OB Chapt 10 Fetal Development & Genetics
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 a) 1 in 4. b) 0 in 4. c) 3 in 4. d) 2 in 4.
1 in 4. Correct Explanation: Autosomal recessive inherited diseases occur at a 1-in-4 incidence in offspring.
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 a) 2 in 4. b) 1 in 4. c) 0 in 4. d) 3 in 4.
1 in 4. Correct Explanation: 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.
A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week?
1 lb Explanation: The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb per week. Overweight women should gain about 2/3 lb per week
A woman is to undergo chorionic villus sampling as part of a risk assessment for genetic disorders. Which of the following would the nurse include when describing this test to the woman? a) "A small amount of amniotic fluid will be withdrawn and collected for analysis." b) "A needle will be inserted directly into your fetus's umbilical vessel to collect blood for testing." c) "A small piece of tissue from the fetal placenta will be removed and analyzed." d) "An intravaginal ultrasound measures fluid in the space between the skin and spine."
"A small piece of tissue from the fetal placenta will be removed and analyzed." Correct Explanation: Percutaneous umbilical cord sampling involves the insertion of a needle into the umbilical vessel. An amniocentesis involves the collection of amniotic fluid from the amniotic sac. Fetal nuchal translucency involves the use of intravaginal ultrasound to measure fluid collected in the subcutaneous space between the skin and cervical spine of the fetus. Chorionic villus sampling involves the removal of a small tissue specimen from the fetal portion of the placenta.
A pregnant woman undergoing amniocentesis asks her nurse why the baby needs this fluid. What would be an accurate response from the nurse? a) "Amniotic fluid cushions your baby to prevent injury." b) "Amniotic fluid keeps the fetus from moving freely inside it to prevent injury." c) "Amniotic fluid provides fetal blood circulation." d) "Amniotic fluid supplies the food your baby needs to grow."
"Amniotic fluid cushions your baby to prevent injury." Correct Explanation: The amniotic fluid, kept inside the amnion, cushions the fetus against injury, regulates temperature, and allows the fetus to move freely inside it, which allows normal musculoskeletal development of the fetus. The woman's blood supplies food to—and carries wastes away from—the fetus. The placenta supplies the developing organism with food and oxygen; then the umbilical cord connects the fetal blood vessels contained in the villi of the placenta with those found within the fetal body.
Yvonne, a 27-year-old client, is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell Yvonne about the potential effects of smoking in pregnancy?
"Babies of women who smoke tend to weigh significantly less than other infants."
A young couple who underwent preconceptual genetic counseling and testing have learned that they are at high risk for having a child with Down syndrome. They have decided not to have children. Which of the following would be the most appropriate response for the nurse to give? a) "I understand. In case you would like to discuss this further with a genetic counselor, here is the contact information for the genetic counseling center." b) "I appreciate your decision, but I urge you to think through this further. Having a child, even one with Down syndrome, is so rewarding." c) "I understand and support your decision. The risk is just not worth it." d) "I think you made the right decision. After all, I never had children, and I'm perfectly happy."
"I understand. In case you would like to discuss this further with a genetic counselor, here is the contact information for the genetic counseling center." Correct Explanation: Even if a couple decides not to have more children, be certain they know genetic counseling is available for them should their decision change. It is never appropriate for a health care provider to impose his or her own values or opinions on others. Individuals with known inherited diseases in their family must face difficult decisions, such as how much genetic testing to undergo or whether to terminate a pregnancy that will result in a child with a specific genetic disease. Be certain couples have been told all the options available to them, and then leave them to think about the options and make their decision by themselves. Help them to understand nobody is judging their decision because they are the ones who must live with the decision in the years to come.
A couple has just learned that their son will be born with Down's syndrome. The nurse shows a lack of understanding when making which of the following statements? a) "We have counseling services available, and I recommend them to everyone facing these circumstances." b) "I will give you as much information as I can about this condition." c) "I will support you in any decision that you make." d) "I will alert your entire family about this so you don't have to."
"I will alert your entire family about this so you don't have to." Correct Explanation: It is necessary to maintain confidentiality at all times, which prevents healthcare providers from alerting family members about any inherited characteristic unless the family member has given consent for the information to be revealed.
When she discovers that she is unexpectedly pregnant, a patient calls the nurse in a panic. She reports that although she does not drink heavily, the night she must have gotten pregnant she was at a wedding and had drunk quite a lot. The day after the wedding she had taken several acetaminophens. Since that day 3 weeks earlier, she has also had a nightly glass of wine with dinner. She asks if she has caused irreversible damage to the fetus. What is an appropriate response for the nurse to make? a) "You didn't know you were pregnant, so you haven't done anything wrong. The fetus isn't exposed to the mother's blood until after it implants, so the wedding's not an issue. But, don't have any more alcohol while you're pregnant." b) "Why did you have unprotected sex if you had been drinking?" c) "You didn't know you were pregnant, so you haven't done anything intentionally wrong. But alcohol is very damaging to the growing fetus, so you'd better be sure to stop drinking. Do you need any support for that?" d) "Exposure to alcohol can cause facial deformities, low birth weights, and underdeveloped brains. The wedding night isn't an issue because the fetus isn't exposed to the mother's blood at first, but I hope this last week of drinking hasn't caused any problems."
