Chapter 05: Hereditary and Environmental Influences on Childbearing My Nursing Test Banks

Chapter 05: Hereditary and Environmental Influences on Childbearing

MULTIPLE CHOICE

1. A clinic nurse is planning a teaching session for childbearing-age female clients. Which should the nurse include in the teaching session with regard to avoiding exposing a fetus to teratogens?

a.

Use only category A medications during pregnancy.

b.

Immunizations should be updated during the first trimester of pregnancy.

c.

Use of saunas and hot tubs during pregnancy should be during the winter months only.

d.

Alcoholic beverages can be consumed in the first and third trimesters of pregnancy.

ANS: A

In well-controlled studies, class A medications have no demonstrated fetal risk. Immunizations for diseases such as rubella are contraindicated during pregnancy. Use of saunas and hot tubs are not recommended because maternal hyperthermia is an important teratogen. Alcohol is an environmental substance known to be teratogenic.

PTS: 1 DIF: Cognitive Level: Application REF: 67

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

2. The parents of a child with a karyotype of 47,XY, +21 ask the nurse what this means. Which is an accurate response by the nurse?

a.

This karyotype is for a normal male.

b.

This karyotype is for a normal female.

c.

This karyotype is for a male with Down syndrome.

d.

This karyotype is for a female with Turners syndrome.

ANS: C

This child is male because his sex chromosomes are XY. He has one extra copy of chromosome 21 (for a total of 47, instead of 46), resulting in Down syndrome. A normal female would have 46 chromosome and XX for the sex chromosomes. A normal male would have 46 chromosomes. A female with Turners syndrome would have 45 chromosomes; the sex chromosome would have just one X.

PTS: 1 DIF: Cognitive Level: Application REF: 59, 60

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

3. People who have two copies of the same abnormal autosomal dominant gene will usually be:

a.

mildly affected with the disorder.

b.

infertile and unable to transmit the gene.

c.

carriers of the trait but not affected with the disorder.

d.

more severely affected by the disorder than people with one copy of the gene.

ANS: D

People who have two copies of an abnormal gene are usually more severely affected by the disorder because they have no normal gene to maintain normal function. Those mildly affected with the disorder will have only one copy of the abnormal gene. Infertility may or may not be caused by chromosomal defects. A carrier of a trait has one recessive gene.

PTS: 1 DIF: Cognitive Level: Understanding REF: 61

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

4. An infant is born with blood type AB. The father is type A and the mother is type B. The father asks why the baby has a blood type different from that of the parents. The nurses answer should be based on the knowledge that which is true?

a.

Both A and B blood types are dominant.

b.

Types A and B are recessive when linked together.

c.

The baby has a mutation of the parents blood types.

d.

Type A is recessive and links more easily with type B.

ANS: A

Types A and B are equally dominant, and the baby can thus inherit one from each parent. Both types A and B are dominant, not recessive. The infant has inherited both blood types from the parents and is not a mutation. Both types A and B are equally dominant.

PTS: 1 DIF: Cognitive Level: Application REF: 60, 61

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

5. Which statement is true of multifactorial disorders?

a.

They may not be evident until later in life.

b.

They are usually present and detectable at birth.

c.

The disorders are characterized by multiple defects.

d.

Secondary defects are rarely associated with them.

ANS: B

Multifactorial disorders result from an interaction between a persons genetic susceptibility and environmental conditions that favor development of the defect. They are characteristically present and detectable at birth. They are usually single isolated defects, although the primary defect may cause secondary defects. Secondary defects can occur with multifactorial disorders.

PTS: 1 DIF: Cognitive Level: Remembering REF: 65

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

6. Which point should the nurse include when telling a couple about the prenatal diagnosis of genetic disorders?

a.

The diagnosis may be slow and could be inconclusive.

b.

A comprehensive evaluation will result in an accurate diagnosis.

c.

Common disorders can be quickly diagnosed through blood tests.

d.

Diagnosis can be obtained promptly through most hospital laboratories.

ANS: A

Even the best efforts at diagnosis do not always yield the information needed to counsel the client. The process may require many visits over several weeks. Some tests must be sent to special laboratories, which takes additional time. Despite a comprehensive evaluation, a diagnosis may never be established. There is no quick blood test available at this time to diagnose genetic disorders. Some tests must be sent to a special laboratory, which requires a longer waiting period for results.

PTS: 1 DIF: Cognitive Level: Application REF: 68

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

7. A client tells the nurse at a prenatal interview that she has quit smoking, only has a glass of wine with dinner, and has cut down on coffee to four cups a day. Which response by the nurse will be most helpful in promoting a lifestyle change?

a.

Those few things wont cause any trouble. Good for you.

b.

You need to do a lot better than that. You are still hurting your baby.

c.

Here are some pamphlets for you to study. They will help you to find more ways to improve.

d.

