Chapter 11 Special Reproductive Concerns: Infertility and Genetics My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 11 Special Reproductive Concerns: Infertility and Genetics

1) During the initial visit with the nurse at the fertility clinic, the client asks what effect cigarette smoking has on the ability to conceive. What is the nurses best response?

1. Smoking has no effect.

2. Only if you smoke more than one pack a day will you experience difficulty.

3. After your first semen analysis, we will determine whether there will be any difficulty.

4. Smoking can affect the quantity of sperm.

Answer: 4

Explanation: 4. The quantity and quality of male sperm are affected by cigarette smoking.

Page Ref: 194

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Lifestyle Choices

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Compare the essential components of fertility with the possible causes of infertility.

MNL LO: 1.3.1 Explain infertility and its associated risk factors.

2) A couple is seeking advice regarding what they can do to increase the chances of becoming pregnant. What recommendation can the nurse give to the couple?

1. The couple could use vaginal lubricants during intercourse.

2. The couple should delay having intercourse until the day of ovulation.

3. The woman should refrain from douching.

4. The woman should be on top during intercourse.

Answer: 3

Explanation: 3. This is the correct answer, as douching can alter sperm mobility.

Page Ref: 195

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Self-Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Compare the essential components of fertility with the possible causes of infertility.

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MNL LO: 1.3.1 Explain infertility and its associated risk factors.

3) The nurse is teaching an infertile couple about the causes of infertility. The nurse tells them that infertility can be caused by which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Immunological responses

2. Congenital anomalies

3. Patent fallopian tubes

4. Hypothyroidism

5. Favorable cervical mucus

Answer: 1, 2, 4

Explanation: 1. Immunological responses, such as antisperm antibodies, can cause infertility.

2. Congenital anomalies, such as a septate uterus, can cause infertility.

4. Hypothyroidism is a cause of infertility.

Page Ref: 194

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Compare the essential components of fertility with the possible causes of infertility.

MNL LO: 1.3.1 Explain infertility and its associated risk factors.

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4) A client and her husband have contacted their physician about fertility problems. At the initial visit, the nurse instructs them about the infertility workup. Which statement by the client would indicate that the instructions have been successful?

1. The first test that we need to schedule is a semen analysis.

2. We need to schedule the Pap smear test first.

3. We need to schedule an appointment with the social worker in order to adopt.

4. We need to schedule an appointment with a marriage counselor.

Answer: 1

Explanation: 1. A semen analysis is one of the first diagnostic tests, prior to doing invasive procedures.

Page Ref: 195

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations that foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2 Describe the elements of the preliminary investigation of infertility and the nurses role in supporting/teaching patients during this phase.

MNL LO: 1.3.2 Examine the assessment process for male and female infertility.

5) A nurse working in an infertility clinic should include which information in her discussions with the clients?

1. It is important to know the statistics surrounding couples who never learn why they are infertile.

2. Couples should understand the legal controversy concerning therapeutic insemination.

3. Couples should seek marriage counseling before undergoing fertility treatments.

4. Couples should discuss therapeutic insemination and in vitro fertilization as alternatives.

Answer: 4

Explanation: 4. This is the correct answer. This information should be presented to clients so that they are aware of all the alternatives and can make an informed decision.

Page Ref: 200

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are performed in an infertility workup.

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MNL LO: 1.3.3 Recognize the various strategies for managing infertility.

6) A couple is requesting fertility counseling. The nurse practitioner has identified the factors listed below in the womans health history, and knows which of them could be contributing to the couples infertility?

1. The client is 38 years old.

2. The client was 13 years old when she started her menses.

3. The client works as a dental hygienist 3 days a week.

4. The client jogs 2 miles a day.

Answer: 1

Explanation: 1. As the eggs of older women age, their fertility is reduced.

Page Ref: 197

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 1 Compare the essential components of fertility with the possible causes of infertility.

MNL LO: 1.3.1 Explain infertility and its associated risk factors.

7) A client calls the urologists office to receive instructions about semen analysis. What does the nurse instruct the client to do?

