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

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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 isn’t 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 don’t 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 nurse’s 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 doesn’t matter what we do, our genes are going to determine our health.”
  2. “Since all the people in my family and my wife’s family have brown eyes, I’m suspicious of why my daughter’s 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 don’t 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 nurse’s best response?

  1. “Genetic testing may help to identify the best medication to treat your hypertension.”
  2. “I’m sorry that you couldn’t control your hypertension without medications.”
  3. “The drugs are much better now and don’t 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 client’s 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 organization’s 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 master’s 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 nurse’s 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 grandfather’s 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 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.

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 client’s 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. Today’s 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 Jungner’s criteria were established, screening was limited primarily to results that affected the infant’s health. Today’s 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 Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC). The nurse would inform a newborn’s 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 newborn’s 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 nurse’s priority?

  1. Increasing the number of diseases on the state’s standard screen
  2. Including screening for hearing loss in the state’s 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 baby’s 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 24–48 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 pediatrician’s office was notified this morning that the infant’s 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 don’t 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 client’s 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 already been handled and analyzed, they may have been contaminated.

Rationale 4: The study design would outline the procedure for analyzing the samples, so inexperience should not be a factor.

Rationale 5: The study is likely looking at only one aspect of the sample. The number of tests that could be done is not a factor.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

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

 

Question 13

Type: MCSA

One of a client’s treatment options involves an autologous stem cell transplant from cord blood. What is the best source of this blood?

  1. Stored cord blood from a sibling who is a transfusion match
  2. Stored cord blood from any relative who is a transfusion match
  3. Stored cord blood from any donor who is a transfusion match
  4. Stored cord blood from any donor of the same gender who is a transfusion match

Correct Answer: 1

Rationale 1: A sibling is a first-degree relative, so this is a good source.

Rationale 2: Autologous transfusions must come from a first- or second-degree relative.

Rationale 3: Transfusions from unrelated donors are allogeneic, not autologous.

Rationale 4: Gender is not a factor. This statement describes an allogeneic, not autologous, transfusion.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-7: Discuss the proposed expansion of the newborn screening program.

 

Question 14

Type: MCSA

Which newborn sample would be best to screen for prenatal drug, alcohol, and nicotine exposure?

  1. Mother’s blood
  2. Meconium stool
  3. Hair
  4. Skin cells

Correct Answer: 2

Rationale 1: The mother’s blood could be screened, but this would require a second informed consent.

Rationale 2: Exposure to drugs, alcohol, and nicotine can be determined through meconium stool analysis.

Rationale 3: Hair samples reveal drug and nicotine exposure, but another type of sample is better for alcohol screening.

Rationale 4: Analysis of skin cells would require a scraping or swabbing collection. Another type of sample is more easily obtained.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-7: Discuss the proposed expansion of the newborn screening program.

 

Question 15

Type: MCSA

A state legislature is considering the expansion of funding for newborn screening to assure availability to all newborns in the state. What ethical principle is being upheld by this group?

  1. Distributive justice
  2. Nonmaleficence
  3. Justice
  4. Self-determination

Correct Answer: 1

Rationale 1: Distributive justice is defined as equal access to basic health care and resources.

Rationale 2: Nonmaleficence is defined as doing no harm, not assuring equal access.

Rationale 3: Justice is fairness of actions, not assuring equal access.

Rationale 4: The scenario does not mention whether informed consent will be required or if parents will be allowed to refuse this screening.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-7: Discuss the proposed expansion of the newborn screening program.

Kenner Genetics and Genomics for Nursing, 1/E
Chapter 21

Question 1

Type: MCMA

Which situations would the nurse characterize as indicating substance abuse rather than dependence?

 

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 reports that her boyfriend left her because she drinks so much.
  2. The client reports being fired from three jobs this year due to tardiness after binge drinking.
  3. The client reports needing more marijuana to feel “high.”
  4. The client has been arrested twice for purchasing methamphetamine.
  5. The client has ruined three shirts due to overspraying paint while huffing.

