Maternal Child Nursing Care 3rd Edition Wong Perry Test Bank
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Wong, et al.: Maternal Child Nursing Care, 3rd Edition
Chapter 8: Genetics, Conception, and Fetal Development
- A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple told the nurse that they were planning to have a second baby. Since their daughter has PKU, they believe that their next bais sure not to be affected. Which of the following responses the nurse is most accurate?
|1.||“Good planning; you need to take advantage of the odds in your favor.”|
|2.||“I think you’d better check with your doctor first.”|
|3.||“You are both carriers, so each bahas a 25% chance of being affected.”|
|4.||“The ultrasound indicates a boy, and boys are not affected with PKU.”|
- Incorrect: There is still an increased likelihood of this couple having another child with PKU. Already having already one child with PKU does not guarantee that they will not have another.
- Incorrect: They do need to discuss their options with their doctor. However, an opportune time has presented itself for the couple to receive correct teaching regarding inherent genetic risks.
- Correct: There is a 1 in 4 chance that each child produced this couple will be affected with PKU disorder.
- Incorrect: There is no correlation with gender as PKU disorder is an autosomal recessive pattern disorder.
REF: p. 189 OBJ: Cognitive Level: Application
- Ms. J., gravida 2 and 16 GW, comes in for her prenatal appointment. Her 2-year-old daughter is with her and is wearing a sleeveless top. While interacting with her daughter, you note axillary freckling and several café-au-lait spots (>2 cm). In reviewing her chart, you would assess for documentation of the genetic disease of:
1, 2 and 4. Incorrect: These disorders are not associated with café-au-lait spots.
- Correct: Clinical manifestations of NF may include axillary freckling and café-au-lait spots.
REF: p. 189 OBJ: Cognitive Level: Knowledge
- The nurse is assessing the knowledge of new parents with a child born with maple syrup urine disease. This is an autosomal recessive inherited disorder, which means that:
|1.||both genes of a pair must be abnormal for the disorder to be expressed.|
|2.||only one copy of the abnormal gene is required for the disorder to be expressed.|
|3.||this disorder occurs in males and heterozygous females.|
|4.||this disorder is carried on the X chromosome.|
- Correct: MSUD is a type of autosomal recessive inheritance disorder in which both genes of a pair must be abnormal for the disorder to be expressed.
2, 3 and 4. Incorrect: MSUD is not an X-linked dominant or recessive disorder or an autosomal dominant inheritance disorder. It is an autosomal recessive inheritance disorder in which both genes of a pair must be abnormal for the disorder to be expressed.
REF: p. 189 OBJ: Cognitive Level: Comprehension
- Mr. J.’s wife is pregnant for the third time. One child was born with cystic fibrosis and the other is healthy. He questions the chance that this child will have cystic fibrosis. This type of testing is known as:
- Incorrect: If a couple has not yet had children but they are known to be at risk for having children with a genetic disease, they will be given an occurrence risk. This couple already has a child with a genetic disorder.
- Correct: This couple already has a child with a genetic disease and will be given a recurrence risk test.
- Incorrect: Predictive testing is used to clarify the genetic status of an asymptomatic family member.
- Incorrect: Predispositional testing differs from presymptomatic testing in that a positive result does not indicate 100% risk of developing a condition.
REF: p. 185 OBJ: Cognitive Level: Comprehension
- Which of the following is a key finding from the Human Genome Project?
|1.||There are approximately 30,000 to 40,000 genes that make up the genome.|
|2.||All human beings are 80.99% identical at the DNA level.|
|3.||Human genes produce only one protein per gene, compared with other mammals which produce three proteins per gene.|
|4.||Single gene testing will become a standardized test for all pregnant patients in the future.|
- Correct: There are approximately 30,000 to 40,000 genes that make up the humane genome; this is only twice as many in roundworms and flies.
- Incorrect: Human beings are 99.9% identical at the DNA level.
- Incorrect: Most human genes produce at least three proteins.
- Incorrect: Single gene testing such as alpha-fetal protein testing is already standardized for prenatal care.
REF: p. 184 OBJ: Cognitive Level: Knowledge
- You are a maternal–newborn nurse caring for a mother who just delivered a baborn with Down syndrome. Which of the following nursing diagnoses would be the most essential in caring for the mother of this infant?
|1.||Disturbed body image|
|2.||Risk for interrupted family processes|
|4.||Risk for injury|
- Incorrect: It is common for women to experience body image disturbances in the postpartum period, but this is unrelated to giving birth to a child with Down syndrome.
- Correct: This mother will likely experience a disruption in the family process related to the birth of a bawith an inherited disorder.
- Incorrect: The mother will likely have a mix of emotions that may include anxiety, guilt, and denial, but this is not the most essential nursing diagnosis for this family.
- Incorrect: This nursing diagnosis is not applicable.