"You didn't know you were pregnant, so you haven't done anything wrong. The fetus isn't exposed to the mother's blood until after it implants, so the wedding's not an issue. But, don't have any more alcohol while you're pregnant." Correct Explanation: The fetus was not developing during the initial night of drinking. Now that the fetus is implanted and developing, the fetus would be exposed to the influences of the mother. Alcohol use should be stopped now that she knows she is pregnant, but reassure her that the limited amounts she has consumed will most likely not have an adverse effect on the fetus. As a practitioner, you should not question her choice of drinking and having unprotected sex.
A patient comes to the clinic for genetic testing. The nurse asks them to sign consent forms to obtain their medical records. The patient wants to know why the geneticist needs their old medical records. What is the nurses' best response? a) "We always get old medical records just in case we need them." b) "You don't have anything to hide, do you?" c) "Your medical information is needed so that we have all the appropriate information and counseling are provided to you." d) "We need your medical records in case you forget to tell us something."
"Your medical information is needed so that we have all the appropriate information and counseling are provided to you." Correct Explanation: Nurses obtain patient consent to obtain medical records that may be needed. Nurses explain that the medical information is needed to ensure that appropriate information and counseling (including risk interpretation) are provided. The other answers are incorrect because old medical records are not obtained "just in case"; and answer B is an inappropriate response.
A pregnant client is scheduled to undergo chorionic villi sampling (CVS) to rule out any birth defects. Ideally, when should this testing be completed? a) 4-5 weeks of gestation b) 5-6 weeks of gestation c) 7-9 weeks of gestation d) 10-12 weeks of gestation
10-12 weeks of gestation Correct Explanation: Chorionic villus sampling (CVS) is typically performed between 10 to 12 weeks' gestation. Sometimes it may be offered up to 14 weeks. The test is not conducted before 10 weeks' gestation.
A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks and gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document this woman's obstetric history as:
30111 Explanation: The woman's obstetric history would be documented as 30111, G (gravida) = 3 (current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability) = 1, and L (number of living children) = 1.
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 of the following? a) 47XY21+ b) 46XX5p- c) 47XX21+ d) 46XX
47XX21+ Correct Explanation: In Down syndrome, the person has an extra chromosome 21, so this is abbreviated as 47XX21+ (for a female) or 47XY21+ (for a male). 46XX is a normal genome for a female. The abbreviation 46XX5p- is the abbreviation for a female with 46 total chromosomes but with the short arm of chromosome 5 missing (Cri-du-chat syndrome).
When a woman is planning pregnancy, what is her window around ovulation to have intercourse? a) 5 days before to 2 days after ovulation b) 3 days before or the day of ovulation c) 2 days before to 1 days after ovulation d) 1 day before ovulation to 2 days after ovulation
5 days before to 2 days after ovulation Correct Explanation: Sperm are able to live for up to 72 hours after ejaculation and the ovum remains fertile for a maximum of 48 hours after ovulation. The window of opportunity for conception is 5 days before to 2 days after ovulation.
You prepare a couple to have a karyotype performed. Which of the following describes a karyotype? a) A blood test that will reveal an individual's homozygous tendencies b) The dominant gene that will exert influence over a correspondingly located recessive gene c) A visual presentation of the chromosome pattern of an individual d) The gene carried on the X or Y chromosome
A visual presentation of the chromosome pattern of an individual Correct Explanation: A karyotype is a photograph of a person's chromosomes aligned in order.
You prepare a couple to have a karyotype performed. Which of the following describes a karyotype? a) The gene carried on the X or Y chromosome b) A blood test that will reveal an individual's homozygous tendencies c) The dominant gene that will exert influence over a correspondingly located recessive gene d) A visual presentation of the chromosome pattern of an individual
A visual presentation of the chromosome pattern of an individual Correct Explanation: A karyotype is a photograph of a person's chromosomes aligned in order.
A pregnant client has heard about Down syndrome and wants to know about the risk factors associated with it. Which of the following would the nurse include as a risk factor? a) Advanced maternal age b) Recurrent miscarriages c) Advanced paternal age d) Family history of condition
Advanced maternal age Correct Explanation: Advanced maternal age is one the most important factors that increases the risk of an infant being born with Down syndrome. Down syndrome is not associated with advanced paternal age, recurrent miscarriages, or family history of Down syndrome.
The nurse should administer Rhogam (Rh immune globulin) to the pregnant woman who is Rho(D)-, after which of the following tests?
Amniocentesis
The fluid-filled, inner membrane sac surrounding the fetus is which of the following? a) Endometrium b) Decidua c) Chorion d) Amnion
Amnion Correct Explanation: The fluid-filled, inner membrane sac surrounding the fetus is the amnion. The chorion is the outer membrane surrounding the fetus. The endometrium is the inner lining of the uterus. The decidua is the name used for the endometrium during pregnancy.
