Deck 8: Genetic Implications of Adult Health Nursing

Question 1

A nurse is planning to teach the parents of a child with cystic fibrosis about the disorder. Which statement should the nurse include in this explanation?

A) "While all people carry the gene CFTR, which is responsible for cystic fibrosis, those who develop the disease have a mutation in that gene."
B) "A small percentage of the general population carries the gene for cystic fibrosis. If two carriers have children, then 25% of those children will develop the disease."
C) "One in four people carry the gene for cystic fibrosis. If two carriers have children, then 25% of those children will develop the disease."
D) "Some people carry the gene for cystic fibrosis. Of those carriers, one in four will develop the disease."

Answer 1

"While all people carry the gene CFTR, which is responsible for cystic fibrosis, those who develop the disease have a mutation in that gene."

Question 2

A patient has been told that her unborn child will most likely have Down syndrome. The nurse realizes this diagnosis is consistent with which genetic finding?

A) trisomy
B) monosomy
C) translocation
D) deletions

Answer 2

trisomy

Question 3

A patient planning to have genetic testing prior to having children tells the nurse that she is fearful that too many people will learn about the test. How should the nurse respond to this patient?

A) "The results of the tests are confidential and no one can have the results without your permission."
B) "Most insurance companies will want the results before paying for the tests."
C) "The results will be available to anyone who reviews your medical record."
D) "The doctor will most likely use the results when planning care and treatment for other patients with the same genetic disorder."

Answer 3

"The results of the tests are confidential and no one can have the results without your permission."

Question 4

A patient planning to be married tells the nurse that she has a strong family history of Huntington chorea but does not plan to let her fiancé know. How should the nurse respond to this patient?

A) "Is there any reason why you do not want your fiancé to know about the genetic illness?"
B) "It is probably best that he is not aware of the disease."
C) "Are you afraid that he will not want to marry you if he knows?"
D) "There are worse disease processes than Huntington chorea."

Question 5

A patient is having difficulty achieving adequate anticoagulation with prescribed doses of warfarin. The nurse realizes that what might be indicated for this patient?

A) genetic testing to determine if the patient metabolizes warfarin slower
B) use of a different anticoagulant
C) review of the patient's diet
D) analysis of the patient's lifestyle

Question 6

A patient tells the nurse that she does not want to pass on a disease that is genetic in origin to any future children. How should the nurse respond to this patient?

A) "A complete genetic study could help guide you in your decision making."
B) "I suppose, then, that you are not going to have any children."
C) "Adoption is always a possibility."
D) "Are you sure that the disease is genetic in origin?"

Question 7

While assessing a patient, the nurse notes an irregularity that has been observed in other patients, but on an inconsistent basis. What did the nurse most likely discover in this patient?

A) a polymorphism
B) a mutation
C) a single-gene inheritance pattern
D) an X-linked inheritance pattern

Question 8

From genetic testing, a patient learns that a specific medication can help a developing disease process. What does the nurse understand that genetic testing provided for the patient?

A) biological marker
B) phenotype
C) genotype
D) translocation

Question 9

A patient learning that her newborn baby has a genetic disorder tells the nurse that it was because a stranger gave her baby the "evil eye." What should this information suggest to the nurse?

A) The patient's culture supports the notion that a stranger looking at the baby caused the disorder.
B) The patient needs psychiatric counseling.
C) The patient is not going to be a good mother since she permits strangers around the baby.
D) Healthcare dollars should not be spent trying to change this patient's opinion of why the baby has a genetic disorder.

Question 10

A patient tells the nurse that her mother has type 2 diabetes and heart problems. The nurse realizes that this information:

A) means that the patient will probably not change her health habits.
B) can help predict the patient's future health problems.
C) helps predict the future health of the patient's children.
D) means that the patient keeps in touch with her parents.

Question 11

At the completion of a genetic assessment, the nurse learns that a patient has three family members diagnosed with rectal cancer before the age of 40 years. What should the nurse discuss with the patient?

