OB Chapter 8
A pregnant client who is planning to have genetic testing asks the nurse when she should schedule her amniocentesis. What should the nurse tell the client? 30 weeks 10 weeks 16 weeks 24 weeks
16 weeks
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? "Was your mother or grandmother diagnosed with gestational diabetes?" "Do you plan to breastfeed or bottle feed your new baby?" "Are you planning to develop a birth plan for use during the birthing process?" "Does anyone in your or the father's family have any genetic disorders?"
"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? "With each child the odds of inheritance decrease significantly." "If I have four children, only one will have the disease." "Each child will have a 25% chance of developing the disease." "My children will have a 50/50 chance of having a genetic disease."
"Each child will have a 25% chance of developing the disease."
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? "Have you thought about what this disease will do to the person you are going to marry and any children you may have?" "Your information will remain confidential until the geneticist reviews everything. Then he will have to tell your family." "I will respect your wishes and keep your information confidential. I do wish you would reconsider though." "I am ethically bound to tell your family and your fiancé."
"I will respect your wishes and keep your information confidential. I do wish you would reconsider though."
A young couple who underwent preconceptual genetic testing is at high risk for having a child with Down syndrome and have decided not to have children. Which response by the nurse is most appropriate? "To still have a child of your own, you should consider asking a friend or family member to be a surrogate." "If you would like to discuss this further, here is the contact information for the genetic counseling center." "The health care provider can refer you for a second opinion if you are not happy with these results." "You always have the option to adopt a child if you are really wanting to become parents."
"If you would like to discuss this further, here is the contact information for the genetic counseling center."
The nurse is teaching a couple about the pros and cons of genetic testing. Which statement by the nurse best describes the limits of genetic testing? "Various genetic tests help the primary care provider choose appropriate treatments." "Some genetic tests can give a probability for developing a disorder." "Genetic testing helps couples avoid having children with fatal diseases." "Genetic tests identify people at high risk for preventable conditions."
"Some genetic tests can give a probability for developing a disorder."
A nurse is teaching the parents of a male child recently diagnosed with Klinefelter syndrome about the disorder and its treatment. The nurse determines that more teaching is needed based on which parental statement? "His condition is due to having an extra X chromosome." "He may not be able to have children." "Taking testosterone will correct this problem." "He may need surgery to reduce his breast size."
"Taking testosterone will correct this problem."
A pregnant client asks the nurse if the fetus can be tested for Down syndrome. Which statement by the nurse is most appropriate? "Of course. The primary health care provider can prescribe a DNA analysis for this." "When you have ultrasounds done, they look for signs of Down syndrome." "You need to be sure you want to know this information before you think about being tested." "Yes, a chromosomal analysis can be done to assess for Down syndrome."
"Yes, a chromosomal analysis can be done to assess for Down syndrome."
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? "The insurance company may consider it a preexisting condition since you know." "There are laws in place that prohibit that from happening." "They will charge you a higher premium every month." "The insurance company may ask you to change policies once the baby is born."
"There are laws in place that prohibit that from happening."
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? "The health care provider just wants to make sure there are not any other diseases in the family genes." "Wilms tumor is associated with a genetic link to chromosome 11; with early detection and treatment there are better outcomes." "Your child has a benign tumor. The testing is not necessary, and I would suggest that you don't put your children through it." "The tumor is a collection of fat cells in the body that just collect in that one spot. The testing will see if the other children will develop that as well."
"Wilms tumor is associated with a genetic link to chromosome 11; with early detection and treatment there are better outcomes."
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 placed in a home facility. The child stays at home with a parent. The child is kept in a day care setting. The child is enrolled in kindergarten.
The child is enrolled in kindergarten.
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 38-year-old client whose partner is 43 years of age and who have a child diagnosed with hypoplastic left heart syndrome 17-year-old client diagnosed with schizophrenia whose partner is 15 years of age and has type 2 diabetes 28-year-old client diagnosed with hemophilia whose partner is 38 years of age and has hypertension
36-year-old client with thalassemia whose partner is 55 years of age and who have a son with Duchenne muscular dystrophy
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 chromosome combination? 47XY21+ 47XX21+ 46XX 46XX5p-
47XX21+
A genetic nurse is taking a health history for a 1-month-old male client with Edwards syndrome. How will the nurse note this genetic disorder in the documentation? 47XX18- 47XX18+ 47XY18+ 47XY18-
47XY18+
An Rh-negative client is having an amniocentesis. What is the highest priority nursing intervention to perform immediately after the procedure? Observe fetal heart rate for 90 minutes. Monitor for labor contractions for 1 hour. Administer Rh immune globulin. Observe the client's vital signs for 2 hours.