REF: p. 188 OBJ: Cognitive Level: Application
- A newly married couple plans to use natural family planning. It is important for them to know how long an ovum can live after ovulation. The nurse knows that teaching is effective when the couple responds that an ovum is considered fertile for:
|1.||6 to 8 hours.|
|3.||2 to 3 days.|
1, 3 and 4. Incorrect: Ova are considered fertile for about 24 hours after ovulation. If unfertilized a sperm, the ovum degenerates and is reabsorbed.
- Correct: Ova are considered fertile for about 24 hours after ovulation.
REF: p. 193 OBJ: Cognitive Level: Comprehension
- A woman’s cousin gave birth to an infant with a congenital heart anomaly. The woman asked the nurse when such anomalies occur. Which of the following responses the nurse is most accurate?
|1.||“We don’t really know when such defects occur.”|
|2.||“It depends on what caused the defect.”|
|3.||“They occur between the third and fifth weeks of development.”|
|4.||“They usually occur in the first 2 weeks of development.”|
- Incorrect: This is an inaccurate statement. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begin in the third week—the heart is developmentally complete in the fifth week.
- Incorrect: Regardless of the cause, the heart is vulnerable during its period of development – in the third to fifth weeks.
- Correct: The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begin in the third week; the heart is developmentally complete in the fifth week.
- Incorrect: The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begin in the third week; the heart is developmentally complete in the fifth week.
REF: p. 201 OBJ: Cognitive Level: Application
- The volume of amniotic fluid is an important factor in assessing fetal well-being. Oligohydramnios (having less than 300 ml of amniotic fluid) is associated with which kind of fetal anomalies?
- Correct: Having less than 300ml of amniotic fluid (oligohydramnios) is associated with fetal renal anomalies.
- Incorrect: The fetal cardiovascular system has no bearing on amniotic fluid.
- Incorrect: Gastrointestinal anomalies are associated with hydramnios, or having more than 2L of amniotic fluid.
- Incorrect: The fetal neurologic system has no bearing on amniotic fluid.
REF: p. 203 OBJ: Cognitive Level: Knowledge
- A woman is 8 months pregnant. She tells the nurse that she knows her balistens to her, but her husband thinks she is imagining things. Which of the following responses the nurse is most appropriate?
|1.||“Many women imagine what their bais like.”|
|2.||“Babies in utero do respond to their mother’s voice.”|
|3.||“You’ll need to ask the doctor if the bacan hear yet.”|
|4.||“Thinking that your bahears will help you bond with the baby.”|
- Incorrect: Although this statement is accurate, it is not the most appropriate.
- Correct: Fetuses respond to sound 24 weeks. The fetus can be soothed the sound of the mother’s voice.
- Incorrect: This statement is not appropriate. The mother should be instructed that her fetus can hear at 24 weeks and can respond to the sound of her voice.
- Incorrect: The statement is not appropriate. It gives the impression that her bacannot, in fact, hear her. Additionally, it belittles the mother’s interpretation of her fetus’s behaviors.
REF: p. 203 OBJ: Cognitive Level: Application
- A pregnant woman at 25 weeks’ gestation told the nurse that she dropped a pan last week and her bajumped at the noise. Which of the following responses the nurse is most accurate?
|1.||“That must have been a coincidence; babies cannot respond like that.”|
|2.||“The fetus is demonstrating the aural reflex.”|
|3.||“Babies respond to sound starting at about 24 weeks’ gestation.”|
|4.||“Let me know if it happens again; we need to report that to your midwife.”|
- Incorrect: This statement is inaccurate. Fetuses respond to sound 24 weeks. Acoustic stimulations can evoke a fetal heart rate response.
- Incorrect: There is no such thing as an aural reflex.
- Correct: This statement is accurate.
- Incorrect: This statement is not appropriate; it gives the impression that something is wrong.
REF: p. 203 OBJ: Cognitive Level: Application
- At approximately ____ gestational weeks, lecithin is forming on the alveolar surfaces, eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110g.
1, 2 and 3. Incorrect: These milestones in human development occur at approximately 28 weeks.
- Correct: These are all milestones that occur at 28 weeks.
REF: p. 208 OBJ: Cognitive Level: Knowledge
- The placenta:
|1.||produces nutrients for fetal nutrition.|
|2.||secretes both estrogen and progesterone.|
|3.||forms a protective, impenetrable barrier to microorganisms such as bacteria and viruses.|
|4.||excretes prolactin and insulin.|
- Incorrect: The placenta does not produce nutrients. The placenta functions as a means of metabolic exchange between the maternal and fetal blood supplies.
- Correct: One of the early functions of the placenta is as an endocrine gland that produces four hormones necessary to maintain the pregnancy and support the embryo and fetus: hCG, hPL, estrogen, and progesterone.
- Incorrect: Many bacteria and viruses can cross the placental membrane.
- Incorrect: One of the early functions of the placenta is as an endocrine gland that produces four hormones necessary to maintain the pregnancy and support the embryo and fetus: hCG, hPL, estrogen, and progesterone.
REF: p. 198 OBJ: Cognitive Level: Knowledge
- Meconium is produced which of the following?
- Correct: As the fetus nears term, fetal waste products accumulate in the intestines as dark green to black, tarry meconium.
