NUR 128 - Maternity and Pediatric Nursing, Ch. 10, 11, 12 -- Ricci, Kyle & Carman Fourth E, Study Guides, Projects, Research of Pediatrics

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NUR 128 - Maternity and Pediatric Nursing, Ch. 10, 11, 12 --

Ricci, Kyle & Carman Fourth Edition

1. Fetal circulation differs from the circulatory path of the newborn infant. In utero the fetus has a hole connecting the right and left atria of the heart. This allows oxygenated blood to quickly pass to the major organs of the body. What is this hole called?: Foramen ovale Explanation: The foramen ovale is a hole that connects the right and left atria so the majority of oxygenated blood can quickly pass into the left side of the fetal heart, go to the brain, and move to the rest of the fetal body.
2. A nursing student is explaining to a newly pregnant woman what happens during each stage of fetal development. At which stage does the nurse inform the woman that the lungs are fully shaped?: end of 16 weeks Explanation: At the end of 16 weeks, the lungs are fully shaped, fetus swallows amniotic fluid, skeletal structure is identifiable, downy lanugo hair is present on the body, and sex can be determined using ultrasound. 3. A pregnant client is scheduled to undergo chorionic villus sampling (CVS) to rule out any birth defects. Ideally, when should this testing be completed?- : 10 to 12 weeks' gestation Explanation: Chorionic villus sampling (CVS) is typically performed between 10 to 12 weeks' gestation. Sometimes it may be offered up to 14 weeks. The test is not conducted before 10 weeks' gestation.
3. A couple has just been notified that their unborn child carries a genetic disorder. The couple expresses concern that the insurance company will not cover the costs associated with the medical bills for the child. What is the most appropriate response by the nurse?: "There are laws in place that prohibit that from happening." Explanation: The Genetic Information Nondiscrimination Act of 2008 prohibits insurance compa- nies from denying coverage or charging higher premiums based solely on genetic predisposition. 5. The nurse is seeing a client who is going to be married in a month. This client has a history of Huntington disease in her family. The genetic testing has come back, and the client has just been told she carries the gene for Huntington disease and will develop the disease when she gets older. The client asks the nurse if this information is confidential and if it will remain that way. The nurse explains to the client that her family should be told and so should her fiancé. The client forcefully tells the nurse "no." She is not going

to tell either her family or her fiancé. What is the nurse's best response?: "I will respect your wishes and keep your information confidential. I do wish you would reconsider though." Explanation: The nurse must honor the client's wishes and should be sure the client is aware that this action will be done. Although the nurse may ask the client to consider the potential benefit this information may have for other family members, this reply is not the critical or best one. The other two replies should not be stated, because the nurse has to honor the wishes of the client.

6. A pregnant woman asks the nurse about medications taken during preg- nancy and if they cross the placental barrier. What response by the nurse is appropriate?: "Some medications cross the placental barrier, so be sure to discuss medications with your provider." Explanation: Some medications cross the placental barrier, so the nurse will encourage the woman to talk more specifically with her provider. The nurse would be in error to state that all or none cross the placental barrier. Regardless of the route, some medications cross the barrier and are unsafe during pregnancy. The first trimester is the most dangerous time to take a medication that crosses the placental barrier.
7. A client at a preconception screening appointment indicates to the nurse that she is a carrier of muscular dystrophy, an X-linked recessive trait. Her partner does not have the trait. Which statement made by the client indicates an understanding of the implications?: "Each time I have a child, there is a 25% chance a female child will be a carrier." Explanation: X-linked recessive inheritance affects more males than females. There is no male-to-male transmission but any man who is affected with an X-linked recessive disorder will have carrier daughters. If a woman is a carrier, there is a 25% chance she will have an "affected son," a 25% chance that her daughter will be a "carrier," a 25% chance that she will have an "unaffected" son, and a 25% chance her daughter will be a "noncarrier."
8. The nurse is working for an obstetrician. Which couple(s) may benefit from genetic counseling? Select all that apply.: The father-to-be is 58 years old. The parents-to-be are cousins. The parents-to-be are of African heritage. The parents-to-be have a child who was born blind and deaf. Explanation: People who should receive genetic counseling prior to our during pregnancy: couple where the father is older than 50 years of age, if the couple have at least one common

ancestor (consanguinity), couple with one or both parents with African heritage, and couple who have a biologic child who was born blind or deaf. A mother-to-be older than 35 years of age may also benefit from genetic counselingterm-8.

9. The term that describes the percentage of individuals known to carry the gene for a trait and who actually manifest the condition is:: penetrance. Explanation: Penetrance is the percentage of persons known to have a particular gene mutation and who actually show the trait. Pedigree is a first step in establishing the pattern of inheritance. A genotype consists of the genes and variations therein that a person inherits from his or her parents. Variable expression is the variation in the degree to which a trait is manifested.
10. A client with symptoms of pregnancy is having an ultrasound is to de- termine the gestation of the pregnancy. The nurse explains that the visual- ization of different developmental milestones correlates with the gestation of the pregnancy. Place the following developmental milestones in order, from earliest to latest, as they appear during the first trimester. Use all options.: - Gestational sac Cardiac pulsation Spine formation Formation of limb buds Explanation: A gestational sac appears between 4 to 5 weeks' gestation. Cardiac pulsation begins at 6 weeks' gestation, the spine is visible at 7 weeks' gestation, and evidence of four limb buds is present at 8 weeks' gestation.
11. At a prenatal checkup with a client at 7 weeks' gestation, the nurse would identify what as a normal finding?: Fetal heart sounds are heard. Explanation: Although the heart is not fully developed, it begins to beat at week 5, and a regular rhythm and can be heard at week 7. Quickening is felt around week 13. Gender identity can be determined at weeks 9 to 12. The startle reflex can be seen around weeks 21 to 24.
12. A recently married couple come to the prenatal clinic because they are concerned about genetic testing. The husband is of Jewish heritage. The nurse should recommend the couple undergo genetic testing to determine if the fetus has which disorder common among Ashkenazi Jews (Jews of Eastern European lineage)?: Tay-Sachs disease Explanation:

Tays-Sachs disease is a autosomal recessive disorder that occurs primarily in Ashkenazi Jews.