Amniotic fluid does not grow stagnant because a) Amniotic fluid circulates through the chorionic villi b) The fetal urine increases the bulk of amniotic fluid c) Amniotic fluid is constantly absorbed by the chorion d) Amniotic fluid is constantly formed by the amnion
Amniotic fluid is constantly formed by the amnion Correct Explanation: Amniotic fluid is formed by the amnion; a main portion of it is swallowed by the fetus and then excreted by the fetus back into the fluid area. The fluid is constantly being produced and filtered.
A pregnant patient is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function? a) Fetal reactivity b) Fetal heart rate c) Fetal breathing record d) Amniotic fluid volume
Amniotic fluid volume Correct Explanation: A biophysical profile combines five parameters (fetal reactivity, fetal breathing movements, fetal body movement, fetal tone, and amniotic fluid volume) into one assessment. The fetal heart and breathing record measures short-term central nervous system function; the amniotic fluid volume helps measure long-term adequacy of placental function.
A woman in her third trimester has just learned that her fetus has been diagnosed with cri-du-chat syndrome. The nurse recognizes that this child will likely have which of the following characteristics? a) Rounded soles of the feet (rocker-bottom) b) An abnormal, cat-like cry c) Small and nonfunctional ovaries d) Cleft lip and palate
An abnormal, cat-like cry Correct Explanation: Cri-du-chat syndrome is the result of a missing portion of chromosome 5. In addition to an abnormal cry, which sounds much more like the sound of a cat than a human infant's cry, children with cri-du-chat syndrome tend to have a small head, wide-set eyes, a downward slant to the palpebral fissure of the eye, and a recessed mandible. They are severely cognitively challenged. Rounded soles of the feet are characteristic of trisomy 18 syndrome. Cleft lip and palate are characteristic of trisomy 13 syndrome. Small and nonfunctional ovaries are characteristic of Turner syndrome.
The blood tests for a primigravida client indicate that the client is Rh-negative and her partner is Rh-positive. What is an appropriate nursing intervention for this client?
Arrange for Rho immune globulin at 28 weeks' gestation
Cystic fibrosis is an example of which type of inheritance? a) Autosomal recessive b) Autosomal dominant c) Multifactorial d) X-linked recessive
Autosomal recessive Correct Explanation: Cystic fibrosis is an autosomal recessive inherited condition. Huntington disease would be an example of an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Cleft lip is a multifactorial inherited condition.
Which of the following designations would the nurse identify as homozygous dominant? a) XY b) Bb c) XX d) BB
BB Correct Explanation: Homozygous dominant would be reflected in both alleles as the same with both also identified by an uppercase letter. Recessive alleles would be identified with a lower case letter. X and Y are sex chromosomes, where XX would indicate a female, and XY would be a male.
After teaching a class on the various structures formed by the embryonic membranes, the nurse determines that the teaching was successful when the class identifies which structure as being formed by the mesoderm? a) Stomach b) Ears c) Lungs d) Bones
Bones Correct Explanation: The endoderm forms the structures of the respiratory system. The mesoderm forms the structures of the skeletal system. The ectoderm forms the structures of the special senses. The endoderm forms the structures of the digestive system.
You care for a child with Down syndrome (trisomy 21). This is an example of which type of inheritance? a) Chromosome nondisjunction b) Mendelian recessive c) Phase 2 atrophy d) Mendelian dominant
Chromosome nondisjunction Correct Explanation: Down syndrome occurs when an ovum or sperm cell does not divide evenly, permitting an extra 21st chromosome to cross to a new cell.
What are the two fetal membranes? a) Amnion and mesoderm b) Ectoderm and amnion c) Amnion and endoderm d) Chorion and amnion
Chorion and amnion Correct Explanation: The chorion and amnion are the two fetal membranes. The ectoderm, mesoderm, and endoderm are layers in the developing blastocyst.
For which of the following clients is preimplantation genetic diagnosis (PGD) a viable option? a) Prevention of Pyloric stenosis b) Prevention of DiGeorge syndrome c) Clients carrying cystic fibrosis gene d) Client in the second week of pregnancy
Clients carrying cystic fibrosis gene Correct Explanation: Preimplantation genetic diagnosis (PGD) is a viable option for clients carrying the cystic fibrosis gene. PGD does not help prevent DiGeorge syndrome or pyloric stenosis. PGD is not a viable option for pregnant clients.
Which of the following would the nurse identify as a normal physiologic change in the renal system due to pregnancy?
Dilation of the renal pelvis
Some women contract with other women to provide support during pregnancy and delivery, to provide emotional support during labor and delivery, and to aid in establishing breastfeeding. What is the name of the woman who is contracted?