You have made some good progress toward having a healthy baby. Lets talk about the changes you have made.

ANS: D

Praising her for making positive changes is an effective technique for motivating a client. She still has risk factors to change for optimal outcome, and a gentle maneuver to help her see these for herself will be most likely to succeed. Alcohol and coffee consumption are still major risk factors and need to be addressed in a positive, nonjudgmental manner. The statement, You need to do a lot better, is belittling to the client; she will be less likely to confide in the nurse. The nurse is not acknowledging the efforts that the client has already accomplished by offering pamphlets; those accomplishments need to be praised to motivate the client to continue.

PTS: 1 DIF: Cognitive Level: Application REF: 70

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

8. A 35-year-old client has an amniocentesis performed to find out whether her baby has a chromosomal defect. Which statement indicates that the client understands her situation?

a.

The doctor will tell me if I should have an abortion when the test results come back.

b.

When all the lab results come back, my husband and I will make a decision about the pregnancy.

c.

My mother must not find out about all this testing. If she does, she will think Im having an abortion.

d.

I know there are support groups for parents who have a baby with birth defects, but we have plenty of insurance to cover what we need.

ANS: B

The final decision about genetic testing and the future of the pregnancy lies with the client. The client will involve only those people whom she chooses. The final decision about the future of the pregnancy lies only with the client. An amniocentesis is done to detect chromosomal defects; many women have this done to prepare and educate themselves for the babys arrival. The woman should also be assured that her care is confidential. Insurance will help cover expenses, but birth defects also take a toll on the emotional, physical, and social aspects of the parents lives. Support groups are extremely important for parents of a baby with birth defects.

PTS: 1 DIF: Cognitive Level: Analysis REF: 68, 69

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

9. Which characteristic is related to Down syndrome?

a.

Up-slanting eyes

b.

Abnormal genitalia

c.

Bleeding tendency

d.

Edema of extremities

ANS: A

Up-slanting eyes, wide short fingers, and low-set ears are often seen in infants with Down syndrome. Bleeding tendency, edema of extremities, and abnormal genitalia are not characteristics of Down syndrome.

PTS: 1 DIF: Cognitive Level: Understanding REF: 63

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

10. Which question posed by the nurse will most likely promote the sharing of sensitive information during a genetic counseling interview?

a.

What kind of defects or diseases seem to run in the family?

b.

How many people in your family are mentally retarded or handicapped?

c.

Did you know that you can always have an abortion if the fetus is abnormal?

d.

Are there any members of your family who have learning or developmental problems?

ANS: D

The nurse should probe gently using layperson-oriented terminology, such as learning problems rather than defects or diseases. Some individuals may not be aware of which diseases are genetically linked and may not answer the question accurately. How many people in your family are mentally retarded or handicapped? assumes that there are genetic problems that resulted in retardation in the family. Some individuals may find these terms offensive. Did you know that you can always have an abortion if the fetus is abnormal? is taking the decision away from the parents. They are seeking counseling to prevent problems, not to find out what to do if there is a problem.

PTS: 1 DIF: Cognitive Level: Application REF: 70

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

11. Testing for the cause of anomalies in a stillborn infant is being done. The mother angrily asks the nurse how long these tests are going to take. The nurse should understand that the mother is:

a.

exhibiting normal grief behavior.

b.

trying to place blame on someone.

c.

being impatient and unreasonable.

d.

feeling guilty and blaming herself.

ANS: A

Grief after a fetal loss may initially be expressed as anger. The mother is not placing blame; she is in the anger stage of the grieving process. The mother is not being impatient or unreasonable. The mother is expressing anger as a beginning stage of grief, not blaming herself or feeling guilty.

PTS: 1 DIF: Cognitive Level: Application REF: 71

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Psychosocial Integrity

12. During the course of obtaining a genetic history from a female client, you note that there is a family history of a genetic disease on the maternal side but no evidence of symptomatology in the client or the clients children, two girls. Which observation can you make related to genetic expression?

a.

Autosomal dominant expression is observed.

b.

X-linked dominant trait is observed.

c.

More information is needed to determine the answer.

d.

Autosomal recessive expression is observed and both the children will be carriers of the disease process.

ANS: C

Because we have no information about the father and/or paternal side, the other stated options do not apply. If an autosomal dominant expression were present in the family history, the client would be symptomatic. It is more likely to see X-linked recessive traits than X-linked dominant traits and, again, the client and children are not symptomatic. Although an autosomal recessive expression may be present, we cannot predict that the children will be carriers. There is a 25% chance of being affected.

PTS: 1 DIF: Cognitive Level: Analysis REF: 69

OBJ: Nursing Process Step: Diagnosis

MSC: Client Needs: Physiologic Integrity: Pathophysiology

13. Which statement made by the nurse is evidence of therapeutic communication for a couple who is undergoing genetic counseling and very concerned about the possibility of having a child with a birth defect as a result of a strong family history on both sides of the family?

a.

