med-surg chapter 4

A 36-year-old client with a suspicious mammogram tells the nurse that her mother died of bone cancer at age 40. In assessing the client for cancer risk, what question does the nurse ask next?

"Did your mother ever have any other type of cancer?"

The daughter of a client diagnosed with bilateral breast cancer has been counseled about genetic testing. She has decided not to be tested, despite the client's insistence. How does the nurse respond to the daughter's decision?

"It is your decision. You can always call if you change your mind."

The nurse is teaching a client about genetic counseling. Which statement by the client indicates that the teaching has been effective?

"Just because I have the trait does not mean that I will get the disease."

A 23-year-old female client has a BRCA1 gene mutation, which increases her risk for developing breast cancer. She says, "I do not want to cut off my breasts!" What is the nurse's response?

"Let's discuss some other options."

A health care provider prescribes genetic testing for a client who has a family history of colorectal cancer. Which action should the nurse take before scheduling the client for the procedure?

Confirm that informed consent was obtained and placed on the clients chart.

In analyzing a three-generation pedigree for a client, which questions help determine the genetic implications of a health trait? (Select all that apply.)

Do affected or unaffected individuals have children affected by the trait? Is the trait expressed equally among male and female family members or is it expressed unequally? Is the trait present in every generation, or does it skip one or more generations? Is a pattern evident, or does the trait appear to be sporadic?

What is the purpose of genetic testing?

Determines whether a mutation exists

When teaching the client and family about genetic counseling, what information does the nurse include in the teaching plan?

Diagnostic genetic testing determines the risk for a specific disorder.

A nurse cares for an adult client who has received genetic testing. The clients mother asks to receive the results of her daughters genetic tests. Which action should the nurse take?

Direct the mother to speak with the client and support the clients decision to share or not share the results.

Which activity related to genetic counseling best illustrates the role of the medical-surgical nurse?

Ensures that the client understands the consequences of having a genetic test performed

Which statement is true about the structure and forms of DNA?

Every time a cell divides, it must replicate its DNA

A client who tests positive for a mutation in the BRCA1 gene allele asks a nurse to be present when she discloses this information to her adult daughter. How should the nurse respond?

This conversation may be difficult for both of you; I will be there to provide support.

A nurse teaches clients about patterns of inheritance for genetic disorders among adults. Which disorders have an autosomal dominant pattern of inheritance? (Select all that apply.)

a. Breast cancer d. Huntington disease e. Marfan syndrome

A nurse cares for a client who recently completed genetic testing that revealed that she has a BRCA1 gene mutation. Which actions should the nurse take next? (Select all that apply.)

a. Discuss potential risks for other members of her family. b. Assist the client to make a plan for prevention and risk reduction. e. Assess the clients response to the test results.

A nurse completes pedigree charts for clients at a community health center. Which diagnosis should the nurse refer for carrier genetic testing? (Select all that apply.)

c. Hemophilia e. Sickle cell disease f. Cystic fibrosis

Which statement is true about the role of a gene in the synthesis of a specific protein?

A gene contains the code for a specific protein.

A nurse cares for a client who has a specific mutation in the a1AT (alpha1-antitrypsin) gene. Which action should the nurse take?

Advise the client to limit exposure to secondhand smoke and other respiratory irritants.

A client with a family history of polycystic kidney disease, an autosomal dominant disorder, states to the nurse, "I would like to be genetically tested for the disease, but I don't want my family to know the results." How does the nurse respond?

Assures the client that confidentiality will be maintained

A nurse cares for a client of Asian descent who is prescribed warfarin (Coumadin). What action should the nurse perform first?

Confirm the prescription starts warfarin at a lower-than-normal dose.

A nurse consults a genetic counselor for a client whose mother has Huntington disease and is considering genetic testing. The client states, I know I want this test. Why do I need to see a counselor? How should the nurse respond?

Genetic testing can be a stressful experience. Counseling can provide support and education throughout the process.

Which condition might require genetic counseling for a client?

Huntington disease

A client is typed and crossmatched for a unit of blood. Which statement by the nurse indicates a need for further genetic education?

If the clients blood type is AB, then the client is homozygous for that trait.

What is the effect of gene mutation and amino acid sequencing on insulin and blood sugar control?

Ineffective insulin is produced.

A nurse cares for a client who has a genetic mutation that increases the risk for colon cancer. The client states that he does not want any family to know about this result. How should the nurse respond?

It is not required that you tell anyone about this result. However, your siblings and children may also be at risk for colon cancer and this information might help them.

A nurse obtains health histories when admitting clients to a medical-surgical unit. With which client should the nurse discuss predisposition genetic testing?

Middle-aged woman whose mother died at age 48 of breast cancer

A nurse cares for a pregnant client who has a family history of sickle cell disease. The client is unsure if she wants to participate in genetic testing. What action should the nurse take?

Provide information about the risks and benefits of genetic testing.

A client wishes to become pregnant, but has a family member with cystic fibrosis. She asks about the need for genetic testing. How does the nurse respond?

Refers the client to a genetic counselor

Which statement is consistent with an autosomal dominant pattern of inheritance for a specific trait or characteristic?

The genotype cannot be predicted from the phenotype.

A nurse is educating a client about genetic screening. The client asks why red-green color blindness, an X-linked recessive disorder noted in some of her family members, is expressed more frequently in males than females. How should the nurse respond?

The incidence of X-linked recessive disorders is higher in males because they do not have a second X chromosome to balance expression of the gene.

A nurse cares for a client who recently completed genetic testing and received a negative result. The client states, I feel guilty because so many of my family members are carriers of this disease and I am not. How should the nurse respond?

We usually encourage clients to participate in counseling after receiving test results. Can I arrange this for you?