Medical Surgical Nursing 2nd Edition By Osborn Wraa Watson A+

$35.00
Medical Surgical Nursing 2nd Edition By Osborn Wraa Watson A+

Medical Surgical Nursing 2nd Edition By Osborn Wraa Watson A+

$35.00
Medical Surgical Nursing 2nd Edition By Osborn Wraa Watson A+

While conducting a health assessment, the nurse documents a patient’s response under the heading “chief complaint.” Which part of the assessment is the nurse conducting?

  1. History of present illness
  2. Family history
  3. Psychosocial history
  4. Past medical history

Correct Answer: 1

Rationale 1: The history of the present illness includes information about what brought the patient to the health care provider. The reason is usually written verbatim in the health record and often becomes the chief complaint.

Rationale 2: The patient’s chief complaint is not part of the family history.

Rationale 3: The patient’s chief complaint is not part of the psychosocial history.

Rationale 4: The patient’s chief complaint is not part of the past medical history.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-1

Question 2

Type: MCSA

A patient comes to the emergency department and states, “I am having chest pain and I feel short of breath.” How is the data the patient has just given the nurse classified?

  1. Nonspecific
  2. Objective
  3. Factual
  4. Subjective

Correct Answer: 4

Rationale 1: Nonspecific is not a term used to describe types of assessment data.

Rationale 2: Objective data is information collected when the nurse uses the senses: observation, palpation, auscultation, percussion, and smell.

Rationale 3: Factual is not a term used to describe types of assessment data.

Rationale 4: Subjective data is information the patient provides to the nurse.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-3

Question 3

Type: MCSA

The nurse has completed the collection and analysis of data from a patient assessment. What is the nurse’s next action?

  1. Evaluate outcomes from care.
  2. Plan care.
  3. Determine patient care goals.
  4. Formulate nursing diagnoses.

Correct Answer: 4

Rationale 1: Evaluation occurs after care is implemented.

Rationale 2: Planning occurs later in the nursing process.

Rationale 3: Determining patient goals is a later step of the nursing process.

Rationale 4: Once data is collected, it is used to formulate nursing diagnoses, which is the next step of the nursing process.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-2

Question 4

Type: MCSA

The nurse asks the patient, “What brings you to the hospital today?” What is the nurse’s rationale for using this type of question?

  1. It acknowledges agreement between the patient and the nurse.
  2. It elicits specific information.
  3. It is useful for introducing a subject in general terms.
  4. It helps to clarify information.

Correct Answer: 3

Rationale 1: The question does not acknowledge agreement between the patient and the nurse. The nurse’s summary at the end of the interview acknowledges agreement.

Rationale 2: Direct questions are used to elicit specific information.

Rationale 3: The question is an open-ended question and asks for narrative information by stating the topic in general terms. It is used to introduce a topic.

Rationale 4: The question does not help to clarify information.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-3

Question 5

Type: MCSA

While conducting a health history, the nurse nods her head as the patient is talking. What is the nurse’s primary rationale for this action?

  1. It conveys acknowledgment of the patient’s feelings.
  2. It helps to reduce the patient’s anxiety level.
  3. It encourages the patient to continue talking.
  4. It allows the nurse time to observe the patient’s nonverbal cues.

Correct Answer: 3

Rationale 1: Empathy is used to acknowledge the patient’s feelings.

Rationale 2: Explanation will reduce the patient’s anxiety level.

Rationale 3: Nodding the head encourages the patient to tell the nurse more and is considered facilitation.

Rationale 4: The use of silence will allow the nurse time to observe the patient’s nonverbal cues.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-3

Question 6

Type: MCSA

A patient tells the nurse that he has a history of back pain that is controlled with yoga and herbal supplements. How would the nurse document this information?

  1. The patient does not believe in Western medicine.
  2. The patient has strong spiritual beliefs.
  3. The patient uses some alternative forms of medicine to treat illness.
  4. The patient uses stress reduction techniques to control back pain.

Correct Answer: 3

Rationale 1: Western medicine is the type of health care traditionally provided in the United States and includes diagnostic testing, treatments, and medications. There is no indication that the patient does not believe in Western medicine.

Rationale 2: The strength of the patient’s spiritual beliefs cannot be assessed by this information alone.

Rationale 3: The use of herbal supplements to relieve back pain is a form of complementary or alternative medicine. The nurse must assess this practice, as some “natural cures” are ineffective and some can interfere with prescribed medications.

Rationale 4: There is not enough information to make this statement. The patient may use yoga as a strengthening exercise for back muscles. The herbs may not be taken for stress reduction.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 06-01

Question 7

Type: MCSA

The nurse introduces herself and shakes the patient’s hand, then sits so as to maintain eye contact during the health interview. What do the nurse’s actions demonstrate?

