Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig - Test Bank

Chapter 03_LO 01_Q01 A client tells the clinic nurse that sometimes, between menstrual periods, she experiences a sharp pain low in her abdomen on either the right or the left side. The client states that this pain is different from the menstrual cramps that she experiences, and wants to know why this is happening. What is the nurse’s best response? 1. “You are experiencing ovarian cysts that are occurring each month with ovulation. Talk to your nurse practitioner about this.” 2. “Your ovaries are releasing an egg at that time. Many women experience some pain in one side of the lower abdomen during ovulation.” 3. “Your fallopian tubes sometimes get a spasm, similar to a muscle cramp in your leg. That’s what you are feeling.” 4. “The uterus moves up and down during your menstrual cycle. When it is up high during your least fertile times, you can feel that pain.” Correct Answer: 2 Rationale: 1. Ovarian cysts do not occur with each menstrual cycle in normal women. The client is experiencing the mittelschmerz, or mid-cycle pain, of ovulation. 2. The client is experiencing the mittelschmerz, or mid-cycle pain, of ovulation. This is a very common experience. 3. Fallopian tubes do not go into spasms. The client is experiencing the mittelschmerz, or mid-cycle pain, of ovulation. 4. Although the uterus does move up and down through the menstrual cycle, at mid-cycle, the client is most fertile, and will be at the lowest position of the pelvis, to facilitate conception. The client is experiencing the mittelschmerz, or mid-cycle pain, of ovulation. Cognitive level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Diagnosis Learning Outcome: 3.1 Identify the structures and functions of the female reproductive system. Chapter 03_LO2 _Q02 The clinic nurse is caring for a young woman seeking contraception because she has recently married and become sexually active. The teen states, “The opening of my husband’s penis isn’t at the tip; it’s around the corner below the tip. He tells me that he was born that way. Will that cause problems if we want to have children?” What is the best response for the nurse to give? “This variation is called: 1. “Epispadias. It is not likely to impact his fertility.” 2. “Epispadias. It will likely cause him to be infertile.” 3. “Hypospadias. It is not likely to impact his fertility.” 4. “Hypospadias. It will likely cause him to be infertile.” Correct Answer: 3 Rationale: 1. Epispadias is the condition where the urethral opening is on the upper aspect of the penis. The client is describing hypospadias, when the urethral opening is on the lower side of the penis. Mild hypospadias, when the urethral opening is on the glans of the penis, does not impact fertility. 2. Epispadias is the condition where the urethral opening is on the upper aspect of the penis. The client is describing hypospadias, when the urethral opening is on the lower side of the penis. Mild hypospadias, when the urethral opening is on the glans of the penis, does not impact fertility. 3. The client is describing hypospadias, which is the urethral opening on the lower aspect of the penis. Mild hypospadias, when the urethral opening is on the glans of the penis, does not impact fertility. 4. The client is describing hypospadias, where the urethral opening is on the lower side of the penis. Mild hypospadias, where the urethral opening is on the glans of the penis, does not impact fertility. Cognitive level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Diagnosis Learning Outcome: 3.2 Identify the structures and functions of the male reproductive system. Chapter 03_LO03 _Q03 A prenatal client asks the nurse how the baby can possibly come out through her vagina, because a vagina is not nearly as big as a baby. What should the nurse include when answering this patient’s question? The vagina: 1. Usually tears as it stretches during childbirth. 2. Is designed to allow a baby come through. 3. Changes from pregnancy hormones and stretches more. 4. Dilates and effaces in labor so the baby can get out. Correct Answer: 3 Rationale: 1. Vaginal tears are not routine in childbirth, because the vagina stretches during childbirth because of hormonal changes, creating deeper rugae. 2. Although this is a true statement, giving more detailed information better educates the client. 3. The hormones of pregnancy create deeper rugae of the vagina to facilitate stretching during birth. 4. The cervix dilates and effaces, not the vagina. Cognitive level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning Learning Outcome: 3.3 Explain the significance of specific female reproductive structures during childbirth. Chapter 03_LO03 _Q04 The client shows an understanding of the pelvic cavity divisions by stating: 1. “The true pelvis is made up of the sacrum, coccyx, and the innominate bones.” 