Chapter 10: Hereditary and Environmental Influences on Development My Nursing Test Banks

Chapter 10: Hereditary and Environmental Influences on Development

Test Bank

MULTIPLE CHOICE

1. How can a woman avoid exposing her fetus to teratogens?

a.

Update her immunizations during the first trimester of her pregnancy.

b.

Use saunas and hot tubs during the winter months only.

c.

Use only class A drugs during her pregnancy.

d.

Use alcoholic beverages only in the first and third trimesters of pregnancy.

ANS: C

Feedback

A

Immunizations, such as rubella, are contraindicated in pregnancy.

B

Maternal hyperthermia is an important teratogen.

C

In well-controlled studies, class A drugs have no demonstrated fetal risk.

D

Alcohol is an environmental substance known to be teratogenic.

PTS: 1 DIF: Cognitive Level: Application REF: p. 194

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

2. The karyotype of a person is 47, XY, +21. This person is a

a.

Normal male

b.

Male with Down syndrome

c.

Normal female

d.

Female with Turner syndrome

ANS: B

Feedback

A

A normal male has 46 chromosomes.

B

This person 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.

C

A normal female has 46 chromosomes and XX for the sex chromosomes.

D

A female with Turner syndrome has 45 chromosomes; the sex chromosomes have just one X.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 191

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

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

a.

More severely affected by the disorder than will people with one copy of the gene

b.

Infertile and unable to transmit the gene

c.

Carriers of the trait but not affected with the disorder

d.

Mildly affected with the disorder

ANS: A

Feedback

A

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.

B

Infertility may or may not be caused by chromosomal defects.

C

A carrier of a trait has one recessive gene.

D

Those mildly affected with the disorder will have only one copy of the abnormal gene.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 191

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

4. A baby 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 those of his parents. The nurses answer should be based on the knowledge that

a.

Both A and B blood types are dominant.

b.

The baby has a mutation of the parents blood types.

c.

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

d.

Types A and B are recessive when linked together.

ANS: A

Feedback

A

Types A and B are equally dominant, and the baby can thus inherit one from each parent.

B

The infant has inherited both blood types from the parents; it is not a mutation.

C

Both types A and B are equally dominant.

D

Both types A and B are dominant.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 190

OBJ: Nursing Process: Implementation 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 multifactorial disease.

ANS: B

Feedback

A

They are usually detectable at birth.

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.

C

They are usually single isolated defects, although the primary defect may cause secondary defects.

D

Secondary defects can occur with multifactorial disorders.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 193 | Box 10-1

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

6. Both members of an expectant couple are carriers for phenylketonuria (PKU), an autosomal recessive disorder. In counseling them about the risk to their unborn child, the nurse should tell them that

a.

The child has a 25% chance of being affected.

b.

The child will be a carrier, like the parents.

c.

The child has a 50% chance of being affected.

d.

One of four of their children will be affected.

ANS: A

Feedback

A

Each child born to a couple who carries an autosomal recessive trait has a 25% chance of having the disorder, because the child receives either a normal or an abnormal gene from each parent.

B

If one member of the couple has the autosomal recessive disorder, all of their children will be carriers. If both parents are carriers, each child has a 50% chance of being a carrier.

C

The child has a 25% chance of being affected and a 50% chance of being a carrier.

D

Each child has the identical odds of being affected. Because both parents are carriers, each child has a 25% chance of being affected, a 50% change of being a carrier, and a 25% change of not having the gene transmitted.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 190-191 | Box 10-1

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

7. Which statement should a counselor make when telling a couple about the prenatal diagnosis of genetic disorders?

a.

Diagnosis can be obtained promptly through most hospital laboratories.

b.

Common disorders can quickly be diagnosed through blood tests.

c.

A comprehensive evaluation will result in an accurate diagnosis.

d.

Diagnosis may be slow and could be inconclusive.

ANS: D

Feedback

A

Some tests must be sent to a special laboratory, which requires a longer waiting period for results.

B

There is no quick blood test available at this time to diagnose genetic disorders.

C

Despite a comprehensive evaluation, a diagnosis may never be established.

D

Even the best efforts at diagnosis do not always yield the information needed to counsel patients. They may require many visits over several weeks.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 195

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

8. A woman 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. What response by the nurse will be most helpful in promoting a lifestyle change?

a.

