Genetics And Genomics for Nursing, 1st Edition Carole A. Kenne – Test Bank

 

 

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Sample Test

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 client’s 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 client’s 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 client’s grandchild was diagnosed with Turner syndrome.

2.    The client’s child was adopted by the client’s sister and has Down syndrome.

3.    The client’s aunt developed Alzheimer disease at age 45.

4.    The client’s grandmother had breast cancer.

5.    The client’s mother died of heart disease at age 40.

Correct Answer: 2,5

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

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

Rationale 3: The client’s aunt is a second-degree relative.

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

Rationale 5: The client’s 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 client’s 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.    Niece’s child

4.    Daughter

5.    Sister

Correct Answer: 2,5

Rationale 1: The client shares about 25% of the grandmother’s gene pool.

Rationale 2: The client shares about 50% of the father’s gene pool.

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

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

Rationale 5: The client shares about 50% of this relative’s 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, “Don’t include anyone who is not a blood relative in your history. They aren’t family.” What unintended message is the nurse sending?

1.    Only people who are related by blood have an influence on a client’s genetics.

2.    People who are not related by blood have no influence on the client’s health.

3.    The client’s 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 client’s 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 don’t 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 don’t 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 family’s 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 family’s 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 family’s 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 family’s 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 nurse’s 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 child’s 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 nurse’s 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 client’s insurance to pay for additional services

2.    Educating the teachers at the child’s 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 client’s 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 nurse’s 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 nurse’s role in ensuring the consideration of the family when applying genetics to practice.

 

Question 14

Type: MCSA

What is the nurse’s 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 nurse’s 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 nurse’s role in ensuring the consideration of the family when applying genetics to practice.