1. Avoid sexual intercourse 24 hours prior to obtaining a specimen.

2. Use a latex condom to collect the specimen.

3. Expect that a repeat test might be required.

4. Expect a small sample.

Answer: 3

Explanation: 3. A repeat semen analysis might be required to adequately assess the mans fertility potential.

Page Ref: 200

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Describe the elements of the preliminary investigation of infertility and the nurses

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role in supporting/teaching patients during this phase.

MNL LO: 1.3.2 Examine the assessment process for male and female infertility.

8) A client scheduled a laparoscopy. After the procedure, what does the nurse instruct the client to do?

1. Stay on bed rest for 48 hours.

2. Expect to have shoulder and arm pain.

3. Purchase a rectal tube to relieve the gas.

4. Lie on her back to relieve the gas pain after the procedure.

Answer: 4

Explanation: 4. Assuming a supine position may help relieve residual shoulder and chest discomfort caused by any remaining gas.

Page Ref: 199

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy that fosters patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are performed in an infertility workup.

MNL LO: 1.3.2 Examine the assessment process for male and female infertility.

9) The nurse is reviewing assessment data from several different male clients. Which one should receive information about causes of infertility?

1. Circumcised client

2. Client with a history of premature ejaculation

3. Client with a history of measles at age 12

4. Client employed as an engineer

Answer: 2

Explanation: 2. Premature ejaculation is a possible cause of infertility.

Page Ref: 194

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Teamwork: Function competently with ones own scope of practice as leader or member of the health care team and manage delegation effectively. | Nursing/Integrated Concepts: Nursing Process: Planning

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Learning Outcome: 2 Describe the elements of the preliminary investigation of infertility and the nurses role in supporting/teaching patients during this phase.

MNL LO: 1.3.2 Examine the assessment process for male and female infertility.

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10) A client is to receive fertility drugs prior to in vitro fertilization. What is the expected action of this medication?

1. Prolonging of the luteal phase

2. Stimulation of ovulation

3. Suppression of menstruation

4. Promotion of cervical mucus production

Answer: 2

Explanation: 2. In IVF, a womans ovaries are stimulated by a combination of medications, one or more oocytes are aspirated from her ovaries and fertilized in the laboratory, and then they are placed into her uterus after normal embryo development has begun.

Page Ref: 203

Cognitive Level: Remembering

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are performed in an infertility workup.

MNL LO: 1.3.3 Recognize the various strategies for managing infertility.

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11) A couple who have sought fertility counseling have been told that the mans sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which condition occurs?

1. The vas deferens is ligated.

2. Male obesity is present.

3. The prostate gland is enlarged.

4. The flagella are segmented.

Answer: 2

Explanation: 2. Male obesity is associated with poor spermatogenesis and increased amount of time to conception.

Page Ref: 194

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare setting. | NLN Competencies: Knowledge and Science: Relationship between knowledge and science (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 2 Describe the elements of the preliminary investigation of infertility and the nurses role in supporting/teaching patients during this phase.

MNL LO: 1.3.2 Examine the assessment process for male and female infertility.

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12) An infertile couple confides in the nurse at the infertility clinic that they feel overwhelmed with the decisions facing them. Which nursing strategy would be most appropriate?

1. Refer them to a marriage counselor.

2. Provide them with information and instructions throughout the diagnostic and therapeutic process.

3. Express concern and caring.

4. Inquire about the names they have chosen for their baby.

Answer: 2

Explanation: 2. The nurse can provide comfort to couples by offering a sympathetic ear, a nonjudgmental approach, and appropriate information and instruction throughout the diagnostic and therapeutic processes.

Page Ref: 195

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Describe the elements of the preliminary investigation of infertility and the nurses role in supporting/teaching patients during this phase.

MNL LO: 1.3.4 Implement the nurses role in caring for and supporting couples who experience infertility.

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13) What type of testing is an inexpensive way to predict the presence of tubal disease and may be more predictive of infertility than an abnormal HSG?

1. Chlamydia trachomatis IgG antibody testing

2. Preimplantation genetic testing

3. Noninvasive prenatal testing (NIPT)

4. DNA testing

Answer: 1

Explanation: 1. Chlamydia trachomatis IgG antibody testing is an inexpensive way to predict the presence of tubal disease and may be more predictive of infertility than an abnormal HSG.

