Test Bank For Genetics and Genomics for Nursing 1st Edition By Carole A. Kenne

Description

WITH ANSWERS

 

Genetics and Genomics for Nursing, 1st Edition Carole A. Kenne tb

Kenner Genetics and Genomics for Nursing, 1/E
Chapter 1

Question 1

Type: MCSA

A client states, My wife has been reading about the human genome project. Do you think that may help with my cancer treatment? Which nursing response is most appropriate?

1. While that work is interesting, it isnt very far along.
2. In the future there may be some changes because of this project.
3. Some of the work of this project is changing the way we treat different diseases.
4. The results of the project are too broad to help individual clients.

Correct Answer: 3

Rationale 1: By 2003 the entire human genome had been sequenced.

Rationale 2: It is true that the human genome project will affect health care in the future, but this is not the best answer.

Rationale 3: The human genome project has already impacted the way health care is provided.

Rationale 4: One of the purposes of the human genome project is to provide personalized approaches to health promotion and disease treatment.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-1: Define genetics and genomics.

 

Question 2

Type: MCMA

The clinical nurse specialist educating staff about genetics and genomics would include which figures as central to the history of this specialty?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. James Watson
2. Joseph Lister
3. Gregory Mendel
4. Francis Collins
5. Francis Crick

Correct Answer: 1,3,4,5

Rationale 1: James Watson was half of the team that first described the structure of the DNA molecule

Rationale 2: Joseph Lister was instrumental in the support of medical asepsis.

Rationale 3: Gregory Mendel is known as the father of genetics for his scientific study of inheritance patterns in the mid-1800s.

Rationale 4: Dr. Francis Collins was a leader in the project to sequence the human genome.

Rationale 5: Francis Crick was half of the team that first described the structure of the DNA molecule.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-1: Define genetics and genomics.

 

Question 3

Type: MCSA

A client states, I dont know why it is that I get so sick when I get the flu but my friend never seems to catch it. What is the nurses best response?

1. You must have a weaker system than your friend.
2. Your friend probably takes better care of himself.
3. The way you respond to illness has a lot to do with genetics as well as your environment.
4. It has to do with genomics.

Correct Answer: 3

Rationale 1: Describing this client as having a weaker system is not an accurate portrayal of the situation.

Rationale 2: There is no evidence to support this statement.

Rationale 3: This statement gives the client correct information without being confrontational.

Rationale 4: This is a true statement, but not one that the client is likely to understand. The nurse should offer clearer explanation.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-1: Define genetic and genomics.

 

Question 4

Type: MCMA

Which statements, made by participants in a genetics seminar, should the nurse presenting the session be quick to correct?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. It doesnt matter what we do, our genes are going to determine our health.
2. Since all the people in my family and my wifes family have brown eyes, Im suspicious of why my daughters eyes are blue.
3. Our understanding of eugenics is much clearer today.
4. The fact that I have several family members with heart disease and cancer should make me more aware of risk factors.
5. Genes are dependable to express themselves consistently.

Correct Answer: 1,2,5

Rationale 1: Health and illness are dependent upon a wide range of factors, including genetics and environment.

Rationale 2: Genetics is not as clear cut as some believe. The recessive gene for blue eyes may be carried in both families.

Rationale 3: The concept of eugenics was once used to provide rationale for attempts to remove inferior genes and the people who carried them from the human gene pool.

Rationale 4: Familial tendency toward diseases does not mean a person will develop that disorder. Environment also plays a part and many environmental risk factors can be controlled.

Rationale 5: Genes may express themselves differently in different situations.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-1: Define genetics and genomics.

 

Question 5

Type: MCSA

A client who has hypertension says, I dont want to have to start on medication. It took my dad two years of suffering with side effects before they figured out which one was best for him to take. What is the nurses best response?

1. Genetic testing may help to identify the best medication to treat your hypertension.
2. Im sorry that you couldnt control your hypertension without medications.
3. The drugs are much better now and dont have many side effects.
4. Trial-and-error is the best way we have to determine the best medication for you.

Correct Answer: 1

Rationale 1: Genetic testing has been used to tailor drug therapy to the individual with hypertension.

