. "Your baby could be type O- (negative)." 3. "Your baby could be type AB- (negative)." 4. "Your baby could be type A+ (positive)." 5. "Your baby could be type B- (negative)."

4 5 To answer this question, the test taker must be familiar with the concept of codominance. In addition, the test taker must create separate Punnett squares. Codominance refers to the fact that both blood type A and type B dominate. If a person possesses the gene for both types, he or she will, therefore, be type AB. Three Punnett squares are needed to determine the answer to this question because the father's Rh genotype could be either homozygous or heterozygous and because a person's blood type is independent or a person's Rh factor.

A client is hospitalized in the acute phase of severe ovarian hyperstimulation syndrome. The following nursing diagnosis has been identified: Fluid volume excess (extravascular) related to third spacing. Which of the following nursing goals is highest priority in relation to this diagnosis? 1. Client's weight will be within normal limits by date of discharge. 2. Client's skin will show no evidence of breakdown throughout hospitalization. 3. Client's electrolyte levels will be within normal limits within one day. 4. Client's lung fields will remain clear throughout hospitalization

4 A client who is suffering from ovarian hyperstimulation syndrome experiences intravascular hypovolemia, and a related extravascular hypervolemia. Although the exact cause of the shift in fluids is unknown, the client may experience very serious complications, including pulmonary edema and ascites. The client is hospitalized and palliative therapy is provided until the client's fluid and electrolytes stabilize. It is essential throughout the client's acute phase to make sure that her pulmonary function remains intact.

A client is to have a hysterosalpingogram. Which of the following information should the nurse provide the client prior to the procedure? 1. "The test will be performed through a small incision next to your belly button." 2. "You will be on bed rest for a full day following the procedure." 3. "An antibiotic fluid will be instilled through a tube in your cervix." 4. "You will be asked to move from side to side so that x-ray pictures can be taken."

4 A hysterosalpingogram is one of the many tests performed during a standard infertility work-up. The test taker should be familiar with the rationale for each of the tests as well as the procedures themselves and the information that should be conveyed to each client who is to undergo one of the procedures.

A 35-year-old client is being seen for her yearly gynecological examination. She states that she and her partner have been trying to become pregnant for a little over 6 months, and that a friend had recently advised her partner to take ginseng to improve the potency of his sperm. The woman states that they have decided to take their friend's advice. On which of the following information should the nurse base his or her reply? 1. Based on their history, the client and her partner have made the appropriate decision regarding their fertility. 2. Ginseng can cause permanent chromosomal mutations and should be stopped immediately. 3. It is unnecessary to become concerned about this woman's fertility because she has tried to become pregnant for only a few months. 4. Although ginseng may be helpful, it would be prudent to encourage the woman to seek fertility counseling

4 Complementary therapies are becoming more and more popular among clients. Although many have not been shown to have direct effects, it can be counterproductive to discourage clients from using complementary therapies. This may alienate the clients from the health care provider. Unless they are known to be dangerous, it is much better to encourage clients to combine standard and complementary methods rather than to dissuade clients from using them.

A client is to have a hysterosalpingogram. In this procedure, the physician will be able to determine which of the following? 1. Whether or not the ovaries are maturing properly. 2. If the endometrium is fully vascularized. 3. If the cervix is incompetent. 4. Whether or not the fallopian tubes are obstructed.

4 During a hysterosalpingogram, a dye is inserted through the vagina into the uterine cavity. The dye, visualized on x-ray, then travels up into the fallopian tubes. If the tubes are blocked owing to scarring or endometriosis, the dye does not ascend.

A client wants to undergo amniocentesis because she has a family history of breast cancer. Which of the following choices is the most important information for the nurse to discuss with the client regarding the request? 1. The breast cancer gene is highly penetrant. 2. The breast cancer gene has moderate expressivity. 3. The amniocentesis could result in a miscarriage. 4. The majority of breast cancers are not inherited.

