Lewis: Medical-Surgical Nursing, 10th Edition 12: Genetics and Genomics

1. The sister of a patient diagnosed with BRCA gene-related breast cancer asks the nurse, "Do you think I should be tested for the gene?" Which response by the nurse is most appropriate? "In most cases, breast cancer is not caused by having the BRCA gene." "It depends on how you will feel if the test is positive for the BRCA gene." "There are many things to consider before deciding to have genetic testing." "You should decide first whether you are willing to have a bilateral mastectomy." - ANS: C Although presymptomatic testing for genetic disorders allows patients to take action (e.g., mastectomy) to prevent the development of some genetically caused disorders, patients also need to consider that test results in their medical record may affect insurance, employability, and so on. Telling a patient that a decision about mastectomy should be made before testing implies that the nurse has made a judgment about what the patient should do if the test result is positive. Although the patient may need to think about her reaction if the test is positive, other issues (e.g., insurance) also should be considered. Although most breast cancers are not related to BRCA gene mutations, the patient with a BRCA gene mutation has a markedly increased risk for breast cancer. DIF: Cognitive Level: Analyze (analysis) REF: 188TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 2. When counseling a couple in which the man has an autosomal recessive disorder and the woman has no gene for the disorder, the nurse uses Punnett squares to show the couple the probability of their having a child with the disorder. Which statement by the nurse is accurate? "Each child would be a carrier of the disorder." "Each child would have 50% chance of having the disorder." "Your male children would display characteristics of the disorder." "Your female children would display characteristics of the disorder." - ANS: A When one parent has an autosomal recessive disorder and the other parent has no genes for the autosomal recessive disorder, the children will be carriers of the autosomal recessive disorder. The children will not have the disorder or display characteristics of the disorder, regardless of gender. DIF: Cognitive Level: Apply (application) REF: 181TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 3. A patient with a family history of cystic fibrosis (CF) asks for information about genetic testing. Which response by the nurse is most appropriate? Refer the patient to a qualified genetic counselor. Ask the patient why genetic testing seems necessary.