Chapter 10 prepU

When describing gender determination at a prenatal class, the nurse would include which statement?

"Gender is determined at fertilization when the ovum is fertilized."

A woman at 15 weeks' gestation is about to undergo amniocentesis. Which nursing intervention should be made first?

Obtain a signed consent form. - 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.

Amniotic fluid is produced throughout the pregnancy by the fetal membranes. Amniotic fluid has four major functions. What is one of these functions?

Physical protection -Amniotic fluid serves four main functions for the fetus: physical protection, temperature regulation, provision of unrestricted movement, and symmetrical growth.

The nurse prepares a couple to have a karyotype performed. What describes a karyotype?

a visual presentation of the chromosome pattern of an individual -A karyotype is a photograph of a person's chromosomes aligned in order.

Which genetic condition is caused by a small gene mutation that affects protein structure, producing hemoglobin S?

sickle cell anemia

For which client is preimplantation genetic diagnosis (PGD) a viable option?

Client whose partner has cystic fibrosis

A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage?

From fertilization to the end of the second week after fertilization

Cystic fibrosis is an example of which type of inheritance?

autosomal recessive

A nursing student is explaining to a newly pregnant woman what happens during each stage of fetal development. At which stage does the nurse inform the woman that the lungs are fully shaped?

end of 16 weeks

A fertilized ovum is known as which structure?

zygote

A woman who has a recessive gene for sickle cell anemia marries a man who also has a recessive gene for sickle cell anemia. Their first child is born with sickle cell anemia. The chance that their second child will develop this disease is:

1 in 4 -Autosomal recessive inherited diseases occur at a 1-in-4 incidence in offspring. The possibility of a chance happening does not change for a second pregnancy.

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

1.25

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?

"There are laws in place that prohibit that from happening."

The nurse is seeing a client who is going to be married in a month. This client has a history of Huntington disease in her family. The genetic testing has come back, and the client has just been told she carries the gene for Huntington disease and will develop the disease when she gets older. The client asks the nurse if this information is confidential and if it will remain that way. The nurse explains to the client that her family should be told and so should her fiancé. The client forcefully tells the nurse "no." She is not going to tell either her family or her fiancé. What is the nurse's best response?

"I will respect your wishes and keep your information confidential. I do wish you would reconsider though." -The nurse must honor the client's wishes and should be sure the client is aware that this action will be done. Although the nurse may ask the client to consider the potential benefit this information may have for other family members, this reply is not the critical or best one. The other two replies should not be stated, because the nurse has to honor the wishes of the client.

A client at a preconception screening meeting indicates to the nurse that she is a carrier of muscular dystrophy. Which statement made by the client indicates an understanding of the implications?

"If I have a female child there is a 25% chance she will be a carrier." -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."

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.

"My genome is my genetic blueprint." -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 4-year-old child is recently diagnosed with Wilms tumor. The health care provider suggests that the child's siblings have genetic testing performed. What is the best response by the nurse when explaining this to the parents?

"Wilms tumor is associated with a genetic link to chromosome 11; with early detection and treatment there are better outcomes."

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."

A nurse is counseling a couple who have a 5-year-old daughter with Down syndrome. The nurse recognizes that their daughter's genome is represented by which chromosone combination?

47XX21+

The primary care provider has prescribed a karyotype for a newborn. The mother questions what the type of information that will be provided by the test. What information should be included in the nurse's response?

The karyotype will assess the baby's chromosomal makeup.

The nurse in the genetics clinic is gathering a family history. The client has asked a question about inheritance and genetics that requires the nurse to investigate further. Which action would be most appropriate for the nurse to take?

Complete the family history then conduct a health history along with physical and developmental assessments. - All nurses should be able to recognize when a client is asking a question related to genetic or genomic information and should know how to obtain genetic information by gathering family and health histories and conducting physical and developmental assessments.

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?

Decisional conflict related to continuation of pregnancy

A woman, who is 18 weeks' gestation, is at a follow-up appointment regarding the test results of alpha-fetoprotein testing. Which would the nurse suspect with if the woman has low levels of alpha-fetoprotein?

Down syndrome

A pregnant woman undergoes a triple screen at 16 to 18 weeks' gestation. What would the nurse suspect if the woman's estriol and alpha-fetoprotein levels are decreased with high hCG levels?

Down syndrome -Decreased levels might indicate Down syndrome or trisomy 18. Sickle cell anemia may be identified by chorionic villus sampling. Levels would be increased with cardiac defects, such as tetralogy of Fallot. It does not detect respiratory disorders.

During the initial assessment of a preterm infant, it is noted that the infant has a heart murmur. Which shunt from fetal life most likely remains open?

Ductus arteriosus

A 45-year-old man has just been diagnosed with Huntington disease. He and his wife are concerned about their four children. What will the nurse explain about the children's possibility of inheriting the gene for the disease?