Correct Answer: 1,2,5

Rationale 1: This is an example of substance abuse in that it has had consequences in the client’s relationship. Neither of the hallmarks of substance dependence is noted.

Rationale 2: This is an example of substance abuse in that it has had a social consequence. Neither of the hallmarks of substance dependence is noted.

Rationale 3: This is an example of dependence. The hallmarks of substance dependence are tolerance (needing increased amounts of a substance to feel the desired effects) and withdrawal (the uncomfortable physiological and cognitive behavioral changes associated with lowered blood or tissue concentrations of the substance).

Rationale 4: This is an example of substance abuse in that a social consequence has occurred. There are no hallmarks of dependence noted.

Rationale 5: This is an example of substance abuse in that a social consequence has occurred. There are no hallmarks of dependence noted.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-3: Evaluate the diagnostic procedures used to identify substance dependence disorders.

 

Question 2

Type: MCMA

Which situations would the nurse interpret as indicating the client has a true substance dependence problem rather than a substance abuse issue?

 

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

Standard Text: Select all that apply.

  1. At every clinical visit the client initiates a discussion about her need to stop using drugs.
  2. The client reports, “I’m going back to my plan of drinking only on weekends.”
  3. The client states, “I’m trying to quit using sleeping pills but I can’t do it. Without them I’m awake all night.”
  4. The client reports that his parents have “kicked me out of the house” for repeatedly coming home drunk.
  5. The client was arrested for shoplifting cigarettes at a convenience store.

Correct Answer: 1,2,3

Rationale 1: People with substance dependence spend a lot of time either trying to obtain the substance or trying to cut down or schedule their use.

Rationale 2: People who are dependent on a substance often try to control the dependence by scheduling when they will use it.

Rationale 3: One of the hallmarks of dependence is the inability to withdraw from the substance.

Rationale 4: Neither of the hallmarks of dependence (tolerance and withdrawal) is demonstrated in this statement. The client has encountered an adverse social consequence, which indicates abuse.

Rationale 5: Neither of the hallmarks of dependence (tolerance and withdrawal) is demonstrated in this statement. The client has encountered an adverse consequence, which indicates abuse.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-3: Evaluate the diagnostic procedures used to identify substance dependence disorders.

 

Question 3

Type: MCSA

Which finding would the nurse attribute to withdrawal in a client who has substance dependence?

  1. The client presented to the clinic and asked for help “so I can stop wrecking my life.”
  2. The client is sitting quietly in a rocking chair in the corner.
  3. The client asks the same question repeatedly.
  4. The client complains of a headache.

Correct Answer: 3

Rationale 1: This statement may well be a first step toward not being substance dependent.

Rationale 2: There is no indication that withdrawal is occurring in this client.

Rationale 3: Maladaptive cognitive changes, in this case either not remembering the answer or not remembering asking the question, can indicate withdrawal in a client who is substance dependent.

Rationale 4: Withdrawal may present a number of physical symptoms, but headache could be caused by a number of other illnesses. It is not as specific as another option.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-3: Evaluate the diagnostic procedures used to identify substance dependence disorders.

 

Question 4

Type: MCSA

The nurse working in an alcohol addiction program would evaluate which statement as true regarding genetics and alcohol abuse?

  1. Alcoholism is likely caused by a single genetic factor.
  2. Once science identifies the common genetic profile leading to alcoholism, this addiction can be treated more successfully.
  3. Our knowledge of how genetics impacts the development of alcoholism is minimal, but is increasing.
  4. Alcoholism is likely unrelated to any genetic etiology.

Correct Answer: 3

Rationale 1: Alcoholism is complex; it is not likely that a single genetic factor is causative.

Rationale 2: There is not likely to be a single genetic profile associated with alcoholism.

Rationale 3: Our current level of useful knowledge is low, but there is substantial research going on which is increasing our knowledge base.