Doula
Nondisjunction of a chromosome results in which of the following diagnoses? a) Duchenne muscular dystrophy b) Down syndrome c) Marfan syndrome d) Huntingon disease
Down syndrome Correct Explanation: When a pair of chromosomes fails to separate completely (nondisjunction) the resulting sperm or oocyte contains two copies of a particular chromosome. Nondisjunction can result in a fertilized egg having trisomy 21 or Down syndrome. Huntington disease is one example of a germ-line mutation. Duchenne muscular dystrophy, an inherited form of muscular dystrophy, is an example of a genetic disease caused by structural gene mutations. Marfan syndrome is a genetic condition that may occur in a single family member as a result of spontaneous mutation.
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? a) Each child will have a 75% chance of inheriting the disease b) Each child will have a 50% chance of inheriting the disease c) Each child will have no chance of inheriting the disease d) Each child will have a 25% chance of inheriting the disease
Each child will have a 50% chance of inheriting the disease Correct Explanation: 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.
A woman who is 4 months pregnant has pyrosis. Which of the following suggestions would you give her?
Eat small meals and do not lie down after meals
On what day during pregnancy does the embryo implant on the uterine surface?
Eight days after ovulation
The incidence of Down syndrome is 1:1600 in women older than 40 years of age, compared with 1:100 in women younger than 20 years. a) True b) False
False Correct Explanation: The incidence of Down syndrome is 1:100 in women older than 40 years of age, compared with 1:1600 in women younger than 20 years.
A woman at 15 weeks' gestation asks the nurse what the fetus looks like. Which response by the nurse would be most accurate? a) Fingernails and toenails are present. b) The fetus is covered with a white, greasy film called vernix. c) Rhythmic breathing movements are occurring. d) The fetus is about 15 inches in length.
Fingernails and toenails are present. Correct Explanation: Vernix caseosa, a white, greasy film, covers the fetus at weeks 17 through 20. The fetus reaches a length of approximately 15 inches by weeks 25 to 28. Fingernails and toenails are present between weeks 13 through 15. Rhythmic breathing movements occur between weeks 29 through 32.
The nurse is explaining to a primigravida how the zygote becomes implanted into the uterus. How would the nurse describe the structure formed in this process known as the blastocyst? a) A ball of about 16 identical cells is formed when the zygote divides. b) First one, then two layers of cells surround a fluid-filled space. c) The endometrium is enriched in nutrients in preparation for pregnancy. d) A group of cells is forming what will become the embryo.
First one, then two layers of cells surround a fluid-filled space. Explanation: The zygote divides rapidly, until it forms a ball of about 16 identical cells, which is then called a morula. The morula is then swept down the fallopian tube and into the uterus, a process that takes approximately 7 to 9 days. The lining of the uterus, or endometrium, has become rich in nutrients in preparation for the pregnancy. Just before the morula reaches the uterus, the cells begin to form layers; first one, then two layers surround a fluid-filled space, called a blastocyst. Another group of cells form what will become the embryo.
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
The nurse is describing the pre-embryonic stage of fetal development to a group of students. Place the events in their proper sequence for this stage. Formation of the zygote Formation of the morula Cleavage Formation of blastocyst Implantation
Formation of the zygote Cleavage Formation of the morula Formation of blastocyst Implantation Correct Explanation: The pre-embryonic stage begins with fertilization and the formation of a zygote. Mitosis or cleavage occurs. After four cleavages, the 16 cells appear as a solid ball of cells or morula. With additional cell division, the morula divides into specialized cells, the blastocyst and trophoblast. The trophoblast attaches itself to the surface of the endometrium and implantation occurs
A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history?
G3 P0020
Genetics-related health care is basic to the holistic practice of nursing. What should nursing practice in genetics include? a) Identifying genetic markers b) Gathering relevant family and medical history information c) Providing advice on termination of pregnancy d) Discouraging females to conceive after the age of 40 years
Gathering relevant family and medical history information Correct Explanation: The nurse's role in genetic counseling is to provide information, collect relevant data, offer support, and coordinate resources. The other answers are incorrect because the nurse does not provide advice or influence the patient to make choices. The nurse also does not identify genetic markers.
When assessing newborns for chromosomal disorders, which assessment would be most suggestive of a problem? a) Low-set ears b) Bowed legs c) Slanting of the palpebral fissure d) Short neck
Low-set ears Correct Explanation: A number of common chromosomal disorders, such as trisomies, include low-set ears.
A nurse is conducting prenatal classes and is reviewing the stages of fetal development. When discussing the pre-embryonic stage, what should the nurse inform the group about when this stage begins and ends? a) It begins at fertilization and lasts through the end of the second week after fertilization. b) It begins at 6 weeks after fertilization and ends at the 8th week after fertilization. c) It begins at 9 weeks after fertilization and ends at birth. d) It begins approximately 2 weeks after fertilization and ends at the conclusion of the eighth week after fertilization.
It begins at fertilization and lasts through the end of the second week after fertilization. Correct Explanation: The pre-embryonic stage begins at fertilization and lasts through the end of the second week after fertilization.