13. A mother has come to the clinic with her 13-year-old daughter to find out why she has not started her menses. After a thorough examination and history, genetic testing is prescribed to rule out which abnormality?: Turner syndrome Explanation: Turner syndrome is a common abnormality of the sex chromosome in which a portion or all of the X chromosome is missing. Only about one third of the cases are diagnosed as newborns; the remaining two thirds are diagnosed in early adoles- cence when they experience primary amenorrhea. No cure exists for this syndrome. Hormone replacement therapy may be used to induce puberty.
14. A nurse overhears a colleague tell a client that based on the genetic testing results she should terminate the pregnancy. Which action is most appropriate for the nurse to take?: Immediately stop the nurse. Explanation: The nurse should interrupt the nurse and remind him or her that it is important not to impose personal values onto the client.
15. When educating parents on recessive genetic disease statistics, the nurse understands that which statement by the parents indicates an accurate un- derstanding of genetic inheritance?: "Each child will have a 25% chance of developing the disease." Explanation: The statistics of inheritance are reset with each pregnancy; therefore, each pregnan- cy has the same statistical probability of displaying the genetic disease.
16. A nurse is caring for a couple during a prenatal clinic visit. Which as- sessment finding would lead the nurse to suggest genetic counseling for the couple?: The mother just turned 39 years of age. Explanation: Genetic counseling is indicated for any woman older than 35 years of age and any man older than 55 years of age. This is directly related to the association between advanced parental age and the occurrence of Down syndrome. The mother's family history would be significant if there were indications of inherited diseases, congenital anomalies, or other such disorders. The father's age would not be a concern at 48 years old. The family may benefit from family counseling to assure the blended family is healthy, but genetic counseling cannot help with that issue. 17. A pregnant client who is planning to have genetic testing asks the nurse when she should schedule her amniocentesis. What should the nurse tell the

client?: 16 weeks Explanation: The nurse should tell the client that an amniocentesis is typically scheduled between 15 and 18 weeks' gestation.

18. A woman with both heart disease and osteoarthritis has come to the genetics clinic for genetic screening. What would the nurse know about these two diseases?: They are multifactorial. Explanation: Genomic or multifactorial influences involve interactions among several genes (gene-gene interactions) and between genes and the environment (gene-environ- ment interactions), as well as the individual's lifestyle.
19. A couple has just been notified that their unborn child carries a genetic disorder. The couple expresses concern that the insurance company will not cover the costs associated with the medical bills for the child. What is the most appropriate response by the nurse?: There are laws in place that prohibit that from happening." Explanation: The Genetic Information Nondiscrimination Act of 2008 prohibits insurance compa- nies from denying coverage or charging higher premiums based solely on genetic predisposition.
20. A couple wants to start a family. They are concerned that their child will be at risk for cystic fibrosis because they each have a cousin with cystic fibrosis. They are seeing a nurse practitioner for preconceptual counseling. What would the nurse practitioner tell them about cystic fibrosis?: It is an autosomal recessive disorder. Explanation: Cystic fibrosis is autosomal recessive. Nurses also consider other issues when assessing the risk for genetic conditions in couples and families. For example, when obtaining a preconception or prenatal family history, the nurse asks if the prospective parents have common ancestors. This is important to know because people who are related have more genes in common than those who are unrelated, thus increasing their chance for having children with autosomal recessive inherited condition such as cystic fibrosis. Mitochondrial inheritance occurs with defects in energy conversion and affects the nervous system, kidney, muscle, and liver. X-linked inheritance, which has been inherited from a mutant allele of the mother, affects males. Autosomal dominant is an X-linked dominant genetic disease. 21. During a clinical rotation at a prenatal clinic, a client asks a nurse what causes certain birth defects. The nurse replies that they can be caused by teratogens. What does the severity of the defects depend on? Select all that

apply.: when during development the conceptus is exposed to the teratogen the particular teratogen to which the fetus is exposed Explanation: A teratogen is a substance that causes birth defects. The severity of the defect depends on when during development the conceptus is exposed to the teratogen and the particular teratogenic agent to which the fetus is exposed. Reference:

22. Which type of Mendelian inherited condition results in both genders being affected equally in a vertical pattern?: autosomal dominant inheritance Explanation: An individual who has an autosomal dominant inherited condition carries a gene mutation for that condition on one chromosome of a pair. The pattern of inheritance in autosomal recessive inherited conditions is different from that of autosomal dominant inherited conditions in that it is more horizontal than vertical, with rela- tives of a single generation tending to have the condition. Chromosome X-linked conditions may be inherited in families in recessive or dominant patterns. In both patterns, the gene mutation is located on the X chromosome. All males inherit an X chromosome from their mother with no counterpart; hence, all males express the gene mutation. Neural tube defects, such as spina bifida and anencephaly, are examples of multifactorial genetic conditions. The majority of neural tube defects are caused by both genetic and environmental influences that combine during early embryonic development, leading to incomplete closure of the neural tube. 23. A client at 38 weeks' gestation is diagnosed with placental insufficiency. Which prescription from the health care provider will the nurse anticipate?: - sonogram amniocentesis umbilical blood sampling cfDNA testing Explanation: Once the client is pregnant, the client can expect to undergo nuchal translucency, hormonal screening, cfDNA testing, quadruple test analysis, chorionic villus sam- pling, amniocentesis, percutaneous umbilical blood sampling, and sonography.
23. A client of African descent at 12 weeks' gestation states concern about her fetus having a genetic disorder. Which statement by the nurse is most appropriate?: "Does anyone in your or your partner's families have a genetic disorder?" Explanation:

Assessing family history is important to help identify individuals and couples who could benefit from genetic testing for carrier identification. Although the client will have the option to be tested, the nurse would discuss the client's current concern and not dismiss it. The nurse would not state "to see if anything is wrong" because finding an indication of a disorder does not mean something is "wrong" with the fetus. The nurse would not initially discuss termination, nor dismiss the client to the health care provider to discuss.

