Ch 3: Genetics, Conception, Fetal Development, and Reproductive Technology

20. An infertile couple voices concern to the nurse about assisted reproductive technologies (ART). The nurse agrees that ART has created numerous dilemmas. Which potential questions does the nurse discuss with the couple? Select all that apply. 1. Which partner has ownership of the embryos? 2. Should a child be told about donors or surrogates? 3. Are there parental rights for sperm donors? 4. Does a fertility donor have financial obligations? 5. What happens to any surplus embryos?

. ANS: 1, 2, 3, 5 This is correct. Maternal and paternal ownership is a potential ethical issue for ART, especially if the relationship does not last. This is correct. Informing the child about ART is a potential ethical issue, especially if a sperm donor or surrogate is used. This is correct. Parental rights of sperm donors are a potential ethical issue. This issue is most likely in the event of a surrogate. This is correct. The fate of embryos is a potential ethical issue, especially when the owners of the embryos are no longer able or interested in becoming pregnant

14. The nurse is counseling a female patient who has unsuccessfully attempted to become pregnant through a variety of methods and treatments for infertility. Which psychosocial manifestation is the nurse most likely to recognize? 1. Close connections with extended family 2. Strong intimate relationship with her partner 3. Difficulty accepting pregnancy if it does occur 4. Greater focus on career and job opportunities

3. This is correct. Once pregnancy is achieved, the woman often has difficulty perceiving herself as a pregnant woman.

5. A patient who has just received confirmation that she is pregnant is distressed because she has a seizure disorder that she manages with carbamazepine. Which is the nurse's greatest concern? 1. The carbamazepine may be discontinued. 2. The pregnancy is likely to end with fetal demise. 3. The fetus will experience loss of vision and hearing. 4. Carbamazepine is teratogenic and causes neural and facial defects.

4. This is correct. Carbamazepine is prescribed as an anticonvulsant medication that is classified as a teratogenic drug that causes neural tube defects, craniofacial defects, and intrauterine growth restriction. This is the nurse's greatest concern.

15. An infertile couple learns that the female is unable to produce viable eggs. The male partner suggests the use of a surrogate as a means of having a child. The female states, "I don't want your baby with another woman!" The nurse is aware of which psychosocial issue with this couple? 1. The male blames the female for the infertility. 2. The female is jealous of the surrogate's fertility. 3. The male needs to have a child with his genes. 4. The female is experiencing self-esteem issues.

4. This is correct. The nurse is aware that the diagnosis and treatment of infertility can cause self-esteem issues. The female partner is likely to be feeling "less of a woman" because of the inability to conceive. She may also have feelings of shame for having a "defective" body.

7. A patient at 13 weeks gestation asks the nurse how her baby is nourished during pregnancy. Which information does the nurse use to explain the process to the mother? 1. Fetal waste products and CO2 pass through the placenta to the mother. 2. The placenta is a special organ developed to create nutrients and oxygen. 3. The mother's blood and fetus's blood mix for an exchange of nutrients. 4. Glucose, amino acids, and oxygen pass through the placenta from mother to baby.

4.This is correct. Glucose, amino acids, and oxygen are transported across the placenta membrane from the mother to the fetus by a mechanism of diffuse and active transport.

4. Genomic medicine is an emerging medical discipline that involves using genomic information about an individual as part of the individual's clinical care. Which example does the nurse associate with genomic medicine? 1. Screening of neonates for inherited, treatable genetic diseases 2. Creating drugs specifically for the treatment of cancer 3. Conducting trial studies to determine how drugs effect individuals 4. Tracing and gaining knowledge about how genetic mutations occur

1. This is correct. An example of genomic medicine is screening of neonates for inherited, treatable genetic diseases.

3. The nurse is counseling a couple who just learned their 16-week fetus tested positive for a serious genetic disorder. Which action by the nurse is inappropriate upon learning that the couple plan to continue the pregnancy? 1. Determine whether termination is still a consideration. 2. Explain they will experience grief, which is normal. 3. Provide additional information about the disorder. 4. Refer them to a disorder-specific support group.