2. “The false pelvis consists of the inlet, the pelvic cavity, and the outlet.” 3. “The true pelvis is the portion above the pelvic brim.” 4. “The relationship between the false pelvis and the fetal head is of paramount importance.” Answer: 1 Rationale: 1. The true pelvis is made up of the sacrum, coccyx, and innominate bones, and represents the bony limits of the birth canal. 2. The true pelvis consists of the inlet, the pelvic cavity, and the outlet. 3. The false pelvis is the portion above the pelvic brim. 4. It is the relationship between the true pelvis (not the false) and the fetal head that is of paramount importance. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome 3.3 Explain the significance of specific female reproductive structures during childbirth. Chapter 03_LO03 _Q05 A pregnant adolescent asks the nurse, “Why does the physician call measuring my uterus a ‘fundal height’?” The nurse’s answer is based on the fact that the fundus of the uterus is located: 1. In the elongated portion where the fallopian tubes enter. 2. In the lower third area. 3. At the uppermost (dome-shaped top) portion. 4. Between the internal cervical os and the endometrial cavity. Answer: 3 Rationale: 1. The elongated portion where the fallopian tubes enter the uterus is called the cornua. 2. The lower third of the uterus is called the cervix, or neck. 3. The rounded, uppermost (dome-shaped top) portion of the uterus that extends above the points of attachment of the fallopian tubes is called the fundus. 4. The isthmus is the portion of the uterus between the internal cervical os and the endometrial cavity. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome 3.3 Explain the significance of specific female reproductive structures during childbirth. Chapter 03_LO04 _Q06 A nurse teaches newly pregnant clients that if an ovum is fertilized and implants in the endometrium, the hormone the fertilized egg begins to secrete is: 1. Estrogen. 2. Human chorionic gonadotropin (hCG). 3. Progesterone. 4. Luteinizing hormone. Answer: 2 Rationale: 1. Estrogen is an ovarian hormone. 2. When the ovum is fertilized, and implants in the endometrium, the fertilized egg begins to secrete human chorionic gonadotropin (hCG) hormone to maintain the corpus luteum. 3. Progesterone is an ovarian hormone. 4. Luteinizing hormone is excreted by the anterior pituitary. Implementation Health Promotion and Maintenance Application Learning Outcome 3.4 Describe the actions of the hormones that affect reproductive functioning. Chapter 03_LO04 _Q07 A school nurse is teaching a health class to middle school children. The nurse explains that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are secreted by the: 1. Hypothalamus. 2. Ovaries and testes. 3. Posterior pituitary. 4. Anterior pituitary. Answer: 4 Rationale: 1. The hypothalamus secretes gonadotropin-releasing hormone to the pituitary gland in response to signals from the central nervous system. 2. The ovaries secrete the female hormones estrogen and progesterone, and the testes secrete testosterone. 3. The posterior pituitary gland secretes oxytocin and anti-diuretic hormone. 4. The anterior pituitary secretes FSH and LH, which are primarily responsible for maturation of the ovarian follicle. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome 3.4 Describe the actions of the hormones that affect reproductive functioning. Chapter 03_LO 04_Q08 The nurse is presenting a community education session on female hormones. Which statement from a participant indicates the need for further information? 1. “Estrogen is what causes females to look female.” 2. “The presence of some hormones causes other to be secreted.” 3. “Progesterone is present at the end of the menstrual cycle.” 4. “Prostaglandin is responsible for achieving conception.” Correct Answer: 4 Rationale: 1. This is a true statement. The question is asking for an incorrect statement. Estrogen causes secondary sex characteristics, such as enlarged breasts and widened hips. 2. This is a true statement. The question is asking for an incorrect statement. One example is that the production of gonadotropin-releasing hormone (GnRH) causes the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). 3. This is a true statement. The question is asking for an incorrect statement. Progesterone is present in large quantities during the secretory phase of the menstrual cycle. 4. Prostaglandin is not related to conception. Prostaglandin is called the hormone of pregnancy because it maintains pregnancy. Cognitive level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome: 3.4 Describe the actions of the hormones that affect reproductive functioning. Chapter 03_LO 04_Q09 A woman has been unable to complete a full-term pregnancy because the fertilized ovum failed to implant in the uterus. This is most likely due to a lack of which hormone? 