  1. Facilitation
  2. Negative nonverbal messages
  3. Positive nonverbal messages
  4. Empathy

Correct Answer: 3

Rationale 1: Facilitation would occur if the nurse nodded the head to encourage the patient to continue talking.

Rationale 2: Negative nonverbal messages include tense posture, yawning, and avoiding eye contact. The nurse’s actions are not negative.

Rationale 3: Positive nonverbal messages enhance the relationship with the patient and include eye contact and equal-status seating.

Rationale 4: Empathy is acknowledging a patient’s feelings with a statement of understanding.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-3

Question 8

Type: MCSA

During the health history, a patient tells the nurse that she is in an abusive relationship and is fearful of getting hurt if her husband finds out that she told the nurse. Which response by the nurse is most appropriate for this patient?

  1. “Don’t worry. They only strike back when they are angry.”
  2. “Are you saying that you are in danger?”
  3. “I would get an attorney if I were you.”
  4. “Remember, what goes around comes around.”

Correct Answer: 2

Rationale 1: This answer does not promote the patient’s health.

Rationale 2: The nurse needs to clarify what the patient is explaining, and the best response would be to clarify if the patient is saying she is in danger.

Rationale 3: The nurse should not offer legal advice to the patient.

Rationale 4: This statement dismisses the patient’s concern for her safety and does not promote her health.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-3

Question 9

Type: MCSA

During an assessment, the patient describes shoulder pain. The nurse responds, “So, you have this shoulder pain when you eat fried foods or ice cream, is that correct?” The nurse is using which interview technique?

  1. Facilitation
  2. Empathy
  3. Interpretation
  4. Summary

Correct Answer: 3

Rationale 1: Facilitation is a technique that would encourage the patient to continue talking.

Rationale 2: Empathy acknowledges the patient’s feelings with a statement of understanding to help the patient feel accepted.

Rationale 3: Interpretation links events or implies a cause, which is what the nurse is doing when responding to this patient.

Rationale 4: Summary occurs at the end of the interview, when the nurse summarizes the perception of the patient’s health problem from the information gained during the interview.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-3

Question 10

Type: MCSA

The nurse notices a patient has a strong, foul body odor. The patient tells the nurse he has trouble getting in and out of the bathtub. Which areas of the physical assessment does this information address?

  1. Behavior and pain
  2. Nutritional assessment, mental status, and behavior
  3. Physical appearance, height, and weight
  4. Functional assessment, physical appearance, and mobility

Correct Answer: 4

Rationale 1: The patient did not say that his inability to use the bathtub was associated with pain, and the nurse should be careful not to make this assumption.

Rationale 2: An inability to use the bathtub does not speak specifically to nutrition, mental status, or behavior.

Rationale 3: The inability to use the bathtub does affect physical appearance. The patient did not mention that the tub was too small or that his weight made using it difficult, so these issues cannot currently be considered a factor. The nurse must be careful not to make assumptions without data.

Rationale 4: The patient states difficulty with using a bathtub, which provides information relevant to functional assessment, physical appearance, and mobility.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-4

Question 11

Type: MCSA

Prior to palpating the abdomen of a patient with several skin lesions, the nurse puts on a pair of gloves. The patient asks, “What are the gloves for?” Which is the best response the nurse can give the patient?

  1. “Gloves are considered a standard precaution to provide protection to the health care provider during an exam.”
  2. “I don’t want to catch anything from you.”
  3. “I prefer to wear gloves when touching people.”
  4. “The gloves help me to grip my equipment better.”

Correct Answer: 1

Rationale 1: The nurse needs to use standard precautions throughout the entire physical examination and should explain this to the patient. Gloves are particularly important when skin lesions are present.

Rationale 2: The nurse should not make the patient feel “dirty” or “bad” when answering this question.

Rationale 3: This should not be the reason the nurse is wearing gloves and is not an appropriate answer.

Rationale 4: This statement is not accurate.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-4

Question 12

Type: MCMA

While performing percussion in a physical examination, the nurse elicits dullness. Which structure is the nurse likely percussing?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Intestines
  2. Lungs
  3. Pelvic bone
  4. Liver
  5. Kidney

Correct Answer: 4,5

Rationale 1: Tympany is the percussion sound heard over air-filled intestines.

Rationale 2: Resonance is the percussion sound heard over normal lungs.

Rationale 3: Flatness is the percussion sound heard over muscle and bone.

Rationale 4: Dullness is the percussion sound heard over large, solid organs such as the liver.