1. This is correct. Once the couple has decided to continue the pregnancy, it is inappropriate and unnecessary for the nurse to determine pregnancy termination is still a consideration. It is likely that counseling from family and medical personnel has helped with their difficult decision.

13. After counseling with an obstetrician about infertility, a couple is advised to undergo testicular sperm aspiration. The nurse is aware that the procedure may be recommended for which infertility? 1. Blocked fallopian tubes 2. Unsuccessful vasectomy reversal 3. Poor cervical mucus production 4. Diminished sperm motility

2. This is correct. An unsuccessful vasectomy reversal is treated with testicular sperm aspiration. Other reasons for this infertility treatment are the absence of a vas deferens, an extremely low sperm count, or absence of sperm in ejaculated semen.

The nurse is counseling a patient regarding pregnancy. The patient lost her first two pregnancies in the second trimester of gestation for undetermined reasons. Which initial advice does the nurse provide for this patient? 1. Consider adoption. 2. Seek genetic studies. 3. Plan for fertility tests. 4. Attend grief counseling.

2. This is correct. Following two spontaneous abortions, the nurse initially suggests genetic studies in order to identify any genetic factors that may have caused the loss of previous pregnancies.

10. The nurse works in an infertility clinic and is interviewing a male patient whose partner has been unable to conceive. Which finding obtained during a health history will cause the nurse greatest concern? 1. The patient is a passionate gardener. 2. The patient had a vasectomy reversed. 3. The patient rides a bicycle daily to work. 4. The patient is concerned about infertility.

2. This is correct. The fact that the patient had a vasectomy reversed causes the nurse greatest concern about male infertility. A vasectomy reversal can result in the development of sperm antibodies that decreases sperm motility.

6. The nurse is teaching a class about embryonic and fetal development to couples in the early stage of pregnancy. For which reason does the nurse emphasize the first 8 weeks of gestation? 1. Pregnancies often abort before or at this time of development. 2. Lack of size and movement prevents confirmation of pregnancy. 3. All organ systems are developing during this period. 4. Factors that can interrupt the pregnancy are no longer a concern.

3. This is correct. At 8 weeks the primary germ layers have transformed into a clearly defined human. The embryo is now a fetus with all major organ systems formed. The nurse emphasizes this period because interfering factors for development should be avoided up to this point.

16. A female carries one positive genetic marker for Huntington's disease. Her partner does not have any markers for the disease. For which reason is it so important for this family to identify persons with the genetic marker? 1. The Huntington gene is recessive. 2. All of the couple's offspring will have the disease. 3. Symptoms do not manifest until 30 to 50 years of age. 4. The expression of the disease is varied by individual.

3. This is correct. Huntington's disease does not exhibit symptoms until the gene carrier is between 20 and 50 years of age, which is after many of the carriers have already had children. The disease is perpetuated by lack of knowledge regarding the presence of the gene.

11. A female patient is concerned about an inability to become pregnant after trying for 1 year. Which information collected during a health history causes the nurse the greatest amount of concern about possible infertility? 1. The patient works as a ballroom dance instructor. 2. The patient is turning 37 years old this year. 3. The patient has hot flashes and mood swings. 4. The patient was treated for a pelvic inflammatory disease while in college.

3. This is correct. Premature ovarian failure, which is menopause prior to age 40, is a cause of female infertility. At age 37, the client is experiencing some manifestations of early menopause (hot flashes and mood swings). This finding causes the nurse greatest concern and prompts additional assessment.

12. The nurse works in a urologist's office. A male patient is scheduled for routine fertility testing. For which test does the nurse refrain from making preparation? 1. STI screening 2. Hormonal levels 3. Sexual functioning 4. Ejaculate analysis

3. This is correct. Sexual functioning is not routinely measured by a test. If the patient voices concern about sexual functioning, vascular studies may be performed.