25. While talking with a pregnant woman who has undergone genetic testing, the woman informs the nurse that her baby will be born with Down syndrome. The nurse understands that Down syndrome is an example of a:: trisomy numeric abnormality. Explanation: Down syndrome is an example of a chromosomal abnormality involving the number of chromosomes (trisomy numeric abnormality), in particular chromosome 21, in which the individual has three copies of that chromosome. Multifactorial inheritance gives rise to disorders such as cleft lip, congenital heart disease, neural tube defects, and pyloric stenosis. X-linked recessive inheritance is associated with disorders such as hemophilia. Chromosomal deletion is involved with disorders such as cri-du-chat syndrome.
26. While in utero, a fetus swallows many substances that are deposited in the fetal intestinal system as meconium. What problem can arise from this occurrence?: If the fetus becomes stressed, the meconium is released into the amniotic fluid, placing the fetus at risk for pneumonia. Explanation: Infants develop meconium in their intestines; if they are stressed or hypoxic, the anal sphincter relaxes and meconium is passed into the amniotic fluid. This poses a danger to the fetus since they breathe in this fluid and swallow it. The meconium lines the lungs and respiratory passages, making it difficult for the infant to breathe once it is born. 27. The nurse is reviewing prenatal charts in the clinic and notes some clients report infections during their pregnancies. Which maternal infection(s) places the fetus at high risk for developmental abnormalities? Select all that apply.- : rubella varicella Zika virus Explanation:

The Zika virus, varicella, and rubella are known as infectious teratogens. A urinary tract infection and a sinus infection would likely not alone cause fetal abnormalities.

28. The nurse is teaching a class about conception. The nurse explains to the participant that which factors are necessary for conception to occur? Select all that apply.: Equal maturation of both sperm and ovum Ability of the sperm to reach the ovum Ability of the sperm to penetrate the ovum Explanation: For conception to occur three factors must be present: equal maturation of the sperm and ovum, ability to the sperm to reach the ovum, and the ability of the sperm to penetrate the ovum. The ovum does not ingest the sperm; the ovum is passive and the sperm must penetrate the zona pellucida and cell membrane and achieve fertilization. The ovum is not motile. The ovum is propelled through the fallopian tube by the cilia lining the tube. Unlike the motile sperm, an ovum has no independent motility.
29. The nurse is teaching a prenatal class on the functions of the various struc- tures involved with a pregnancy. The nurse determines the class is successful when the class correctly chooses which function of amniotic fluid?: "It helps cushion the baby." Explanation: The amniotic fluid has four functions: physical protection, temperature regulation, provision of unrestricted movement, and symmetrical growth. Feeding the baby, preventing infection, and providing oxygen are functions of the placenta.
30. The nurse is conducting an initial history and assessment on a client at 10 weeks' gestation who is pregnant with her first child. Which question is a priority for the nurse to ask the client at this time?: "Does anyone in your or the father's family have any genetic disorders?" Explanation: Due to the timing of the client's pregnancy, it is a priority for the nurse to assess for potential risk factors for genetic abnormalities. The client is in the appropriate time frame to begin genetic testing if desired. The nurse will determine the client's feeding preference and plans to have a birth plan closer to birth to allow the client time to research these topics and make an informed decision about both. Gestational diabetes is not thought to be genetic in nature. The client will be tested for gestational diabetes regardless of family history during her second trimester.
31. The fluid-filled, inner membrane sac surrounding the fetus is which struc- ture?: Correct response: amnion Explanation:

The fluid-filled, inner membrane sac surrounding the fetus is the amnion. The chorion is the outer membrane surrounding the fetus. The endometrium is the inner lining of the uterus. The decidua is the name used for the endometrium during pregnancy.

32. A young couple who underwent preconceptual genetic testing is at high risk for having a child with Down syndrome and have decided not to have children. Which response by the nurse is mostappropriate?: "If you would like to discuss this further, here is the contact information for the genetic counseling center." Explanation: Even if a couple decides not to have more children, the nurse should be certain they know genetic counseling is available for them should their decision change. It is not appropriate for the nurse to discuss adoption or surrogacy at this time. The couple needs time to process this information first. The nurse should avoid using terms such as "always" as the couple may have barriers that would prevent them from being able to adopt. The nurse should not state the client should approach family or friends for surrogacy at this time. If the couple would request information, the nurse would list all potential possibilities for surrogacy and not place emphasis/pressure on a certain group. Being referred for a second opinion is providing the couple with false hope. If the couple would request a referral, it would not be denied. 33. A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as the:: phenotype. Explanation: Phenotype refers to a person's outward appearance or the expression of genes. Alleles are two like genes. Genotype refers to his or her actual gene composition. Genome is the complete set of genes present in a person.
33. A nurse working in the newborn nursery hears an innocent murmur on auscultation of a 24-hour-old infant's chest. The nurse recognizes this as most likely the result of which condition?: delayed fetal shunt closure Explanation: Functional closure of all fetal shunts usually occurs anywhere from the first hour to three to four weeks after birth. These delayed fetal shunt closures are usually not associated with a heart lesion. If they are still present at a later date, evaluation may be warranted. 35. A nurse is conducting a presentation at a community health center about congenital malformations. The nurse describes that some common congenital malformations can occur and are recognized to be caused by multiple genetic

and environmental factors. Which example would the nurse most likely cite?- : spina bifida Explanation: Spina bifida is a multifactorial inherited disorder thought to be due to multiple genetic and environmental factors. Cystic fibrosis is considered an autosomal recessive inherited disorder, while color blindness and hemophilia are considered X-linked inheritance disorders.