Rationale 4: A number of twin and adoption studies as well as family research have helped us determine that alcoholism is very likely associated with genetic factors.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-1: Classify genetic factors considered contributory to inherited addictive behaviors.

 

Question 5

Type: MCMA

The nurse suspects that a child has fetal alcohol syndrome (FAS). Which assessments would lead to this suspicion?

 

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

Standard Text: Select all that apply.

  1. The child’s facial features are not normally proportional.
  2. The child cannot sit still or stay on task.
  3. The child’s legs are bowed from the knees to the ankles.
  4. The parents report the child is behind grade level in all school subjects.
  5. The client has a heart murmur.

Correct Answer: 1,2,4,5

Rationale 1: Malformation of facial features is a hallmark of FAS.

Rationale 2: Hyperactivity is seen in children with FAS.

Rationale 3: Bowed legs are not a finding associated with FAS.

Rationale 4: Intellectual disorders are common in children with FAS.

Rationale 5: Heart defects are a common finding in children with FAS.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-1: Classify genetic factors considered contributory to inherited addiction behaviors.

 

Question 6

Type: MCMA

During a research study, an African-American woman was found to have a TT genotype. What information should the nurse provide?

 

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

Standard Text: Select all that apply.

  1. “You will never need to worry about becoming an alcoholic, because your genes will protect you.”
  2. “You may wish to take steps to minimize stressors in your life.”
  3. “I have some information for you on how to maximize your coping skills.”
  4. “Your genetic profile makes it almost inevitable that you will become a substance abuser.”
  5. “You have a genotype that would make you vulnerable to substance abuse if you were not African-American.”

Correct Answer: 2,3

Rationale 1: This statement does not reflect current knowledge about the TT gene.

Rationale 2: This woman is genetically vulnerable to addiction. Minimizing stressors may help her resist the temptation to abuse substances.

Rationale 3: This woman is genetically vulnerable to addiction. Those with addiction often have poor coping skills. Information and efforts to improve coping skills may be beneficial to this client.

Rationale 4: Although this woman’s genetic profile indicates vulnerability, it is not inevitable that she will become an abuser.

Rationale 5: The research on this genotype indicates vulnerability in African-American women.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-4: Illustrate how genetic linkages are reported to be involved in addictive behaviors in the literature.

 

Question 7

Type: MCSA

The nurse is discussing potential therapy with a client who has abused alcohol and cocaine. Which planning is indicated?

  1. The focus of the initial therapy must be to reduce the client’s abuse of cocaine because it is illegal.
  2. Therapy for alcohol addiction should be addressed first as it is the more easily obtainable of the two substances.
  3. Because the client is a polysubstance abuser, it is much more likely that genetics are the cause of the addictions, so inpatient therapy is indicated.
  4. Both of these addictions should be addressed simultaneously.

Correct Answer: 4

Rationale 1: Legality is not a factor in the need for therapy for both addictions.

Rationale 2: Easier access does not mean the cocaine addiction should be addressed first.

Rationale 3: There is nothing in this scenario that indicates the client can only be successful in an inpatient setting.

Rationale 4: With polysubstance addiction, it is important to address all the addictions. Any headway made on one addiction may make the other easier to treat.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-1: Classify genetic factors considered contributory to inherited addiction behaviors.

 

Question 8

Type: MCSA

A mother is concerned because her teenage son’s father and grandfather are alcoholics. How should the nurse respond to this concern?

  1. “You should have genetic testing done for your son.”
  2. “You are a strong parent, and that will overcome any genetic or environmental tendency toward alcoholism.”
  3. “Regardless of what genetic testing might reveal, your son will need assistance in developing healthy stress responses.”
  4. “Genetics is such a strong determinant of alcohol abuse that no interventions are likely to help.”

Correct Answer: 3

Rationale 1: There is a strong likelihood that the son does have some genetic tendency toward alcoholism. In any case, the child has been exposed to alcoholism in the environment. Genetic testing is not the best answer to this situation.