It is important to ask other members of your family for any information they can provide that will help obtain more insight into the health history.

b.

Given what you have told me, there is little that anyone can do to improve outcomes.

c.

Although you may feel that you have no options, I cant really discuss these matters as only the physician can provide you with information.

d.

Do you have all your forms filled out correctly? This will make the review easier to accomplish.

ANS: A

Having as much information as possible will help analyze potential health patterns. It also shows that the nurse is taking the clients concerns seriously. Telling the clients that there is little anyone can do does not provide any comfort or hope and is therefore self-defeating. Although the clients may have limited options based on their genetic and medical history, it is important to provide support and not defer all communication to the physician. The nurse must be able to provide support and counseling to clients. It is important to have completed forms, but asking clients about them does not address their psychological concerns.

PTS: 1 DIF: Cognitive Level: Analysis REF: 70

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Psychosocial Integrity: Therapeutic Communication

14. Identification of a newborns blood indicates type AB. Based on this assessment, which statement is correct?

a.

Each parent had recessive genes for type O.

b.

One parent had type O and the other parent had type A.

c.

One parent had type A and the other parent had type B.

d.

Each parent had type A.

ANS: C

Type AB blood indicates that the parental contribution was types A and B, which are considered dominant genes.

PTS: 1 DIF: Cognitive Level: Application REF: 60

OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Physiologic Integrity: Reduction of Risk Potentials

15. A client presents with curly hair and blue eyes. These findings are consistent with:

a.

phenotype.

b.

genotype.

c.

dominant alleles.

d.

recessive traits.

ANS: A

Curly hair is considered to be a dominant trait, whereas blue eyes are considered to be a recessive trait. Observation of characteristics is noted as phenotype. Genotype identifies the genetic makeup of traits.

PTS: 1 DIF: Cognitive Level: Application REF: 60

OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Physiologic Integrity: Reduction of Risk Potentials

16. A nurse is working with a client to obtain information needed for genetic counseling. Which tool will be used to obtain this information?

a.

Braden scale

b.

Genogram

c.

Chorionic villus sampling (CVS)

d.

Serum protein electrophoresis

ANS: B

When obtaining information with regard to genetic counseling, it is important to obtain a family history using a genogram or pedigree as the clinical tool. The use of this diagram provides information for maternal and paternal histories and allows for the interpretation of significance based on findings of age, death, and medical history. A Braden scale is used to assess problems with skin leading to potential breakdown. CVS is a diagnostic procedure used during pregnancy to obtain genetic information about the fetus. Serum protein electrophoresis is a lab test used to determine immunoglobulin levels.

PTS: 1 DIF: Cognitive Level: Application REF: 62

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Physiologic Integrity: Reduction of Risk Potentials

17. The nurse receives a report on an infant whose analysis indicates 47 total chromosomes, with the abnormality noted at chromosome 21. What additional assessments will the nurse include when evaluating the infant?

a.

Cleft palate

b.

Protruding tongue

c.

Extra fingers or toes (polydactyly)

d.

Intellectual developmental delay

ANS: B

Trisomy 21 is associated with a number of notable physical characteristics, including wide-set eyes, flat bridge of the nose, protruding tongue, short neck, small chin, poor muscle tone, and space between the great and second toes. An infant with trisomy 21 tend to be short in stature and developmentally delayed, but two characteristics will become more noticeable as the child gets older. Cleft palate and polydactyly are more common with trisomy 13.

PTS: 1 DIF: Cognitive Level: Application REF: 63

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

18. The patient indicates to the clinic nurse that she is trying to become pregnant. The clinic nurse reviews the patients chart and notes the following laboratory values: blood type O, RPR nonreactive, rubella nonimmune, HCT 35%. Which laboratory value is most concerning to the nurse?

a.

HCT 35%

b.

Blood type O

c.

RPR nonreactive

d.

Rubella nonimmune

ANS: D

Rubella nonimmune indicates that the patient does not have immunity against rubella and is therefore susceptible to the infection. Exposure to rubella, or German measles, in the first trimester is associated with fetal congenital anomalies. The client needs a rubella immunization and must not become pregnant within the next 28 days. Although a HCT of 35% is low, women of childbearing age may have mild anemia associated with menstruation. A blood type of O means that the client will require RhoGAM but is not of concern in the preconception period. A nonreactive RPR indicates that the patient has not been exposed to syphilis.

PTS: 1 DIF: Cognitive Level: Synthesis REF: 67

OBJ: Nursing Process Step: Analysis MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

19. The clinic nurse is reviewing charts on prenatal clients. Which client histories should the nurse understand that a referral to a genetic counselor is warranted? (Select all that apply.)

a.