36. The nurse is preparing a pregnant client with severe hypertension for an emergent amniocentesis for possible early delivery of the fetus. The nurse will explain to the client that the health care provider is evaluating which parameter?: level of fetal surfactants Explanation: Amniocentesis is done to check the lung surfactant ratio of the fetus, which will determine if the lungs are matured enough for delivery. Amniocentesis can be used to determine fetal renal and alimentary output, but these factors are not critical to birth. Maternal blood work will reveal information about the mother and not the lung maturity of the fetus.
37. A nurse is providing prenatal care to a pregnant woman. Understanding a major component of this care, the nurse would conduct a risk assessment for:: genetic conditions and disorders. Explanation: Nurses at all levels should be participating in risk assessment for genetic conditions and disorders, explaining genetic risk and genetic testing, and supporting informed health decisions and opportunities for early intervention.
38. The nurse cares for multiple clients planning to have children. Which client will the nurse identify as priority for needing a referral for prenatal genetic testing?: A male client with family history of sickle cell disease Explanation: The nurse would refer the male client with a family history of a sickle cell disease, a genetic disorder, for prenatal genetic testing. Women older than 35 years of age and men older than 45 years of age should be referred. However, age is not priority over a known family history. Women with diabetes need not necessarily be referred for genetic testing.
39. A nurse is discussing the importance of good nutrition to a young pregnant client. The nurse would point out that the growing fetus is getting nutrition from the mother via which structure?: placenta Explanation:

The placenta is a flat, round structure which forms on the decidua and attaches to the fetus by the umbilical cord. The placenta is the organ responsible for supplying nutrients and oxygenated blood to the fetus. The amniotic fluid surrounds the fetus and provides protection, temperature regulation, allows movement, and symmetric growth. It collects urine and other waste products from the fetus. The decidua is the name given to the endometrium after the pregnancy starts. The umbilical arteries carry waste products away from the fetus to the placenta, where they are filtered out into the maternal body for proper disposal.

40. A community health nurse is visiting a 16-year-old new mother. The nurse explains to the client and her mother the genetic screening that is required by the state's law. The client asks why it is important to have the testing done on the infant. What is the nurse's best response?: PKU, congenital hypothyroidism, and galactosemia are conditions that could result in disability or death if untreated." Explanation: The first aim is to improve management, that is, identify people with treatable genetic conditions that could prove dangerous to their health if left untreated. The other answers are incorrect because genetic testing does not determine the rate of infectious disease. The other answers do not adequately explain the rationale for newborn testing.
41. A nurse is conducting a presentation for a group of nurses at the prenatal clinic on basic genetic information. After teaching the group about genetics, the nurse determines that the teaching was effective based on which state- ment by the group?: "My genome is my genetic blueprint." Explanation: An individual's genome represents his or her genetic blueprint, which determines genotype (the gene pairs inherited from parents) and phenotype (observed outward characteristics of an individual). A primary goal of human genome project (HGP) is to translate the findings into new strategies for the prevention, diagnosis, and treatment of genetic diseases and disorders.
42. The parents are questioning why their newborn was born deaf when there are no other deaf family members. The nurse could explore possible exposure to a teratogenic agent at which stage of the pregnancy?: 6 weeks Explanation: Teratogenic agents ingested during the embryonic stage (2 to 8 weeks) can affect the neurologic system of the fetus, including the hearing. During weeks 6 through 8, the ear is most vulnerable to teratogenic agents. From the preembryonic stage of fertilization to the beginning of week 2, there is decreased risk due to no implantation

or transfer of substances from the mother to the developing blastocyte. During the fetal stage ( weeks to birth), the fetus is fully formed and is now concentrating on increasing in size. There is a decreased risk from teratogenics during this time period.

43. Some chromosomal abnormalities of number often result because of the failure of the chromosome pair to correctly separate during cell division. One type is referred to as polyploidy. The nurse recognizes that this type usually results in:: early spontaneous abortion (miscarriage). Explanation: Polyploidy usually results in an early spontaneous abortion (miscarriage) and is incompatible with life. Down syndrome, Edward syndrome, and Patau syndrome are types of trisomy disorders.
44. A client who has one child with a genetic disorder tells the nurse, "I told my husband I was ready to have another baby and now he does not want to be intimate with me." What is the mostappropriate nursing diagnosis for this client's husband?: Altered sexuality pattern related to fear Explanation: The client's husband may be not engaging in intercourse because he is afraid of conceiving a second child with a genetic disorder. The nurse should identify resources for the client that allow for increased communication and education for the couple.
45. The nursing instructor is presenting a session on the cellular division involved in the reproduction of human life. Which statement indicates the group's need for further education?: At ovulation, the gametes unite to form the cell that becomes the developing fetus. Explanation: The female gamete is the ovum, and the male gamete is the sperm. At conception, not ovulation, the gametes unite to form the cell that eventually becomes the developing fetus. The other answers are correct.
46. The nurse prepares a couple to have a karyotype performed. What de- scribes a karyotype?: a visual presentation of the chromosome pattern of an individual Explanation: A karyotype is a photograph of a person's chromosomes aligned in order. 47. A client at 38 weeks' gestation is diagnosed with placental insufficiency. Which prescription from the health care provider will the nurse anticipate?: -

Prepare the client for an induction of labor. Explanation: Placental insufficiency is a serious complication where the placenta no longer works properly to provide nutrition and oxygen to the fetus, nor remove waste products from the fetus. Because this client's fetus is at full term, the nurse would anticipate an induction of labor or a cesarean birth. The client is not stable enough to be sent home for monitoring. Hypertension can be a cause of placental insufficiency; however, at this point in the pregnancy, birth is the best option. Betamethasone is a steroid given to clients to hasten preterm fetal lung development. This client is at term and does not need betamethasone.