1. Estrogen 2. Progesterone 3. FSH (follicle-stimulating hormone) 4. LH (luteinizing hormone) Correct Answer: 2 Rationale: 1. Estrogen primarily assists in maturation of the ovarian follicles, and causes endometrial mucosa to proliferate. 2. Progesterone is the likely cause, because it decreases uterine motility and contractibility caused by estrogens, thereby preparing the uterus for implantation. 3. FSH is a hormone secreted by the pituitary gland. 4. LH is a hormone secreted by the pituitary gland. Nursing Process: Diagnosis Category of Client Need: Health Promotion and Maintenance: Growth and Development Cognitive Level: Comprehension Learning Outcome: 3.4 Describe the actions of the hormones that affect reproductive functioning. Chapter 03_LO 05_Q10 The nurse is explaining the menstrual cycle to a group of women. The teaching on phases of the menstrual cycle should include the fact that the corpus luteum begins to degenerate, estrogen and progesterone levels fall, and the blood supply to the endometrium is reduced in which phase? 1. Menstrual phase 2. Proliferative phase 3. secretory phase 4. Ischemic phase Answer: 4 Rationale: 1. The menstrual phase is the menses. 2. The proliferative phase is characterized by proliferation of the endometrium. 3. The secretory phase involves glycogen secretion by the endometrium after ovulation. 4. The ischemic phase is characterized by ischemia of the endometrium. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome 3.5 Identify the two phases of the ovarian cycle, and the changes that occur in each phase. Chapter 03_LO 05_Q11 Which statement best indicates that the client understands the differences in the follicular and luteal phases of the ovarian cycle? 1. “My period will be every 28 days.” 2. “The first part of my period might vary in length, but not the second.” 3. “The follicular phase is the second half of my cycle.” 4. “The follicular phase is when the egg is fertilized.” Answer: 2 Rationale: 1. The follicular phase can vary, resulting in cycle length other than 28 days. 2. For a female with a 28-day cycle, the follicular phase comprises days 1–14 of the menstrual cycle, and the luteal phase comprises days 15–28. The luteal phase does not vary. 3. The luteal phase is the second half of the cycle. 4. The follicular phase comprises days 1–14 of the menstrual cycle, not when the egg is fertilized. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome 3.5 Identify the two phases of the ovarian cycle, and the changes that occur in each phase. Chapter 03_LO 05_Q12 The nurse is preparing a handout on the ovarian cycle to a group of middle school girls. Which information should the nurse include? 1. There are two phases of the ovarian cycle: luteal and follicular. 2. Irregular menstrual cycles have varying lengths of the follicular phase. 3. The ovum travels from the ovary to the tube during the luteal phase. 4. The hormone human chorionic gonadotropin stimulates ovulation. Correct Answer: 1 Rationale: 1. The two phases of the ovarian cycle are follicular (days 1–14 of the menstrual cycle) and luteal (days 15–28 of the menstrual cycle). 2. Menstrual cycles that are irregular in length have a consistent follicular phase but a varying luteal phase. 3. The ovum is released from the graafian follicle of the ovary and travels to the fallopian tube during the follicular phase of the ovarian cycle. 4. Human chorionic gonadotropin (hCG) is secreted by a fertilized ovum, and does not stimulate ovulation. Cognitive level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning Learning Outcome: 3.5 Identify the two phases of the ovarian cycle and the changes that occur in each phase. Chapter 03_LO 06_Q13 The nurse is preparing a presentation on the menstrual cycle for a group of high school students. Which statement should the nurse include in this presentation? 1. “The menstrual cycle has five distinct phases that occur during the month.” 2. “One hormone controls the phases of the menstrual cycle.” 3. “The secretory phase occurs when a woman is most fertile.” 4. “Menstrual cycle phases vary in order from one woman to another.” Correct Answer: 3 Rationale: 1. There are four phases of the menstrual cycle: menstrual, proliferative, secretory, and ischemic phases. 2. Four hormones control ovulation and therefore the menstrual cycle: progesterone, estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). 