A) importance of having screening for colorectal cancer at an earlier age
B) importance of ingesting a diet high in protein and carbohydrates
C) ways to maximize time spent in exercise
D) reasons why having children would not be recommended for this patient

Question 12

A patient has a strong family history of nonpolyposis colorectal cancer. What is the best advice the nurse can give to the patient?

A) Have predispositional genetic testing done to detect the presence of the genetic disorder even though the patient may never develop cancer.
B) Teach the patient the symptoms of colon cancer and suggest a high-fiber diet to prevent cancer.
C) Have regular colonoscopies; if one is abnormal, then predispositional genetic testing is indicated.
D) Have predispositional genetic testing done to detect the presence of colorectal cancer so that treatment can be initiated as early as possible.

Question 13

Through genetic testing, a patient learns that he has an apolipoprotein E2 gene. What should this information suggest to the nurse?

A) The patient is at reduced risk for developing Alzheimer disease.
B) The patient is at increased risk for developing Alzheimer disease.
C) The patient is at risk for contracting malaria.
D) The patient is at risk for developing colorectal cancer.

Question 14

Through testing, a patient learns of a genetic disease that he has inherited from his parents, yet none of his other siblings have inherited the same disease. The patient tells the nurse that he has always believed his parents "didn't want him" and now he has proof. What should the nurse counsel this patient?

A) Suggest the patient talk with a counselor to discuss the results of the test and future options.
B) Ask the patient if he has ever discussed his thoughts and fears with his parents.
C) Encourage the patient to talk with his siblings about the illness and ask them for help now before he has manifestations of the disease.
D) Remind the patient that genetic testing is inconclusive, and there is a great chance that the results are wrong.

Question 15

A female patient tells the nurse that she is genetically predisposed to type 2 diabetes. What is the most important information that the nurse should provide?

A) the importance of maintaining a healthy weight and activity level
B) the need to avoid carbohydrate intake
C) the need to begin monitoring daily blood glucose levels
D) the need to address active health problems and not those that have yet to manifest

Question 16

At the completion of genetic testing it has been determined that a patient's baby will have Down syndrome. What should the nurse say to the patient after learning this information?

A) "I realize that this news is difficult for you. Is there anything that I can do to help you at this time?"
B) "It's not too late to consider ending the pregnancy."
C) "You are young enough to be able to handle the baby's challenges."
D) "It does not matter if the baby has problems; all life is precious."

Question 17

A patient tells the nurse that many of her family members have a type of anemia that is genetic. What should the nurse realize will occur in this patient?

A) The patient will develop the disease only if there is a mutation in the gene.
B) The patient will develop the same type of anemia.
C) The patient will die from the anemia.
D) The patient will develop the disease only if the gene translocates.

Question 18

A patient expresses concern about transmitting genetic illnesses to any future children. What can the nurse do to help the patient determine which diseases might be transmitted?

A) Complete a pedigree.
B) Conduct a health promotion assessment.
C) Schedule for a complete genetic analysis.
D) Refer to a geneticist for diagnosis.

Question 19

The nurse is developing a teaching plan for parents who need genetic counseling. Which statement by a parent indicates the need for further education?

A) "All the chromosomes are the same size in males and females alike."
B) "Half of the sets of chromosomes come from the mother and the other half comes from the father."
C) "The 23rd pair of chromosomes will determine if our child will be male or female."
D) "One Y chromosome and one X sex chromosome will produce a male child."

Question 20

At the conclusion of genetic testing, a patient learns that he has a predisposition for developing cardiovascular disease at a young age. What should the nurse instruct the patient regarding this information?

A) "This information can help guide you to make lifestyle changes to reduce the chance of developing cardiovascular disease."
B) "At least you know now that you will need cardiac bypass surgery."
C) "Since you will most likely develop the disease early in life, enjoy your life as much as possible now."
D) "I would not place too much emphasis on these test results because most of the time they are inconclusive."