Page Ref: 198

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all health care settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are performed in an infertility workup.

MNL LO: 1.3.2 Examine the assessment process for male and female infertility.

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14) The nurse is talking with a couple who have been trying to get pregnant for 5 years. They are now at the fertility clinic seeking help. The nurse assesses their emotional responses as part of the workup. Which responses would the nurse expect to hear?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Experiencing a sense of loss of status

2. Feelings of failure because they cannot make a baby

3. Healthy relationship with healthcare partners

4. Stress on the marital and sexual relationship

5. Feelings of frustration

Answer: 1, 2, 4, 5

Explanation: 1. The couple may experience feelings of loss of status and ambiguity as a couple.

2. Feelings of failure are common.

4. The couple may experience stress on the marital and sexual relationship.

5. Tests and treatments may heighten feelings of frustration or anger between partners.

Page Ref: 208, 209

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 4. Assess presence and extent of pain and suffering. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 4 Relate the physiologic and psychologic effects of infertility on a couple to the nursing care management of the couple.

MNL LO: 1.3.4 Implement the nurses role in caring for and supporting couples who experience infertility.

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15) The nurse is planning to teach couples factors that influence fertility. Which factor should not be included in the teaching plan?

1. Sexual intercourse should occur every day of the week.

2. Get up to urinate 1 hour after intercourse.

3. Do not douche.

4. Institute stress-reduction techniques.

Answer: 1

Explanation: 1. It is optimal if sexual intercourse occurs every other day during the fertile period.

Page Ref: 195

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships to promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5 Describe the nurses roles as counselor, educator, and advocate during infertility evaluation and treatment.

MNL LO: 1.3.3 Recognize the various strategies for managing infertility.

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16) A male client visits the infertility clinic for the results of his comprehensive exam. The exam indicated oligospermia. The client asks the nurse which procedure would assist him and his wife to conceive. The nurses best response would include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. You might want to consider adoption.

2. An option you might consider is in vitro fertilization.

3. Surrogacy might be your best option.

4. Many couples utilize therapeutic husband insemination.

5. The GIFT procedure has had much success.

Answer: 2, 4

Explanation: 2. The in vitro fertilization procedure is used in cases in which infertility has resulted from male infertility.

4. Therapeutic husband insemination is generally indicated for such seminal deficiencies as oligospermia.

Page Ref: 203

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are performed in an infertility workup.

MNL LO: 1.3.3 Recognize the various strategies for managing infertility.

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17) The physician has prescribed the medication clomiphene citrate (Clomid) for a client with infertility. What should the nurses instructions to the woman include?

1. Have intercourse every day of 1 week, starting 5 days after completion of medication.

2. This medication is administered intravenously.

3. Contact the doctor if visual disturbances occur.

4. A contraindication is kidney disease.

Answer: 3

Explanation: 3. Side effects of clomiphene citrate include visual symptoms such as spots and flashes.

Page Ref: 201

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are performed in an infertility workup.

MNL LO: 1.3.3 Recognize the various strategies for managing infertility.

18) Approximately 80% of anovulatory women have which condition?

1. Turner syndrome

2. Polycystic ovary syndrome (PCOS)

3. Klinefelter syndrome

4. Fragile X syndrome

Answer: 2

Explanation: 2. Approximately 80% of anovulatory women have polycystic ovary syndrome (PCOS), causing insulin resistance and hyperinsulinemia.

Page Ref: 202

Cognitive Level: Remembering

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development; pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1 Compare the essential components of fertility with the possible causes of infertility.

MNL LO: 1.3.1 Explain infertility and its associated risk factors.

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19) The nurse in a fertility clinic is working with a woman who has been undergoing infertility treatment with clomiphene citrate. Which statement would the nurse expect the woman to make?

1. I feel moody so much of the time.

2. If this doesnt work, I think my husband will leave me.

3. This medication will guarantee a pregnancy.

4. My risk of twins or triplets is the same as for the general population.

Answer: 1

Explanation: 1. Mood swings are a side effect of clomiphene citrate.

Page Ref: 201

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are performed in an infertility workup.

MNL LO: 1.3.3 Recognize the various strategies for managing infertility.