3. During the secretory phase, the endometrium is thickest, and glycogen is produced to nourish a fertilized ovum. 4. Although the length of the menstrual cycle might vary, the phases of the menstrual cycle always occur in the same order. Cognitive level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning Learning Outcome: 3.6 Describe the phases of the menstrual cycle, their dominant hormones, and the changes that occur in each phase. Chapter 03_LO 06_Q14 The nurse is preparing a handout for female adolescents on the menstrual cycle. The nurse is including information on the phases of the menstrual cycle. What term should be used for the phase in which the vascularity of the uterus increases and the endometrium becomes prepared for a fertilized ovum? 1. Menstrual 2. Proliferative 3. Secretory 4. Ischemic Answer: 2 Rationale: 1. The menstrual phase refers to the cyclic uterine bleeding in response to hormonal changes. 2. The proliferative phase refers to the buildup of the endometrium as blood supply and uterine size are increased. 3. The secretory phase occurs after ovulation. 4. The ischemic phase occurs if fertilization does not occur. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning Learning Outcome 3.6 Describe the phases of the menstrual cycle, their dominant hormones, and the changes that occur in each phase. Chapter 03_LO 06_Q15 A woman is experiencing mittelschmerz and increased vaginal discharge. Her temperature has increased by 0.6°C (1.0° F) for the past 36 hours. This most likely indicates that: 1. Menstruation is about to begin. 2. Ovulation will occur soon. 3. Ovulation has occurred. 4. She is pregnant, and will not menstruate. Answer: 3 Rationale: 1. A temperature increase does not occur when menstruation is about to begin. 2. A temperature increase does not occur before ovulation has occurred. 3. Signs that ovulation has occurred include: pain associated with rupture of the ovum (mittelschmerz), increased vaginal discharge, and a temperature increase of 0.6°C over the past 36 hours. 4. Pregnancy can be detected only through testing the urine or serum for the presence of human chorionic gonadotropin hormone. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Assessment Learning Outcome 3.6 Describe the phases of the menstrual cycle, their dominant hormones, and the changes that occur in each phase. Chapter 07_LO01_Q01 A client who has been unable to conceive asks the nurse if it is her fault or her husband’s fault that they have not been able to become pregnant. The best response by the nurse is: 1. “The male infertility factors are more common than female.” 2. “Female infertility issues are more common than male issues.” 3. “The testing the doctor will order will determine who is at fault.” 4. “We will know what is causing your infertility after some tests are done.” Correct Answer: 4 Rationale: 1. This statement is not true. Because of the complexity of ovulation and maintaining a pregnancy, it is more likely that a female issue is causing the infertility. However, using the term “at fault” is blaming, and should be avoided. 2. Although this statement is true, because of the complexity of ovulation and maintaining a pregnancy, using the term “at fault” is blaming, and should be avoided. 3. Testing will determine what the infertility issue is, but using the term “at fault” is blaming, and should be avoided. 4. This is a factual answer that avoids using the term “at fault.” This statement is therapeutically worded, and therefore is the best answer. Cognitive level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning Learning Outcome: 7.1 Compare the essential components of fertility with the possible causes of infertility. Chapter 07_LO02 _Q02 The client experiencing infertility is to complete three months of documenting her basal body temperatures. Which statement by the client indicates a need for additional teaching? 1. “I should check my temperature with this special thermometer before I get out of bed each day.” 2. “I will track my temperatures and the consistency of my cervical mucus for the next three months.” 3. “If I am ovulating, my temperature will be a smooth, even line on the graph that does not go up or down.” 4. “The point of checking my basal body temperature is to determine whether I am ovulating regularly.” Correct Answer: 3 Rationale: 1. The basal body temperature is most accurate prior to arising each day. A thermometer with larger spaces between tenths of a degree is used to facilitate accurate recording. 2. Taking the temperature each morning will help detect ovulation. Checking cervical mucus daily for changes in consistency and stretchiness is another method to detect ovulation. Combining the two methods gives better information on when ovulation is occurring than one does method alone. 3. A flat line on the graph is a monophasic cycle indicating a lack of ovulation. An ovulating woman will have a biphasic pattern to her basal body temperature. The temperature will drop slightly prior to ovulation, and rise about .5–1.0-degree Fahrenheit as ovulation occurs, remaining elevated if conception occurs or dropping just prior to onset of menses. 