Rationale 2: This is a kind statement, but does not provide any direction for the client.

Rationale 3: This is not a true statement about medications used for hypertension.

Rationale 4: This is not a true statement regarding antihypertensive medications. The idea of trial-and-error is not a concept that builds confidence in the client.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-2: Identify current trends in genetics and genomics.

 

Question 6

Type: MCMA

A clients history reveals that both his mother and his father have Type 2 diabetes. How should the nurse use this information in providing care to this client?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Begin to prepare the client for the eventuality of developing Type 2 diabetes.
2. Have the client schedule more frequent screenings of blood glucose levels.
3. Discuss the benefits of a diet based on lean meats and fresh vegetables.
4. Discuss the pharmacotherapy associated with Type 2 diabetes.
5. Explain signs and symptoms of Type 2 diabetes.

Correct Answer: 2,3,5

Rationale 1: While this client has strong risk factors for developing Type 2 diabetes it is not a sure thing.

Rationale 2: The client should be aware that his or her risk is higher and should monitor for development of Type 2 diabetes more closely than if this risk did not exist.

Rationale 3: Since this client has risk for development of Type 2 diabetes, the nurse should discuss dietary support.

Rationale 4: Discussing medication regimens at this point assumes that client will develop the disease. This is not assured.

Rationale 5: Since this client is at higher risk an explanation of signs and symptoms to monitor for is indicated.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-2: Identify current trends in genetics and genomics.

 

Question 7

Type: MCSA

1. The local community college
2. National Institutes of Health (NIH)
3. A private nurse practitioner/physician clinic
4. Funding for genetics and genomics research is limited at this time.

Correct Answer: 2

Rationale 1: Genetics and genomics research is expensive and is likely outside the realm of a community college.

Rationale 2: The NIH has several research priorities listed on their website and would be a good source of funding information.

Rationale 3: Genetics and genomics research is expensive and requires expensive equipment. A private clinic is not the best source of potential funding.

Rationale 4: Genetics and genomics research is robust and active. There is no indication that there is no funding for this endeavor.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts:

Learning Outcome: 1-2: Identify current trends in genetics and genomics.

 

Question 8

Type: MCSA

A client expresses interest in developing a plan to promote optimal health in her spouse, her children, and herself. What guidance should the nurse provide?

1. A good first step is to investigate your family medical histories.
2. It is going to be very hard to enforce the rules with your children.
3. Since your children are already teenagers you have almost waited too late.
4. Unless there is something in your family history of concern, I would not be too worried.

Correct Answer: 1

Rationale 1: The family history is a key component of understanding the role genetics plays in health.

Rationale 2: The nurse should not discourage the client from this goal.

Rationale 3: The nurse should support this mother in her goal, no matter the age of the children involved.

Rationale 4: The nurse should support this mother in her goal. Genetics is only one part of optimal health.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-2: Identify current trends in genetics and genomics.

 

Question 9

Type: MCSA

The health care organizations vice president in charge of nursing services is planning to educate nurses regarding genetic and genomic literacy. Which option best describes the nurses who should be included in this education?

1. Nurses who work in labor and delivery
2. All nurses throughout the organization
3. Nurses whose primary assignment is in the postpartum unit.
4. Nurses who work on oncology treatment units.

Correct Answer: 2

Rationale 1: This answer is not broad enough.

Rationale 2: All nurses, in every specialty and role, should be educated in genetic and genomic literacy.

Rationale 3: This answer is not broad enough.

Rationale 4: This answer is not broad enough.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-3: Discuss the relevance of genetics and genomics to nursing practice.

 

Question 10

Type: MCMA

The faculty of a baccalaureate school of nursing is rearranging the curriculum to include additional information regarding genetics and genomics. What are rationales for this action?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Accreditation decisions may be based on this inclusion.
2. Genetics and genomics literacy is considered a competency of professional nursing.
3. Many other components in nursing are no longer as important as genetics and genomics.
4. The future of nursing will include more information about genetics and genomics.
5. These competencies are not required until the nurse reaches the masters level of education.