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20) The nurse is planning a group session for clients who are beginning infertility evaluation. Which statements should be included in this session?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Infertility can be stressful for a marriage.

2. The doctor will be able to tell why you have not conceived.

3. Your insurance will pay for the infertility treatments.

4. Keep communicating with one another through this process.

5. Support organizations can be helpful to deal with the emotional issues associated with infertility.

Answer: 1, 4, 5

Explanation: 1. Often an intact marriage will become stressed by the intrusive but necessary infertility procedures and treatments.

4. Communication is important; clients should communicate verbally and share feelings and support.

5. Referral to mental health professionals is helpful when the emotional issues become too disruptive in the couples relationship or life. Couples should be made aware of infertility support and education organizations, which may help meet some of these needs and validate their feelings.

Page Ref: 208, 209

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Describe the elements of the preliminary investigation of infertility and the nurses role in supporting/teaching patients during this phase.

MNL LO: 1.3.2 Examine the assessment process for male and female infertility.

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21) A client has been diagnosed with fallopian tube obstruction and told that her best option for becoming pregnant is with in vitro fertilization. The client asks the nurse about the procedure. What is the nurses best explanation of this procedure?

1. In vitro fertilization (IVF) occurs over a full menstrual cycle.

2. In IVF, a womans ovaries are stimulated by a combination of egg and sperm donations.

3. After ovarian stimulation, you will be inseminated with your partners sperm.

4. The oocytes are aspirated from the ovaries and fertilized in the laboratory.

Answer: 4

Explanation: 4. This is true. The oocytes are aspirated from the clients ovaries and fertilized in the laboratory.

Page Ref: 203

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. C. 2. Respect and encourage individual expression of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Summarize the indications for the tests and associated treatments, including assisted reproductive technologies, that are performed in an infertility workup.

MNL LO: 1.3.3 Recognize the various strategies for managing infertility.

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22) A nurse working with couples undergoing genetic testing recognizes which of the following as nursing responsibilities?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Allowing the family to interact with the genetic counselor without interference

2. Giving information about support groups when asked

3. Identifying families at risk for genetic problems

4. Aiding families in coping with the crisis

5. Ensuring continuity of nursing care to the family

Answer: 3, 4, 5

Explanation: 3. The nurse has a responsibility to identify families at risk for genetic problems.

4. The nurse should aid families in coping.

5. The nurse needs to ensure continuity of care to the family.

Page Ref: 220

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Family Dynamics

Standards: QSEN Competencies: I. B. 11. Respect patient preferences for degree of active engagement in care processes. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6 Identify couples who may benefit from preconceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns.

MNL LO: 1.4.4 Examine the role of the nurse and the process involved with genetic counseling.

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23) Methods to increase fertility awareness include which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Home assessment of cervical mucus

2. Pharmacologic agents

3. Therapeutic insemination

4. IVF

5. Basal body temperature (BBT) recordings

Answer: 1, 5

Explanation: 1. Methods to increase fertility awareness include home assessment of cervical mucus and basal body temperature (BBT) recordings.

5. Methods to increase fertility awareness include home assessment of cervical mucus and basal body temperature (BBT) recordings.

Page Ref: 195

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Relate the physiologic and psychologic effects of infertility on a couple to the nursing care management of the couple.

MNL LO: 1.3.3 Recognize the various strategies for managing infertility.

24) The nurse is reviewing preconception questionnaires in charts. Which couple are the most likely candidates for preconceptual genetic counseling?

1. Wife is 30 years old, husband is 31 years old

2. Wife and husband are both 29 years old, first baby for husband, wife has a normal 4-year-old

3. Wifes family has a history of hemophilia

4. Single 32-year-old woman is using donor sperm

Answer: 3

Explanation: 3. For families in which the woman is a known or possible carrier of an X-linked disorder, such as hemophilia, the risk of having an affected male fetus is 25%.

Page Ref: 217

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 14. Demonstrate clinical judgment and accountability for patient outcomes when delegating to and supervising other members of the healthcare team. | NLN Competencies: Teamwork: Function competently within ones own scope of practice as leader or member of the health care team and manage delegation effectively. |

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Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6 Identify couples who may benefit from preconceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns.