Administer Rh immune globulin.
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? Risk for loneliness related to lack of communication Ineffective coping related to personal issues Hopelessness related to increased tension Altered sexuality pattern related to fear
Altered sexuality pattern related to fear
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)? Turner syndrome cystic fibrosis Tay-Sachs disease Down syndrome
Tay-Sachs disease
A client asks about a child inheriting an autosomal recessive disorder. What must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? One parent, usually the father, must not be a carrier or have the disease. One parent must have the disease. One parent, usually the mother, must be a carrier. Both parents must be carriers.
Both parents must be carriers.
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? Find the answer to the client's question in the office resource books. Complete the family history then conduct a health history along with physical and developmental assessments. Find the answer to the client's question on the Internet. Ask the geneticist for the answer.
Complete the family history then conduct a health history along with physical and developmental assessments.
A client is undergoing genetic testing and counseling. What is the responsibility of the nurses during this process? Clarify values and goals for the couple. Notify insurance companies of test results. Share with the client the nurse's opinion when asked. Explain the results of the testing to the client.
Clarify values and goals for the couple.
A client in her late 20s visits the clinic to begin the process of in vitro fertilization (IVF). Her husband in his late 50s asks if there are any tests to check for any irregularities. What tests should the nurse discuss with this couple? amniocentesis chorionic villus sampling examination of egg and sperm purified protein derivative (PPD) skin test
examination of egg and sperm
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 Fear related to birth of a baby Situational low self-esteem Deficient knowledge related to inheritance pattern
Decisional conflict related to continuation of pregnancy
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? cardiac defects sickle-cell anemia respiratory disorders Down syndrome
Down syndrome
Nondisjunction of a chromosome results in which diagnosis? Huntington disease Duchenne muscular dystrophy Marfan syndrome Down syndrome
Down syndrome
When describing genetic disorders to a group of couples planning to have children, the nurse would identify which as an example of an autosomal dominant inheritance disorder? Huntington disease sickle cell disease cystic fibrosis phenylketonuria
Huntington disease
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. Call the client later and apologize. Tell the unlicensed assistive personnel Contact the health care provider.
Immediately stop the nurse.
A couple comes in for genetic testing. They are planning to start a family and are concerned because the wife's sister has a genetic disorder. The clinic's consent form is in English and only the wife is literate in English. The nurse does not speak the clients' first language. What should the nurse do? Let the wife translate for her husband. Inform the couple they just need to sign so the testing could be done. Explain the form to the clients in English and have them sign it. Inform the geneticist that the couple cannot give informed consent.
Inform the geneticist that the couple cannot give informed consent.
A new client has come to the clinic. While the nurse is taking the client's history, the client tells the nurse she is trying to get pregnant and she is very fearful she will have another miscarriage. The client states she has lost two pregnancies and she shares with the nurse that she does not know why this occurred. Based on this client's history, what recommendation is best for the nurse to make at the present time? Instruct the client to continue to try to get pregnant Tell the client to have an amniocentesis with the next pregnancy Let the client know that her loss may not occur again Instruct the client on chromosome testing studies
Instruct the client on chromosome testing studies
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. Fragile X syndrome. Down syndrome. Turner syndrome.
Klinefelter syndrome.
A nurse assesses that a 7-year-old male client has a prominent lower jaw, large ears, speech deficits, and displays hyperactivity. The nurse identifies this as being most likely related to which diagnosis? Klinefelter syndrome fragile X syndrome Philadelphia syndrome cri-du-chat syndrome
fragile X syndrome
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 disease does the nurse identify to be a risk for this client's baby based on the family's ancestry? Down syndrome Tay-Sachs disease beta-thalassemia sickle cell anemia
Tay-Sachs disease
In evaluating expected outcomes of a client, what might a nurse consider a priority when working with genetic counseling? (Select all that apply.) The couple states understanding of inheritance. The couple is happily married. The couple needs no further information. The couple receives test results timely. The couple demonstrates positive coping skills.
The couple receives test results timely. The couple states understanding of inheritance. The couple demonstrates positive coping skills.
