Deck 6: Genetic Concepts for Medical-Surgical Nursing

Question 1

After genetic testing,a client is found to have a specific mutation in the a1AT gene (alpha₁-antitrypsin).What is the best action for the nurse to take to guide the client?

A) Advise scheduling an annual mammogram and ovarian ultrasound.
B) Assess whether close family members have other identified genetic problems.
C) Suggest limiting exposure to secondhand smoke and other respiratory irritants.
D) Advise that cancer may be a risk but not a certainty for this mutation.

Answer 1

Suggest limiting exposure to secondhand smoke and other respiratory irritants.

Question 2

The client,who has been found to have a mutation in the BRCA1 gene allele and to be at increased risk for breast and ovarian cancer,has asked the nurse to be present when she discloses this information to her adult daughter.What is the nurse's role in this situation?

A) To act as the primary health care provider
B) To function as a genetic counselor
C) To serve as a client advocate
D) To provide client support

Answer 2

To provide client support

Question 3

The nurse has been working with a client who has asked to receive the results of genetic testing.What will the nurse do before discussing the results with the client?

A) Obtain a signed and witnessed informed consent form and place it on the client's chart.
B) Assess the client's ability to communicate clearly with the nurse and other personnel.
C) Reassure the client that it is not necessary to inform other family members of the test results.
D) Encourage the client to agree to undergo several sessions of further counseling.

Answer 3

Assess the client's ability to communicate clearly with the nurse and other personnel.

Question 4

Which disorder presents a need for predisposition genetic testing?

A) Huntington disease
B) Sickle cell disease
C) Hemophilia
D) Breast cancer

Question 5

Which statement by the nurse indicates correct understanding of the purpose of a pedigree?

A) "It is used for genetic counseling of the client by the geneticist."
B) "It is used to show family history of a trait over at least three generations."
C) "It is used to show a specific pattern of inheritance of a trait."
D) "It is used to identify penetrance of a gene in a family."

Question 6

The client exhibits a trait that has appeared in every generation of his or her family.This is an example of which type of inheritance?

A) Autosomal recessive
B) Sex-linked recessive
C) Autosomal dominant
D) Sex-linked dominant

Question 7

The client,whose mother has Huntington disease,is considering genetic testing but is not sure whether she really wants to know the results.She asks what the nurse would do in her situation.What is the nurse's best response?

A) "I would have the test so I could decide whether to have children or to adopt children."
B) "I can only tell you the benefits and the risks of testing. You must make this decision yourself."
C) "Because there is no cure for this disease and testing would not be beneficial, I would not have the test."
D) "You need to check with your brothers and sisters to determine whether testing for this disease would be appropriate for you."

Question 8

Which client needs to undergo carrier genetic testing?

A) A middle-aged man whose father died at age 48 of colorectal cancer
B) A young woman who has all the symptoms of rheumatoid arthritis
C) A middle-aged woman whose mother died at age 52 of breast cancer
D) A young woman of Eastern European Jewish ancestry

Question 9

A client's father has hemochromatosis.Which type of genetic testing would be the primary type that is most appropriate for the client to have?

A) Presymptomatic
B) Predisposition
C) Diagnostic
D) Carrier

Question 10

The client has a family history of breast cancer.The physician has recommended that she undergo genetic testing.What action is most important for the nurse to take before scheduling the client for the procedure?

A) Making certain the client is prepared for the risk of psychological side effects
B) Obtaining informed consent from the client and placing it on the chart
C) Simultaneously scheduling genetic counseling with an advanced practice nurse
D) Carefully explaining the procedure to the client and assuring her confidentiality

Question 11

Which disorder qualifies a client for presymptomatic diagnostic genetic testing?

A) Colorectal cancer
B) Huntington disease
C) Hemophilia
D) Tay Sachs disease

Question 12

The client has just completed genetic testing and received a negative result.The client tells the nurse that he feels guilty because so many of his family members are carriers of a genetic disease but he is not.What is the nurse's best response?

A) Make certain that the client recognizes that although he is not a carrier of the disease, he could still be symptomatic.
B) Encourage the client to undergo a second round of testing to verify that the result was accurate.
C) Arrange for the client to undergo counseling and offer support to him during this time.
D) Emphasize to the client the importance of revealing his test results to other family members.

Question 13

The client undergoes genetic testing but chooses not to be told the results of the testing once it is completed.Which action is most important for the nurse to implement?

A) Encourage the client to ask for the results of the genetic testing.
B) Share the results of the testing with the client's family members.
C) Explain to the client how this choice may affect other family members.
D) Respect the client's right to not know the results of the testing.