Correct Answer: 1,2,4

Rationale 1: Accreditation for nursing programs will include standards that ensure that nurses are educated appropriately to be prepared to practice professional nursing in the genetic/genomic era of health care.

Rationale 2: Both the ANA and ISONG (International Society of Nurses in Genetics) have identified that genetics/genomics literacy is a core component of nursing.

Rationale 3: There is no indication that genetics and genomics are more important than other competencies of nursing. Genetics and genomics are important in their own right.

Rationale 4: The future of medical care in general will focus on genetics and genomics to a greater degree.

Rationale 5: Genetics and genomics are identified as a competency for baccalaureate education at the undergraduate level.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-3: Discuss the relevance of genetics and genomics to nursing practice.

 

Question 11

Type: MCSA

A nurses undergraduate education program did not include information about genetics and genomics. How can the nurse obtain this information?

1. A return to school for additional coursework
2. Current textbooks and websites on genetics and genomics
3. Discussion with other nurses on the unit
4. Wait for workplace-based seminars on the topic

Correct Answer: 2

Rationale 1: There are other avenues to obtain this information.

Rationale 2: Current textbooks and websites are excellent sources of information for this nurse.

Rationale 3: It is unlikely that many nurses currently in practice are sufficiently literate in genetics and genomics.

Rationale 4: It may be sometime before such seminars are commonplace. The nurse should approach the nurse educator about providing such information.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-3: Discuss the relevance of genetics and genomics to nursing practice.

 

Question 12

Type: MCSA

Which statement best illustrates the concept of genetic determinism?

1. I am determined not to let my family history of multiple sclerosis frighten me away from my personal goals.
2. I can eat what I want since there is no diabetes in my family.
3. Since my mother was diagnosed with breast cancer at age 50, I will do my self-breast exams every month.
4. I think my grandfathers death from lung cancer when I was a teenager has kept me from ever smoking cigarettes.

Correct Answer: 2

Rationale 1: This is not an example of genetic determinism.

Rationale 2: Genetic determinism is a two-way street. Some feel they are destined to develop an illness because it is prevalent in their family. Others may believe they cannot get an illness because no one in their family has it.

Rationale 3: This statement does not reveal genetic determinism, but rather a sensible approach to the knowledge that risk may be higher due to genetics.

Rationale 4: This is not genetic determinism, but does reflect a logical concern.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-3: Discuss the relevance of genetics and genomics to nursing practice.

Kenner Genetics and Genomics for Nursing, 1/E
Chapter 3

Question 1

Type: MCSA

The nurse is preparing to create a pedigree. How should the nurse instruct the client about filling out a standard family history form?

1. Complete this information form about your family.
2. Complete this form about your children and husband.
3. Complete this form about your family living at home.
4. Complete this form on as many of your blood relatives as you can.

Correct Answer: 4

Rationale 1: Family may have a different meaning for this client.

Rationale 2: The clients husband is not a blood relative and is not included in a pedigree.

Rationale 3: The nurse will need information about extended family to create a pedigree.

Rationale 4: The initial step of creating a pedigree is for the client to complete information on blood relatives. Once this information is analyzed, additional sources of information may be contacted.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-1: Define family context in relation to having a family member with present or possible genetic conditions.

 

Question 2

Type: MCMA

The nurse completing a clients family history would list which information as involving a first-degree relative?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The clients grandchild was diagnosed with Turner syndrome.
2. The clients child was adopted by the clients sister and has Down syndrome.
3. The clients aunt developed Alzheimer disease at age 45.
4. The clients grandmother had breast cancer.
5. The clients mother died of heart disease at age 40.

Correct Answer: 2,5

Rationale 1: A grandchild is a second-degree relative.

Rationale 2: The clients child is a first-degree relative despite being adopted by the sister.

Rationale 3: The clients aunt is a second-degree relative.

Rationale 4: The grandmother is a second-degree relative.

Rationale 5: The clients mother is a first-degree relative.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3-1: Define family context in relation to having a family member with present or possible genetic conditions.

 

Question 3

Type: MCMA

A clients family history reveals multiple cases of a particular disease. The presence of the disease in which relatives is most significant to the health of the client?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Grandmother
2. Father
3. Nieces child
4. Daughter
5. Sister

Correct Answer: 2,5

Rationale 1: The client shares about 25% of the grandmothers gene pool.