Each child will have a 50% chance of inheriting the disease. -Huntington disease is an autosomal dominant disorder. 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. Based on this information, the choices of 25%, 75%, or no chance of inheriting the disease are incorrect.

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

Ectopic pregnancy - An ectopic pregnancy or tubal pregnancy can result when there is blockage or scarring of the fallopian tubes due to infection (PID) or trauma (tubal ligation reversal). Ectopic pregnancy may present with vague signs and symptoms but is the leading cause of maternal death in the first trimester and should be given priority when determining the cause of abdominal complaints. The other choices would be ruled out after the ectopic pregnancy is ruled out.

During which stage of fetal development is exposure to teratogens most damaging?

Embryonic stage

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?

I will alert your entire family about this so you don't have to."

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.

A couple wants to start a family. They are concerned that their child will be at risk for cystic fibrosis because they each have a cousin with cystic fibrosis. They are seeing a nurse practitioner for preconceptual counseling. What would the nurse practitioner tell them about cystic fibrosis?

It is an autosomal recessive disorder.

A couple has just learned that their unborn son has a chromosome disorder that results in an extra X chromosome. The primary care provider explains that secondary sex characteristics will not develop in this child at puberty and that his testes will remain small and produce ineffective sperm. The nurse recognizes that this child likely has:

Klinefelter syndrome.

A client comes to the clinic with concerns about her pregnancy. She is in her first trimester and is now experiencing moderate abdominal pain on the right side. What would be the nurse's first action?

Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy. - The nurse should recognize that abdominal pain is not normal during pregnancy and warrants investigation since ectopic pregnancy is a distinct possibility. An abdominal ultrasound would be best practice for this complaint. Dismissing her reports as normal is not a wise choice.

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? You Selected:

Report it to the nursing supervisor.

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?

Review what has been discussed with the specialist. -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.

A recently married couple come to the prenatal clinic because they are concerned about genetic testing. The husband is of Jewish heritage. The nurse should recommend the couple undergo genetic testing to determine if the fetus has which disorder common among Ashkenazi Jews (Jews of Eastern European lineage)?

Tay-Sachs disease

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? You Selected:

The child is enrolled in kindergarten.

A baby is born with what the primary care provider believes is a diagnosis of trisomy 21. This means that the infant has three number 21 chromosomes. What factor describes this genetic change?

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

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 second trimester - 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 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 -The chorion and amnion are the two fetal membranes. The ectoderm, mesoderm, and endoderm are layers in the developing blastocyst.

A client is confused concerning her fertile period each month. The nurse would educate the client by providing which information?

The window of opportunity for conception is from 3 days before to 2 days following ovulation.

A nurse is caring for a 32-year-old Jewish client who is pregnant with a female baby. The parents are not directly related by blood. The mother reports that her husband's cousin had an infant born with Tay-Sachs disease that died two years ago and she is concerned about her baby. Which information does the nurse need to give the client to help alleviate her concerns regarding her baby having the same disease?

There is a risk to the baby based upon the Jewish background, so genetic testing would be recommended.

A nurse working in the newborn nursery hears an innocent murmur on auscultation of a 24-hour-old infant's chest. The nurse recognizes this as most likely the result of which condition?

delayed fetal shunt closure

Down syndrome may occur because of a translocation defect. This means the:

additional chromosome was inherited because it was attached to a normal chromosome.

A pregnant client has heard about Down syndrome and wants to know about the risk factors associated with it. What would the nurse include as a risk factor?

advanced maternal age

The nursing instructor is preparing a class presentation covering the various hormones and their functions during pregnancy. The instructor determines the class is successful when the class correctly matches which function with hCG?

continues progesterone production by corpus luteum

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?

embryonic

The maternal serum alpha fetoprotein blood test is performed on pregnant women to screen for which condition?

fetal neural tube defects -The maternal serum alpha fetoprotein blood test is performed on pregnant women to screen for fetal neural tube defects. The 1-hour random glucose tolerance test is used to screen for diabetes in pregnant women, and a urine test is used to screen for bladder infections. Different tests are used to screen for sexually transmitted infections.

The nurse is creating an educational pamphlet for pregnant mothers. Which is the best description of fetal development for the nurse to emphasize?

gestational age, length, weight, and systems developed

An expectant mother is on heparin for previous blood clots and voicing concerns about how her medications will affect her baby. The nurse would inform the mother that:

heparin does not cross the placenta and is safe for her to take.

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?

if couples are related to each other or have blood ties

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

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:

may reveal chromosomal abnormalities.

A woman is confused after finding out the ultrasound results predict a different due date for the birth of her baby. Which factor should the nurse point out is most likely the reason for the miscalculation of the fetal age?

mistaking implantation bleeding for last menstrual period (LMP)

A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as the:

phenotype

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?

placenta

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 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.

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:

trisomy numeric abnormality.