Question 14

The client has been found to have a genetic mutation that increases the risk for colon cancer.The client does not want any family to know about this result.What is the nurse's best response?

A) "It is required by law that you inform your siblings and your children about this result so that they also can be tested and monitored for colon cancer."
B) "It is not necessary to tell your siblings because they are adults, but you should tell your children so that they can be tested before they decide to have children of their own."
C) "It is not required that you tell anyone about this result. However, because your siblings and children may also be at risk for colon cancer, you should think about how this information might help them."
D) "It is your decision to determine with whom, if anyone, you discuss this test result. However, if you do not tell any of your family members and they get colon cancer, you could be held liable."

Question 15

The client has just completed the first session of genetic counseling.Which intervention will the nurse perform next?

A) Assessing the phase of the grieving process most applicable to the client at this time
B) Asking the client to explain the various terms used in the discussion
C) Determining whether the client has adequate coping methods to deal with the counseling process
D) Asking the client to explain expectations and how they may have changed after the session

Question 16

Which response is accurate regarding a client who has type O blood? The client has:

A) A genotype of AO
B) A genotype of OO
C) Heterozygous alleles
D) A different genotype and phenotype

Question 17

A client is not certain whether she and her family should participate in a genetic screening plan.She asks the nurse why the X-linked recessive disorder that has been noted in some of her family members is expressed in males more frequently than in females.What is the nurse's best response?

A) "The disease tends to show up in males because they don't have a second X chromosome to balance expression of the gene."
B) "One X chromosome of a pair is always inactive in females. This inactivity effectively negates the effects of the gene."
C) "Females are known to have more effective DNA repair mechanisms than males, thus negating the damage caused by the recessive gene."
D) "Expression of genes from the male's Y chromosome does not occur in females, so they are essentially immune to the effects of the gene."

Question 18

Which client response best indicates that the client has concerns about a genetic link to a specific condition?

A) "Heart disease in women seems to be a growing concern in the United States."
B) "Obesity is prevalent in the elementary school age population."
C) "My grandmother died of both breast and bone cancer at age 50."
D) "Both my aunt and my second cousin have osteoarthritis."

Question 19

Which statement regarding genotype and phenotype is accurate?

A) For autosomal recessive traits, the phenotype is the same as the genotype.
B) The only trait in which phenotype always follows genotype is physiologic gender.
C) When a phenotype is fully penetrant, the trait is expressed in the heterozygous person.
D) Genotype changes as a person ages, whereas phenotype is not affected by the aging process.

Question 20

Which statement best describes the concept of multifactorial inheritance?

A) A mutation in a single gene results in the expression of problems in a variety of tissues and organs.
B) Susceptibility to a problem is inherited as a single gene trait, but development of the problem is enhanced by environmental conditions.
C) A mutated gene is inherited, but the results of expression of that gene are not evident until middle or late adulthood.
D) Several genes are responsible for the mechanism of hearing, and a mutation in any one of them results in hearing impairment.

Question 21

The client has just been typed and crossmatched for a unit of blood.Which statements by the nurse indicate a need for further genetic education?

A) "The client can receive any unit of blood because all blood types are basically the same."
B) "Blood type is formed from three possible gene alleles: A, B, and O."
C) "Each blood type allele is inherited from the mother or the father."
D) "If the client's blood type is AB, then the client is homozygous for that trait."
E) "If the client has a dominant and a recessive blood type allele, only the dominant will be expressed."

Question 22

A client recently underwent genetic testing that revealed that she has a BRCA1 gene mutation for breast cancer.What are the best actions of the nurse?

A) Encourage genetic counseling for self and family.
B) Disclose the information to the medical insurance company.
C) Recommend self-breast examination every week.
D) Assess the client's response to the test results.
E) Aid in making a plan for prevention and risk reduction.

Question 23

What client diagnosis indicates a need for carrier genetic testing?

A) Colorectal cancer
B) Huntington disease
C) Sickle cell disease
D) Hemophilia
E) Breast cancer
F) Cystic fibrosis
G) Tay Sachs disease

Question 24

In the hospital,the nurse is caring for a client of Asian descent who was just started on warfarin (Coumadin).What would be the best plan of care for the client?

A) Start warfarin at a high dose to decrease the chance for further clotting problems.
B) Monitor international normalized ratio (INR) once a day in the hospital.
C) Teach the client to frequently check for any bruising.
D) Initiate fall precautions and strict activity limitations.
E) Start warfarin at a lower-than-normal dose owing to slower metabolism of the drug.