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

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 find more ways to improve.

d.

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

ANS: A

Feedback

A

Praising her for making positive changes is an effective technique for motivating a patient. She still has to identify the risk factors to optimize the results.

B

This statement is belittling to the patient. She will be less likely to confide in the nurse.

C

The nurse is not acknowledging the efforts that the woman has already accomplished. Those accomplishments need to be praised to motivate the woman to continue.

D

Alcohol and coffee consumption are still major risk factors and need to be addressed in a positive, nonjudgmental manner.

PTS: 1 DIF: Cognitive Level: Application REF: p. 197

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

9. A 35-year-old woman has an amniocentesis performed to find out whether her baby has a chromosome defect. Which statement by this patient indicates that she understands her situation?

a.

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

b.

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

c.

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

d.

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

ANS: C

Feedback

A

The final decision about the future of the pregnancy lies with the patient only.

B

Support groups are extremely important for parents of a baby with a defect. Insurance will help cover expenses, but the defect also takes a toll on the emotional, physical, and social aspects of the parents lives.

C

The final decision about genetic testing and the future of the pregnancy lies with the patient. She will involve only those people whom she chooses in her decisions.

D

An amniocentesis is performed 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 196

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

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

a.

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

b.

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

c.

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

d.

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

ANS: D

Feedback

A

This question assumes that there are genetic problems that result in intellectual disability in the family. Some individuals may find these terms offensive.

B

Some individuals may not be aware of which diseases are genetically linked and may not answer the question accurately.

C

This is taking the decision away from the parents. They are seeking counseling in order to prevent problems, not to find out what to do if there is a problem.

D

The nurse should probe gently by using lay-oriented terminology rather than direct questions or statements.

PTS: 1 DIF: Cognitive Level: Application REF: p. 197

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

11. You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis is the most essential in caring for the mother of this infant?

a.

Disturbed body image

b.

Interrupted family processes

c.

Anxiety

d.

Risk for injury

ANS: B

Feedback

A

Women commonly experience body image disturbances in the postpartum period, but this is unrelated to giving birth to a child with Down syndrome.

B

This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. Family disruption is common, and the strain of having a child with a serious birth defect may lead to divorce. Siblings may feel neglected because the child with a disorder requires more of their parents time and attention.

C

The mother likely will have a mix of emotions that may include anxiety, guilt, and denial, but this is not the most essential nursing diagnosis for this family.

D

This nursing diagnosis is not applicable.

PTS: 1 DIF: Cognitive Level: Application REF: p. 198

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity

12. A couple has been counseled for genetic anomalies. They ask you, What is karyotyping? Your best response is

a.

Karyotyping will reveal if the babys lungs are mature.

b.

Karyotyping will reveal if your baby will develop normally.

c.

Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes.

d.

Karyotyping will detect any physical deformities the baby has.

ANS: C

Feedback

A

The L/S ratio, not karyotyping, reveals lung maturity.

B

Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive.

C

Karyotyping provides genetic information, such as gender and chromosomal structure. Karyotyping is completed by photographing or using computer imaging to arrange chromosomes in pairs from largest to smallest. The karyotype can then be analyzed.

D

Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word. Furthermore, physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 187

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

13. In practical terms regarding genetic health care, nurses should be aware that

a.

Genetic disorders equally affect people of all socioeconomic backgrounds, races, and ethnic groups.

b.

Genetic health care is more concerned with populations than individuals.

c.

The most important of all nursing functions is providing emotional support to the family during counseling.

d.

Taking genetic histories is the province of large universities and medical centers.

ANS: C

Feedback

A

Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups.

B

Genetic health care is highly individualized, because treatments are based on the phenotypic responses of the individual.

C

Nurses should be prepared to help with a variety of stress reactions from a couple facing the possibility of a genetic disorder.

D

Individual nurses at any facility can take a genetic history, although larger facilities may have better support services.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 197

OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

14. The nurse is working in an OB/GYN office, where part of her duties include obtaining a patients history and performing an initial assessment. Which woman is likely to be referred for genetic counseling after her first visit?

a.

A pregnant woman who will be 40 years or older when her infant is born

b.

A woman whose partner is 38 years of age

c.