2, 3 and 4. Incorrect: Meconium is an accumulation of fetal waste products that is found in the intestines.
REF: p. 202 OBJ: Cognitive Level: Knowledge
- A woman asks the nurse, “What protects my baby’s umbilical cord from being squashed while inside of me?” The nurse’s best response is:
|1.||“Your baby’s umbilical cord is surrounded connective tissue called Wharton’s jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby.”|
|2.||“Your baby’s umbilical floats around in blood anyway.”|
|3.||“You don’t need to be worrying about things like that.”|
|4.||“The umbilical cord is a group of blood vessels that are very well protected the placenta.”|
- Correct: This statement is the most appropriate response.
- Incorrect: This statement is inaccurate.
- Incorrect: This statement is not appropriate. It negates the patient’s need for teaching and discounts her feelings.
- Incorrect: The placenta does not protect the umbilical cord; it is surrounded Wharton’s jelly.
REF: p. 197 OBJ: Cognitive Level: Application
- The ____ is/are responsible for oxygen and carbon dioxide transport from and to the maternal bloodstream.
- Incorrect: The deciduas basalis is the portion of the deciduas (endometrium) under the blastocyst where the villi attach.
- Incorrect: The blastocyst is the embryonic development stage following the morula. At this stage, implantation occurs.
- Incorrect: The germ layer is a layer of the blastocyst.
- Correct: Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood filled spaces of the endometruim. These villi obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood.
REF: p. 195 OBJ: Cognitive Level: Comprehension
- An 8-month-pregnant woman asks the nurse, “Does my bahave any antibodies to fight infection?” The most appropriate response the nurse is:
|1.||“Your bahas all the immunoglobulins he will need: IgG, IgM, and IgA.”|
|2.||“Your bawon’t receive any antibodies until he is born and you breastfeed him.”|
|3.||“Your badoes not have any antibodies to fight infection.”|
|4.||“Your bahas IgG and IgM immunoglobulins.”|
- Incorrect: During the third trimester, the only immunoglobulin that crosses the placenta, IgG, provides passive acquired immunity to specific bacterial toxins. The fetus produces IgM the end of the first trimester. IgA immunoglobulins are not produced the baby.
- Incorrect: By the third trimester, the fetus has IgG and IgM. Breastfeeding will supply the bawith IgA immunoglobulins.
- Incorrect: This is not an accurate statement. By the third trimester, the fetus has IgG and IgM.
- Correct: During the third trimester, the only immunoglobulin that crosses the placenta, IgG, provides passive acquired immunity to specific bacterial toxins. The fetus produces IgM the end of the first trimester.
REF: p. 205 OBJ: Cognitive Level: Application
- The fetal concentration of glucose is lower than the glucose level in the maternal blood because of its rapid metabolism the fetus.
ANS: 1 REF: p. 199 OBJ: Cognitive Level: Comprehension
- The measurement of lecithin in relation to sphingomyelin (L/S ratio) is used to determine fetal lung maturity. Identify which ratio below would be considered to be mature.
- Incorrect: This level would indicate immaturity of fetal lungs.
- Incorrect: This level would indicate immaturity of fetal lungs.
- Correct: This indicates a two-to-one ratio of lecithin to sphingomyelin and lung maturity.
- Incorrect: This level would indicate immaturity of fetal lungs.
REF: p. 200 OBJ: Cognitive Level: Knowledge
- Sally is at her first prenatal examination. This is her first child. She asks you, “How does my baget air inside my uterus?” The correct response would be:
|1.||“The baby’s lungs work in utero to exchange oxygen and carbon dioxide.”|
|2.||“The baabsorbs oxygen from your blood system.”|
|3.||“The placenta provides oxygen to the baand excretes carbon dioxide into your bloodstream.”|
|4.||“The placenta delivers oxygen-rich blood through the umbilical artery to the baby’s abdomen.”|
- Incorrect: The fetal lungs do not function for respiratory gas exchange in utero.
- Incorrect: The badoes not simply absorb oxygen from a woman’s blood system. Blood and gas transport occur through the placenta.
- Correct: The placenta functions supplying oxygen and excreting carbon dioxide to the maternal blood stream.
- Incorrect: The placenta delivers oxygen-rich blood through the umbilical vein, not artery.
REF: p. 199 OBJ: Cognitive Level: Application
- ____________________ twins is another term for fraternal twins. These twins may be the same or different sexes and are genetically no more alike than siblings born at different times.
REF: p. 205 OBJ: Cognitive Level: Comprehension
- The capability of the fetus to survive outside the uterus is called ____________________.
REF: p. 200 OBJ: Cognitive Level: Comprehension
- Very fine hairs, called ____________________, appear first at 12 weeks’ gestational age on the fetus’ eyebrows and upper lip. By 20 weeks, they cover the entire body. By 28 weeks, the scalp hair is longer than these fine hairs, which thin and may disappear term gestation.
REF: p. 204 OBJ: Cognitive Level: Comprehension