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? a) It is an autosomal dominant disorder b) It is passed by mitochondrial inheritance c) It is an autosomal recessive disorder d) It is an X-linked inherited disorder
It is an autosomal recessive disorder Correct Explanation: Cystic fibrosis is autosomal recessive. Nurses also consider other issues when assessing the risk for genetic conditions in couples and families. For example, when obtaining a preconception or prenatal family history, the nurse asks if the prospective parents have common ancestors. This is important to know because people who are related have more genes in common than those who are unrelated, thus increasing their chance for having children with autosomal recessive inherited condition such as cystic fibrosis. Mitochondrial inheritance occurs with defects in energy conversion and affects the nervous system, kidney, muscle, and liver. X-linked inheritance, which has been inherited from a mutant allele of the mother, affects males. Autosomal dominant is an X-linked dominant genetic disease.
A woman complains of constant redness and itching of her palms early in her pregnancy. She fears that she is suffering an allergic reaction and asks the nurse whether this is normal. Which of the following should the nurse mention?
It is caused by increased estrogen levels and should disappear in time
If a pregnant woman's estimated date of delivery (EDD) is April 23, what was the first day of her last menstrual period (LMP), according to Nagele's rule?
July 16 Explanation: According to Nagele's rule, the last menstrual period was July 16th. Take the LMP and add 7 days and subtract 3 months; if finding the LMP from the EDD, subtract 7 days and add 3 months.
A couple has just learned that their unborn son has a chromosome disorder that results in an extra X chromosome. The physician 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 which of the following conditions? a) Klinefelter syndrome b) Fragile X syndrome c) Down syndrome d) Turner syndrome
Klinefelter syndrome Correct Explanation: Infants with Klinefelter syndrome are males with an extra X chromosome. At puberty, secondary sex characteristics do not develop; the child's testes remain small and produce ineffective sperm. Turner syndrome occurs in females and is characterized by only one functional X chromosome. Fragile X syndrome is an X-linked disorder in which one long arm of an X chromosome is defective, which results in inadequate protein synaptic responses; it results in cognitive challenges in males. Down syndrome (trisomy 21) is characterized by an extra chromosome at chromosome 21.
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. The nurse should mention which of the following as the primary function of progesterone? a) Ensures the corpus luteum of the ovary continues to produce estrogen b) Contributes to mammary gland development c) Maintains the endometrial lining of the uterus during pregnancy d) Regulates maternal glucose, protein, and fat levels
Maintains the endometrial lining of the uterus during pregnancy Correct Explanation: Progesterone is necessary to maintain the endometrial lining of the uterus during pregnancy. It is human chorionic gonadotropin (hCG) that acts to ensure the corpus luteum of the ovary continues to produce estrogen and progesterone. Estrogen contributes to mammary gland development, and human placental lactogen regulates maternal glucose, protein, and fat levels.
A woman in her 15th week of pregnancy is about to undergo amniocentesis. Which of the following nursing interventions should be made first? a) Have the patient void b) Place the patient in supine position c) Observe the fetal heart rate monitor d) Obtain a signed consent form
Obtain a signed consent form Correct Explanation: 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 patient sign a consent form should be completed before the others.
The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which of the following is the recommended schedule for prenatal care?
Once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.
A woman is aware that she is the carrier of a sex-linked recessive disease (hemophilia A); her husband is free of the disease. What frequency of this disease could she expect to see in her children? a) All female children will be carriers like she is. b) One-half of her male children will inherit the disease. c) One-half of her female children will inherit the disease. d) All male children will inherit it.
One-half of her male children will inherit the disease. Correct Explanation: With X-linked inheritance, no female children will demonstrate the disease; 50% of the male children will demonstrate the disease.
A nurse teaching a couple says that when X-linked recessive inheritance is present in a family, the genogram will reveal which of the following? a) A history of boys dying at birth for unknown reasons often exists. b) Only males in the family have the disorder. c) The parents of the affected man have the disorder. d) Sons of an affected man are also affected.
Only males in the family have the disorder. Correct Explanation: When X-linked recessive inheritance is in a family, a genogram will reveal only males in the family with the disorder, a history of girls dying at birth for unknown reasons, unaffected sons of affected men, and parents of affected children not having the disorder.
The structure to supply the fetus with nutrients is which of the following? a) Placenta b) Chorion c) Amnion d) Yolk sac
Placenta Correct Explanation: The placenta is a flat, round structure attached to the fetus by the umbilical cord. Blood is passed through the umbilical cord and the placenta is the organ responsible for supplying nutrients and oxygenated blood to the fetus via the umbilical cord. The amnion and chorion are parts of the placenta. The human yolk sac is a membrane outside the embryo that is connected by a tube (the yolk stalk) though the umbilical opening to the embryo's midgut. The yolk sac serves as an early site for the formation of blood, and in time is incorporated into the primitive gut of the embryo
Pregnancy tests analyze for the presence of human chorionic gonadotropin (HCG) hormone. The nurse understands the function of this hormone as which of the following? a) Prolong the life of the corpus luteum b) Permit the uterus to increase in size c) Ensure chorionic somatomammotropin hormone production d) Ensure oxygen transport across the placenta
Prolong the life of the corpus luteum Correct Explanation: The corpus luteum is responsible for producing progesterone until this function is assumed by the placenta. HCG is a "fail-safe" mechanism to prolong the life of the corpus luteum and ensure progesterone production. Somatomammotropin is a growth hormone. The uterine growth is in response to estrogen and other growth factors. Oxygen transport occurs via blood flow from the mother.