Rationale 5: Dullness is the percussion sound heard over large, solid organs such as the kidney.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-4

Question 13

Type: MCSA

A patient in the unit has a blood pressure of 55/30, is lethargic, has slurred speech, and is unable to get back to bed from the bathroom. The nurse calls for a rapid response team. Which component of critical thinking is the nurse exhibiting?

  1. Analysis of situation, distinguishing normal from abnormal
  2. Selection of alternative by developing outcomes and plans
  3. Collection of information, subjective and objective
  4. Evaluation of situation, determination of outcomes achieved

Correct Answer: 1

Rationale 1: Analysis of the situation is the second component of critical thinking. This component includes the ability to distinguish normal from abnormal.

Rationale 2: Selection of alternatives is the fourth step in the critical thinking process and is used when developing outcomes and plans.

Rationale 3: Collection of information is the first step in the critical thinking process and is used during the health assessment.

Rationale 4: Evaluation of the situation is the last step of the critical thinking process and is used to determine if the expected outcomes have been achieved.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5

Question 14

Type: MCSA

The nurse and a patient are discussing a variety of options that may help alleviate a health problem. The nurse and patient are involved in which step of the critical thinking process?

  1. Evaluation
  2. Collection of information
  3. Generation of alternatives
  4. Analysis of the situation

Correct Answer: 3

Rationale 1: Evaluation is the last step of the process and is done to determine whether the expected outcomes have been achieved.

Rationale 2: Collection of information begins with the interview and continues throughout the entire health assessment.

Rationale 3: Generation of alternatives occurs when options are identified and priorities are established. The nurse and patient work together to discuss the options so the patient can make an informed decision.

Rationale 4: Analysis of the situation follows the collection of information and helps distinguish normal from abnormal findings.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5

Question 15

Type: MCMA

The nurse is reviewing the outcomes of a patient’s plan of care. Which portions of the critical thinking process are used in this evaluation?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Revision of cues
  2. Generation of alternatives
  3. Analysis of the situation
  4. Selection of alternatives
  5. Collection of information

Correct Answer: 3,4,5

Rationale 1: Cues are bits of information that may hint at the possibility of a health problem. The cues are static and cannot be revised.

Rationale 2: Each step of the critical thinking process is used in evaluation. The nurse may need to generate new alternatives to address unmet or undesirable outcomes.

Rationale 3: Each step of the critical thinking process is used in evaluation. The nurse reanalyzes the situation to see if any omissions or misinterpretations have occurred.

Rationale 4: Each step of the critical thinking process is used in evaluation. The nurse uses critical thinking to determine if the alternatives selected were appropriate and if any omissions occurred.

Rationale 5: Each step of the critical thinking process is used in evaluation. The nurse uses critical thinking to determine if all pertinent information was collected and if any misinterpretation occurred.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-5

Question 16

Type: FIB

A 54-year-old patient reports that she smokes a pack and a half of cigarettes daily and has been smoking since she was 16 years old. The nurse would record a smoking history of ______ pack-years.

Standard Text:

Correct Answer: 57

Rationale : This patient has been smoking for 38 years (54-16). 38 × 1.5 = 57 pack-years.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-1

Question 17

Type: MCMA

The nurse is using the technique of inspection during a patient’s physical examination. Which findings are possible using this technique?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The patient’s left leg is larger than the right leg.
  2. The patient’s abdomen is scaphoid.
  3. The patient has a strong radial pulse.
  4. The patient has difficulty extending the right arm above the head.
  5. The patient has periorbital edema.

Correct Answer: 1,2,4,5

Rationale 1: The nurse can see the differences in size using inspection.

Rationale 2: The nurse can see the contours of the abdomen using inspection.

Rationale 3: To assess the radial pulse, the nurse must use palpation.

Rationale 4: Difficulty in movement can be assessed through inspection.

Rationale 5: Edema can be assessed through inspection, although it must be graded through palpation.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-4

Question 18

Type: MCMA

The nurse is preparing to use auscultation as part of a patient’s physical examination. Which techniques should the nurse use?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Pressing the bell of the stethoscope firmly on the skin to hear muffled tones
  2. Using the diaphragm of the stethoscope to hear normal lung sounds
  3. Placing the diaphragm of the stethoscope firmly against the patient’s gown
  4. Focusing on one sound at a time
  5. Using the bell of the stethoscope to hear low-pitched sounds

Correct Answer: 2,4,5

Rationale 1: The bell of the stethoscope becomes a diaphragm when pressed firmly on the skin. The skin under the bell stretches, creating a surface that reduces audible vibratory sensations.

Rationale 2: The diaphragm of the stethoscope is best for hearing high-pitched sounds such as normal lung sounds.

