RICCI Chapter 10

A female patient learns that she is the carrier of the X-linked recessive disease hemophilia A. Her spouse is free of the disease. What should the nurse teach the patient about the frequency of this disease in future children?

All male children will have a 50% risk to inherit the disease.

A nurse is teaching a prenatal class and is asked the purpose of amniotic fluid. Which statements are correct? Select all that apply.

Amniotic fluid promotes fetal movement enhancing musculoskeletal development. Sufficient amounts of amniotic fluid cushion the fetus from trauma. Amniotic fluid allows the fetal umbilical cord to be relatively free from compression. Sufficient amounts of amniotic fluid help the fetus maintain a constant body temperature.

Which body system is most affected throughout the embryonic and fetal period by teratogens?

Central nervous system

A 25-year-old client wants to know if her baby boy is at risk for Down syndrome because one of her distant relatives was born with it. Which information would the nurse share with the client while counseling her about Down syndrome?

Children with Down syndrome have extra genetic material in the 21 chromosome that occurs during development of the sperm or egg.

A young married woman tells you that she is going to have a tubal ligation because there are two people with mental retardation in her husband's family, and she is afraid this problem will surface in her children. Which of the following nursing diagnoses would best apply to this couple?

Deficient knowledge of genetically inherited disorders

Nondisjunction of a chromosome results in which diagnosis?

Down syndrome

A 38-year-old client presents to the clinic desiring to get pregnant. She reports she had a tubal ligation in her early 20s after two babies and a divorce. After learning that the client recently underwent a reversal of the tubal ligation, the nurse will warn the client of which potential risk?

Ectopic pregnancy

During which stage of fetal development is exposure to teratogens most damaging?

Embryonic stage

What should the nurse include when counseling potential parents about genetic disorders?

Environmental influences may affect multifactorial inheritance.

At a prenatal checkup with a client at 7 weeks' gestation, the nurse would identify what as a normal finding?

Fetal heart sounds are heard.

A nurse educator is describing prenatal care for clients at 15 weeks' gestation. What information would the nurse not include?

Fetal weight will have tripled.

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

A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embyonic stage?

From fertilization and to the end of the second week .

A nurse is reviewing a journal article about fetal development and the formation of various body systems. When reading about the development of the digestive system, the nurse finds information related to the developmental abnormality of omphalocele. The nurse demonstrates understanding of this information by identifying which situation as the reason for an omphalocele?

Intestines failed to return to the abdominal cavity during intrauterine life.

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?

It is an autosomal recessive disorder.

A pregnant patient asks why an α-fetoprotein serum level has been ordered. What should the nurse explain to the patient about this test?

It may reveal chromosomal abnormalities.

A patient becomes concerned upon learning for the need to have a karyotype performed. What should the nurse explain to this patient about this test? (Select all that apply.)

It photographs and displays chromosomes. It reveals diseases present on chromosomes.

A patient who is 28 weeks pregnant is demonstrating signs of placental insufficiency. The health care provider prescribes betamethasone. When teaching the patient about this drug's purpose, which information would the nurse include?

It potentiates the formation of surfactant.

A pregnant patient is directed to perform a daily fetal movement count. What should the nurse instruct the patient about this count? Select all that apply.

Lie down to do the count after eating a meal. Count fetal movements until a total of 10 are counted and record the time.

Which factor suggests that a child's disorder is a X-linked inherited one?

Male children of an affected male are free of the disease.

The nurse is completing a physical assessment with a patient who has just learned of being pregnant. The patient's last menstrual period was August 15. When should the nurse instruct the patient that the baby will be due?

May 22 When using the Naegele rule, the nurse should count backward 3 calendar months from the first day of the patient's last menstrual period and then add 7 days. For August 15, the month would be May and the day would be 15 plus 7 or 22. May 22 is when the patient's baby is due. July 15, June 22, and April 15 are inappropriate applications of the Naegele rule

An expectant mother asks the nurse which of her antibodies from previous immunizations would be passed to her fetus during pregnancy. Which response by the nurse would be correct?

Measles antibodies will cross the placenta to protect the fetus.

A client asks the nurse to describe the difference between menstruation and implantation bleeding. Which statements should the nurse include in the description? Select all that apply.

Menstruation occurs when the ovum is not fertilized. Implantation bleeding occurs when the blastocyst burrows into the endometrium. Menstruation occurs 14 days after ovulation. Implantation bleeding occurs 7 to 10 days after fertilization.