A patient who carries a Y-linked disorder

d.

An anxious woman with a normal quadruple screening result

ANS: B

Feedback

A

Pregnant women who will be 35 years of age or older when the infant is born should be referred to a genetic counselor.

B

Men who father children after the age of 40 should also be sent for referral. Men who father children in their 5th decade or later are more likely to have offspring with a new autosomal dominant mutation.

C

Women who are carriers of X-linked disorders should be referred for genetic counseling. Women do not carry a Y chromosome.

D

Pregnant women with abnormal prenatal screening results, such as triple or quadruple screening, or suspicious ultrasound findings may require referral to other health care specialists. This patient simply requires further support and encouragement.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 197 | Box 19-4

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

MULTIPLE RESPONSE

1. Mechanical forces that interfere with normal prenatal development include oligohydramnios and fibrous amniotic bands. A patient at 34 weeks of gestation has reported to the OB triage unit for assessment of oligohydramnios. The nurse assigned to care for this patient is aware that prolonged oligohydramnios may result in (select all that apply)

a.

Intrauterine limb amputations

b.

Clubfoot

c.

Delayed lung development

d.

Other fetal abnormalities

e.

Fetal deformations

ANS: B, C, D

Feedback

Correct

Oligohydramnios, an abnormally small volume of amniotic fluid, reduces the cushion surrounding the fetus and may result in deformations such as clubfoot. Prolonged oligohydramnios interferes with fetal lung development because it does not allow normal development of the alveoli. Oligohydramnios may not be the primary fetal problem but rather may be related to other fetal anomalies.

Incorrect

Fibrous amniotic bands may result from tears in the inner sac of fetal membranes and can result in fetal deformation or intrauterine limb amputations. Fibrous bands are usually sporadic and unlikely to recur. Because these bands can cause multiple defects, they may be confused with birth defects from other causes such as chromosome or single gene abnormalities.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 195

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

2. Chromosomes are composed of genes, which are composed of DNA. Abnormalities are either numerical or structural in nature. Which abnormalities are structural? Select all that apply.

a.

Part of a chromosome is missing.

b.

The material within a chromosome is rearranged.

c.

One or more sets of chromosomes are added.

d.

Entire single chromosome is added.

e.

Two chromosomes adhere to each other.

ANS: A, B, E

Feedback

Correct

It is critical to remember that characteristics of structural abnormalities include part of a chromosome missing or added, rearrangement of material within chromosomes, two chromosomes that adhered to each other, and fragility of a specific site on the X chromosome.

Incorrect

The addition of a single chromosome (trisomy), the deletion of a single chromosome (monosomy), and one or more added sets of chromosomes (polyploidy) are numerical abnormalities.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 191

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

COMPLETION

1. The ____________________ Project is an international effort begun in 1990 for the purpose of identifying all 46 human chromosomes.

ANS:

Human Genome

The Human Genome Project completed the full sequence of human genes in April 2003. Information gleaned from this project may allow advances in genetic testing, reproductive decision making, identifying genetic susceptibility, and modification of defective genes.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 187

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

2. A change in a gene that alters or harms function is known as a mutation. In contrast, an alternate healthy form of a gene is known as a ___________.

ANS:

polymorphism

Normal alleles that are common in a population, or polymorphisms, provide genetic variety and sometimes a biologic advantage.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 187

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

TRUE/FALSE

1. Nurses who work in a high-risk perinatal setting may occasionally care for a pregnant woman who is given a specific drug for the sole purpose of fetal therapy, that is, cardiac medications. Is this statement true or false?

ANS: T

This approach uses the mother as a conduit for medicating the fetus. This may be done at varying times during the pregnancy to allow for normal development and function of the fetus. Digoxin or propranolol might be given to an otherwise well mother who is carrying a fetus with a cardiac disorder.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 194-195

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

2. The nurse who has chosen to work in the field of genetics must have a clear understanding of genetic abnormalities when counseling parents. The nurse is explaining a single gene abnormality to new parents and states, Although you are second cousins, you are at no greater risk for having a child with a genetic disorder.

ANS: F

Parental consanguinity (blood relationships) increases the risk of having a child with an autosomal recessive disorder.

PTS: 1 DIF: Cognitive Level: Application REF: p. 189

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

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