Rationale 3: The stethoscope should be placed on bare skin. The patient’s gown or bed sheets will produce sounds that interfere with body sounds.

Rationale 4: A variety of sounds can be heard when the nurse listens at each auscultatory landmark. The nurse should focus on one sound at a time.

Rationale 5: The bell is the best side of the stethoscope for hearing low-pitched sounds such as heart murmurs.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 06-04

Question 19

Type: MCMA

The nurse is using blunt percussion to assess a patient who was involved in a motor vehicle accident. The nurse would use this technique to assess for injury to which organs?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Kidney
  2. Liver
  3. Lungs
  4. Bladder
  5. Heart

Correct Answer: 1,2

Rationale 1: Blunt percussion is often used as a quick screen for inflammation or damage to the kidney.

Rationale 2: Blunt percussion over the liver that elicits pain would indicate injury.

Rationale 3: Blunt percussion is not used to assess the lungs.

Rationale 4: Indirect percussion is used to assess the bladder.

Rationale 5: Blunt percussion is not used to assess the heart.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-4

Question 20

Type: MCSA

Using critical thinking, the nurse assesses that a patient is not a reliable historian. How should the nurse proceed?

  1. Stop the assessment because all data is invalid.
  2. Document that the patient is not answering questions truthfully.
  3. Ask different questions to assess the same information.
  4. Document the information just as the patient reports it.

Correct Answer: 3

Rationale 1: There are many parts of assessment that do not depend on the patient being an accurate historian.

Rationale 2: Being an unreliable historian does not mean that the patient is not truthful. In some cases it indicates that the patient has memory or hearing issues.

Rationale 3: The nurse can assess information in a variety of ways. Asking different questions to elicit information is a valid technique.

Rationale 4: The nurse should not taint the data set by recording obviously inaccurate data. Further attempts to verify data should be taken.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-5

Osborn, Medical-Surgical Nursing, 2e
Chapter 07

Question 1

Type: MCSA

A patient tells the nurse that she does not want to pass on a genetic disorder to any future children. What is the nurse’s most accurate response?

  1. “A complete genetic study could help guide you in your decision making.”
  2. “I suppose, then, that you are not going to have any children.”
  3. “Adoption is always a possibility.”
  4. “Just because the disease is genetic doesn’t mean your children will inherit it.”

Correct Answer: 1

Rationale 1: Findings from genetic research can be used by patients and family members to improve their own health and prevent illness.

Rationale 2: It is premature to suggest refraining from having children until a genetic study is completed.

Rationale 3: It is premature to suggest adoption until a genetic study is completed.

Rationale 4: This may be true, but it does not help to allay the patient’s concerns. Additional intervention is indicated.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-1

Question 2

Type: MCSA

A patient tells the nurse that she is genetically predisposed to type 2 diabetes. The patient is hypertensive and smokes a pack of cigarettes daily. What information should the nurse provide for this patient?

  1. “Maintaining a healthy weight and activity level will help you avoid type 2 diabetes.”
  2. “Unfortunately, you are probably predestined to develop type 2 diabetes.”
  3. “You probably need to begin monitoring your blood glucose levels daily.”
  4. “The risk of developing diabetes is several years away, and you have other health problems to consider now.”

Correct Answer: 1

Rationale 1: The best way for this patient to avoid illness is to maintain a healthy weight and activity level.

Rationale 2: A genetic predisposition does not guarantee the disease will develop.

Rationale 3: Daily monitoring of blood glucose levels is not indicated for this patient.

Rationale 4: It is important to take action to prevent disease and not wait for the disease to manifest.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-1

Question 3

Type: MCSA

The nurse is conducting a class for expectant parents who need genetic counseling. Which statement by a parent would indicate the need for further education?

  1. “The reason men and women are so different from one another is that none of their chromosomes are alike.”
  2. “Half of the sets of chromosomes come from the mother and the other half come from the father.”
  3. “The 23rd pair of chromosomes will determine if our child will be male or female.”
  4. “One Y chromosome and one X chromosome will produce a male child.”

Correct Answer: 1

Rationale 1: The first 22 pairs of chromosomes are alike in males and females.

Rationale 2: One copy, or half of the complete set of 46 chromosomes, is inherited from the mother, and the other copy is inherited from the father.

Rationale 3: The 23rd pair, the sex chromosomes, determines an individual’s gender.

Rationale 4: A female has two copies of the X chromosome and a male has one X chromosome and a Y chromosome. These X and Y chromosomes are known as sex chromosomes.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7-2

Question 4

Type: MCSA

At the conclusion of genetic testing, a patient learns that he has a predisposition for developing cardiovascular disease at a young age. Which instruction should the nurse provide this patient?