Rationale 2: The client shares about 50% of the fathers gene pool.

Rationale 3: A nieces child is a third-degree relative. The client shares about 10% of this relatives gene pool.

Rationale 4: The client has contributed to the daughters gene pool, not received genes from it.

Rationale 5: The client shares about 50% of this relatives gene pool.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3-1: Define family context in relation to having a family member with present or possible genetic conditions.

 

Question 4

Type: MCSA

While instructing a client on filling in a family history, the nurse says, Dont include anyone who is not a blood relative in your history. They arent family. What unintended message is the nurse sending?

1. Only people who are related by blood have an influence on a clients genetics.
2. People who are not related by blood have no influence on the clients health.
3. The clients nonblood relatives are not family.
4. Nonblood relatives are not important.

Correct Answer: 3

Rationale 1: This is the intended message.

Rationale 2: The nurse is specifically giving health history instruction, so this message is not communicated by the statement.

Rationale 3: The clients family likely consists of people who are related by blood (children, siblings, parents, grandparents) and people who are not (spouse, significant other, family-in-law, friends).

Rationale 4: The nurse is not suggesting these people are not important, only that they are not family.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-1: Define family context in relation to having a family member with present or possible genetic conditions.

 

Question 5

Type: MCSA

Newborn screening reveals that a baby is positive for the gene causing a genetic disorder. How should the nurse help the parents interpret this finding?

1. The finding is probably incorrect.
2. There are many good treatments for this disease today.
3. Screening only indicates that more specific testing should be done.
4. These things come back positive all the time, so dont worry.

Correct Answer: 3

Rationale 1: The nurse should not offer false reassurances.

Rationale 2: It is not inevitable that the child will develop the disorder.

Rationale 3: A screen is just a tool to discover who requires additional testing.

Rationale 4: It is not therapeutic to tell parents not to worry.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-1: Define family context in relation to having a family member with present or possible genetic conditions.

 

Question 6

Type: MCMA

A nurse who is new to maternal/child nursing says, I am shocked at how many of our clients do not allow newborn screening of their infants. How should the nurse manager reply?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Some cultural groups are fearful of what they see as government interference with their children and family.
2. I dont know why we even ask. We should just run the screens.
3. We all need to do a better job at educating our clients about the benefits of this screening.
4. Some cultural groups believe screening violates their religious principles.
5. Despite legislation, some families are afraid their health insurance carriers will be given the information.

Correct Answer: 1,3,4,5

Rationale 1: Some cultural groups do have fears about the government gathering personal information. This may be in response to historical events.

Rationale 2: Parents should be able to act as surrogate decision makers for their children.

Rationale 3: Education helps people understand the need for many interventions, including newborn screening.

Rationale 4: Some cultural groups do not believe in screening exams.

Rationale 5: Fear of being uninsurable or of premium cost inflation may lead some families to decline screening.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-1: Define family context in relation to having a family member with present or possible genetic conditions.

 

Question 7

Type: MCMA

Genetic testing has revealed that a family has a strong predisposition to a disease that occurs late in life. What ethical dilemmas does the nurse recognize as resulting from this information?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Should the children be screened for this disease?
2. Should the children be allowed to make their own decision about testing?
3. Should the testing be considered reliable?
4. Should other adult members of the family be informed?
5. Should testing be repeated?

Correct Answer: 1,2,4

Rationale 1: Testing children without symptoms is an ethical dilemma. What would be the benefit of the information? Is it fair for the children not to know?

Rationale 2: This is an ethical dilemma. Are children prepared to make a decision that will affect the remainder of their lives?

Rationale 3: The reliability of the test is a matter of science, not ethics.

Rationale 4: The ethical dilemma has to do with affecting the life of others. The other adults may not want to be informed.

Rationale 5: Repetition of testing is a matter of science, not ethics.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3-1: Define family context in relation to having a family member with present or possible genetic conditions.

