NUR 128 - Maternity and Pediatric Nursing, Ch. 10, 11, 12.100% ACCURATE GRADE A+ GUARANTEED

Fetal circulation differs from the circulatory path of the newborn infant. In utero the fetus has a hole connecting the right and left atria of the heart. This allows oxygenated blood to quickly pass to the major organs of the body. What is this hole called? Foramen ovale Explanation: The foramen ovale is a hole that connects the right and left atria so the majority of oxygenated blood can quickly pass into the left side of the fetal heart, go to the brain, and move to the rest of the fetal body. A nursing student is explaining to a newly pregnant woman what happens during each stage of fetal development. At which stage does the nurse inform the woman that the lungs are fully shaped? end of 16 weeks Explanation: At the end of 16 weeks, the lungs are fully shaped, fetus swallows amniotic fluid, skeletal structure is identifiable, downy lanugo hair is present on the body, and sex can be determined using ultrasound. A pregnant client is scheduled to undergo chorionic villus sampling (CVS) to rule out any birth defects. Ideally, when should this testing be completed? 10 to 12 weeks' gestation Explanation: Chorionic villus sampling (CVS) is typically performed between 10 to 12 weeks' gestation. Sometimes it may be offered up to 14 weeks. The test is not conducted before 10 weeks' gestation. A couple has just been notified that their unborn child carries a genetic disorder. The couple expresses concern that the insurance company will not cover the costs associated with the medical bills for the child. What is the most appropriate response by the nurse? "There are laws in place that prohibit that from happening." Explanation: The Genetic Information Nondiscrimination Act of 2008 prohibits insurance companies from denying coverage or charging higher premiums based solely on genetic predisposition. The nurse is seeing a client who is going to be married in a month. This client has a history of Huntington disease in her family. The genetic testing has come back, and the client has just been told she carries the gene for Huntington disease and will develop the disease when she gets older. The client asks the nurse if this information is confidential and if it will remain that way. The nurse explains to the client that her family should be told and so should her fiancé. The client forcefully tells the nurse "no." She is not going to tell either her family or her fiancé. What is the nurse's best response? "I will respect your wishes and keep your information confidential. I do wish you would reconsider though." Explanation: The nurse must honor the client's wishes and should be sure the client is aware that this action will be done. Although the nurse may ask the client to consider the potential benefit this information may have for other family members, this reply is not the critical or best one. The other two replies should not be stated, because the nurse has to honor the wishes of the client. A pregnant woman asks the nurse about medications taken during pregnancy and if they cross the placental barrier. What response by the nurse is appropriate? "Some medications cross the placental barrier, so be sure to discuss medications with your provider." Explanation: Some medications cross the placental barrier, so the nurse will encourage the woman to talk more specifically with her provider. The nurse would be in error to state that all or none cross the placental barrier. Regardless of the route, some medications cross the barrier and are unsafe during pregnancy. The first trimester is the most dangerous time to take a medication that crosses the placental barrier. A client at a preconception screening appointment indicates to the nurse that she is a carrier of muscular dystrophy, an X-linked recessive trait. Her partner does not have the trait. Which statement made by the client indicates an understanding of the implications? "Each time I have a child, there is a 25% chance a female child will be a carrier." Explanation: X-linked recessive inheritance affects more males than females. There is no male-to-male transmission but any man who is affected with an X-linked recessive disorder will have carrier daughters. If a woman is a carrier, there is a 25% chance she will have an "affected son," a 25% chance that her daughter will be a "carrier," a 25% chance that she will have an "unaffected" son, and a 25% chance her daughter will be a "noncarrier." The nurse is working for an obstetrician. Which couple(s) may benefit from genetic counseling? Select all that apply. The father-to-be is 58 years old. The parents-to-be are cousins. The parents-to-be are of African heritage. The parents-to-be have a child who was born blind and deaf. Explanation: People who should receive genetic counseling prior to our during pregnancy: couple where the father is older than 50 years of age, if the couple have at least one common ancestor (consanguinity), couple with one or both parents with African heritage, and couple who have a biologic child who was born blind or deaf. A mother-to-be older than 35 years of age may also benefit from genetic counselingterm-8. The term that describes the percentage of individuals known to carry the gene for a trait and who actually manifest the condition is: penetrance. Explanation: Penetrance is the percentage of persons known to have a particular gene mutation and who actually show the trait. Pedigree is a first step in establishing the pattern of inheritance. A genotype consists of the genes and variations therein that a person inherits from his or her parents. Variable expression is the variation in the degree to which a trait is manifested. A client with symptoms of pregnancy is having an ultrasound is to determine the gestation of the pregnancy. The nurse explains that the visualization of different developmental milestones correlates with the gestation of the pregnancy. Place the following developmental milestones in order, from earliest to latest, as they appear during the first trimester. Use all options. Gestational sac Cardiac pulsation Spine formation Formation of limb buds Explanation: A gestational sac appears between 4 to 5 weeks' gestation. Cardiac pulsation begins at 6 weeks' gestation, the spine is visible at 7 weeks' gestation, and evidence of four limb buds is present at 8 weeks' gestation. At a prenatal checkup with a client at 7 weeks' gestation, the nurse would identify what as a normal finding? Fetal heart sounds are heard. Explanation: Although the heart is not fully developed, it begins to beat at week 5, and a regular rhythm and