4. Basal body temperatures are less predictive of when ovulation occurs, but an increase in the latter half of the cycle indicates that ovulation has occurred. Cognitive level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome: 7.2 Describe the elements of the preliminary investigation of infertility, and the nurse’s role in supporting/teaching clients during this phase. Chapter 07_LO03 _Q03 The infertile couple will have ovulation induced and retrieval of ovum, followed by mixing with washed donor sperm. One day later, the fertilized ovum will be placed in the fallopian tube. The nurse knows that education has been successful if the client describes the procedure as: 1. Zygote intrafallopian transfer (ZIFT). 2. Gamete intrafallopian transfer (GIFT). 3. Tubal embryo transfer (TET). 4. In vitro fertilization (IVF). Correct Answer: 1 Rationale: 1. ZIFT is the return of fertilized ovum into the fallopian tube after ovum retrieval and mixing the ovum with washed sperm. 2. GIFT is placing retrieved ovum and washed sperm into the fallopian tube. 3. TET is placing embryos into the fallopian tube. The embryos form in a laboratory after ovum are retrieved and then mixed with washed sperm. 4. IVF is the placement of embryos into the uterus. The embryos form in a laboratory after ovum are retrieved and then mixed with washed sperm. Cognitive level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome: 7.3 Compare the indications for the tests with the associated treatments, including assisted reproductive technologies, that are done in an infertility workup. Chapter 07_LO03_Q04 A nurse is reviewing the basal body temperature method with a couple. Which of the following statements would indicate that the teaching has been successful? 1. “I have to go buy a special type of thermometer.” 2. “I need to wait five minutes after smoking a cigarette before I take my temperature.” 3. “I need to take my temperature before I get out of the bed in the morning.” 4. “I need to take my temperature for at least two minutes every day.” Answer: 3 Rationale: 1. The temperature can be taken with a standard oral or rectal thermometer. 2. In the basal body temperature method, the woman takes her temperature every day before starting any activity, including smoking. 3. In the basal body temperature method, the woman takes her temperature every day before arising. 4. In the basal body temperature method, the woman takes her temperature every day for five minutes. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome 7.3 Compare the indications for the tests and associated treatments, including assisted reproductive technologies, that are done in an infertility workup. Chapter 07_LO03_Q05 A client calls the urologist’s office to receive instructions about semen analysis. The nurse should instruct the client to: 1. Avoid sexual intercourse 24 hours prior to obtaining 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 Rationale: 1. The specimen is collected after 2–3 days of abstinence, usually by masturbation. 2. Regular condoms should not be used, because of the spermicidal agents that they contain. 3. A repeat semen analysis might be required to adequately assess the man’s fertility potential. 4. Instructing the client to expect a small sample is not appropriate. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome 7.3 Compare the indications for the tests and associated treatments, including assisted reproductive technologies, that are done in an infertility workup. Chapter 07_LO04_Q06 The client undergoing infertility treatment reports to the nurse that her partner is angry all of the time since beginning treatment, and is very negative in comments made about the likelihood of their achieving pregnancy. The client states, “I was angry and depressed, but now I am dedicated to following through with treatment, and hoping we get pregnant.” What is the best interpretation of these comments? The partner is: Select all that apply. 1. Exhibiting signs of the anger stage of grieving the loss of their dreams of having children. 2. In a different stage of grief than the client. 3. Having difficulty accepting the reality of their infertility. 4. Showing that he will not be a good parent. 5. Feeling guilty about not being able to father a child. Correct Answers: 1, 2 Rationale: 1. The client’s description of her partner correlates with the anger stage of grief. Couples often experience the stages of grief when infertility is diagnosed, because childbearing is an expected outcome in marriage; the inability to become pregnant is the loss of the dream of parenthood. 2. The client is in acceptance stage of grief, while the partner is in the anger stage. It is common and normal for families to be in different stages of the grieving process. 3. The partner is in the anger stage of grief. Lack of acceptance would manifest as not believing that the diagnosis is correct. 4. Being in the anger stage of grief is expected and normal, and has no bearing on parenting ability. 