4 Every year about 200,000 cases of breast cancer are diagnosed, but only 5%-10% of the cases are inherited. It would be inappropriate to perform an amniocentesis for breast cancer unless the mother has been found to carry one of the genes. In addition, it must be remembered that even inherited breast cancer has a strong environmental component.

Infertility increases a client's risk of which of the following diseases? 1. Diabetes mellitus. 2. Nystagmus. 3. Cholecystitis. 4. Ovarian cancer.

4 For a number of years, an association was noted between the long-term use of Clomid (clomiphene) to treat infertility and the incidence of ovarian cancer. It has also been shown that infertility itself is a contributing factor for ovarian cancer. The reason for the association is not yet known.

A nurse teaches a woman who wishes to become pregnant that if she assesses for spinnbarkeit she will be able closely to predict her time of ovulation. Which technique should the client be taught to assess for spinnbarkeit? 1. Take her temperature each morning before rising. 2. Carefully feel her breasts for glandular development. 3. Monitor her nipples for signs of tingling and sensitivity. 4. Assess her vaginal discharge for elasticity and slipperiness.

4 It is important for the test taker to be familiar with self-help techniques to assist clients to understand their bodies. Spinnbarkeit is a German term that literally means "the ability to create a thread."

A couple inquires about the inheritance of Huntington's disease (HD) because the prospective father's mother is dying of the illness. There is no history of the disease in his partner's family. The man has never been tested for HD. Which of the following responses by the nurse is appropriate? 1. "Because HD is an autosomal dominant disease, each and every one of your children will have a 1 in 4 chance of having the disease." 2. "Because only one of you has a family history of HD, the probability of any of your children having the disease is less than 10%." 3. "Because HD is such a devastating disease, if there is any chance of passing the gene along, it would be advisable for you to adopt." 4. "Because neither of you has been tested for HD, the most information I can give you is that each and every one of your children may have the disease."

4 It is important for the test taker to know the clinical course of Huntington's disease (HD), a deteriorating Father: A a Mother: A AA Aa a Aa aa disease of the brain. Affected patients slowly succumb to abnormal movements, behavioral changes, and dementia. There is no cure for this devastating disease. Many clients are reluctant to be tested for the gene since they then end up waiting for the dreaded symptoms to appear. It is not uncommon, therefore, for clients to have no definitive knowledge of their genetic makeup in relation to HD.

A woman is menstruating. If hormonal studies were to be done at this time, which of the following hormonal levels would the nurse expect to see? 1. Both estrogen and progesterone are high. 2. Estrogen is high and progesterone is low. 3. Estrogen is low and progesterone is high. 4. Both estrogen and progesterone are low.

4 Menstruation begins the menstrual cycle. Since pregnancy has not occurred, the test taker can deduce that the hormones of pregnancy did not remain elevated. Option 4, that both estrogen and progesterone are low, is, therefore, the correct response.

An Orthodox Jewish couple is seeking infertility counseling. The woman states that her menstrual cycle is 21 days long. After testing, no physical explanation is found for the infertility. Which of the following may explain why the woman has been unable to conceive? 1. Her kosher diet is lacking the essential nutrients needed for achieving optimal reproductive health. 2. The positions allowed Orthodox Jewish couples during intercourse hinder the process of fertilization. 3. Orthodox Jewish couples are known to have a high rate of infertility because of inborn genetic diseases. 4. Orthodox Jewish couples refrain from intercourse during menses and for seven days after it ends.

4 Remember to consider cultural differences when making nursing assessments and considering nursing interventions. There are three main Jewish traditions: Orthodox, Conservative, and Reform. Orthodox Jews strictly adhere to the Laws set forth in the Torah, the first 5 books of the Bible. Conservative Jews are observant but less restrictive in their beliefs, while Reform Jews are the most liberal in their traditions. When asked about Jewish traditions, it is important for the test taker to be aware of which group of Jews is being discussed.