48. A nurse is obtaining the genetic history of a pregnant client by eliciting historical information about her family members. Which question is most appropriate for the nurse to ask?: "What was the cause and age of death for deceased family members?" Explanation: The nurse should find out the age and cause of death for deceased family members, as it will help establish a genetic pattern. Although inquiry of a history of premature birth or depression during pregnancy are important and should be included in the data collection, they do not relate to genetically inherited disorders. A family history of alcohol or substance use disorder does not increase the risk of genetic disorders.
49. The nurse is creating an educational pamphlet for pregnant mothers. Which is the best description of fetal development for the nurse to empha- size?: gestational age, length, weight, and systems developed Explanation: Client education is a major component of maternal-child nursing. During pregnancy, nurses provide anticipatory guidance to prepare the woman and her significant other for the changes each month brings. Clients most often want to know gestational age in weeks, length, weight, and systems developed; the client is then able to visualize what the fetus looks like.
50. During which stage of fetal development is exposure to teratogens most damaging?: embryonic stage Explanation: The most sensitive period of fetal development related to teratogens is during the embryonic period when the different body systems are developing. During the pre-embryonic stage, the fetal stage, and the mitosis stage, the risk of teratogenic exposure is not as influential on the fetus.

51. A woman is confused after finding out the ultrasound results predict a different due date for the birth of her baby. Which factor should the nurse point out is most likely the reason for the miscalculation of the fetal age?: mistaking implantation bleeding for last menstrual period (LMP) Explanation: The most common cause is implantation bleeding, which can occur as the blastocyst implants itself into the endometrium. This bleeding can be mistaken for a scanty menstrual period and can lead to miscalculation of fetal age by 2 weeks. The other choices might also contribute, especially the math miscalculation, but are not the primary reason.
52. Cystic fibrosis is an example of which type of inheritance?: autosomal recessive Explanation: Cystic fibrosis is an autosomal recessive inherited condition. Huntington disease would be an example of an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Cleft lip is a multifactorial inherited condition.
53. A baby is born with what the primary care provider believes is a diagnosis of trisomy 21. This means that the infant has three number 21 chromosomes. What factor describes this genetic change?: The client has a nondisjunction occurring during meiosis. Explanation: During meiosis, a pair of chromosomes may fail to separate completely, creating a sperm or oocyte that contains either two copies or no copy of a particular chromosome. This sporadic event, called nondisjunction, can lead to trisomy. Down syndrome is an example of trisomy. The mother does not have a mutation of chromosome 21, which is indicated in the question. Also, trisomy does not produce a single X chromosome and infertility. Genes are packaged and arranged in a linear order within chromosomes, which are located in the cell nucleus. In humans, 46 chromosomes occur in pairs in all body cells except oocytes and sperm, which contain only 23 chromosomes.
54. The nurse is caring for several pregnant clients in the office setting. Which client's statement would be of most concern to the nurse?: "I forgot to tell you at my first prenatal appointment that I take phenytoin for seizures." Explanation: Phenytoin is a teratogen and the provider would consider an alternate seizure medication if indicated. Ideally, the client would have alerted the health care provider as early as possible. Acetaminophen is not considered a teratogen when taken

as directed and heparin does not cross the placental barrier and is considered safe during pregnancy. Smoking during pregnancy can cause intrauterine growth restriction, but this client stopped smoking before the pregnancy.

55. When describing the characteristics of the amniotic fluid to a pregnant woman, the nurse would include which information?: The amount gradually fluctuates during pregnancy. Explanation: Amniotic fluid is alkaline. Amniotic fluid is composed of 98% water and 2% organic matter. Amniotic fluid volume gradually fluctuates throughout pregnancy. Sufficient amounts promote fetal movement to enhance musculoskeletal development.
56. A nurse is providing genetic counseling to a pregnant client. Which are nursing responsibilities related to counseling the client? Select all that ap- ply.: explaining basic concepts of probability and disorder susceptibility ensuring complete informed consent to facilitate decisions about genetic testing knowing basic genetic terminology and inheritance patterns Your selection: Explanation: The responsibilities of the nurse while counseling the client include knowing basic genetic terminology and inheritance patterns and explaining basic concepts of probability and disorder susceptibility. The nurse should ensure complete informed consent to facilitate decisions about genetic testing. The nurse should explain ethical and legal issues related to genetics as well. The nurse should never instruct the client on which decision to make and should let the client make the decision.
57. A nurse is interviewing the family members of a pregnant client to obtain a genetic history. While asking questions, which information would be most important?: if couples are related to each other or have blood ties Explanation: While obtaining the genetic history of the client, the nurse should find out if the members of the couple are related to each other or have blood ties, as this increas- es the risk of many genetic disorders. The socioeconomic status or the physical characteristics of family members do not have any significant bearing on the risk of genetic disorders. The nurse should ask questions about race or ethnic background because some races are more susceptible to certain disorders than others. 58. A pregnant woman indicates taking prescribed tetracycline during preg- nancy, without realizing it was a concern. What infant assessments will the

nurse recommend be checked on an ongoing basis?: bone development Explanation: Tetracycline is an antibiotic that may cause dental and osseous concerns for the fetus/infant when taken during pregnancy. Nervous system deficits may be experi- enced when the fetus is exposed to mercury. When exposed to rubella, deafness and cardiac abnormalities may occur.