Rationale 2: While strong parenting will be helpful, there are additional actions that would be recommended.

Rationale 3: Because the son likely has a genetic tendency toward alcohol abuse and has been exposed environmentally, additional emphasis on positive and healthy stress responses is necessary.

Rationale 4: There is no indication that genetics is the sole determinant of alcohol abuse.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-4: Illustrate how genetic linkages are reported to be involved in addictive behaviors in the literature.

 

Question 9

Type: MCMA

The nurse has taken a position in a clinic in an area where fetal alcohol syndrome (FAS) is prevalent. What information should the nurse’s manager provide?

 

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

Standard Text: Select all that apply.

  1. FAS is found mostly in the economically disadvantaged population.
  2. The most common cause of intellectual disorders that are not inherited is the use of alcohol by the pregnant woman.
  3. FAS is common but occurs only when the mother is a very heavy drinker.
  4. Children with FAS may be at risk for addictions.
  5. FAS is caused by a created genetic disease.

Correct Answer: 2,4,5

Rationale 1: FAS occurs in all populations.

Rationale 2: FAS is considered the most common nonhereditary form of intellectual disorders.

Rationale 3: Any alcohol use during pregnancy kills brain cells in the fetus. Heavy drinkers run a higher risk, but FAS can occur with moderate social drinking as well.

Rationale 4: The child with FAS may have both a genetic tendency toward addiction and environmental exposure to an addicted parent. Both would increase the likelihood that the child would become an abuser.

Rationale 5: Alcohol changes the genetic makeup of cells in the fetus, thereby potentially creating a genetic disease that could be passed to the children of the person with FAS.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-4: Illustrate how genetic linkages are reported to be involved in addictive behaviors in the literature.

 

Question 10

Type: MCSA

The nurse assesses that a newborn is of low birth weight, has distinctively malformed facial features, and is irritable and inconsolable. The nurse would review the mother’s admission interview for which information?

  1. Did the mother consume alcohol during the pregnancy?
  2. Was preeclampsia a problem in the pregnancy?
  3. Did the mother have problems becoming pregnant?
  4. Does either the mother or father have heart defects?

Correct Answer: 1

Rationale 1: Low birth weight, hyperactivity, and malformed facial features may be indicators of fetal alcohol syndrome.

Rationale 2: Preeclampsia could account for the low birth weight and irritability, but not the facial feature malformation.

Rationale 3: Infertility would not cause the assessment findings described.

Rationale 4: The presence of heart defects in the mother or father might contribute to low birth weight but not to irritability, inconsolability, or malformed facial features.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-2: Integrate the implications of clinical interviews in testing and screening for clients and their families.

 

Question 11

Type: MCSA

A client who is addicted to opioids says, “I don’t know how I got myself hooked on drugs. I just can’t seem to resist them. Could I have inherited this from my mother? She was a junkie.” How should the nurse respond?

  1. “Opioid addictions are not inherited.”
  2. “Not much research has been done regarding opioid drug addiction and inheritance.”
  3. “Despite the research, the medical community is still not certain about drug addiction and inheritance.”
  4. “Because you are unable to resist the temptation of opioids, it is likely that you have a genetic tendency toward abuse.”

Correct Answer: 3

Rationale 1: A tendency to addiction for many substances, including opioids, is thought to have a genetic basis.

Rationale 2: The relationship between drug addiction and genetics has been studied for many years.

Rationale 3: Despite a multitude of genetics studies, the underlying mechanism of opioid dependency remains unclear.

Rationale 4: The fact that the client feels “unable to resist” the drug is a part of dependency and may or may not be genetically determined.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-4: Illustrate how genetic linkages are reported to be involved in addictive behaviors in the literature.

 

Question 12

Type: MCMA

A client says, “I am so afraid I will become an alcoholic. Both my mom and dad drank heavily throughout my childhood.” How should the nurse respond?

