Description
Maternal Child Nursing Care In Canada 2nd Edition Perry Lowdermilk Test Bank
- ISBN-10:1771720360
- ISBN-13:978-1771720366
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Chapter 09: Preconception, Genetics, Conception, and Fetal Development
Perry: Maternal Child Care Nursing in Canada, 2nd Canadian Edition
MULTIPLE CHOICE
- A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby won’t be affected. What information will the nurse use to formulate a response?
| a. | The odds of having another baby with PKU are very slim. |
| b. | Each baby has a 50% chance of being affected. |
| c. | Males are not affected by PKU. |
| d. | The parents are both carriers so each baby has a 25% chance of being affected. |
ANS: D
The chance is one in four that each child produced by this couple will be affected by PKU disorder. This couple still has an increased likelihood of having a child with PKU. Having one child already with PKU does not guarantee that they will not have another. No correlation exists between gender and inheritance of the disorder, because PKU is an autosomal recessive disorder.
DIF: Cognitive Level: Application REF: p. 184 OBJ: Nursing Process: Planning
- The nurse is providing genetic counselling for an expectant couple who already have a child with trisomy 18. What should the nurse do?
| a. | Tell the couple they need to terminate the pregnancy within 2 to 3 weeks. |
| b. | Explain that the fetus has a 50% chance of having the disorder. |
| c. | Discuss options, including amniocentesis, to determine whether the fetus is affected. |
| d. | Refer the couple to a psychologist for emotional support. |
ANS: C
Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected. The couple should be given information about the likelihood of having another baby with this disorder so that they can make an informed decision. A genetic counsellor is the best source for determining genetic probability ratios. The couple eventually may need emotional support, but the status of the pregnancy must be determined first.
DIF: Cognitive Level: Comprehension REF: p. 182 | p. 185 | p. 192
OBJ: Nursing Process: Planning | Nursing Process: Implementation
- The nurse is assessing the knowledge of new parents with a child born with maple syrup urine disease (MSUD). Which is accurate related to MSUD?
| a. | Both genes of a pair must be abnormal for the disorder to be present. |
| b. | Only one copy of the abnormal gene is required for the disorder to be present. |
| c. | The disorder occurs in males and heterozygous females. |
| d. | The disorder is carried on the X chromosome. |
ANS: A
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. MSUD is not an X-linked dominant disorder. MSUD is not a recessive disorder. MSUD is not an autosomal dominant inheritance disorder.
DIF: Cognitive Level: Comprehension REF: p. 184
OBJ: Nursing Process: Assessment
- During a presentation to obstetrical nurses interested in genetics, what does the genetic nurse identify as the primary factor to consider with genetic testing?
| a. | Anxiety and altered family relationships |
| b. | Accessibility related to the availability of genetic testing |
| c. | High false-positive rates associated with genetic testing |
| d. | Ethnic and socioeconomic disparity associated with genetic testing |
ANS: B
Decisions about genetic testing are shaped by accessibility of available genetic testing. The geographic location where the woman receives prenatal care and social norms are the primary factors to consider. Smaller rural communities in Canada do not offer the array of choices available in larger urban centres. Anxiety and altered family relationships, high false-positive rates, and ethnic and socioeconomic disparity are factors that may be difficulties associated with genetic testing, but they are not risks associated with testing.
DIF: Cognitive Level: Comprehension REF: p. 180
OBJ: Nursing Process: Implementation
- A man’s wife is pregnant for the third time. One child was born with cystic fibrosis and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. What is this type of testing known as?
| a. | Occurrence risk |
| b. | Recurrence risk |
| c. | Predictive testing |
| d. | Predisposition testing |
ANS: B
The couple already has a child with a genetic disease; therefore, they will be given a recurrence risk test. If a couple has not yet had children but are known to be at risk for having children with a genetic disease, they are given an occurrence risk test. Predictive testing is used to clarify the genetic status of an asymptomatic family member. Predisposition testing differs from presymptomatic testing in that a positive result does not indicate 100% risk of a condition developing.