59. The nurse is providing prenatal education in the community. The nurse advises the pregnant women to check with their health care provider before what activity(ies)? Select all that apply.: receiving immunizations taking over-the-counter herbs taking "natural" medications Explanation: The pregnant woman is taught to consider that substances she takes into her body may pass to the fetus. These include immunizations, over-the-counter herbs, and all medications, even the ones labeled as "natural." The woman should verify with her health care provider before any of those things are taken. Eating spicy food and drinking specific brands of bottled water would not need to be cleared with the provider unless the woman experienced gastrointestinal symptoms following ingestion.
60. A client at a preconception screening appointment indicates to the nurse that she is a carrier of muscular dystrophy, an X-linked recessive trait. Her partner does not have the trait. Which statement made by the client indicates an understanding of the implications?: Each time I have a child, there is a 25% chance a female child will be a carrier." Explanation: X-linked recessive inheritance affects more males than females. There is no male-to-male transmission but any man who is affected with an X-linked recessive disorder will have carrier daughters. If a woman is a carrier, there is a 25% chance she will have an "affected son," a 25% chance that her daughter will be a "carrier," a 25% chance that she will have an "unaffected" son, and a 25% chance her daughter will be a "noncarrier."
61. A nurse is preparing a presentation on genetic disorders. Which condition would the nurse most likely include as the most common form of male autism spectrum disorder?: fragile X syndrome Explanation: Fragile X syndrome is a common form of intellectual disability and autism spectrum disorder. Conservative estimates report that fragile X syndrome affects approximate- ly one in 3,600 males and one in 6,000 females (National Fragile X Foundation,

2020). Typically, a female becomes the carrier and will be mildly affected. The male who receives the X chromosome that has a fragile site will exhibit the full effects of the syndrome. Cri du chat syndrome is a rare genetic disorder. Most children with Down syndrome have an intellectual disability in the mild-to-moderate range. Children with Patau syndrome (rate genetic disorder) have a life expectancy of only a few days after birth. Although intellectual disability may be associated with these other disorders, typically autism spectrum disorders are not.

62. A client presents to the hospital experiencing a spontaneous abortion (miscarriage) at 8 weeks' gestation, which is the third spontaneous abortion (miscarriage) in 2 years. The health care provider offers to send the products of conception for genetic testing. The client expresses not understanding the reason for this action. How does the nurse explain?: Many spontaneous abortions (miscarriages) occur due to chromosomal disorders and this testing may determine if this is the cause. Explanation: Many spontaneous abortions (miscarriages) occur due to chromosomal disorders, and genetic testing may be completed to find out if this was the cause of this spon- taneous abortion (miscarriage). The testing will not determine hormone levels, and the client may need further testing to determine the cause of recurrent spontaneous abortions (miscarriages). If the client declines testing the decision will be respected, but the client should be provided with information to make an informed decision first. The nurse should not assume how the client will feel or respond to learning if there were or were not genetic abnormalities.
63. A child is diagnosed with Turner syndrome. The nurse understands that this condition is associated with which genetic problem?: only 1 functional X chromosome Explanation: The child with Turner syndrome (gonadal dysgenesis) has only one functioning X chromosome. Cri- du-chat syndrome is the result of a missing portion of chromosome
64. Children with trisomy 18 syndrome (Edwards syndrome) have three copies of chromosome 18. In trisomy 13 syndrome (Patau syndrome), the child has an extra chromosome 1.
65. The nurse is performing a newborn examination. What assessment finding by the nurse may identify potential chromosomal anomalies?: ears set below the level of the eyes Explanation: Low-set ears may be associated with trisomy 13 or trisomy 18 and is an abnormal

finding. Acrocyanosis is a normal finding on newborn assessment in the first 24 hours and is not associated with chromosomal anomalies. Two creases on the palms is a normal finding; a single palmar crease may be associated with trisomy 21. Flexed muscle tone is a normal finding; decreased muscle tone may be associated with trisomy 21.

65. A pregnant client is scheduled for a nuchal translucency scan. Which statement by the client demonstrates understanding of the nurse's teaching about this procedure?: "If this scan is positive, we will need further testing to confirm a diagnosis." Explanation: Nuchal translucency scan is an ultrasound that measures fluid collection in the subcutaneous space between the skin and cervical spine of the fetus, done at 10 to 14 weeks' gestation. This test screens for fetal anomalies; abnormal fluid collection can be associated with genetic disorders (trisomies 13, 18, and 21), Turner syndrome, cardiac deformities, and/or physical anomalies. Further testing would be required to confirm a diagnosis. This scan does not determine the sex of the fetus.
66. What is an example of an X-linked recessive condition?: Duchenne muscu- lar dystrophy Explanation: Duchenne muscular dystrophy is an example of an X-linked recessive condition. Os- teoarthritis is a multifactorial inherited condition. Huntington disease is an autosomal dominant inherited condition. Sickle cell anemia is an autosomal recessive inherited condition.
67. The pregnant client at 6 weeks' gestation asks the nurse if an ultrasound will reveal the sex of the fetus yet. What is the best response by the nurse?: - "We will have to wait until the baby is 16 weeks' gestation to determine what the sex is." Explanation: The sex of the baby can be determined by ultrasound at 16 weeks' gestation. An ultrasound at 6 and 8 weeks would be too early to determine the sex. An ultrasound at 20 weeks should confirm what was found at 16 weeks.
68. The nursing instructor is preparing a class presentation covering the various hormones and their functions during pregnancy. The instructor de- termines the class is successful when the class correctly matches which function with hCG?: continues progesterone production by corpus luteum Explanation:

The corpus luteum is responsible for producing progesterone until this function is assumed by the placenta. hCG is a fail-safe mechanism to prolong the life of the corpus luteum and ensure progesterone production. Estrogen is responsible for providing a rich blood supply to the decidua. Progesterone helps maintain a nutrient-rich decidua.