A woman is pregnant. During amniocentesis it is discovered that her child has Down syndrome with a mosaic chromosomal configuration. She asks the nurse what that means. What is the nurse's best response? 1. "Instead of two number 21 chromosomes, your child has three." 2. "Your baby's number 21 chromosomes have black and white bands on them." 3. "Some of your baby's number 21 chromosomes are longer than others." 4. "Some of your baby's cells have two number 21 chromosomes and some have three."

4 The concept of mosaicism can be remembered by thinking about a mosaic piece of art. Mosaic tiles are bits of glass or ceramic that are different colors and shapes, but when put into a design create a piece of art. In genetics, mosaicism refers to the fact that various cells of the body have different numbers of chromosomes.

A woman asks the nurse, "My nuchal fold scan results were abnormal. What does that mean?" Which of the following comments is appropriate for the nurse to make at this time? 1. "I am sorry to tell you that your baby will be born with a serious deformity." 2. "The results show that your child will have cri du chat syndrome." 3. "The test is done to see if you are high risk for preterm labor." 4. "An abnormal test indicates that your baby may have Down syndrome."

4 The first-trimester screen is performed to assess for Down syndrome and other trisomy chromosomal syndromes. It is important for the test taker to remember that screening tests are NOT diagnostic. They are relatively inexpensive tests that are performed on the majority of clients to identify those who are likely to exhibit a disease process. If screening test results are positive, more sophisticated diagnostic tests are performed to make definitive diagnoses.

A male client has green color blindness, an X-linked recessive genetic disorder. His wife has no affected genes. Which of the following statements by the nurse is true regarding the couple's potential for having a child who is color blind? 1. All male children will be color blind. 2. All female children will be color blind. 3. All male children will be carriers for color blindness. 4. All female children will be carriers for color blindness.

4 The male client has a genotype of "x"Y, the "x" being the recessive gene responsible for green color blindness. The female has a genotype of XX; both of her genes are normal.

A client is to undergo a postcoital test for infertility. The nurse should include which of the following statements in the client's preprocedure counseling? 1. "You will have the test the day after your menstruation ends." 2. "You will have a dye put into your vein that will show up on x-ray." 3. "You should refrain from having intercourse for the four days immediately prior to the test." 4. "You should experience the same sensations you feel when your doctor does your Pap test."

4 The postcoital test is a simple assessment done to see whether the sperm are able to navigate the woman's cervical mucus to ascend into the uterus and fallopian tubes. A few hours postcoitus, immediately before ovulation, the practitioner harvests cervical mucus to assess whether the sperm are still motile and to assess the ferning patterns of the mucus.

A client has been notified that because of fallopian tube obstruction, her best option for becoming pregnant is through in vitro fertilization. The client asks the nurse about the procedure. Which of the following responses is correct? 1. "During the stimulation phase of the procedure, the physician will make sure that only one egg reaches maturation." 2. "Preimplantation genetic diagnosis will be performed on your partner's sperm before they are mixed with your eggs." 3. "After ovarian stimulation, you will be artificially inseminated with your partner's sperm." 4. "Any extra embryos will be preserved for you if you wish to conceive again in the future."

4 The preserved embryos may be implanted in the future. For example, if the first transfer fails to result in a pregnancy, the remaining embryos may be transferred within a few months. If a pregnancy and a delivery do result, the couple may choose to implant the remaining embryos in the future when they choose to have another child.

The genetic counselor informs a couple that they have a 25% probability of getting pregnant with a child with a severe genetic disease. The couple asks the nurse exactly what that means. Which of the following responses by the nurse is appropriate? 1. Their first child will have the genetic disease. 2. If they have four children, one of the children will have the disease. 3. Their fourth child will have the genetic disease. 4. Whenever they get pregnant, the fetus may have the disease.

4 The term "probability" refers to the likelihood of something occurring, rather than to whether something definitely will occur. This concept is often misunderstood by a layperson. It is very important that nurses communicate to parents who carry gene mutations that every time the woman is pregnant, she has the possibility of carrying a baby with the defect.