DIF: Cognitive Level: Comprehension REF: p. 186 OBJ: Nursing Process: Planning
- A couple has been counselled for genetic anomalies. They ask you, “What is karyotyping?” The nurse’s response is based on which information related to karyotyping?
| a. | It will provide the status of lung maturity. |
| b. | It is a predictor of normal fetal development. |
| c. | It identifies fetal gender and chromosomal information. |
| d. | It can detect physical deformities. |
ANS: C
Karyotyping provides genetic information such as gender and chromosome structure. The lecithin-to-sphingomyelin (L/S) ratio, not karyotyping, reveals lung maturity. Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word. Furthermore, physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).
DIF: Cognitive Level: Analysis REF: p. 192
OBJ: Nursing Process: Implementation
- In practical terms regarding genetic health care, which should the nurse be aware of?
| a. | Genetic disorders equally affect all socioeconomic backgrounds, races, and ethnic groups. |
| b. | Genetic health care is more concerned with populations than individuals. |
| c. | It is most important to provide emotional support to the family during genetic counselling. |
| d. | Taking genetic histories is only done in large university hospital and tertiary-care centres. |
ANS: C
Nurses should be prepared to help with a variety of stress reactions from a couple facing the possibility of a genetic disorder. Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups. Genetic health care is highly individualized because treatments are based on the phenotypic responses of the individual. Individual nurses at any facility can take a genetic history, although larger facilities may have better support services.
DIF: Cognitive Level: Comprehension REF: p. 179 OBJ: Nursing Process: Planning
- What should nurses be aware of with regard to prenatal genetic testing?
| a. | Integrated prenatal screening can determine risk of carrying a fetus with Down syndrome. |
| b. | Carrier screening tests are used to look for gene mutations of people already showing symptoms of a disease. |
| c. | Predisposition testing predicts with near certainty that symptoms will appear. |
| d. | Presymptomatic testing is used to predict the likelihood of breast cancer. |
ANS: A
Integrated prenatal screening (blood test combined with ultrasound screening) is used to identify risk for the neural tube defect and the specific chromosome abnormality involved in Down syndrome. Carriers of some diseases such as sickle cell disease do not display symptoms. Predisposition testing determines susceptibility such as for breast cancer; presymptomatic testing indicates that, if the gene is present, symptoms are certain to appear.
DIF: Cognitive Level: Knowledge REF: p. 180 OBJ: Nursing Process: Planning
- With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, what should nurses be aware of?
| a. | With a dominant disorder, the likelihood of the second child also having the condition is 100%. |
| b. | An autosomal recessive disease carries a one in eight risk of the second child also having the disorder. |
| c. | Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child. |
| d. | The risk factor remains the same no matter how many affected children are already in the family. |
ANS: D
Each pregnancy is an independent event. The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family. In a dominant disorder the likelihood of recurrence in subsequent children is 50% (one in two). An autosomal recessive disease carries a one in four chance of recurrence. Subsequent children would be at risk only if the mother continued to take drugs; the rate of risk would be difficult to calculate.
DIF: Cognitive Level: Comprehension REF: p. 186 OBJ: Nursing Process: Diagnosis
- What is the term for an individual’s genetic makeup?
| a. | Genotype |
| b. | Phenotype |
| c. | Karyotype |
| d. | Chromotype |
ANS: A
The genotype comprises all the genes the individual can pass on to a future generation. The phenotype is the observable expression of an individual’s genotype. The karyotype is a pictorial analysis of the number, form, and size of an individual’s chromosomes. Genotype refers to an individual’s genetic makeup.
DIF: Cognitive Level: Knowledge REF: p. 181
OBJ: Nursing Process: Assessment
- What should the nurse be aware of with regard to chromosome abnormalities?
| a. | They occur in approximately 10% of newborns. |
| b. | Abnormalities of number are the leading cause of pregnancy loss. |
| c. | Down syndrome is a result of an abnormal chromosome structure. |
| d. | Unbalanced translocation results in a mild abnormality that the child will outgrow. |
ANS: B
Aneuploidy is an abnormality of number that also is the leading genetic cause of intellectual disability. Chromosome abnormalities occur in fewer than 1% of newborns. Down syndrome is the most common form of trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosome structure that often has serious clinical effects.