MNL LO: 1.4.4 Examine the role of the nurse and the process involved with genetic counseling.

25) A couple is at the clinic for preconceptual counseling. Both parents are 40 years old. The nurse knows that the education session has been successful when the wife makes which statement?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. We are at low risk for having a baby with Down syndrome.

2. Our children are more likely to have genetic defects.

3. Children born to parents this age have sex-linked disorders.

4. The tests for genetic defects can be done early in pregnancy.

5. It will be almost impossible for us to conceive a child.

Answer: 2, 4

Explanation: 2. Women 35 or older are at greater risk for having children with chromosome abnormalities.

4. Genetic testing such as amniocentesis and chorionic villus sampling are done in the first trimester.

Page Ref: 216, 217

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Identify couples who may benefit from preconceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns.

MNL LO: 1.4.4 Examine the role of the nurse and the process involved with genetic counseling.

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26) A newborn has been diagnosed with a disorder that occurs through an autosomal recessive inheritance pattern. The parents ask the nurse, Which of us passed on the gene that caused the disorder? Which answer should the nurse tell them?

1. The female

2. The male

3. Neither

4. Both

Answer: 4

Explanation: 4. An affected individual can have clinically normal parents, but both parents are generally carriers of the abnormal gene.

Page Ref: 214

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: I. 1. Integrate theories and concepts from liberal education into nursing practice. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care; (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders.

MNL LO: 1.4.3 Contrast the various genetic inheritance patterns.

27) Couples at risk for having a detectable single gene or chromosomal anomaly may wish to undergo which procedure?

1. Preimplantation genetic screening (PGS)

2. Preimplantation genetic diagnosis (PGD)

3. Intracytoplasmic sperm injection (ICSI)

4. Gamete intrafallopian transfer (GIFT)

Answer: 2

Explanation: 2. Preimplantation genetic diagnosis (PGD) is a term used when one or both genetic parents carry a gene mutation and testing is performed to determine whether that mutation or unbalanced chromosomal compliment has been passed to the oocyte or embryo.

Page Ref: 206

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Screening

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 6 Identify couples who may benefit from preconceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns.

MNL LO: 1.4.4 Examine the role of the nurse and the process involved with genetic counseling.

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28) The nurse in the OB-GYN clinic counsels a couple that in autosomal dominant inheritance, which of the following occur?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. An affected individual might have an affected parent.

2. The affected individual has a 75% chance of passing on the abnormality.

3. Males and females are equally affected by the gene.

4. A father can pass the defective gene to a son.

5. There are no variances in the genetic pattern for autosomal dominant disorders.

Answer: 1, 3, 4

Explanation: 1. The family pedigree usually shows multiple generations having the disorder.

3. Males and females are equally affected in autosomal dominant disorders.

4. In autosomal dominant disorders, the father can pass the defective gene to a son.

Page Ref: 213

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders.

MNL LO: 1.4.3 Contrast the various genetic inheritance patterns.

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29) The couple at 12 weeks gestation has been told that their fetus has sickle cell disease. Which statement by the couple indicates that they are adequately coping?

1. We knew we were both carriers of sickle cell. We shouldnt have tried to have a baby.

2. If we had been healthier when we conceived, our baby wouldnt have this disease now.

3. Taking vitamins before we got pregnant would have prevented this from happening.

4. The doctor told us there was a 25% chance that our baby would have sickle disease.

Answer: 4

Explanation: 4. A true statement indicates coping. When both parents are carriers of an autosomal recessive disease, there is a 25% risk for each pregnancy that the fetus will be affected.

Page Ref: 217

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 9. Assess level of patients decisional conflict and provide access to resources. | AACN Essentials Competencies: IX. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7 Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders.

MNL LO: 1.4.3 Contrast the various genetic inheritance patterns.

30) A pregnant client asks the nurse, What is this knuckle test that is supposed to tell whether my baby has a genetic problem? What does the nurse correctly explain?

1. In the first trimester, the nuchal translucency measurement is added to improve the detection rate for Down syndrome and trisomy 18.