can be heard at week 7. Quickening is felt around week 13. Gender identity can be determined at weeks 9 to 12. The startle reflex can be seen around weeks 21 to 24. A recently married couple come to the prenatal clinic because they are concerned about genetic testing. The husband is of Jewish heritage. The nurse should recommend the couple undergo genetic testing to determine if the fetus has which disorder common among Ashkenazi Jews (Jews of Eastern European lineage)? Tay-Sachs disease Explanation: Tays-Sachs disease is a autosomal recessive disorder that occurs primarily in Ashkenazi Jews. A mother has come to the clinic with her 13-year-old daughter to find out why she has not started her menses. After a thorough examination and history, genetic testing is prescribed to rule out which abnormality? Turner syndrome Explanation: Turner syndrome is a common abnormality of the sex chromosome in which a portion or all of the X chromosome is missing. Only about one third of the cases are diagnosed as newborns; the remaining two thirds are diagnosed in early adolescence when they experience primary amenorrhea. No cure exists for this syndrome. Hormone replacement therapy may be used to induce puberty. A nurse overhears a colleague tell a client that based on the genetic testing results she should terminate the pregnancy. Which action is most appropriate for the nurse to take? Immediately stop the nurse. Explanation: The nurse should interrupt the nurse and remind him or her that it is important not to impose personal values onto the client. When educating parents on recessive genetic disease statistics, the nurse understands that which statement by the parents indicates an accurate understanding of genetic inheritance? "Each child will have a 25% chance of developing the disease." Explanation: The statistics of inheritance are reset with each pregnancy; therefore, each pregnancy has the same statistical probability of displaying the genetic disease. A nurse is caring for a couple during a prenatal clinic visit. Which assessment finding would lead the nurse to suggest genetic counseling for the couple? The mother just turned 39 years of age. Explanation: Genetic counseling is indicated for any woman older than 35 years of age and any man older than 55 years of age. This is directly related to the association between advanced parental age and the occurrence of Down syndrome. The mother's family history would be significant if there were indications of inherited diseases, congenital anomalies, or other such disorders. The father's age would not be a concern at 48 years old. The family may benefit from family counseling to assure the blended family is healthy, but genetic counseling cannot help with that issue. A pregnant client who is planning to have genetic testing asks the nurse when she should schedule her amniocentesis. What should the nurse tell the client? 16 weeks Explanation: The nurse should tell the client that an amniocentesis is typically scheduled between 15 and 18 weeks' gestation. A woman with both heart disease and osteoarthritis has come to the genetics clinic for genetic screening. What would the nurse know about these two diseases? They are multifactorial. Explanation: Genomic or multifactorial influences involve interactions among several genes (gene-gene interactions) and between genes and the environment (gene-environment interactions), as well as the individual's lifestyle. A couple has just been notified that their unborn child carries a genetic disorder. The couple expresses concern that the insurance company will not cover the costs associated with the medical bills for the child. What is the most appropriate response by the nurse? There are laws in place that prohibit that from happening." Explanation: The Genetic Information Nondiscrimination Act of 2008 prohibits insurance companies from denying coverage or charging higher premiums based solely on genetic predisposition. A couple wants to start a family. They are concerned that their child will be at risk for cystic fibrosis because they each have a cousin with cystic fibrosis. They are seeing a nurse practitioner for preconceptual counseling. What would the nurse practitioner tell them about cystic fibrosis? It is an autosomal recessive disorder. Explanation: Cystic fibrosis is autosomal recessive. Nurses also consider other issues when assessing the risk for genetic conditions in couples and families. For example, when obtaining a preconception or prenatal family history, the nurse asks if the prospective parents have common ancestors. This is important to know because people who are related have more genes in common than those who are unrelated, thus increasing their chance for having children with autosomal recessive inherited condition such as cystic fibrosis. Mitochondrial inheritance occurs with defects in energy conversion and affects the nervous system, kidney, muscle, and liver. X-linked inheritance, which has been inherited from a mutant allele of the mother, affects males. Autosomal dominant is an X-linked dominant genetic disease. During a clinical rotation at a prenatal clinic, a client asks a nurse what causes certain birth defects. The nurse replies that they can be caused by teratogens. What does the severity of the defects depend on? Select all that apply. when during development the conceptus is exposed to the teratogen the particular teratogen to which the fetus is exposed Explanation: A teratogen is a substance that causes birth defects. The severity of the defect depends on when during development the conceptus is exposed to the teratogen and the particular teratogenic agent to which the fetus is exposed. Reference: Which type of Mendelian inherited condition results in both genders being affected equally in a vertical pattern? autosomal dominant inheritance Explanation: An individual who has an autosomal dominant inherited condition carries a gene mutation for that condition on one chromosome of a pair. The pattern of inheritance in autosomal recessive inherited conditions is different from that of autosomal dominant inherited conditions in that it is more horizontal than vertical, with relatives of a single generation tending to have the condition. Chromosome X-linked conditions may be inherited in families in recessive or dominant patterns. In both patterns, the gene mutation is located on the X chromosome. All males inherit an X chromosome from their mother with no counterpart; hence, all males express the gene mutation. Neural tube defects, such as spina bifida and anencephaly, are examples of multifactorial genetic conditions. The CONTINUED......