A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her?
Rest on the left side for at least 1 hour in the morning and afternoon.
The placenta is the site where antibodies in the mother's blood pass into the fetal circulation. These antibodies give passive immunity to the fetus for several common childhood diseases. There are some infections for which the mother does not provide antibodies to the fetus. What infection is the fetus not protected from? a) Small pox b) Rubella c) Diptheria d) Rubeola
Rubella Correct Explanation: The fetus does not receive immunity to rubella, cytomegalovirus (CMV), varicella, or measles. If the woman encounters these pathogens during her pregnancy, fetal infection may ensue.
Many couples attempt to influence the gender of the child they are trying to conceive by using special sexual positions, eating special food, or having intercourse at specific times. None of these are factors in the determination of the gender of the conceptus. What has research shown about gender determination? a) Female gametes can have either X or Y chromosomes b) There is a 50-50 chance of having a male or a female c) Female determines the sex of the conceptus d) Male gametes carry only Y chromosomes
Sex determination occurs at the time of fertilization based on the inheritance of X or Y chromosomes. Because the spermatozoon can have either an X or a Y chromosome, the male gamete is responsible for fetal sex determination. Research indicates that there is an approximately 50-50 chance of either occurrence.
Which of the following is a genetic condition caused by a small gene mutation that affects protein structure, producing hemoglobin S? a) Tay-Sachs disease b) Sickle cell anemia c) Hemophilia d) Marfan syndrome
Sickle cell anemia Correct Explanation: Sickle cell anemia is an example of a genetic condition caused by a small gene mutation that affects protein structure, producing hemoglobin S. Marfan syndrome is an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Tay-Sachs disease is an autosomal recessive inherited condition.
A woman in the last trimester of pregnancy complains of sleeping poorly. She becomes light-headed and dizzy whenever she sleeps on her back, but she can't sleep at all if she lies on her side. How would you suggest she try sleeping?
Sleep with a pillow under her right hip
Mitosis is the process of cell division for which cells?
Somatic
A pregnant woman of Jewish descent comes to the clinic for counseling and tells the nurse that she is worried her baby may be born with a genetic disorder. Which of the following diseases does the nurse identify to be a risk for this patient's baby based on the family's ancestry? a) Down syndrome b) B-thalassemia c) sickle-cell anemia d) Tay-Sachs
Tay-Sachs Correct Explanation: Sickle-cell anemia occurs most often in African Americans, Tay-Sachs disease occurs most often in people of Jewish ancestry. B-thalassemia is a blood dyscrasia that occurs frequently in families of Greek or Italian heritage. Down syndrome is not attributed to Jewish ancestry.
When describing the characteristics of the amniotic fluid to a pregnant woman, which would the nurse include? a) It is usually an acidic fluid. b) It is composed primarily of organic substances. c) The amount gradually fluctuates during pregnancy. d) It limits fetal movement in utero.
The amount gradually fluctuates during pregnancy. Correct Explanation: Amniotic fluid is alkaline. Amniotic fluid is composed of 98% water and 2% organic matter. Amniotic fluid volume gradually fluctuates throughout pregnancy. Sufficient amounts promote fetal movement to enhance musculoskeletal development.
Nurses are expected to know how to use the first genetic test. What is it? a) The psychosocial assessment b) The developmental assessment c) The physical assessment d) The family history
The family history Correct Explanation: The family history is considered the first genetic test. It is expected that all nurses will know how to use this genetic tool. The other answers are incorrect because the developmental, physical, and psychosocial assessments are not the first genetic test
A non-stress test is performed on a pregnant woman. The nurse informs the client the test was reactive. Which of the following statements by the patient indicates understanding of the test results?
The fetal heart rate increases with activity and indicates fetal well-being
The fetus receives blood flow from the mother via the placenta and umbilical cord. What is the route of fetal circulation through the umbilical cord? a) The two umbilical veins carry waste products from the fetus to the placenta b) The two umbilical arteries carry waste products from the placenta to the fetus c) The one umbilical vein carries oxygen rich blood to the fetus from the placenta d) The one umbilical artery carries oxygen rich blood to the fetus from the placenta
The one umbilical vein carries oxygen rich blood to the fetus from the placenta Correct Explanation: There are two umbilical arteries and one umbilical vein. The arteries carry waste from the fetus to the placenta; the vein carries oxygenated blood to the fetus from the placenta.
A baby is born with what the physician believes is a diagnosis of trisomy 21. This means that the infant has three number 21 chromosomes. What factor describes this genetic change? a) During meiosis, a reduction of chromosomes resulted in 23 b) The patient has a nondisjunction occurring during meiosis c) The patient will have a single X chromosome and infertility d) The mother also has genetic mutation of chromosome 21
The patient has a nondisjunction occurring during meiosis Correct Explanation: 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.