2. You will need to ask the physician for an explanation.

3. It tests for hemophilia A or B.

4. It tests for Duchenne muscular dystrophy.

Answer: 1

Explanation: 1. Screening tests, such as nuchal translucency ultrasound are designed to gather information about the risk that the pregnancy could have chromosome abnormalities or open spina bifida.

Page Ref: 215

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Screening

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and, (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8 Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders.

MNL LO: 1.4.3 Contrast the various genetic inheritance patterns.

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31) The OB-GYN nurse is assessing a pregnant client, and recognizes genetic amniocentesis will be indicated. The nurse makes this conclusion because the indications for genetic amniocentesis include which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Maternal age under 35

2. Fetus with no abnormalities on ultrasound

3. One child with a chromosome abnormality

4. A family history of neural tube defects

5. Both parents with an abnormal chromosome

Answer: 3, 4, 5

Explanation: 3. Couples who have had a child with trisomy 21, 18, or 13 have approximately a 1% risk or their age-related risk, whichever is higher, of a future child having a chromosome abnormality.

4. Family history of neural tube defects is an indication for genetic amniocentesis.

5. If both parents carry an autosomal recessive disease, they have a 25% chance with each pregnancy that the fetus will be affected.

Page Ref: 216, 217

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: III. B. 3. Base individualized care plan on patient values, clinical expertise, and evidence. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science; Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 8 Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders.

MNL LO: 1.4.3 Contrast the various genetic inheritance patterns.

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32) The clinic nurse assesses a newborn that is not progressing as expected. Genetic tests are ordered. The nurse explains to the parents that the laboratory tests to be done include which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Chromosome analysis

2. Complete blood count

3. Phenylketonuria

4. Enzyme assay

5. Antibody titers

Answer: 1, 4, 5

Explanation: 1. Laboratory analysis includes chromosome analysis.

4. Laboratory analysis includes enzyme assay for inborn errors of metabolism.

5. Laboratory analysis includes antibody titers for infectious teratogens.

Page Ref: 218

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8 Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders.

MNL LO: 1.4.3 Contrast the various genetic inheritance patterns.

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33) A nurse counsels a couple on sex-linked disorders. Both the man and the woman are carriers of the disorder. They ask the nurse how this disorder will affect any children they might have. What is the nurses best response?

1. If you have a daughter, she will not be affected.

2. Your son will be affected because the father has the disorder.

3. There is a 25% chance that your son will have the disorder because the mother has the disorder.

4. There is a 50% chance that your son will be a carrier only.

Answer: 4

Explanation: 4. There is a 50% chance that a carrier mother will pass the normal gene to each of her sons, who will be unaffected.

Page Ref: 214

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders.

MNL LO: 1.4.2 Describe the function and structure of chromosomes and genes.

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34) A 58-year-old father and a 45-year-old mother gave birth to a baby boy 2 days ago. The nurse assesses a single palmar crease and low-set ears on the newborn. The nurse plans to counsel the couple about which chromosomal abnormality?

1. Trisomy 13

2. Trisomy 18

3. Trisomy 21

4. Trisomy 26

Answer: 3

Explanation: 3. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome).

Page Ref: 211

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 10. Engage patients or designates surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 8 Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders.

MNL LO: 1.4.3 Contrast the various genetic inheritance patterns.

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35) Which couples may benefit from prenatal diagnosis?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Couples including women under the age of 35

2. Couples with an unbalanced translocation

3. Couples with a family history of known or suspected single-gene disorder

4. Couples including women with a teratogenic risk secondary to an exposure or maternal health condition

5. Family history of birth defects and/or intellectual disability

Answer: 3, 4, 5

Explanation: 3. Couples with a family history of known or suspected single-gene disorder (e.g., cystic fibrosis, hemophilia A or B, Duchenne muscular dystrophy) may benefit from prenatal diagnosis.

4. Women with a teratogenic risk secondary to an exposure or maternal health condition (e.g., diabetes, seizure disorder) may benefit from prenatal diagnosis.

5. Family history of birth defects and/or intellectual disability (mental retardation) (e.g., neural tube defects, congenital heart disease, cleft lip and/or palate) may benefit from prenatal diagnosis.

Page Ref: 217

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 8 Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders.

MNL LO: 1.4.3 Contrast the various genetic inheritance patterns.

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