5. Guilt would manifest as feelings that it is his fault that pregnancy has not yet occurred. The client is describing anger. Cognitive level: Analysis Category of Client Need: Psychosocial Integrity Nursing Process: Diagnosis Learning Outcome: 7.4 Explain the physiologic and psychologic effects of infertility on a couple in the nursing care management of the couple. Chapter 07_LO05_Q07 The nurse manager is interviewing nurses for a position in an infertility clinic. Which statement best indicates that the interviewee understands the role of the nurse when working with infertile clients? 1. “My job will be teaching patients how to take their medications, and scheduling tests.” 2. “Much of my duties will involve forming therapeutic relationships with clients struggling with infertility.” 3. “This position is an assistant to the physician during diagnostic testing for infertility.” 4. “I will both teach and support families struggling with emotions as they attempt to become pregnant.” Correct Answer: 4 Rationale: 1. Although teaching and facilitating scheduling are important, the emotions that families deal with during treatment for infertility must also be addressed. 2. Although this response addresses the emotional aspects of infertility, it does not mention providing support or teaching, which are also major components of the job. 3. Some assisting might be a part of this position; the role of the RN in an infertility clinic involves much teaching and providing emotional support to infertile clients. 4. This answer addresses the two main aspects of the RN working with infertile clients: emotional support and education. Cognitive level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome: 7.5 Describe the nurse’s role as counselor, educator, and advocate for couples during infertility evaluation and treatment. Chapter 07_LO06_Q08 Which client(s) should the nurse refer to a genetics practitioner prior to attempting pregnancy? 1. 32-year-old woman and 29-year-old man with 3-year-old twins 2. 22-year-old woman whose sister has Tay-Sachs disease 3. 30-year-old woman whose husband has AIDS 4. 19-year-old woman whose sister has primary infertility Correct Answer: 2 Rationale: 1. This patient has no indication of having a genetic problem. 2. Tay-Sachs disease is an autosomal recessive condition; therefore, if the client’s sister has the disease, the client could be a carrier for the condition. 3. The risk for this client is becoming infected with HIV while attempting conception. This couple has no indication of a genetic condition. 4. Primary infertility is not likely to be caused by a genetic defect that could be carried by a sibling. This client has no indication of a genetic condition. Cognitive level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning Learning Outcome: 7.6 Distinguish couples who might benefit from preconceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns. Chapter 07_LO07_Q09 The nurse has presented an in-service to nurses new to the maternal–child health care unit. Which statement indicates that teaching on genetic disorders has been successful? 1. “Down syndrome is an autosomal recessive condition. If both parents carry the gene, there is a 1-in-4 chance that a child will be affected.” 2. “Galactosemia is a sex-linked condition. Both parents must carry the gene, and more girls than boys will be affected by this condition.” 3. “Sickle-cell disease is a trisomy; the affected client has three copies of a gene. Trisomies are more common in pregnancies of young women than those of older women.” 4. “Huntington’s disease is an autosomal dominant condition. Only one parent carries the gene, and males and females are equally affected by the disease.” Correct Answer: 4 Rationale: 1. Down syndrome is a trisomy, and most likely to occur in parents over age 35. Autosomal recessive conditions are passed along to offspring when both parents carry the affected gene and pass the affected gene to the child. 2. Galactosemia is not a sex-linked disorder; it is an autosomal recessive disorder. Both parents must carry the gene and pass that gene on to he child. Males and females are equally affected. Sex-linked disorders are carried on the X chromosome; therefore, males are more likely to have the condition, because they only have one copy of the X chromosome. 3. Trisomies are three copies of a specific gene, and occur most often in parents over age 35. Sickle-cell disease is not a trisomy; it is an autosomal recessive condition. Both parents must carry the gene; there is a 1-in-4 chance that their child will be affected. 