Question 21

A baby is born with a genetic disorder, and neither parent has a history of this disorder. What should the nurse use to explain the baby's genetic disorder?

A) de novo
B) penetrance
C) an X-linked dominant condition
D) multifactorial conditions

Question 22

The nurse is reviewing the process of mitosis and meiosis with a patient receiving care in a fertility clinic. Which patient statements are examples of scenarios that involve mitotic cell division?

A) "Sperm cells use mitosis to divide."
B) "The patient has a healing wound on the coccyx."
C) "The patient has acute bronchitis."
D) "A fetus grows using mitosis."
E) "The patient has acute gastritis."

Question 23

A newborn has just been diagnosed with a negative result from genetic testing. What should the nurse realize this finding means?

A) No further follow-up is needed.
B) There is no clinical explanation for the symptoms that are seen.
C) The baby is likely a carrier of a genetic abnormality.
D) The baby will develop symptoms of a genetic abnormality later in life.

Question 24

While reviewing a male patient's history in the chart provided, the nurse becomes concerned. The patient states, "I haven't been to see a physician in years, and it's time for me to get a thorough check-up." Based on the nurse's understanding of genetically related diseases, which diagnostic screening examination may be ordered for this patient? $$\begin{array} { | l | l | } \hline \text { Disease or condition } & \text { Patient's history } \\\hline \text { Cerebrovascular Accident } & \begin{array} { l } \text { The patient's mother had a cerebrovascular } \\\text { accident at the age of } 45 .\end{array} \\\hline \text { Breast cancer } & \begin{array} { l } \text { The patient's mother was diagnosed with } \\\text { breast cancer at the age of } 55 .\end{array} \\\hline \text { Colon cancer } & \begin{array} { l } \text { The patient' sister was diagnosed with } \\\text { colon cancer the age of } 62 .\end{array} \\\hline \text { Heart disease } & \begin{array} { l } \text { The patient's father was diagnosed with } \\\text { coronary artery disease at the age of } 42 .\end{array} \\\hline \text { Prostate cancer } & \begin{array} { l } \text { The patient's uncle was diagnosed with } \\\text { prostate cancer at the age of } 87 .\end{array} \\\hline\end{array}$$

A) a mammogram
B) a prostate exam
C) a colonoscopy
D) a cardiovascular assessment

Question 25

A male patient has a history of a genetic disorder and is concerned that this same disorder will be passed to his children. What information should the nurse provide to this patient?

A) All genetic disorders are passed to future children.
B) If the genetic disorder is a disorder of metabolism, it will most likely not be passed to any children.
C) The best possible plan for this problem is to avoid children.
D) The children will inherit the disorder only if the disorder is on chromosomes 13, 18, and 21.

Question 26

The nurse working in a geneticist's office is reviewing information about human cells with a patient. Which patient statements indicate that an adequate amount of learning has occurred?

A) "Every human cell has 23 pairs of chromosomes and a total of 46 chromosomes."
B) "Chromosome 1 will be the smallest while chromosome 46 will be the largest."
C) "Each human cell contains mitochondria."
D) "The 22nd pair of chromosomes determines the person's gender."
E) "Every human cell functions in the same way regardless of its location."

Question 27

A baby with Down syndrome has been born to a mother who refuses to allow any family members to visit her or the newborn. What should the nurse realize this patient is demonstrating?

A) postpartum depression
B) denial
C) anxiety and guilt
D) poor bonding

Question 28

A patient who is pregnant reports a family history of cystic fibrosis and asks about the risks for transmission to her child. What concepts should the nurse include in the discussion?

A) There is less risk for transmission to male children.
B) The condition does not skip generations.
C) Male and female children are equally affected.
D) Both parents must be affected with this disorder for transmission to occur.

Question 29

A patient scheduled for a genetic evaluation has

A) The geneticist examines the patient.
B) The patient is scheduled for diagnostic tests.
C) The patient constructs a 3-generation pedigree.
D) The geneticist discusses the findings with the patient and makes recommendations.
E) The genetic clinical nurse interviews the patient.
F) non of the above.