2. The nurse is discussing genetically linked diseases with a couple planning a pregnancy. The female states, "I am concerned because there is a history of sickle-cell disease in my family." Which information from the nurse is correct? 1. Any offspring will have the disease. 2. Only male children will have the disease. 3. The male partner needs genetic testing. 4. The couple should not become pregnant.

3. This is correct. The nurse needs to advise the male partner to have genetic testing to determine whether he is also a carrier of the sickle-cell gene. If both partners have the gene, 25% of the offspring will have the disease, 50% will be carriers, and 25% will be neither.

8. A patient at 37 weeks gestation arrives at the labor and delivery unit and reports a rupture of her membranes. Which factor causes the nurse to anticipate the HCP will prescribe a medical method of labor induction? 1. The fetus is viable and the barrier for a sterile uterine environment is breached. 2. The fetus is at risk for "drying out" and causing the mother to have a dry birth. 3. The mother must be maintained on complete bedrest until contractions begin. 4. The mother is at risk for developing an infection and passing it to the fetus.

1. This is correct. The nurse anticipates a prescription for a medical method of labor induction because the fetus is viable and the sterile environment of the uterus is breached when the embryonic membranes rupture.

9. A patient at 34 weeks gestation is undergoing an ultrasound. The nurse notes that the amniotic fluid is estimated at between 500 and 600 mL. Which deduction does the nurse make from this finding? 1. Oligohydramnios is present. 2. Fluid is normal for gestation age. 3. Polyhydramnios has formed. 4. Follow-up ultrasound is warranted.

1. This is correct. The volume of amniotic fluid at 34 weeks gestation should peak at 800 to 1,000 mL. The current volume indicates oligohydramnios, which is indicative of a decrease in placental function. The newborn is at increased risk for congenital renal problems.

17. A female patient with a history of infertility is scheduled to have a hysterosalpingogram. Which findings can be detected with this procedure? Select all that apply. 1. Tubal occlusions 2. Uterine fibroids 3. Cervical irritation 4. Bicornate uterus 5. Vaginal infection

ANS: 1, 2, 4 This is correct. A hysterosalpingogram is a radiological examination that provides information about fallopian tubes; occlusions and adhesions can be visualized. This is correct. A hysterosalpingogram is a radiological examination that provides information about the uterus; the presence of fibroids can be diagnosed. This is correct. A hysterosalpingogram is a radiological examination that provides information about the uterus; a structural defect such as a bicornate uterus can be identified.

18. A male patient is diagnosed with low sperm count as the cause of infertility. Which interventions will the nurse recommend to improve the patient's sperm count? Select all that apply. 1. Yoga or relaxation techniques 2. Surgical repair of an inguinal hernia 3. Switch to underwear made from cotton 4. Avoidance of showers with hot water temperature 5. Consultation to change hypertension drugs

ANS: 1, 2, 5 This is correct. Stress can be a cause of infertility caused by a low sperm count. The nurse will recommend yoga, relaxation techniques, or other stress reducers. This is correct. The presence of an inguinal hernia can interfere with sperm transport; the nurse will recommend surgical repair of the hernia. This is correct. If the client is taking a channel blocker for management of hypertension, the nurse will recommend a consultation with the patient's HCP to change the medication. Certain medications are considered to be gonadotoxins.

19. The nurse is counseling a female patient diagnosed with anovulation as a cause of infertility. Which information does the nurse provide to the patient? Select all that apply. 1. Methods for dietary planning 2. Consultation for myomectomy 3. Refrain from unprotected sex 4. Surgical correction of fallopian tubes 5. Instructions for clomiphene citrate

ANS: 1, 5 This is correct. One method of treating anovulation is to improve the patient's nutrition. The nurse will provide the patient with a variety of methods to promote a healthier dietary intake. This is correct. One drug used to treat anovulation is clomiphene citrate, which has a very high success rate. The nurse will provide the patient with information regarding this therapy. The routine patient teaching about drug therapy will be included.