69. The nurse is assessing a primigravida woman at a routine prenatal visit. Which assessment finding is reinforcing to the client that she is definitely pregnant?: ultrasound picture of her fetus Explanation: A positive sign of pregnancy is visualization of the fetus by ultrasound at 6+ weeks. Amenorrhea is a presumptive sign and can be caused by a variety of factors. Positive hCG in the blood and uterine growth are both probable signs but can be caused by hydatidiform or tumors.
70. The nurse is assessing a client who believes she is pregnant. The nurse points out a more definitive assessment is necessary due to which sign being considered a probable sign of pregnancy?: Positive home pregnancy test Explanation: A urine pregnancy test is considered a probable sign of pregnancy as the hCG may be from another source other than pregnancy. Fatigue, amenorrhea, and vomiting are presumptive or possible signs of pregnancy and can also have other causes.
71. During a routine prenatal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse take next?: Tell the woman that this is entirely normal. Explanation: Vaginal secretions increase during pregnancy and this is considered normal leuk- orrhea based on the woman's report that she is not experiencing any itching or irritation. There is no evidence indicating the need to notify the health care provider, check for rupture of membranes, or advise her about the need for a culture.
72. A mother comes in with her 17-year-old daughter to find out why she has not had a menstrual cycle for a few months. Examination confirms the daughter is pregnant with a fundal height of approximately 24 cm. The nurse interprets this finding as indicating that the daughter is approximately how many weeks pregnant?: 24 Explanation: By 20 weeks' gestation, the fundus of the uterus is at the level of the umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in centimeters, which corresponds to the number of gestational weeks, is commonly

used to date the pregnancy. Therefore for this client, the additional 4 cm would be the equivalent of 4 additional weeks making the gestational age of 24 weeks.

73. During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding?: bruising Explanation: Bruising would not be a normal finding. Evidence of bruising might suggest domestic violence. Linea nigra, striae, and darkening of the umbilicus are normal findings.
74. During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which effect of pregnancy?: in- fluence of estrogen and blood vessel proliferation Explanation: During pregnancy, the gums become hyperemic, swollen, and friable and tend to bleed easily. This change is influenced by estrogen and increased proliferation of blood vessels and circulation to the mouth. Elevated progesterone levels cause smooth muscle relaxation, which results in delayed gastric emptying and decreased peristalsis. Increased venous pressure contributes to the formation of hemorrhoids. Relaxation of the cardiac sphincter, in conjunction with slowed gastric emptying, leads to reflux due to regurgitation of the stomach contents into the upper esopha- gus.
75. The nurse is teaching a pregnant woman about breastfeeding. The nurse determines that the teaching was successful when the woman identifies which hormone as being released when the newborn sucks at the breast?: oxytocin Explanation: Oxytocin is responsible for milk ejection during breastfeeding. Its secretion is stim- ulated by stimulation of the breasts via sucking or touching. Secretion of folli- cle-stimulating hormone is inhibited during pregnancy. The secretion of antidiuretic hormone has no effect on breastfeeding. Cortisol secretion regulates carbohydrate and protein metabolism and is helpful in times of stress
76. The nurse is caring for a client at 8 weeks' gestation who states, "I did not plan for this right now and I am not happy or excited about this pregnancy. I am not sure what to do." Which response by the nurse is best?: "Many women feel this way during the first trimester." Explanation: The best response is to let the client know this is a common feeling among all pregnant women. Most women experience ambivalence during the first trimester

whether the pregnancy was planned or not. Acceptance of the pregnancy commonly occurs during the second trimester when quickening, or feeling the baby move, occurs. However, it is not appropriate for the nurse to assume the client will become excited as each pregnancy is unique and a time of dramatic alterations. Stating not to worry and everything will be fine is nontherapeutic communication and does not focus on the client's concern. The nurse would discuss the client's feelings and concerns before making a referral.

77. During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called?- : couvade syndrome Explanation: Some fathers actually experience some of the physical symptoms of pregnancy, such as nausea and vomiting, along with their partner. This phenomenon is called couvade syndrome.

78. The nurse is teaching the pregnant woman about nutrition for herself and her baby. Which statement by the woman indicates that the teaching was effective?: I will need to take iron supplementation throughout my pregnancy even if I am not anemic." Explanation: Iron is recommended for all pregnant women because it is almost impossible for the pregnant woman to get what is required from diet alone, especially after 20 weeks' gestation when the requirements of the fetus increase. Pregnant women can get many nutrients from seafood including phosphorus, but there are specific recom- mendations about types of fish to avoid because of the risk of mercury poisoning. Milk production actually requires higher levels of zinc, which can be obtained from a healthy diet. Calcium requirements do not increase above prepregnancy levels during pregnancy because calcium absorption is enhanced during pregnancy. It can be unsafe for the pregnant woman to eat anything she wants and gain too much weight. A woman who gains too much weight during pregnancy is at risk for delivering a macrosomic baby 79. During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first?: Turn the client on her left side. Explanation: As the enlarging uterus increases pressure on the inferior vena cava, it compromises

venous return, which can cause dizziness, light-headedness, and pallor when the client is supine. The nurse can relieve these symptoms by turning the client on her left side, which relieves pressure on the vena cava and restores venous return. Although they are valuable assessments, fetal heart tone and maternal blood pressure measurements do not correct the problem. Because deep breathing has no effect on venous return, it cannot relieve the client's symptoms.