A woman in her 15th week of pregnancy is about to undergo amniocentesis. Which nursing intervention should be made first?

Obtain a signed consent form.

Assessment for surfactant level via LS ratio in the amniotic fluid is a primary estimation of fetal maturity. The purpose of surfactant is to:

Prevent alveoli from collapsing on expiration.

The nurse is teaching a patient in the first trimester of pregnancy about the importance of folic acid in the diet and how folic acid supplements might be beneficial. For which reason is the nurse teaching the patient about this vitamin?

Prevents neural tube disorders in the developing fetus

The nurse is explaining the ultrasound procedure to a pregnant client and mentions part of the purpose is to evaluate the amniotic fluid. When questioned by the client how the amniotic fluid helps the fetus, which functions should the nurse point out? Select all that apply.

Provides physical protection Helps regulates temperature Provides unrestricted movement Helps permit symmetrical growth

The results of a pregnant patient's quadruple screen were positive, and an amniocentesis was performed. The amniocentesis report states no genetic anomalies present. What should the nurse do to assist this patient understand the test results?

Reassure that the report of the amniocentesis is valid.

A client comes to the clinic with concerns about her pregnancy. She is in her first trimester and is now experiencing moderate abdominal pain on the right side. What would be the nurse's first action?

Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy.

A woman calls the obstetrician's office and states that she is feeling nauseous and tired and suspects she may be pregnant. The nurse asks the woman when her last menstrual cycle was and is told that the woman had a light cycle three weeks ago. How would the nurse respond to this client?

Recommend that the woman come into the office for a pregnancy test or do a home pregnancy test.

A pregnant client and her husband have had a session with a genetic specialist. What is the role of the nurse after the client has seen a specialist?

Review what has been discussed with the specialist.

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?

Rubella

Spermatozoa begin their cellular division in what part of the male reproductive system?

Seminiferous tubules

A pregnant woman tends not to eat for long periods of time because of her busy work schedule. What process safeguards her fetus from becoming hypoglycemic during this time?

Somatomammotropin helps to regulate glucose levels

A Caucasian female client of Jewish ancestry is pregnant. The nurse is aware that the client may be a carrier for which condition?

Tay-Sachs disease

When describing the characteristics of the amniotic fluid to a pregnant woman, the nurse would include which information?

The amount gradually fluctuates during pregnancy.

A baby is born with what the primary care provider believes is a diagnosis of trisomy 21. This means that the infant has three number 21 chromosomes. What factor describes this genetic change?

The client has a nondisjunction occurring during meiosis.

A nurse educator is describing the structures of the fetal heart to a pregnant client. What information would the nurse likely include in the description? Select all that apply.

The ductus venosus connects the umbilical vein to the inferior vena cava. The ductus arteriosus connects the main pulmonary artery to the aorta. The foramen ovale is an anatomic opening between the right and left atrium.

A mutligravida client is concerned that she may deliver early. When asking the nurse what is the earliest her baby can be delivered and survive, which time frame would the nurse point out?

The end of the second trimester

The nurse is assessing a newborn infant for possible intrauterine growth restriction (IUGR). Which factor should the nurse analyze first to help determine if this diagnosis is accurate?

The ethnicity and stature of both the mother and father

What physiologic changes occur after birth when the cord is cut and clamped?

The infant takes its first breath and the lungs expand to increase blood oxygen levels.

The primary care provider has prescribed a karyotype for a newborn. The mother questions what the type of information that will be provided by the test. What information should be included in the nurse's response?

The karyotype will assess the baby's chromosomal makeup.

After an assessment, a couple planning marriage decides to schedule an appointment for genetic counseling in several months. Which information from the assessment would support this couple's decision? (Select all that apply.)

The male and female are second cousins. The male and female are both of Mediterranean descent. The female's sister gave birth to a baby with Down syndrome.

While conducting a class for a group of pregnant women in their first trimester, one of the woman asks, "How is my baby's sex determined?" Which statement would the nures include in the response? Select all that apply.

The male gamete is responsible for sex determination. The Y chromosome is smaller and contains genes for maleness.

The nurse determines that a fetal nonstress test is nonreactive for over 20 minutes. The nurse interprets this result as suggesting which situation? Select all that apply.