The nurse is providing prenatal care to a young couple that is pregnant with their first child. In what period of development would the nurse explain to the couple that most congenital defects would occur? a) All periods are equally vulnerable b) The period of the embryo c) The period of the fetus d) The period of the zygote
The period of the embryo Explanation: During the period of the embryo, which lasts until the eighth week after conception, the embryo is in what is called the critical phase of human development. During these weeks, all the organs and structures of the human are formed and are most susceptible to damage.
A fetus is able to maintain blood circulation in-utero by the presence of circulatory shunts. The ductus arteriosus in-utero shunts blood from: a) The right ventricle to the aorta b) The pulmonary artery to the aorta c) The aorta to the pulmonary veins d) The left to right heart atria
The pulmonary artery to the aorta Correct Explanation: Because the fetal lungs are not inflated, blood must be diverted past them. The ductus arteriosus helps to do this by shunting blood from the pulmonary artery to the aorta. As the heart develops, the septa between the atria and ventricles eventually closes. If it does not, then, depending on the affects, interventions must be planned.
Implantation generally occurs at which place on the uterus? a) Directly over the cervical os b) Directly over an opening to a fallopian tube c) The lower anterior surface d) The upper posterior surface
The upper posterior surface Correct Explanation: Implantation occurs most commonly on the upper posterior surface of the uterus. This position allows the fetus to deliver before the placenta.
What should the nurse explain to the pregnant patient about the importance of the fetal stage of development? a) Cellular division and implantation occur during this stage of development. b) The fetus is ready for delivery. c) There can be no damage to the fetus if the mother drinks alcohol at this stage. d) There is additional growth and development of the organs and body systems.
There is additional growth and development of the organs and body systems. Correct Explanation: The fetal stage is from the beginning of the ninth week after fertilization and continues until birth. At this time, the developing human is called a fetus. During the fetal stage, there is additional growth and maturation of the organs and body systems.
What should the nurse explain to the pregnant patient about the importance of the fetal stage of development? a) There can be no damage to the fetus if the mother drinks alcohol at this stage. b) There is additional growth and development of the organs and body systems. c) The fetus is ready for delivery. d) Cellular division and implantation occur during this stage of development.
There is additional growth and development of the organs and body systems. Correct Explanation: The fetal stage is from the beginning of the ninth week after fertilization and continues until birth. At this time, the developing human is called a fetus. During the fetal stage, there is additional growth and maturation of the organs and body systems.
A nurse is preparing a patient for rhythm strip testing. She places the woman into a semi-Fowler's position. What is the appropriate rationale for this measure? a) To prevent supine hypotension syndrome b) To aid the woman as she pushes during labor c) To decrease the heart rate of the fetus d) To prevent the woman from falling out of bed
To prevent supine hypotension syndrome Correct Explanation: The term "rhythm strip testing" means assessment of the fetal heart rate for whether a good baseline rate and long- and short-term variability are present. For this, help a woman into a semi-Fowler's position (either in a comfortable lounge chair or on an examining table or bed with an elevated backrest) to prevent her uterus from compressing the vena cava and causing supine hypotension syndrome during the test. Placing her in this position does not decrease the heart rate of the fetus. It is not done to aid the woman as she pushes in labor, as she is not in labor yet. It is not done to prevent her from falling out of bed.
Body joints become more relaxed with pregnancy because of relaxin, a hormone produce by the placenta. a) True b) False
True
Green tea should be avoided during pregnancy. (True/False)
True
Smoking may be a cause of ectopic (tubal) pregnancy. a) False b) True
True
Some women report cravings for nonfood substances such as clay, dirt, cornstarch, or ice cubes during pregnancy. (True/False)
True
There is a strong correlation between poor oral health and preterm birth.
True
Women having in vitro fertilization (IVF) can have both the egg and sperm examined for genetic disorders of single gene or chromosome concerns before implantation. a) False b) True
True
The fetal structure with the highest oxygen concentration is which? a) Pulmonary vein b) Umbilical artery c) Umbilical vein d) Ductus arteriosus
Umbilical vein Correct Explanation: The umbilical vein carries oxygenated blood from the placenta to the fetus; the umbilical artery carries de-oxygenated blood from the fetus to the placenta. The ductus arteriosus shunts blood from the right side to the left in order to bypass the deflated lungs. The pulmonary vein drains the deflated lungs.
Down syndrome may occur because of a translocation defect. This means the a) parents have a chromosomal pattern that is exactly alike. b) additional chromosome was inherited because it was attached to a normal chromosome. c) parents are such close relatives that their genes are incompatible. d) infant inherits chromosomal material from only one parent.
additional chromosome was inherited because it was attached to a normal chromosome. Correct Explanation: A translocation defect causes Down syndrome when a 21st chromosome is attached to another chromosome, so dysjunction results in an abnormal distribution of chromosomes.