 

Question 8

Type: MCMA

A family has been shown to carry genes for a rare condition. Researchers would like to use this familys test results as the basis for further study, but the family has serious reservations about participating. How should the researchers proceed?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Use the familys consent for the original testing as consent for the study.
2. Offer the family members understandable information about their role in this research.
3. Offer the family members financial reimbursement for being study participants.
4. Discuss how the findings of the research will be applied.
5. Accept that this familys reservations are probably insurmountable.

Correct Answer: 2,4

Rationale 1: Unless the original consent gave permission for further study, this is not ethical.

Rationale 2: Explaining the research and the family members role increases the likelihood that they will participate.

Rationale 3: If the family has serious reservations about participating, money is not likely to change their decision.

Rationale 4: Understanding the expected outcomes of the research may encourage the family members to change their minds.

Rationale 5: The researchers should not give up without more discussion with the family.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3-2: Describe why the practical application of genetics in a clinical setting must include the family.

 

Question 9

Type: MCSA

A child has been diagnosed with Fragile X syndrome. When the parents are given the diagnosis, which typical initial response does the nurse anticipate?

1. I want to be tested to see if I have it as well.
2. I knew something was not right.
3. I wish we had not had children.
4. What could we have done to prevent it?

Correct Answer: 2

Rationale 1: The first response usually focuses on the child.

Rationale 2: Parents often have recognized developmental delays before testing is done.

Rationale 3: The typical first response is not as drastic as wishing the child had not been born.

Rationale 4: This question is often asked later in the discussion as the parents begin to sort out information.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3-2: Describe why the practical application of genetics in a clinical setting must include the family.

 

Question 10

Type: MCMA

A client has been diagnosed with a devastating genetic illness. The family is in transition from well family to family with a member who is very ill. Which nursing diagnoses are likely to be applicable to this family?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Anticipatory grief
2. Deficient knowledge
3. Impaired verbal communication
4. Compromised family coping
5. Interrupted family processes

Correct Answer: 1,2,4,5

Rationale 1: Anticipatory grieving is grieving for events that have not yet occurred. Having a family member who is very ill presents the potential for many losses.

Rationale 2: This family is likely to have many needs for additional education.

Rationale 3: Impaired verbal communication refers to the inability to make speech and is not likely to be one of this familys nursing diagnoses.

Rationale 4: The ability of this family to cope will be tested during this time of transition.

Rationale 5: Family processes are the daily routines and interactions experienced by the family. These processes are very likely to be interrupted.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 3-3: Explain the nurses role in ensuring the consideration of the family when applying genetics to practice.

 

Question 11

Type: MCMA

The mother of a child with a severe genetic disorder experiences chronic sorrow. The nurse providing care for this family would be especially alert to manifestations of sorrow at which times?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. During clinic visits
2. The childs birthday
3. Holidays
4. Continuously
5. Events such as high school graduations or weddings

Correct Answer: 2,3,5

Rationale 1: Chronic sorrow may be alleviated by contact with a caring health professional.

Rationale 2: Milestone events such as birthdays may evoke feeling of sadness.

Rationale 3: Holidays are developmental experiences that may evoke sadness.

Rationale 4: Chronic sorrow is rarely continuous but rather manifests at intervals.

Rationale 5: Sorrow may be exacerbated by situations that signify normal growth and development in other children.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3-3: Explain the nurses role in ensuring the consideration of the family when applying genetics to practice.

 

Question 12

Type: MCMA

The nurse has identified lack of normalcy in a family with a child who has a mild but discernible genetic defect. Which nursing interventions should the nurse plan?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Advocating for the clients insurance to pay for additional services
2. Educating the teachers at the childs school about the disorder and treatments
3. Helping to coordinate care among the three clinics the child goes to each month
4. Alerting the family against involving the child in activities in which failure is possible
5. Encouraging the family to avoid public gatherings

Correct Answer: 1,2,3

Rationale 1: Advocating for the needs of the client helps to establish normalcy.

Rationale 2: Educating others, with the clients permission and involvement, will help them respond to the family with understanding rather than with speculation or fear.

Rationale 3: By coordinating the care provided by these clinics, the nurse can help ensure smoother, more normal appointments for the child.

Rationale 4: Failure is a normal part of the growth process. Overprotecting the child is not normal.

