Chapter 10: Fetal Development and Genetics
A pregnant woman undergoing amniocentesis asks her nurse why the baby needs this fluid. What would be an accurate response from the nurse?
"Amniotic fluid cushions your baby to prevent injury."
A client is offered preconception genetic testing but reports being worried about the results preventing access to health insurance in the future. How does the nurse respond?
There are laws that prevent discrimination related to genetic information for health insurance.
A woman with both heart disease and osteoarthritis has come to the genetics clinic for genetic screening. What would the nurse know about these two diseases?
They are multifactorial.
A couple is discussing starting a family with the nurse. When should the nurse suggest genetic counseling?
before they conceive
The health care provider has prescribed a karyotype for a newborn. The mother questions the type of information that will be provided by the test. What information should be included in the nurse's response?
The karyotype will assess the baby's chromosomal makeup.
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)
The fluid-filled, inner membrane sac surrounding the fetus is which structure?
amnion
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
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
The nurse has asked the client for a family history. This nursing assessment is the first step in which aspect of genetic counseling?
establishing a pedigree
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 mother has come to the clinic with her 13-year-old daughter to find out why she has not started her menses. After a thorough examination and history, genetic testing is prescribed to rule out which abnormality?
Turner syndrome
A nurse assesses that a 15-year-old female client has not developed secondary sexual characteristics, is short in stature, and has a webbed neck. The nurse identifies this as being most likely related to which diagnosis?
Turner syndrome
A client who has one child with a genetic disorder tells the nurse, "I told my husband I was ready to have another baby and now he does not want to be intimate with me." What is the most appropriate nursing diagnosis for this client's husband?
Altered sexuality pattern related to fear
A client who is 37 years of age presents to the health care clinic for her first prenatal checkup. Due to her advanced age, the nurse should prepare to talk with the client about her increased risk for what complication?
genetic disorders
Fetal circulation differs from the circulatory path of the newborn infant. In utero the fetus has a hole connecting the right and left atria of the heart. This allows oxygenated blood to quickly pass to the major organs of the body. What is this hole called?
Foramen ovale
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 nurse overhears a colleague tell a client that based on the genetic testing results she should terminate the pregnancy. Which action is most appropriate for the nurse to take?
Immediately stop the nurse.
A client presents to the hospital experiencing a spontaneous abortion (miscarriage) at 8 weeks' gestation, which is the third spontaneous abortion (miscarriage) in 2 years. The health care provider offers to send the products of conception for genetic testing. The client expresses not understanding the reason for this action. How does the nurse explain?
Many spontaneous abortions (miscarriages) occur due to chromosomal disorders and this testing may determine if this is the cause.
A woman at 15 weeks' gestation is about to undergo amniocentesis. Which nursing intervention should be made first?
Obtain a signed consent form.
A client at 38 weeks' gestation is diagnosed with placental insufficiency. Which prescription from the health care provider will the nurse anticipate?
Prepare the client for an induction of labor.
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?
Report it to the nursing supervisor.
In developing a plan of care for a 5-year-old child with Down syndrome, what should be a priority for the nurse in meeting the expected growth and development outcomes for this child?
The child is enrolled in kindergarten.
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
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 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
The nurse is caring for four pregnant clients. Which client will the nurse highlight for the health care provider as being at highest risk for carrying a child with a genetic abnormality?
36-year-old client with thalassemia whose partner is 55 years of age and who have a son with Duchenne muscular dystrophy
The nurse is conducting an initial history and assessment on a client at 10 weeks' gestation who is pregnant with her first child. Which question is a priority for the nurse to ask the client at this time?
"Does anyone in your or the father's family have any genetic disorders?"
When educating parents on recessive genetic disease statistics, the nurse understands that which statement by the parents indicates an accurate understanding of genetic inheritance?
"Each child will have a 25% chance of developing the disease."
A client at a preconception screening appointment indicates to the nurse that she is a carrier of muscular dystrophy, an X-linked recessive trait. Her partner does not have the trait. Which statement made by the client indicates an understanding of the implications?
"Each time I have a child, there is a 25% chance a female child will be a carrier."
The nurse is caring for a client following the birth of the newborn with several birth defects. The client states, "I know the baby has defects because of something I did wrong during my pregnancy. I feel like a horrible mom." How will the nurse respond?
"I hear you saying this is a difficult situation. Tell me more about how you are feeling"
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."
A woman carries a recessive gene for sickle cell anemia. If her sexual partner also has this recessive gene, the chance that her first child will develop sickle cell anemia is:
1 in 4.
A client's older child has sickle-cell anemia, an autosomal recessive disorder. The client is now pregnant with a new partner and asks about the chances of this child having sickle-cell anemia. How does the nurse respond?
Sickle-cell anemia is a recessive gene, so the child will be affected only if your new partner also carries this gene.
The nurse is caring for a child with Down syndrome (trisomy 21). This is an example of which type of inheritance?
chromosome nondisjunction
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 female client has the Huntington's disease gene. She and her husband want to have a child but are apprehensive about possibly transmitting the disease to their newborn child. They have strong views against abortion (elective termination of pregnancy). They would also like to have their "own" child and would consider adopting only as a last resort. Which action would be most appropriate in this situation?
opting for a preimplantation genetic diagnosis.
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
While talking with a pregnant client who has undergone genetic testing, the client informs the nurse that the baby will be born with Down syndrome. The nurse understands that Down syndrome is an example of a:
trisomy numeric abnormality.
The nurse is assessing a young couple who desire to start a family and are questioning the nurse concerning various cautions to keep in mind. Which time period should the nurse point out that teratogenics pose the greatest risk and should be avoided?
weeks 3 to 8