Question 30

A 29-year-old patient whose mother died from an unspecified cancer at the age of 33 has the following diagnostic test results. What would be appropriate for this patient? $$\begin{array} { | l | l | } \hline \text { Diagnostic Test } & \text { Results } \\\hline \text { MLH1/ MHL2 gene testing } & \text { Genetic mutation noted } \\\hline\end{array}$$

A) The patient is scheduled for a prostate exam.
B) The patient is scheduled for a colonoscopy.
C) The patient is scheduled for a mammogram.
D) The patient is scheduled for an ovarian cancer screening examination.

Question 31

A patient and her future husband completed genetic testing through a laboratory that they found on the Internet. The patient is upset because the results determined that they are at risk for having children with congenital abnormalities. Which is an appropriate nursing response?

A) "A screening test should be confirmed with a diagnostic test."
B) "The decision about whether or not to have children has been made for you."
C) "Are you concerned that your future husband won't want to get married now?"
D) "I wouldn't worry about those results."

Question 32

A patient tells the nurse that her teenaged son, who has a congenital abnormality, is demonstrating increasing anger and animosity toward her and her husband. The nurse realizes that the son might be

A) behaving as a normal teenager.
B) confused and unaware of how to express it.
C) fostering resentment toward his parents.
D) demonstrating disease from the congenital abnormality.

Question 33

A patient tells the nurse that her husband has chronic myelogenous leukemia, and she is concerned that their children will inherit that genetic disorder. How should the nurse respond to this patient?

A) "The genetic makeup that created the chronic myelogenous leukemia in your husband is not inheritable."
B) "I would be concerned, too."
C) "Maybe you should re-think having children."
D) "It could cause the same disorder, but it's a decision that you will have to make."

Question 34

Upon the completion of genetic testing, a patient is happy to learn that she has a negative test result. The nurse then explains to the patient that

A) she will never experience a genetically-caused disease.
B) any children she has will be free from genetic diseases.
C) her children might develop disease from genetic misplacement of chromosomes.
D) this is no guarantee that she will not develop the disease.

Question 35

At the conclusion of a genetic counseling session, a family member says to the nurse, "There's got to be something that you aren't telling us." The nurse realizes that this individual is

A) feeling guilty because of the outcome of the testing.
B) demonstrating signs of a congenital abnormality.
C) angry with the findings from the testing.
D) confused by the nondirective approach taken by the genetic healthcare providers.

Question 36

A patient is upset to hear the nurse say that the results of genetic testing revealed wild-type genes. The nurse should explains that this type of gene is

A) normal.
B) abnormal with limitations.
C) defective.
D) unexpected.

Question 37

A baby is born with a genetic disorder that did not affect either of the parents. What should the nurse realize about this baby's disorder?

A) The mother is the carrier of the disorder.
B) The father is the carrier of the disorder.
C) The father is not the biological father of the baby.
D) Both parents are carriers of the disorder.

Question 38

The physician has ordered chromosomal analysis for a newborn baby. Which test does the nurse realize will most likely be performed with this baby?

A) karyotype
B) newborn screen
C) carrier testing
D) preimplantation genetic diagnosis

Question 39

A 42-year-old pregnant patient asks the nurse if the baby will be born with Down syndrome because of a chromosomal abnormality. What chromosomal abnormality does the nurse know this to be?

A) 23 pairs of chromosomes
B) 26 pairs of chromosomes
C) One member of a chromosome pair missing
D) One extra member of a chromosome pair

Question 40

Four hundred twenty-two people are involved in a research study regarding warfarin use. Twenty-three are African American, fourteen are Asian, and the rest are Caucasian. Based on previous research, calculate how many of the Caucasian patients may metabolize warfarin at a slower rate due to a polymorphism on the cytochrome P450 CYP2C9 gene. _______

Question 41

The parents learn that their newborn has the CFTR gene located on chromosome 7. During counseling, what should the parents be told about the ways that this genetic alteration may be expressed as the child grows?