Rationale 5: Unless infection is a major concern, the child should be taken to public places just as a child who is healthy would.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3-3: Explain the nurses role in ensuring the consideration of the family when applying genetics to practice.

 

Question 13

Type: MCSA

The husband of a woman with early-onset Alzheimer disease asks the nurse about using a family health history website to create a pedigree. Which information should the nurse consider when formulating a reply?

1. Research has shown such websites to be a valuable tool for all ages.
2. Such websites are expensive and difficult to use.
3. Research has shown health promotion benefits in pediatric clients.
4. The biggest benefit of using this tool is the time saving for the nurse who will not have to ask family history questions.

Correct Answer: 3

Rationale 1: Research reports on the use of such websites have been limited to pediatrics.

Rationale 2: These websites are designed for public use.

Rationale 3: Research has shown that use of this tool promotes health in pediatric populations.

Rationale 4: The benefit to the nurse is not the primary reason to use this tool.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3-3: Explain the nurses role in ensuring the consideration of the family when applying genetics to practice.

 

Question 14

Type: MCSA

What is the nurses primary role on the interdisciplinary health care team treating clients with genetic disorders?

1. Ordering genetic testing
2. Analyzing genetic testing results
3. Assuring open and accurate communication among team members
4. Making certain financial resources are used appropriately

Correct Answer: 3

Rationale 1: In most cases, the nurse does not initiate orders for testing.

Rationale 2: Analyzing test results is generally a team responsibility.

Rationale 3: The nurse is often the coordinator of care and information on multidisciplinary teams.

Rationale 4: Financial matters are generally managed by social workers.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-3: Explain the nurses role in ensuring the consideration of the family when applying genetics to practice.

 

Question 15

Type: MCSA

The medical geneticist often describes treatment options and prognosis in medical terms when speaking to families. How should the nurse advocate for these families?

1. When the geneticist starts using medical terminology, interrupt with, Please describe this so the family can understand.
2. Write down what the geneticist says so the clients will have a copy.
3. Stay with the family after the geneticist leaves to interpret.
4. Prepare the family with a list of common medical terms used to explain the disorder.

Correct Answer: 3

Rationale 1: This discussion should take place in private, not in front of the family.

Rationale 2: The nurse does not need to act in the role of scribe.

Rationale 3: The family is likely to have many questions and possibly misunderstandings that can be clarified by the nurse.

Rationale 4: There is a simpler method of helping the family interpret what is said.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3-3: Explain the nurses role in ensuring the consideration of the family when applying genetics to practice.

Kenner Genetics and Genomics for Nursing, 1/E
Chapter 11

Question 1

Type: MCMA

Which statements regarding newborn screening programs would the nurse recognize as supporting the ethical principle of autonomy?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Mandatory newborn screening programs should be standardized across all states.
2. Parents should have the right to decide if their infant will undergo newborn screening.
3. Newborn screening identifies some treatable conditions and serves to improve the life of the child.
4. Newborn screening identifies some treatable conditions and serves to improve the health of the nation.
5. Ideally the parents would decide which newborn screens are performed.

Correct Answer: 2,5

Rationale 1: Making newborn screening mandatory removes the right of autonomy or the capacity for self-determination.

Rationale 2: Strictly speaking, for the concept of autonomy to be upheld, the newborn should be making this decision. Because newborns do not have this capacity, parents serve as their surrogates. The parents must be competent to fill this role.

Rationale 3: This statement is a reflection of the paternalistic view of medicine. This view is one of knowing what is best for another, what they would logically desire, and what they see as an improvement in their life. The clients autonomy is removed.

Rationale 4: This statement reflects beneficence or doing the most good for the most people.

Rationale 5: This statement reflects self-determination or autonomy. As the newborn lacks the capacity to make decisions, competent parents serve as surrogate decision makers.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-1: Discuss the history and controversies of screening large-scale populations.

 

Question 2

Type: MCMA

A state health department is planning to redesign its newborn screening program. The nurse charged with heading this initiative would identify which concerns about using the Wilson and Jungner Classic Screening Criteria to guide this work?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Interpretation of what is an important health problem is individual and therefore variable.
2. The acceptability of tests to the population is variable.
3. The issue of cost containment is not as important as it was when these criteria were developed.
4. Todays testing may have widespread implications.
5. Screening tests are developing very rapidly.