A gene that is expressed when paired with another gene for the same trait is called a) heterozygous. b) homozygous. c) dominant. d) recessive.
dominant. Explanation: A dominant gene is one that will be expressed when paired with a like gene.
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
An 18-year-old pregnant woman asks why she has to have a routine alpha-fetoprotein serum level drawn. You explain that this a) is a screening test for placental function. b) tests the ability of her heart to accommodate the pregnancy. c) may reveal chromosomal abnormalities. d) measures the fetal liver function.
may reveal chromosomal abnormalities. Correct Explanation: An alpha-fetoprotein analysis is a cost-effective screening test to detect chromosomal and open-body-cavity disorders.
The purpose of a circulatory shunt, such as the ductus arteriosus, is to a) allow fetal blood and maternal blood to mix freely. b) direct blood flow to the lungs to supply nutrients necessary for growth and maturation. c) allow blood to bypass the fetal heart, which does not function as a pump until birth. d) permit oxygenated blood to supply the most important fetal organs.
permit oxygenated blood to supply the most important fetal organs. Explanation: The ductus arteriosus helps propel oxygenated blood quickly to the coronary arteries, brain, and kidneys.
A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as which of the following? a) genome b) genotype c) phenotype d) allele
phenotype Correct Explanation: Alleles are two like genes. Phenotype refers to a person's outward appearance or the expression of genes. Genotype refers to his or her actual gene composition. Genome is the complete set of genes present in a person.
Girls with Turner Syndrome will usually exhibit a) short stature b) progressive dementia c) painful joints d) chorealike movements
short stature Correct Explanation: Girls with Turner syndrome usually have a single X chromosome, causing them to have short stature and infertility. Persons with sickle cell anemia have painful joints. Color blindness occurs in persons diagnosed with Huntington disease and they may exhibit chorealike movements. Progressive dementia occurs in early-onset familial Alzheimer's disease.
When providing education on pre-conceptual considerations to a female patient and her spouse, the nurse knows that teratogens during the embryonic stage pose the greatest risk to the fetus. What weeks of gestation are considered the embryonic stage? a) fertilization to the week 2 b) week 2 week 8 c) week 9 to birth d) the entire pregnancy
week 2 week 8 Correct Explanation: The embryonic stage produces the greatest risk of damaging effects to the fetus because the cells are rapidly dividing and differentiating into specific body structures. Week 9 to birth is the fetal stage; the fertilization to the week 2 is the pre-embryonic stage. Weeks 2 to 8 are the time period known as the embryonic stage.
When providing education on pre-conceptual considerations to a female patient and her spouse, the nurse knows that teratogens during the embryonic stage pose the greatest risk to the fetus. What weeks of gestation are considered the embryonic stage? a) week 2 week 8 b) fertilization to the week 2 c) the entire pregnancy d) week 9 to birth
week 2 week 8 Correct Explanation: The embryonic stage produces the greatest risk of damaging effects to the fetus because the cells are rapidly dividing and differentiating into specific body structures. Week 9 to birth is the fetal stage; the fertilization to the week 2 is the pre-embryonic stage. Weeks 2 to 8 are the time period known as the embryonic stage.
A 40-year-old patient is in her 16th week of pregnancy. So far, her pregnancy appears to be healthy, with no abnormal results from standard diagnostic tests. Because of her age, however, the patient is a candidate for which diagnostic tests? (Select all that apply.) a) Nuchal translucency screening b) Amniocentesis c) Maternal serum screening d) Chorionic villi sampling
• Chorionic villi sampling • Amniocentesis Explanation: Chorionic villi sampling (CVS) and amniocentesis are both techniques that may be offered to women who are older than 35 years of age, or to those whose MSAFP level is abnormal, to further screen for genetic disorders. Women of all ages are offered routine sonogram screening (a nuchal translucency scan) and analysis of maternal serum levels of alpha-fetoprotein (MSAFP) by a quadruple screen early in pregnancy to evaluate for neural tube, abdominal wall, or chromosomal disorders in the fetus.
The nurse explains to the pregnant patient that the placenta is important for many reasons, but one function it has is to secrete hormones to sustain the pregnancy. Which hormones does the nurse inform the patient that the placenta secretes? (Select all that apply.) a) Progesterone b) Testosterone c) Estrogen d) Human placental lactogen e) Human chorionic gonadotropin
• Progesterone • Estrogen • Human chorionic gonadotropin • Human placental lactogen Explanation: The placenta secretes hormones that help to sustain the pregnancy. These include progesterone, estrogen, human placental lactogen, and human chorionic gonadotropin. Progesterone is necessary to maintain the nutrient-rich endometrial lining. It also functions to keep the myometrium quiet, so that contractions do not occur prematurely, leading to loss of the pregnancy. Estrogen functions to provide a rich blood supply to the decidua and placenta. The main function of human chorionic gonadotropin is to sustain the corpus luteum at the beginning of the pregnancy. The main function of hPL is to regulate glucose available for the fetus.
