Chapter 13: Genetics Harding: Lewis’s Medical-Surgical Nursing, 12th Edition

Test Bank For Lewis's Medical-Surgical Nursing, 12th Edition by Mariann M. Harding, Jeffrey Kwong, Debra Hagler Chapter 13: Genetics Harding: Lewis’s Medical-Surgical Nursing, 12th Edition MULTIPLE CHOICE 1. The sister of a patient diagnosed with BRCA gene–related breast cancer asks the nurse, “Do you think Ishould be tested for the gene?” Which response by the nurse is most appropriate? A. “In most cases, breast cancer is not caused by having the BRCA gene.” B. “It depends on how you will feel if the test is positive for the BRCA gene.” C. “There are many things to consider before deciding to have genetic testing.” D. “First you should decide whether you are willing to have a bilateral mastectomy.” ANS: C Although presymptomatic testing for genetic disorders allows patients to take action (e.g., mastectomy) to prevent the development of some genetically caused disorders, patients also need to consider that test results in their medical record may affect insurance, employability, and so on. Telling a patient that a decision about mastectomy should be made before testing implies that the nurse has made a judgment about what the patient should do if the test result is positive. Although the patient may need to think about her reaction if the test is positive, other issues (e.g., insurance) also should be considered. Although most breast cancers are not related to BRCA gene mutations, the patient with a BRCA gene mutation has a markedly increased risk for breast cancer. 2. The nurse is counseling a couple in which one partner has an autosomal recessive disorder and the other partner has no gene for the disorder. The nurse uses Punnett squares to show the couple the probability of their having a child with the disorder. Which statement by the nurse is accurate? A. “Each child would be a carrier of the disorder.” B. “Each child would have a 50% chance of the disorder.” C. “Your male children would display characteristics of the disorder.” D. “Your female children would display characteristics of the disorder.” ANS: A When one parent has an autosomal recessive disorder and the other parent has no genes for the autosomal recessive disorder, the children will be carriers of the autosomal recessive disorder. The children will not have the disorder or display characteristics of the disorder, regardless of gender. 3. A patient with a family history of cystic fibrosis (CF) asks for information about genetic testing. Which response by the nurse is most appropriate? A. Refer the patient to a qualified genetic counselor. B. Ask the patient why genetic testing seems necessary. C. Remind the patient that genetic testing has many social implications. D. Tell the patient that cystic fibrosis is an autosomal recessive disorder. ANS: A A genetic counselor is best qualified to address the multiple issues involved in genetic testing for a patient who is considering having children. Although genetic testing does have social implications, the patient will be better served by a genetic counselor, who will have more expertise in this area. CF is an autosomal recessive disorder, but the patient might not understand the implications of this statement. Asking why the patient feels genetic testing is important may imply to the patient that the nurse is questioning her value system. 4. A male patient with hemophilia asks the nurse if his future children will have hemophilia. Which response by the nurse is accurate? A. “All of your children will be at risk for hemophilia.” B. “Hemophilia is a multifactorial inherited condition.” C. “Only your male children are at risk for hemophilia.” D. “Your female children will be carriers for hemophilia.” ANS: D Because hemophilia is caused by a mutation of the X chromosome, all female children of a man with hemophilia are carriers of the disorder and can transmit the mutated gene to their offspring. Sons of a man with hemophilia will not have the disorder. Hemophilia is caused by a single genetic mutation and is not a multifactorial inherited condition. 5. A young adult patient has abnormalities in the cytochrome P450 (CYP 450) gene. Which action would the nurse include in the patient‘s plan of care? A. Teach that some medications may not work effectively. B. Teach about genetic risk for cystic fibrosis in any children. C. Encourage scheduling screening mammograms starting at age 30. D. Encourage the patient to watch for early symptoms of heart disease. ANS: A The CYP 450 gene affects the metabolism of many medications, and they may not work as effectively or may have unexpected toxic effects. The CYP 450 gene does not affect risk for breast cancer, cystic fibrosis, or coronary artery disease. 6. A patient tells the nurse, “I would like to use a home genetic test to see if I will develop breast cancer.” Which initial response would the nurse provide? A. “Home genetic testing can be very expensive.” B. “Are you prepared to cope with a positive result?” C. “Are you concerned about developing breast cancer?” D. “Genetic testing only determinesif you are at higher risk for breast cancer.” ANS: C Asking about the concern uses the communication technique of clarifying for further assessment. The other options accurately indicate information about genetic testing, but the initial response by the nurse should be focused on assessment. 7. The nurse in the outpatient clinic has obtained health histories for these new patients. Which patient may need referral for genetic testing? A. A 30-yr-old patient who has a sibling with polycystic kidney disease B. A 30-yr-old patient with dyspnea who has a history of cigarette smoking C. A 20-yr-old patient whose maternal grandparent died after a stroke at age 80 D. A 20-yr-old patient with a positive pregnancy test whose first child has cerebral palsy ANS: A The adult form of polycystic kidney disease is an autosomal dominant disorder and frequently it is asymptomatic until the patient is older. Presymptomatic testing will give the patient information that will be useful in guiding lifestyle and childbearing choices. The other patients do not have any indication of genetic disorders or need for genetic testing.