 

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

Standard Text: Select all that apply.

  1. “You are aware of your potential for alcoholism, so you probably will not develop the disorder.”
  2. “There may be some genetic component to alcoholism, so you should take care.”
  3. “If it is genetic, there is not much you can do about it.”
  4. “With your family history of alcoholism, you might consider healthier ways to manage stressors.”
  5. “You could focus on staying strong and healthy rather on your risk for alcoholism.”

Correct Answer: 2,4,5

Rationale 1: This may or may not be true. If the client never drinks, alcoholism cannot develop. However, many people with family members who are alcoholics also go on to develop the disorder.

Rationale 2: While tendency toward alcoholism is not definitely genetic, many studies show that genetics is a strong factor.

Rationale 3: The nurse should offer helpful suggestions to avoid alcoholism. This statement is neither true nor therapeutic.

Rationale 4: Stress and poor coping mechanisms often lead to substance abuse, including alcoholism. Knowing that a genetic tendency is possible, the client should focus on modifiable factors such as stress management.

Rationale 5: A positive outlook, including stress management techniques and positive coping skills, could make a difference for this client.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-5: Design an informational plan for a client and involve family about genetic implications of substance disorders.

 

Question 13

Type: MCSA

The nurse is planning to help a client with smoking cessation. What is the most helpful plan for this client?

  1. Have the client tested for a genetic tendency toward heavy smoking.
  2. Enroll the client in a hotline support group for smoking cessation.
  3. Discuss the health effects of smoking at each clinic visit.
  4. Include the client’s family in discussions about smoking cessation.

Correct Answer: 2

Rationale 1: Learning whether the client has a genetic tendency is not the most helpful plan for smoking cessation.

Rationale 2: Support and encouragement are currently two of the most significant factors in smoking cessation.

Rationale 3: Most people are aware of the health effects of smoking. If this was the most effective way to stop smoking, many people would have already stopped.

Rationale 4: This may or may not be a good idea, depending on the family dynamics. It is also not as effective as another strategy.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-5: Design an informational plan for a client and involve family about genetic implications of substance disorders.

 

Question 14

Type: MCSA

A client has many relatives in the three-generation pedigree who are or were substance abusers. The client says, “I don’t understand all the emphasis on what my ancestors did. I don’t abuse anything.” How should the nurse respond?

  1. “We are trying to develop screening tests for substance abuse tendency, and your family history is very interesting to us.”
  2. “Your history would help guide medication therapy if you ever became a substance abuser.”
  3. “Knowing your family history gives you advance notice to improve your coping skills and learn to manage your stress.”
  4. “We can give you medications to prevent your becoming a substance abuser.”

Correct Answer: 3

Rationale 1: This statement does not explain why the client should be concerned with this information.

Rationale 2: This may be true, but it does not explain why the client should be concerned with this information now.

Rationale 3: The idea that the client can use this information to improve personal health now and in the future makes it real and pertinent.

Rationale 4: No such medication exists.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-5: Design an informational plan for a client and involve family about genetic implications of substance disorders.

 

Question 15

Type: MCSA

A client who is a substance abuser is described as “disinhibited” in a clinical planning conference. How should the nurse interpret this information?

  1. The client is antisocial.
  2. The client lacks the ability to respond flexibly to circumstances.
  3. The client’s substance abuse has caused brain damage.
  4. The client does not respond to reward activation in the brain.

Correct Answer: 2

Rationale 1: An antisocial client may be disinhibited, but the terms are not synonymous.

Rationale 2: Without an intact inhibitory mechanism, the client’s behavior becomes maladaptive.

Rationale 3: There is no indication that the client has brain damage. Genetic damage may be present.

Rationale 4: The client who is disinhibited likely responds more robustly to reward activation.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-4: Illustrate how genetic linkages are reported to be involved in addictive behaviors in the literature.

 

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