80. A client who suspects she is pregnant asks the nurse about the accuracy of home pregnancy tests. The nurse would tell the client that:: some of the home pregnancy tests can detect the presence of hCG within 1 day of the woman's missed period. Explanation: Home pregnancy tests are 95% reliable if used according to the instructions on the kit. In fact, some can detect hCG within 1 day after a missed period. These tests often give a false negative, not false positive, reading. Results can be tested with the first voided specimen of the day.
81. What is a positive sign of pregnancy?: fetal movement felt by examiner Explanation: The positive signs of pregnancy are fetal image on sonogram, hearing a fetal heart rate, and the examiner feeling fetal movement.
82. The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting?: Darkened breast are- olae Explanation: As part of the pigment changes that occur with pregnancy, breast areolae become darker. The breast tissue should not be softer or slacker than before. There should not yet be any lymph enlargement, and the nipples should not have fissures.
83. A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?: Fundal height has dropped since the last recording. Explanation: Between 38 and 40 weeks of gestation, the fundal height drops as the fetus begins to descend and engage into the pelvis. Because it pushes against the diaphragm, many women experience shortness of breath. By 40 weeks, the fetal head begins to descend and engage into the pelvis. Although breathing becomes easier because

of this descent, the pressure on the urinary bladder now increases, and women experience urinary frequency. The fundus reaches its highest level at the xiphoid process at approximately 36, not 39, weeks. By 20 weeks' gestation, the fundus is at the level of the umbilicus and measures 20 cm. At between 6 and 8 weeks of gestation, the cervix begins to soften (Goodell sign) and the lower uterine segment softens (Hegar's sign).

84. A client's menstrual period is two weeks late. She has been feeling tired and has had episodes of nausea in the morning. What classification of preg- nancy symptoms is this client experiencing?: presumptive Explanation: The most common presumptive sign of pregnancy is a missed menstrual period, or amenorrhea. Other presumptive signs include nausea, fatigue, swollen, tender breasts, and frequent urination.
85. The nurse obtains a human chorionic gonadotropin (hCG) level from a woman who thinks that she is pregnant. Which result would the nurse identify as a positive pregnancy result?: 32 mIU/mL (32 IU/L) Explanation: An hCG level lower than 5 mIU/mL (5 IU/l) is considered negative for pregnancy, and anything higher than 25 mIU/mL (25 IU/l) is considered positive for pregnancy.
86. During pregnancy, one of progesterone's actions is to allow sodium to be "wasted" or lost in the urine. The nurse would expect to see which hormone increased to help counteract this loss?: aldosterone Explanation: Aldosterone is secreted by the adrenal glands, and it normally regulates the absorp- tion of sodium in the kidney. During pregnancy, aldosterone is a key regulator of electrolyte and water homeostasis and plays a central role in blood pressure regu- lation. ADH (antidiuretic hormone) is secreted by the kidneys and aids in resorption of fluids in the kidneys. Glycogen assists in the balancing of blood glucose, breaking down to glucose when needed by the body. Cortisol is important in helping the body handle stress.
87. The nurse cares for a pregnant client at the first prenatal visit and reviews expected changes that will occur during pregnancy. Which information will the nurse include in the education?: During pregnancy blood volume can increase by at least 40%. Explanation: The pregnant woman can experience a blood volume increase by approximately 40% to 50% above prepregnancy levels by the end of the third trimester. Pregnancy results in an increased respiratory rate to provide oxygen to both the mother and

fetus. Hemoglobin levels are usually low during pregnancy because of hemodilution of red blood cells, which is termed physiologic anemia of pregnancy. Blood pressure usually reaches a low point mid- pregnancy and, thereafter, increases to prepreg- nancy levels by the third trimester.

88. A client is about 16 weeks' pregnant and is concerned because she feels her "abdomen" contracting. She calls the primary care provider's office and speaks to the nurse. What is the nurse's most appropriate response to this client's concern?: "What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." Explanation: Braxton Hicks contractions are the painless, intermittent, "practice" contractions of pregnancy
89. The nurse is teaching a pregnant teenager the importance of proper nutrition and adequate weight gain throughout the pregnancy. What is the best response when the client refuses to eat due to fear of possible weight gain?: The infant will be small and could have problems. Explanation: Women who gain less than 16 pounds (7257 g) are at risk of giving birth to small infants, which is associated with poor neonatal outcomes. The infant may not quickly gain weight but continue to slowly put on weight.
90. A pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding?: The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. Explanation: Slight bleeding after a pelvic exam in a pregnant woman is common due to the vas- cularity of her cervix during pregnancy. Suggesting a bleeding disorder is frightening and not substantiated by the data. Bleeding is not a normal finding during pregnancy and losing the mucus plug occurs at the end of pregnancy, just prior to labor.
91. The nurse is assessing a pregnant client at 20 weeks' gestation and obtains a hemoglobin level. Which result would be a cause for concern?: 10.6 g/dl Explanation: The average hemoglobin level at term is 12.5 g/dl. The hemoglobin level is consid- ered normal until it falls below 11 g/dl.
92. The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply.: breast changes

amenorrhea morning sickness

93. A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize?: Blood is trapped in the vena cava in a supine position. Explanation: Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava. Cerebral arteries should not be affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in any orientation. The sympathetic nervous system will not be affected by the supine position.
94. A 27-year-old female was just confirmed to be pregnant. She tells the nurse she just switched to a vegan diet. The nurse explains that she must pay special attention to her intake of which elements to ensure she is getting adequate nutrition for her and the baby? Select all that apply.: protein iron vitamin B12 calcium Explanation: Vegan diets do not include any meat, eggs, or dairy products. Pregnant vegetarians must pay special attention to their intake of protein, iron, calcium, and vitamin B12.
95. Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks' pregnant. The nurse would expect this woman's heart rate to be approximately:: 85 beats per minute. Explanation: During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.
96. A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week?: 1 lb (0.45 kg) Explanation: The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (0.45 kg) per week during the second and