Correct Answer: 1,2,4,5

Rationale 1: The discovery of new genetic diseases and the development of the capacity to test for them have changed thinking on what are important health problems. Should we test for every possible problem? Who decides which problems are important?

Rationale 2: What is acceptable to one population may not be to another.

Rationale 3: Cost containment continues to be a major concern for all of health care.

Rationale 4: In 1968, when Wilson and Jungners criteria were established, screening was limited primarily to results that affected the infants health. Todays screening includes genetic testing that may have implications for other generations.

Rationale 5: Tests are developing rapidly, and time is needed to test their validity and reliability.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-1: Discuss the history and controversies of screening large-scale populations.

 

Question 3

Type: FIB

The nurse works in a state that follows the core conditions screening recommendations of the Secretarys Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC). The nurse would inform a newborns parents that their child will be screened for ________ conditions.

Standard Text:

Correct Answer: 30

Rationale : The SACHDNC recommends 30 core conditions in routine newborn screening.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-2: Describe the core conditions that are included in the newborn screen.

 

Question 4

Type: MCSA

A newborns screening tests indicate the presence of a hemoglobin disorder. Which assessment findings would the nurse expect in this newborn?

1. Normal assessment
2. Seizure
3. Listlessness and inability to maintain thermal control
4. Urine that smells like burnt sugar

Correct Answer: 1

Rationale 1: Children with a genetic hemoglobin disorder appear normal as newborns but begin to develop anemia in the first few months of life.

Rationale 2: Seizures would not be expected in an infant with a genetic hemoglobin disorder.

Rationale 3: Listlessness and inability to maintain thermal control are not expected findings in a client with a genetic hemoglobin disorder.

Rationale 4: This finding is associated with the amino acid disorder known as maple syrup urine disease.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-2: Describe the core conditions that are included in the newborn screen.

 

Question 5

Type: MCSA

The mother of a newborn states, I am surprised that my baby is only being tested for 30 genetic diseases. When my son was born in another state he was tested for several dozen. How should the nurse respond?

1. Each state controls how its newborn screening program works.
2. Some states are more advanced than this one.
3. Fewer tests are done now, but more diseases are included in those tests.
4. The federal government has decided that not as many tests are needed now.

Correct Answer: 1

Rationale 1: States are in control of their own newborn screening programs. The federal government makes recommendations only.

Rationale 2: A statement that implies the infant is receiving less than optimal care is not therapeutic.

Rationale 3: This is a false and misleading statement.

Rationale 4: States choose which tests are included in the newborn screen. The federal government makes recommendations only.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3: Discuss how newborn screening may differ between states.

 

Question 6

Type: MCSA

A public health nurse is addressing legislators on the topic of funding for newborn screening. Which topic should be this nurses priority?

1. Increasing the number of diseases on the states standard screen
2. Including screening for hearing loss in the states standard screen
3. Legislation mandating that screenings not paid for by insurance are paid for with state money
4. Ensuring that all parents are offered the opportunity to have their baby screened

Correct Answer: 4

Rationale 1: This may be an important goal but is not the priority.

Rationale 2: Hearing loss screening is already part of the screen in the majority of states. This is an important issue but is not the priority.

Rationale 3: This is not the priority.

Rationale 4: Every parent should have this opportunity and should be educated to make an informed choice.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-3: Discuss how newborn screening may differ between states.

 

Question 7

Type: MCSA

How would the nurse explain the process of newborn screening to new parents?

1. Your infant will be screened for 10 diseases in our lab and the rest of the samples will be sent to the state laboratory.
2. We will collect two urine samples from your child for this screening.
3. The screening will only require one blood sample.
4. The screening sample will be drawn at your babys six-week check-up.

Correct Answer: 3

Rationale 1: The sample is sent to the state laboratory for all testing.

Rationale 2: The screening is done with blood samples.

Rationale 3: A single blood sample is drawn for the screening.