DIF: Cognitive Level: Comprehension REF: pp. 181-182 OBJ: Nursing Process: Diagnosis
- A woman’s cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. The nurse’s response is based on which information?
| a. | It is unknown when such defects occur. |
| b. | The timing depends on the cause of the defect. |
| c. | They occur between the third and fifth weeks of fetal development. |
| d. | They most often occur in the first 2 weeks of pregnancy. |
ANS: C
The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begin in the third week, and the heart is developmentally complete in the fifth week. “We don’t really know when such defects occur” is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. “They usually occur in the first 2 weeks of development” is an inaccurate statement.
DIF: Cognitive Level: Application REF: p. 188 | Figure 9-4
OBJ: Nursing Process: Evaluation
- A pregnant woman at 25 weeks’ gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. The nurse’s response is based on which information?
| a. | Babies can’t respond to noise at 25 weeks’ gestation. |
| b. | Abrupt noise can cause the aural reflex. |
| c. | Babies respond to extrauterine sound beginning at about 24 weeks of gestation. |
| d. | This is an abnormal finding and should be reported to the health care provider. |
ANS: C
“Babies respond to sound starting at about 24 weeks of gestation” is an accurate statement because fetuses respond to sound by 24 weeks. “That must have been a coincidence; babies can’t respond like that” is inaccurate. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The statement, “Let me know if it happens again; we need to report that to your midwife” is not appropriate; it gives the impression that something is wrong.
DIF: Cognitive Level: Application REF: p. 199 OBJ: Nursing Process: Evaluation
- At approximately how many weeks of gestation does lecithin form on the alveolar surfaces, the eyelids open, and the fetus measure approximately 27 cm crown to rump, and weigh approximately 1100 g?
| a. | 20 weeks |
| b. | 24 weeks |
| c. | 26 weeks |
| d. | 28 weeks |
ANS: D
These are all milestones in human development that occur at approximately 28 weeks.
DIF: Cognitive Level: Knowledge REF: p. 203 | Table 9-1
OBJ: Nursing Process: Assessment
- Where does meconium accumulate as the fetus nears term?
| a. | Fetal intestines |
| b. | Fetal kidneys |
| c. | Amniotic fluid |
| d. | The placenta |
ANS: A
As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium.
DIF: Cognitive Level: Knowledge REF: p. 198
OBJ: Nursing Process: Assessment
- A woman asks the nurse, “What protects my baby’s umbilical cord from being squashed while the baby’s inside of me?” The nurse’s response is based on which information?
| a. | The umbilical cord is surrounded by connective tissue called Wharton jelly. |
| b. | The umbilical cord floats around in blood. |
| c. | Nothing really protects the cord but it is unlikely to be squashed. |
| d. | The umbilical cord is a group of blood vessels that are protected by the placenta. |
ANS: A
“Wharton’s jelly prevents compression of the blood vessels and ensures continued nourishment of your baby” is accurate information. The cord does not float around in blood. The statement “Nothing protects the cord” is not true. The placenta does not protect the umbilical cord; the cord is protected by the surrounding Wharton jelly.
DIF: Cognitive Level: Application REF: p. 193 OBJ: Nursing Process: Planning
- What is responsible for the transportation of oxygen and carbon dioxide to and from the maternal bloodstream?
| a. | Decidua basalis |
| b. | Blastocyst |
| c. | Germ layer |
| d. | Chorionic villi |
ANS: D
Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula. Implantation occurs at this stage. The germ layer is a layer of the blastocyst.