The patient is hypoglycemic. The patient is using an illicit drug. The patient is smoking while pregnant.

A nurse is conducting a prenatal class for expectant mothers and one of the mothers asks her how the placenta works. The nurse would explain that the placenta serves which purposes? Select all that apply.

The placenta provides nourishment for the fetus. It serves as an exchange site for oxygen and carbon dioxide. It serves as a barrier to some medications and hormones in the maternal blood supply

How does fetal circulation differ from circulation after birth?

The umbilical vein carries oxygenated blood, while deoxygenated blood is carried by the umbilical arteries.

A client is confused concerning her fertile period each month. The nurse would educate the client by providing which information?

The window of opportunity for conception is from 3 days before to 2 days following ovulation.

A nurse is caring for a 32-year-old Jewish client who is pregnant with a female baby. The parents are not directly related by blood. The mother reports that her husband's cousin had an infant born with Tay-Sachs disease that died two years ago and she is concerned about her baby. Which information does the nurse need to give the client to help alleviate her concerns regarding her baby having the same disease?

There is a risk to the baby based upon the Jewish background, so genetic testing would be recommended.

What should the nurse explain to the pregnant client about the importance of the fetal stage of development?

There is additional growth and development of the organs and body systems.

A pregnant patient has been counseled to have an amniocentesis. For which genetic conditions should the nurse instruct the patient that this diagnostic test will detect?

Trisomy 21

During a clinical rotation at a prenatal clinic, a client asks a nurse what causes certain birth defects. The nurse replies that they can be caused by teratogens. What does the severity of the defects depend on? Select all that apply.

When during development the conceptus is exposed to the teratogen The particular teratogen to which the fetus is exposed

The fetal-assessment technique of a rhythm strip refers to:

a tracing of fetal heart rate and pattern.

The nurse prepares a couple to have a karyotype performed. What describes a karyotype?

a visual presentation of the chromosome pattern of an individual

Down syndrome may occur because of a translocation defect. This means the:

additional chromosome was inherited because it was attached to a normal chromosome.

A pregnant client has heard about Down syndrome and wants to know about the risk factors associated with it. What would the nurse include as a risk factor?

advanced maternal age

A client who is 30 weeks' gestation has recently been diagnosed with polihydramnios. What would be a priority nursing action?

blood sugar monitoring

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?

bones

The nursing instructor is preparing a class presentation covering the various hormones and their functions during pregnancy. The instructor determines the class is successful when the class correctly matches which function with hCG?

continues progesterone production by corpus luteum

A pregnant woman is asked to observe fetal movements as a fetal assessment technique. The nurse would instruct her to:

count fetal movements for 1 hour at the same time each day.

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

A nurse is providing care to a couple with an infant who was born with a congenital condition. When working with these parents, which information would be most appropriate to provide?

experiences the mother had during pregnancy are probably unrelated.

When preparing a presentation for a group of pregnant women about fetal circulation, the nurse would point out which structure is primarily responsible for ensuring that highly oxygenated blood reaches the fetal brain?

foramen ovale

Genetics-related health care is basic to the holistic practice of nursing. What should nursing practice in genetics include?

gathering relevant family and medical history information

A client who is 37 years of age presents to the health care clinic for her first prenatal checkup. Due to her advanced age, the nurse should prepare to talk with the client about her increased risk for what complication?

genetic disorders

The nurse is creating an educational pamphlet for pregnant mothers. Which is the best description of fetal development for the nurse to emphasize?

gestational age, length, weight, and systems developed

An expectant mother is on heparin for previous blood clots and voicing concerns about how her medications will affect her baby. The nurse would inform the mother that:

heparin does not cross the placenta and is safe for her to take.

A nurse is interviewing the family members of a pregnant client to obtain a genetic history. While asking questions, which information would be most important?

if couples are related to each other or have blood ties

When genetics and genomics were incorporated into nursing, the decision was made to include them in what part of the nursing process?

interventions that support identification of the genetics-related health needs of people

When assessing newborns for chromosomal disorders, which assessment would be most suggestive of a problem?

low-set ears

A woman is taking vaginal progesterone suppositories during her first trimester because her body does not produce enough of it naturally. She asks the nurse what function this hormone has in her pregnancy. What should the nurse explain is the primary function of progesterone?

maintains the endometrial lining of the uterus during pregnancy

An 18-year-old pregnant woman asks the nurse why she has to have a routine alpha-fetoprotein serum level drawn. The nurse explains that this:

may reveal chromosomal abnormalities.