Rationale 4: The newborn screening is done much earlier, generally at 2448 hours of age.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-4: Describe the role of the nurse and other health care professionals in the collection and interpretation of newborn screens.

 

Question 8

Type: MCMA

A couple took their newborn home from the hospital yesterday. The pediatricians office was notified this morning that the infants newborn screen was positive. What information should the nurse provide to the parents?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. You need to take your baby back to the hospital for examination.
2. We dont see many false positive screens, so we should take action quickly.
3. I would like to schedule an appointment so that we can talk with you about this screen.
4. We may want to schedule an appointment with a specialist.
5. A second screening may be indicated.

Correct Answer: 3,4,5

Rationale 1: It is not likely that the baby needs immediate hospitalization.

Rationale 2: False positive screens do occur. There is no need to alarm the parents.

Rationale 3: The primary care provider is responsible for initial counseling.

Rationale 4: The services of a genetic specialist or a specialist in the specific diseases of concern may be necessary.

Rationale 5: In some cases, the infant is screened a second time.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-4: Describe the role of the nurse and other health care professionals in the collection and interpretation of newborn screens.

 

Question 9

Type: MCSA

The parents refuse newborn screening for their infant, who was born this morning. What nursing action is indicated?

1. Draw a sample for screening in case they change their minds.
2. Discuss the purposes of the screen with the parents.
3. Obtain a court order for the screening.
4. Warn the parents that the pediatrician may refuse to care for the infant if screening is not performed.

Correct Answer: 2

Rationale 1: Drawing a sample without consent is not ethical.

Rationale 2: The nurse should attempt to offer additional education to these parents.

Rationale 3: If the parents refuse the screen, nothing else can be done.

Rationale 4: Threatening the parents and indicating care will be withdrawn is not ethical.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-5: Discuss ethical principles as they pertain to the newborn screen and other population-based screening programs.

 

Question 10

Type: MCSA

Members of an obstetrical practice group have decided to screen all pregnant women for drugs, alcohol, and nicotine. What is the most important aspect of planning for this screen?

1. Preparing a detailed informed consent form
2. Identifying which insurance carriers will pay for this testing
3. Publicizing the intention to do this screening
4. Securing the most accurate testing available

Correct Answer: 4

Rationale 1: Informed consent is very important but is not the highest priority.

Rationale 2: Payment is an issue but is not the priority.

Rationale 3: The group may want to publicize this plan so that women who do not wish to be screened will seek prenatal care elsewhere. This is not the priority action.

Rationale 4: False positive results from this testing could be devastating to the mother and her relationships with other family members. Accuracy is the priority.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-5: Discuss ethical principles as they pertain to the newborn screen and other population-based screening programs.

 

Question 11

Type: MCSA

A nurse researcher has proposed a study that would require the analysis of thousands of newborn screening samples. Which ethical principle is this study most likely to violate?

1. Beneficence
2. Autonomy
3. Fidelity
4. Nonmaleficence

Correct Answer: 2

Rationale 1: Beneficence is defined as doing the most good for the most people. This study may have results that benefit the population.

Rationale 2: Unless the researcher obtains informed consent from each person (or the parents), the ethical principle of autonomy may be violated.

Rationale 3: Fidelity prioritizes the clients interest first, above all others. In this case, the researcher is prioritizing the results of testing, not the clients interests.

Rationale 4: Nonmaleficence is defined as doing no harm. No physical harm is likely to result from this study, and because thousands of samples are being used, psychological harm is unlikely as well.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-6: Identify the proposed benefits and risks associated with the retention, storage, and use of newborn screening blood samples.

 

Question 12

Type: MCMA

A research study is conducted using newborn screening samples analyzed and stored over two years at a state health department. Study results are inconsistent and erratic. What are the likely reasons for this variability?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Differences in the way samples were originally collected
2. Degradation of the samples over time
3. Contamination from the original analysis
4. Inexperience using newborn screening samples
5. High numbers of conditions screened in these samples

Correct Answer: 2,3

Rationale 1: The samples are all used for the same newborn screen and would have been collected using the same methodology.

Rationale 2: Depending on storage methods, the samples may have degraded significantly in a two-year period.

Rationale 3: As the samples have alre

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