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? Edwards syndrome Patau syndrome Turner syndrome Klinefelter syndrome
Turner syndrome
A nurse is conducting a presentation about genetics and genetic conditions for a group of couples who are receiving preconception care. The nurse is describing the concepts associated with inheritance. The nurse determines that the teaching was successful when the group describes a person's phenotype using which statement? a person's actual gene composition a person who has two like genes for a trait a person's complete set of genes a person's outward appearance
a person's outward appearance
Parents of a newborn have recently found out that their infant has a genetic disorder. The parents say to the nurse, "It's not fair that this is happening to us." The nurse interprets this statement as reflecting which stage of grief? reorganization anger shock and denial bargaining acceptance
anger
A couple at a fertility clinic informs the nurse that they have had genetic counseling and are afraid to get pregnant because the husband is a carrier of several genetic disorders. They still very much, however, want to have a child biologically related. What would be the best choice for the nurse to recommend to this couple? adoption artificial insemination by donor (AID) trying to get pregnant without other interventions surrogate embryo transfer
artificial insemination by donor (AID)
What does the genetic analysis always include? evaluation of other potentially inherited conditions interventions for other potentially inherited conditions assessment for any other potentially inherited condition planning for other potentially inherited conditions
assessment for any other potentially inherited condition
What does the genetic analysis always include? evaluation of other potentially inherited conditions interventions for other potentially inherited conditions planning for other potentially inherited conditions assessment for any other potentially inherited condition
assessment for any other potentially inherited condition
To screen for chromosomal disorders, a 39-year-old woman is scheduled for a circulating cell-free DNA test. What type of test is this? blood specimen collection urine specimen collection skin biopsy ultrasound
blood specimen collection
A nursing instructor is teaching students about genetic disorders and briefly discusses how women can arrange to have a newborn's cord blood frozen and banked. What does the instructor tell students that this blood may be used for in the future? blood transfusions bone marrow transplantation future problems with bleeding diagnostic tests
bone marrow transplantation
A 40-year-old client is in her 10th 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 nurse would anticipate that the client is a candidate for which diagnostic tests? Select all that apply. maternal serum screening nuchal translucency screening amniocentesis cell-free DNA testing chorionic villus sampling
chorionic villus sampling amniocentesis cell-free DNA testing
A client is undergoing a genetic test involving microscopic examination of metaphase chromosomes. The nurse determines that which of the following is being done? cytogenetic analysis direct molecular analysis linkage analysis biochemical assays
cytogenetic analysis
A nurse is providing education to a couple who have just been told their unborn fetus has Down syndrome. The nurse should explain that this is what type of genetic abnormality? inversion translocation deletion duplication
duplication
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? gestational diabetes genetic disorders preterm labor cervical insufficiency
genetic disorders
A clinic nurse is asked by a client receiving genetic counseling about symptoms related to Turner syndrome. Which manifestation would the nurse most likely include? Select all that apply. infertility streak ovaries webbed neck abnormal iris color short stature
infertility streak ovaries webbed neck short stature
A nurse is talking to a group of young couples who wish to conceive. One young woman asks the nurse if any tests predict fetal abnormalities. Which of the following tests should the nurse include in the discussion? Select all that apply. amniocentesis maternal serum alpha-fetoprotein test chorionic villus sampling lipid panel complete blood count
maternal serum alpha-fetoprotein test chorionic villus sampling amniocentesis
Prenatal testing is used to assess for genetic risks and to identify genetic disorders. In explaining to a couple about an elevated maternal serum alpha-fetoprotein screening test result, the nurse would discuss the need for: more definitive evaluations to conclude anything. a more specific determination of the acid-base status. special care needed for a Down syndrome infant. immediate termination of the pregnancy based on results.
more definitive evaluations to conclude anything.
A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as the: phenotype. allele. genotype. genome.A nurse is conducting a presentation about genetics and genetic conditions for a group of couples who are receiving preconception care. The nurse is describing the concepts associated with inheritance. The nurse determines that the teaching was successful when the group describes a person's phenotype using which statement?
phenotype.
After teaching a class on the stages of fetal development, the nurse determines that the teaching was successful when the group identifies which stages? Select all that apply. pre-embryonic fetal umbilical placental embryonic
pre-embryonic embryonic fetal
Girls with Turner syndrome will usually exhibit: painful joints. chorea-like movements. short stature. progressive dementia.
short stature.
A nurse working as a member of a genetic counseling team understands that her careful assessment of which body areas in a newborn may provide important indications for structural genetic disorders? length, weight, and head circumference space between the eyes, the shape of the ears, and the numbers of fingers and toes presence or absence of primitive reflexes color of the eyes, skin color, and parent's race
space between the eyes, the shape of the ears, and the numbers of fingers and toes
Which condition is the most commonly occurring chromosomal disorder? Turner syndrome trisomy 21 (Down syndrome) fragile X syndrome Klinefelter syndrome
trisomy 21 (Down syndrome)
A nurse is interviewing a couple at a preconception counseling session. The couple is of Greek heritage and are concerned about the possibility of their children being born with a genetic disorder. Based on the nurse's understanding of genetic disorders, the nurse would identify this couple as being at risk for which condition? α-thalassemia Tay-Sachs disease sickle cell anemia β-thalassemia
β-thalassemia