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Tkonrye Tkonrye
wrote...
Posts: 554
Rep: 1 0
6 years ago
A nurse completes pedigree charts for clients at a community health center. Which diagnosis should the nurse refer for carrier genetic testing? (Select all that apply.)
 
  a. Huntington disease
  b. Breast cancer
  c. Hemophilia
  d. Colorectal cancer
  e. Sickle cell disease
  f.
  Cystic fibrosis

Question 2

A nurse cares for a client who recently completed genetic testing that revealed that she has a BRCA1 gene mutation. Which actions should the nurse take next? (Select all that apply.)
 
  a. Discuss potential risks for other members of her family.
  b. Assist the client to make a plan for prevention and risk reduction.
  c. Disclose the information to the medical insurance company.
  d. Recommend the client complete weekly breast self-examinations.
  e. Assess the client's response to the test results.
  f.
  Encourage support by sharing the results with family members.

Question 3

A nurse cares for a client who recently completed genetic testing and received a negative result. The client states, I feel guilty because so many of my family members are carriers of this disease and I am not. How should the nurse respond?
 
  a. You are not genetically predisposed for this disease but you could still become ill. Let's discuss a plan for prevention.
  b. Since many of your family members are carriers, you should undergo further testing to verify the results are accurate.
  c. We usually encourage clients to participate in counseling after receiving test results. Can I arrange this for you?
  d. It is normal to feel this way. I think you should share this news with your family so that they can support you.

Question 4

A nurse cares for a pregnant client who has a family history of sickle cell disease. The client is unsure if she wants to participate in genetic testing. What action should the nurse take?
 
  a. Provide information about the risks and benefits of genetic testing.
  b. Empathize with the client and share a personal story about a hereditary disorder.
  c. Teach the client that early detection can minimize transmission to the fetus.
  d. Advocate for the client and her baby by encouraging genetic testing.

Question 5

A nurse cares for a client who has a specific mutation in the a1AT (alpha1-antitrypsin) gene. Which action should the nurse take?
 
  a. Teach the client to perform monthly breast self-examinations and schedule an annual mammogram.
  b. Support the client when she shares test results and encourages family members to be screened for cancer.
  c. Advise the client to limit exposure to secondhand smoke and other respiratory irritants.
  d. Obtain a complete health history to identify other genetic problems associated with this gene mutation.

Question 6

A nurse cares for a client who has a genetic mutation that increases the risk for colon cancer. The client states that he does not want any family to know about this result. How should the nurse respond?
 
  a. It is required by law that you inform your siblings and children about this result so that they also can be tested and monitored for colon cancer.
  b. It is not necessary to tell your siblings because they are adults, but you should tell your children so that they can be tested before they decide to have children of their own.
  c. It is not required that you tell anyone about this result. However, your siblings and children may also be at risk for colon cancer and this information might help them.
  d. It is your decision to determine with whom, if anyone, you discuss this test result. However, you may be held liable if you withhold this information and a family member gets colon cancer.
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Replies
wrote...
6 years ago
The answer to question 1

ANS: C, E, F
Of the disease processes listed, the ones that would make the client a candidate for carrier genetic testing would be hemophilia, sickle cell disease, and cystic fibrosis. Although Huntington disease, breast cancer, and colorectal cancer all have genetic components, there is no evidence that carrier genetic testing would be beneficial in diseases such as these.

The answer to question 2

ANS: A, B, E
The medical-surgical nurse can assess the client's response to the test results, discuss potential risks for other family members, encourage genetic counseling, and assist the client to make a plan for prevention, risk reduction, and early detection. For some positive genetic test results, such as having a BRCA1 gene mutation, the risk for developing breast cancer is high but is not a certainty. Because the risk is high, the client should have a plan for prevention and risk reduction. One form of prevention is early detection. Breast self-examinations may be helpful when performed monthly, but those performed every week may not be useful, especially around the time of menses. A client who tests positive for a BRCA1 mutation should have at least yearly mammograms and ovarian ultrasounds to detect cancer at an early stage, when it is more easily cured. Owing to confidentiality, the nurse would never reveal any information about a client to an insurance company or family members without the client's permission.

The answer to question 3

ANS: C
Clients who have negative genetic test results need counseling and support. Some clients may have an unrealistic view of what a negative result means for their general health. Others may feel guilty that they were spared when some family members were not. The client will not be symptomatic if he is not a carrier of the disease. A second round of testing is not recommended, because false-negatives are rare with this type of testing. It is the client's choice to reveal test results to family members; the nurse should not encourage him to do this.

The answer to question 4

ANS: A
Genetic counseling is to be nondirective. The nurse should provide as much information as possible about the risks and benefits but should not influence the client's decision to test or not test. Once the client has made a decision, the nurse should support the client in that decision. Carrier testing will determine if a client without symptoms has an allele for a recessive disorder that could be transmitted to his or her child. Genetic testing will not minimize transmission of the disorder.

The answer to question 5

ANS: C
The a1AT gene mutation increases risk for developing early-onset emphysema. Clients should be advised to limit exposure to smoke and other respiratory irritants as a means of decreasing environmental influences that may aggravate an early onset of emphysema. This gene mutation does not promote cancer, nor does it occur with other identified genetic problems. The BRCA1 gene mutation gives the client a higher risk for developing breast cancer.

The answer to question 6

ANS: C
This situation represents an ethical dilemma. It is the client's decision whether to disclose the information. However, the information can affect others in the client's family. The law does not require the client to tell family members about the results, nor can the client be held liable for not telling them. The nurse may consider it ethically correct for the client to tell family members so that they can take action to prevent the development of cancer, but the nurse must respect the client's decision.
Tkonrye Author
wrote...
6 years ago
I know you spent a lot of time finding this because I swear it wasn't in my textbook
wrote...
6 years ago
You're partially right, it's found midway in the chapter, but not at all easy to find. Good luck with the rest
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