4. Huntington’s disease is an autosomal dominant disease, meaning that the affected person inherited the condition from only one affected parent. A child has a 50% chance of inheriting an autosomal dominant condition if one parent is affected. Males and females are equally affected by autosomal dominant disorders. Cognitive level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome: 7.7 Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders. Chapter 07_LO07_Q10 A 45-year-old mother gave birth to a baby boy two days ago. The nurse assesses a single palmar crease, poor muscle tone, and low-set ears on the newborn. The nurse understands that these signs most likely indicate the infant has which autosomal abnormalities? 1. Trisomy 13 2. Trisomy 18 3. Trisomy 21 4. Trisomy 26 Answer: 3 Rationale: 1. A single palmar crease and low-set ears are not characteristics of trisomy 13. 2. A single palmar crease and low-set ears are not characteristics of trisomy 18. 3. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome). 4. Trisomy 26 is not an autosomal abnormality. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Assessment Learning Outcome 7.7 Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders. Chapter 07_LO07_Q11 A nurse counsels a couple who have concerns about a sex-linked disorder. Both parents are carriers of the disorder. They ask the nurse how this disorder will affect any children they might have. What is the nurse’s best response? 1. “If you have a daughter, she will not be affected.” 2. “If you have a son, he will not be affected.” 3. “There is a 25% chance that a daughter will have the disorder.” 4. “There is a 50% chance that a son will be a carrier.” Answer: 4 Rationale: 1. If both parents carry a sex-linked disorder, they each have one normal sex chromosome and one abnormal female sex chromosome. 2. There is a 50% chance of males being normal. 3. With female offspring, there is a 50% of being a carrier, and a 50% chance of having the disorder. 4. There is a 50% chance of male offspring being carriers. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome 7.7 Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders. Chapter 07_LO08_Q12 A child with suspected Down syndrome has been born to 32-year-old parents. The parents ask the nurse how the diagnosis will be made, and if there was a way that the diagnosis could have been made during the pregnancy. The best response by the nurse is: 1. “The baby’s genes could have been tested during pregnancy by doing an amniocentesis.” 2. “The doctor will check the baby’s genes by doing a 24-hour urine collection on your child.” 3. “Mom’s blood could have been tested during the pregnancy to check for genetic problems with the baby.” 4. “A swab of the baby’s cheek or a stool sample will be used to check your baby’s chromosomes.” Correct Answer: 1 Rationale: 1. A genetic amniocentesis is the removal of a small amount of amniotic fluid is obtained by inserting a needle through the abdominal wall into the uterus. The amniotic fluid is then processed to examine the chromosomes. 2. Suspected genetic conditions in newborns are diagnosed by examining the baby’s chromosomes either from a blood sample or from a swab of the inside of the cheek. 3. Mom’s blood would contain the mother’s chromosomes, not the baby’s. Prenatal genetic testing is accomplished through genetic amniocentesis. A small amount of amniotic fluid is obtained by inserting a needle through the abdominal wall into the uterus. The amniotic fluid is then processed to examine the chromosomes. 4. Although a cheek swab can be used for genetic testing, stool samples cannot. Because part of the answer is incorrect, the whole answer is incorrect. Cognitive level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome 7.8 Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders, and the nursing considerations for each. Chapter 07_LO08_Q13 The couple has had an ultrasound at 19 weeks’ gestation, and their fetus was found to have anencephaly. The nurse is completing counseling for the couple on the ultrasound findings. Which statement indicates that additional teaching is needed? 1. “We won’t know if something is wrong until the baby’s chromosomes are tested.” 2. “This problem is not caused by one of us having a genetic problem.” 3. “Our baby has an incomplete brain, and might not be born alive.” 4. “Waiting until our 30s did not cause this problem to develop.” Answer: 1 Rationale: 1. Anencephaly is clearly visualized with ultrasound, and does not require genetic testing to verify a diagnosis. 2. Genetic abnormalities in either parent are not related to anencephaly. 3. Anencephaly is a condition in which the skull does not cover the brain completely, and the brain consists mostly of brainstem with little other brain development. 4. The age of either parent is not related to anencephaly. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Evaluation Learning Outcome 7.8 Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders, and the nursing considerations for each. Chapter 07_LO08_Q14 A male infant was born two days ago, and the nurse assessed the infant as having single palmar crease, poor muscle tone, and low-set ears. Genetic testing of the infant has been ordered by the physician. Which statement should the nurse include when explaining this plan to the parents? 1. “We will draw blood from both of you to check for abnormal genes.” 2. “Your son will have his chromosomes sampled and then studied.” 3. “When your son is 2 years old, he will need a blood test.” 4. “After your breast milk is in, we will draw blood from your son.” Answer: 2 Rationale: 1. The parents’ chromosomes do not need to be assessed in order to diagnose the infant. 2. A single palmar crease, poor muscle tone, and low-set ears could indicate trisomy 18. This diagnosis is confirmed by chromosomal analysis of the infant, using either a buccal smear or a blood specimen. 3. The chromosome studies will be undertaken as soon as possible. 4. It is not necessary to wait until the breast milk has come in. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning Learning Outcome 7.8 Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders and the nursing considerations for each. Chapter 07_LO09_Q15 The family of a 3-day-old child has just been informed that their child has cystic fibrosis. Which statement to the family should the nurse make? 1. “I can see that you are adjusting well. I’ll leave you alone for a while.” 2. “This must be difficult news for you. What questions do you have?” 3. “Do you have family members or clergy you would like me to call?” 4. “Why didn’t you have an amniocentesis during your pregnancy?” Correct Answer: 2 Rationale: 1. When a client is given bad news, the grieving process begins. The family is grieving the loss of a normal child. This family is most likely in the shock/disbelief stage of grief. 2. This response uses therapeutic communication techniques and portrays a caring attitude towards the family. Asking if the family has questions further facilitates communication. 3. Although it is good to have supportive family members or a clergy person called if the family desires, it is better for the nurse to take the initiative and establish therapeutic communication, and to portray caring. 4. It is not therapeutic to ask “why” questions. In addition, although cystic fibrosis is diagnosable prenatally, a client opposed to abortion often will not seek prenatal diagnosis, because the pregnancy would not be terminated if the child were affected by a chromosomal abnormality. Cognitive level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Assessment Learning Outcome: 7.9 Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder when providing nursing care to the family undergoing genetic counseling. Chapter 07_LO09_Q16 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 shouldn’t have tried to have a baby.” 2. “If we had been healthier when we conceived, our baby wouldn’t 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 Rationale: 1. Self-blame and judgment do not indicate coping. 2. Preconception health does not affect transmission of an autosomal recessive trait. 3. Nutrition does not affect transmission of an autosomal recessive trait. 4. A true statement indicates coping. When both the mother and father are carriers of an autosomal recessive disease like sickle-cell, there is a 25% chance of a normal child, a 25% chance of a child with sickle-cell disease, and a 50% chance of a child with sickle-cell trait. Cognitive Level: Application Category of Client Need: Health Promotion and Maintenance Nursing Process: Assessment Learning Outcome 7.9 Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder, and explain the nurse’s role in supporting the family undergoing genetic counseling. Chapter 07_LO09_Q17 The 28-year-old husband and wife have just been told their child has trisomy 21. Their 3-year-old child has no health problems. What statement should the nurse include in counseling this family? 1. “Don’t worry. Everything will turn out for the best.” 2. “It can be very difficult to understand why God chose you for this problem.” 3. “Your child’s disorder was not predictable, and not the fault of either of you.” 4. “Your 3-year-old will need extra attention, given a sibling with special needs.” Answer: 3 Rationale: 1. Therapeutic communication avoids clichés. 2. Therapeutic communication avoids philosophical answers involving God. 3. Reassuring the couple that neither of them caused the genetic abnormality of their newborn is most important right now. 4. The needs of the 3-year-old are not a top priority at the moment. Cognitive Level: Analysis Category of Client Need: Health Promotion and Maintenance Nursing Process: Planning Learning Outcome 7.9 Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder, and explain the nurse’s role in supporting the family undergoing genetic counseling.