A) The child develops normally without any clinical manifestations associated with cystic fibrosis.
B) The patient is placed on a lung transplant list.
C) The patient receives bilateral mastectomies.
D) The patient is counseled about the increased risk of developing Alzheimer disease.
E) The child exhibits some mild signs and symptoms associated with cystic fibrosis.

Question 42

The nurse is preparing information for a group of parents as part of genetic counseling. What basic principles of inheritance should the nurse include in this presentation?

A) All genes are paired.
B) Only one gene is passed on to offspring.
C) The mother's genes are transmitted to offspring.
D) The father's genes are used to fill in genetic deficits in offspring.
E) One copy of a gene comes from the mother and the other copy from the father.

Question 43

The nurse is concerned that a patient pregnant with a fetus with a genetic disorder is experiencing moral and ethical problems. What should the nurse offer to support the patient at this time?

A) The patient's use of coping mechanisms
B) Actions to take to reduce stress and anxiety
C) Reasons for terminating the pregnancy at this time
D) Assistance with thinking through the process to increase optimism
E) Ask if the patient has any particular spiritual advisor that can be contacted

Question 44

During a visit to a geneticist's practice a patient with blue eyes asks the nurse to explain eye color, adding that his mother had blue eyes and his father had brown eyes. What should the nurse include in this explanation?

A) "You have two identical alleles that are responsible for your eye color."
B) "The alleles that are responsible for your eye color are heterozygous."
C) "Your eye color is the result of an expressed gene."
D) "Alleles are forms of a gene."
E) "Your eye color is just one part of your phenotype."

Question 45

A fetus is found to have an autosomal recessive condition. After genetic testing is completed, both of the fetus' parents are found to have this same autosomal recessive genetic alteration. Which statements made by a parent indicate that further education is required?

A) "This condition is related to a genetic alteration of the X chromosome."
B) "This condition is a Mendelian condition."
C) "So, we are carriers of this condition because we don't have any signs of symptoms of this condition."
D) "Our baby would have a better chance of living if we would have both been positive for an autosomal dominant condition."
E) "The problem is the result of an alteration of just one single gene."

Question 46

The nurse manager determines that a new staff nurse is capable of caring for patients with genetic disorders. What information did the manager use to make this decision?

A) The nurse evaluates care provided to patients.
B) The nurse identifies patients' needs for referrals.
C) The nurse advocates for pregnancy terminations.
D) The nurse performs physical assessments accurately and thoroughly
E) The nurse consistently completes a genetic-focused family history with patients.

Question 47

A married couple has two children at home who have been diagnosed with the same autosomal dominant condition. The nurse is interviewing the couple after they become pregnant with their third child. Based on the nurse's understanding of related psychosocial issues, which statements by the mother may be expected?

A) "I feel so guilty."
B) "I feel like my daughter is angry with me because I am the one who has this bad gene in my body."
C) "I am depressed and angry with myself."
D) "My son has been smoking marijuana and skipping school."
E) "I hope the new baby is a boy so he won't have the same illness."

Question 48

A patient pregnant with her first child is in need of genetic testing. The health plan will cover the testing to an extent. What should the nurse encourage the patient to consider before making a decision about the testing?

A) Extended family members may resent the patient.
B) There might not be treatment available for the genetic disorder.
C) The patient may terminate the pregnancy before family is informed.
D) The patient must determine whether she is prepared for lifestyle alterations based upon the results.
E) The insurance company will have information about the genetic testing.

Question 49

At the conclusion of a health history and physical assessment, the nurse determines that a patient might benefit from genetic testing. What did the nurse assess to come to this conclusion?

A) Infertility
B) Seizure disorder
C) Menopause at age 32
D) Neighbor committed suicide
E) Cousin addicted to heroin