DIF: Cognitive Level: Comprehension REF: p. 191
OBJ: Nursing Process: Assessment
- A woman who is 8 months pregnant asks the nurse, “Does my baby have any antibodies to fight infection?” The nurse’s response is based on which information?
| a. | At 8 months all of the immunoglobulins (Ig) are present. |
| b. | Antibodies are transferred to the baby only during birth. |
| c. | Babies do not have any antibodies to fight infection until after birth. |
| d. | During pregnancy, babies only acquire IgG and IgM. |
ANS: D
During the third trimester, it is only IgG that crosses the placenta; IgG, provides passive acquired immunity to specific bacterial toxins. The fetus produces IgM by the end of the first trimester. So by the third trimester the fetus has IgG and IgM. IgA is not produced by the baby; breastfeeding supplies the baby with IgA.
DIF: Cognitive Level: Application REF: p. 200 OBJ: Nursing Process: Planning
- The measurement of lecithin in relation to sphingomyelin (L/S ratio) is used to determine fetal lung maturity. Which ratio reflects maturity of the lungs?
| a. | 1.4:1 |
| b. | 1.8:1 |
| c. | 2:1 |
| d. | 1:1 |
ANS: C
A ratio of 2:1 indicates a two-to-one ratio of L/S, an indicator of lung maturity. Ratios of 1.4:1, 1.8:1, and 1:1 indicate immaturity of the fetal lungs.
DIF: Cognitive Level: Knowledge REF: p. 196 OBJ: Nursing Process: Diagnosis
- During an initial prenatal appointment, the woman asks the nurse how her baby gets air while in her uterus. The nurse’s response is based on which information?
| a. | The baby’s lungs work in utero to exchange oxygen and carbon dioxide. |
| b. | The baby absorbs oxygen from the mother’s blood system. |
| c. | The placenta provides oxygen to the baby and excretes carbon dioxide into the mother’s bloodstream. |
| d. | The placenta delivers oxygen-rich blood through the umbilical artery to the baby’s abdomen. |
ANS: C
The placenta functions by supplying oxygen and excreting carbon dioxide to the maternal bloodstream. The fetal lungs do not function for respiratory gas exchange in utero. The baby does not simply absorb oxygen from a woman’s blood system. Blood and gas transport occur through the placenta. The placenta delivers oxygen-rich blood through the umbilical vein, not the artery.
DIF: Cognitive Level: Application REF: p. 195 OBJ: Nursing Process: Planning
- Which is the most basic information a maternity nurse should know concerning conception?
| a. | Ova are considered fertile 48 to 72 hours after ovulation. |
| b. | Sperm remain viable in the woman’s reproductive system for an average of 12 to 24 hours. |
| c. | Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. |
| d. | Implantation in the endometrium occurs 6 to 10 days after conception. |
ANS: D
After implantation, the endometrium is called the decidua. Ova are considered fertile for about 24 hours after ovulation. Sperm remain viable in the woman’s reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.
DIF: Cognitive Level: Knowledge REF: p. 190
OBJ: Nursing Process: Assessment
- A maternity nurse should be aware of which fact about the amniotic fluid?
| a. | It serves as a source of oral fluid and a repository for waste from the fetus. |
| b. | The volume remains about the same throughout the term of a healthy pregnancy. |
| c. | A volume of less than 300 mL is associated with gastrointestinal malformations. |
| d. | A volume of more than 2 L is associated with fetal renal abnormalities. |
ANS: A
Amniotic fluid serves as a source of oral fluid and a repository for waste from the fetus, and it cushions the fetus and helps maintain a constant body temperature. The volume of amniotic fluid changes constantly. Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.
DIF: Cognitive Level: Knowledge REF: p. 192
OBJ: Nursing Process: Assessment
- With regard to the structure and function of the placenta, the maternity nurse should be aware of which information?
| a. | As the placenta widens, it gradually thins to allow easier passage of air and nutrients. |
| b. | As one of its early functions, the placenta acts as an endocrine gland. |
| c. | The placenta is able to keep out most potentially toxic substances. |
| d. | Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing. |
ANS: B
The placenta produces four hormones necessary to maintain the pregnancy. The placenta widens until week 20 and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side.