A father who is aged 35

b.

A client having a first baby at age 30

c.

A family history of unexplained stillbirths

d.

A client with a family history of birth defects

e.

A client who is a carrier of an X-linked disorder

ANS: C, D, E

Reasons for a referral to a genetic counselor include family history of unexplained stillbirths, family history of birth defects, and a woman who is a carrier of an X-linked disorder. Pregnant women who will be 35 years of age or older when the infant is born and men who father children after age 40 constitute reasons for referral to a genetic counselor. The client who is 30 and the father who is aged 35 would not warrant a referral to a genetic counselor.

PTS: 1 DIF: Cognitive Level: Application REF: 70

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

20. The nurse is teaching prenatal clients about avoiding substances or conditions that can harm the fetus. Which should the nurse include in the teaching session? (Select all that apply.)

a.

Elimination of use of alcohol

b.

Avoidance of supplemental folic acid replacement

c.

Stabilization of blood glucose levels in a diabetic client with insulin

d.

Avoidance of nonurgent radiologic procedures during the pregnancy

e.

Avoidance of maternal hyperthermia to temperatures of 37.8 C (100 F) or higher

ANS: A, C, D, E

The best action is for the pregnant woman to eliminate use of nontherapeutic drugs and substances such as alcohol. A woman who has diabetes should try to keep her blood glucose levels normal and stable before and during pregnancy for the best possible fetal outcomes. Nonurgent radiologic procedures may be done during the first 2 weeks after the menstrual period begins, before ovulation occurs. Exposure to temperatures of 37.8 C (100 F) or higher is not advised for the pregnant client. Folic acid supplements should be taken. All women of childbearing age should take at least 0.4 mg (400 mcg) of folic acid daily before and after conception because this has been found to reduce the incidence of neural tube defects by 50% to 70%.

PTS: 1 DIF: Cognitive Level: Application REF: 67

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

21. The nurse is explaining genetics to a group of nursing students. Which are autosomal recessive disorders that the nurse should include in the teaching session? (Select all that apply.)

a.

Hemophilia

b.

Cystic fibrosis

c.

Sickle cell disease

d.

Turners syndrome

e.

Phenylketonuria (PKU) disease

ANS: B, C, E

Cystic fibrosis, sickle cell disease, and PKU disease are autosomal recessive disorders. Hemophilia and Turners syndrome are X-linked genetic disorders.

PTS: 1 DIF: Cognitive Level: Application REF: 61

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

MATCHING

Match each term with the correct definition.

a.

Two genes are required to produce the trait.

b.

A single copy of the gene is enough to produce the trait.

c.

Only one copy of the gene is needed to cause the disorder in the male.

22. Autosomal dominant

23. X-linked recessive

24. Autosomal recessive

22. ANS: B PTS: 1 DIF: Cognitive Level: Understanding

REF: 61 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: The characteristic of X-linked recessive is that although recessive, only one copy of the gene is needed to cause the disorder in the male, who does not have a compensating X without the trait. The characteristic of autosomal recessive is that two autosomal recessive genes are required to produce the trait. Males and females are equally likely to have the trait. The characteristic of autosomal dominant is that a single copy of the gene is enough to produce the trait. Males and females are equally likely to have the trait.

23. ANS: C PTS: 1 DIF: Cognitive Level: Understanding

REF: 62 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: The characteristic of X-linked recessive is that although recessive, only one copy of the gene is needed to cause the disorder in the male, who does not have a compensating X without the trait. The characteristic of autosomal recessive is that two autosomal recessive genes are required to produce the trait. Males and females are equally likely to have the trait. The characteristic of autosomal dominant is that a single copy of the gene is enough to produce the trait. Males and females are equally likely to have the trait.

24. ANS: A PTS: 1 DIF: Cognitive Level: Understanding

REF: 62 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: The characteristic of X-linked recessive is that although recessive, only one copy of the gene is needed to cause the disorder in the male, who does not have a compensating X without the trait. The characteristic of autosomal recessive is that two autosomal recessive genes are required to produce the trait. Males and females are equally likely to have the trait. The characteristic of autosomal dominant is that a single copy of the gene is enough to produce the trait. Males and females are equally likely to have the trait.

SHORT ANSWER

25. Two healthy parents who carry the same abnormal autosomal recessive gene have what percentage chance of having a child affected with the disorder caused by this gene? Record your answer as a whole number.

_____%

ANS:

25

Two healthy parents who carry the same abnormal autosomal recessive gene have a 25%

chance of having a child affected with the disorder caused by this gene. Unaffected

parents are carriers of the abnormal autosomal recessive trait. Children of carriers have a

25% (1 in 4) chance of receiving both copies of the defective gene and thus having the

disorder.

PTS: 1 DIF: Cognitive Level: Application REF: 62

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

Leave a Reply