A woman is confused after finding out the ultrasound results predict a different due date for the birth of her baby. Which factor should the nurse point out is most likely the reason for the miscalculation of the fetal age?

mistaking implantation bleeding for LMP

The nursing instructor is illustrating the fetal circulation to a group of nursing students. The instructor determines the session is successful after the students correctly choose which main structure is most responsible for providing nutrition and removing waste from the fetus?

mother's blood

A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as the:

phenotype.

Girls with Turner syndrome will usually exhibit:

short stature.

Nurses are expected to know how to use the first genetic test. What is it?

the family history

A fetus is capable of producing antibodies. The finding of IgM antibodies in an infant at birth implies that:

the fetus contracted an infection during intrauterine life.

The nurse is providing prenatal care to a young couple who is pregnant with their first child. In what period of development would the nurse explain to the couple that most congenital defects would occur?

the period of the embryo

A group of nursing students are analyzing the fetal circulation. After the session, the students correctly point out which fetal structure contains the highest concentration of oxygen?

umbilical vein

A fertilized ovum is known as which structure?

zygote

A pregnant patient scheduled for an amniocentesis asks the nurse how the placenta is not punctured during the procedure. What should the nurse respond to the patient?

"A sonogram to locate it will be done first."

The school nurse is presenting a lecture to adolescents to teach them how conception occurs. Which statement by the nurse would accurately describe this process?

"Conception usually occurs when the ovum is in the outer third of the fallopian tube."

A couple has just learned that their son will be born with Down syndrome. The nurse shows a lack of understanding when making which statement?

"I will alert your entire family about this so you don't have to."

The nurse is counseling a couple who are concerned about vitamin D-resistant rickets, an X-linked dominant disorder, because a member of the father's family has this disorder. Which statement by the couple indicates that more teaching is necessary?

"If the father doesn't have the gene, then his daughter won't have rickets."

A pregnant patient is concerned that the baby is going to drown in the uterus because of the fluid. What should the nurse respond about fetal respiration?

"Oxygen is provided to the baby through the placenta."

A client who is 15 weeks' gestation is attending prenatal classes and asks the nurse, "What changes in development has my baby made?" Which statements would the nurse include in the response? Select all that apply.

"Soft hair covers your baby's head." "Your baby makes sucking motions now with its mouth." "You will be able to detect quickening."

A client calls the nurse in a panic after a home pregnancy test indicates she is pregnant. She reports that that she consumed a lot of alcohol on the night that she thinks the pregnancy occurred. The next day she had taken several acetaminophen. For the past three weeks, she has had her usual nightly glass of wine with dinner but no other alcohol. What is an appropriate response for the nurse to make when the client questions if she has caused irreversible damage to the fetus?

"The fetus isn't exposed to the mother's blood until after it implants about six days after fertilization, so the first night is not an issue. But it's best to avoid alcohol while you're pregnant."

A pregnant client is undergoing an amniocentesis in her third trimester and is worried why she is undergoing this procedure. Which statement by the nurse would best alleviate this client's anxieties?

"We want to be sure your baby's lungs are mature and this measures the development of the baby's lungs.

During a physical assessment, the nurse palpates a pregnant patient's fundus at the level of the umbilicus. What statement should the nurse make to the patient about this assessment finding?

"You are at 20 weeks of your pregnancy."

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

1 in 4.

The nursing student is preparing a presentation which will depict the pre-embryonic stage. The instructor determines the student has correctly illustrated the process by putting the stages in which order? Use all the options.

1) formation of the zygote 2) cleavage 3) formation of the morula 4) formation of blastocyst 5) implantation

A pregnant client is scheduled to undergo chorionic villi sampling (CVS) to rule out any birth defects. Ideally, when should this testing be completed?

10 to 12 weeks of gestation

A young couple, 8 weeks pregnant with their first child, are being assessed at their first prenatal visit. Which response from the nurse is most accurate when questioned about scheduling an ultrasound to find out the gender of the baby?

16 weeks

The nurse is conducting a prenatal class for a group of first-time parents in the first trimester. The nurse should point out that the mother should feel the baby move by the end of which week of gestation?

20 weeks

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 chromosone combination?

47XX21+