DIF: Cognitive Level: Comprehension REF: p. 194
OBJ: Nursing Process: Assessment
- Which should the nurse be aware of with regard to the development of the respiratory system?
| a. | The respiratory system does not begin developing until after the embryonic stage. |
| b. | The infant’s lungs are considered mature when the lecithin/sphingomyelin (L/S) ratio is 1:1, at about 32 weeks. |
| c. | Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity. |
| d. | Fetal respiratory movements are not visible on ultrasound scans until at least 16 weeks. |
ANS: C
A reduction in placental blood flow stresses the fetus, increases blood levels of corticosteroids, and thus accelerates lung maturity. Development of the respiratory system begins during the embryonic phase and continues into childhood. The infant’s lungs are mature when the L/S ratio is 2:1, at about 35 weeks. Lung movements have been seen on ultrasound scans at 11 weeks.
DIF: Cognitive Level: Knowledge REF: p. 196 OBJ: Nursing Process: Diagnosis
- What should the nurse be able to tell parents when they have questions about multiple births?
| a. | Multiple births are increasing because of the use of fertility drugs. |
| b. | Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. |
| c. | Identical twins are more common in White families. |
| d. | Fraternal twins are same gender, usually male. |
ANS: A
Multiple births and twinning are on the rise given the use of fertility drugs and delayed child-bearing. Conjoined twins are monozygotic; they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference; fraternal twins are more common among Black women. Fraternal twins can be of different gender or the same gender. Identical twins are the same gender.
DIF: Cognitive Level: Knowledge REF: p. 204 OBJ: Nursing Process: Planning
- The nurse caring for a pregnant patient knows that her health teaching regarding fetal circulation has been effective when the patient reports that she has been sleeping in which position?
| a. | In a side-lying position |
| b. | On her back with a pillow under her knees |
| c. | With the head of the bed elevated |
| d. | On her abdomen |
ANS: A
Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, thereby enhancing blood flow to the fetus. However, it is now known that either side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, blood return to the right atrium will be diminished. Although this position is recommended and ideal for later in pregnancy, the woman must still maintain a lateral tilt to the pelvis to avoid compression of the vena cava. Many women will find this position uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus.
DIF: Cognitive Level: Analysis REF: pp. 195-196 OBJ: Nursing Process: Evaluation
- At what age is the embryo or fetus less susceptible to teratogens?
| a. | 4 weeks |
| b. | 6 weeks |
| c. | 8 weeks |
| d. | 10 weeks |
ANS: D
The fetus is less susceptible to teratogens than the embryo. The embryo at 4 weeks is more susceptible than the fetus at 10 weeks. The embryo at 6 weeks is more susceptible than the fetus at 10 weeks. The embryo at 8 weeks is more susceptible than the fetus at 10 weeks.
DIF: Cognitive Level: Knowledge REF: p. 196 OBJ: Nursing Process: Planning
MULTIPLE RESPONSE
- Which are known to delay fetal lung maturity? Select all that apply. Express answer in small letters, followed by a comma and a space—e.g., a, b, c.
| a. | Maternal hypertension |
| b. | Gestational diabetes |
| c. | Chronic glomerulonephritis |
| d. | Infection |
| e. | Maternal corticosteroid use |
| f. | Epilepsy |
ANS: B, C
Gestational diabetes and chronic glomerulonephritis can delay fetal lung maturity. Certain maternal conditions that cause decreased maternal placental blood flow, such as maternal hypertension, placental dysfunction, infection, or corticosteroid use, accelerate lung maturity.
DIF: Cognitive Level: Knowledge REF: p. 196
OBJ: Nursing Process: Assessment
- Which are autosomal dominant disorders?
| a. | Myotonic dystrophy |
| b. | PKU |
| c. | Marfan syndrome |
| d. | Dwarfism |
| e. | Maple syrup urine disease |
| f. | Cystic fibrosis |
ANS: A, C, D
Examples of autosomal dominant disorders are Marfan syndrome, neurofibromatosis, myotonic dystrophy, Stickler syndrome, Treacher Collins syndrome, and achondroplasia (dwarfism).
DIF: Cognitive Level: Application REF: p. 184 OBJ: Nursing Process: Diagnosis