  1. “This information can help guide you to make lifestyle changes to reduce your chances of developing cardiovascular disease.”
  2. “At least you know now that you will need cardiac bypass surgery.”
  3. “As you are likely to develop the disease early in life, enjoy your life as much as possible now.”
  4. “I would not place too much emphasis on these test results, as most of the time they are inconclusive.”

Correct Answer: 1

Rationale 1: One benefit of genetic testing is that it can help patients reduce their chances of developing particular diseases through preventive measures and lifestyle adaptations.

Rationale 2: The nurse has no way of knowing if the patient will need cardiac bypass surgery.

Rationale 3: Having a predisposition does not guarantee the patient will develop the disease.

Rationale 4: The nurse should not minimize the importance of the genetic testing results.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-3

Question 5

Type: MCSA

A patient is concerned about transmitting genetic illnesses to any future children. What can the nurse do initially to help the patient determine which diseases might be transmitted?

  1. Work with the patient to complete a pedigree.
  2. Conduct a health promotion assessment.
  3. Schedule a complete genetic analysis.
  4. Refer the patient to a geneticist for diagnosis.

Correct Answer: 1

Rationale 1: A pedigree is a pictorial representation or diagram of the medical history of a family that typically includes three generations. The finished pedigree presents a family’s medical data and biologic relationships at a glance.

Rationale 2: A health promotion assessment will not provide information regarding the patient’s risk for passing on genetic illnesses to future children.

Rationale 3: There are steps the nurse should take before this analysis is scheduled.

Rationale 4: There are steps the nurse should complete before referring the patient to a geneticist.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7-6

Question 6

Type: MCSA

A patient has been told that her unborn child has Down syndrome. Which information will the nurse include when teaching the patient about the etiology of this disorder?

  1. “Down syndrome is the most common type of trisomy, which occurs when there is an extra chromosome.”
  2. “Most Down syndrome is caused by monosomy.”
  3. “Down syndrome occurs as a result of breaks in chromosomes called translocations.”
  4. “Deletions or loss of part of a chromosome is a common cause of Down syndrome.”

Correct Answer: 1

Rationale 1: Trisomy refers to the presence of a third or extra chromosome instead of the normal pair of a particular chromosome. The most common type of trisomy in infants is trisomy 21 or Down syndrome.

Rationale 2: Monosomy refers to the presence of only one chromosome instead of the normal pair of chromosomes. It is not the cause of Down syndrome.

Rationale 3: Translocations occur when there are breaks in two or more chromosomes with reattachments in new combinations. This is not the etiology of Down syndrome.

Rationale 4: Structural rearrangements of chromosomes may result from deletions or loss of a chromosome segment or piece. This is not the etiology of Down syndrome.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 07-05

Question 7

Type: MCSA

The mother of a child with cystic fibrosis says, “No one in our family has ever had cystic fibrosis. Why did it suddenly appear in my child?” What information should the nurse offer this mother?

  1. “While all people carry the gene for cystic fibrosis, those who develop the disease have a mutation in that gene.”
  2. “A small percentage of the general population carries the gene for cystic fibrosis. If two carriers have children, 25% of those children will develop the disease.”
  3. “One in four people carries the gene for cystic fibrosis. If two carriers have children, 25% of those children will develop the disease.”
  4. “Some people carry the gene for cystic fibrosis. Of those carriers, one in four will develop the disease.”

Correct Answer: 1

Rationale 1: Every individual carries the cystic fibrosis transference regulator (CTFR) gene. Those who develop the disease have a mutation in that gene.

Rationale 2: Every individual carries the cystic fibrosis transference regulator (CTFR) gene.

Rationale 3: Every individual carries the cystic fibrosis transference regulator (CTFR) gene.

Rationale 4: Every individual carries the cystic fibrosis transference regulator (CTFR) gene. Those who develop the disease have a mutation in that gene.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7-4

Question 8

Type: MCSA

At the completion of genetic testing, it has been determined that a patient’s baby will have Down syndrome. What should the nurse say to the patient after learning this information?

  1. “I realize that this news is difficult for you. Is there anything I can do to help you at this time?”
  2. “It’s not too late to consider ending the pregnancy.”
  3. “You are young enough to be able to handle the baby’s challenges.”
  4. “It does not matter if the baby has problems; all life is precious.”

Correct Answer: 1

Rationale 1: When supporting a pregnant patient who learns that her baby has Down syndrome, the best response by the nurse would be to acknowledge that the news is difficult and offer to help the patient.

Rationale 2: The nurse should not suggest that the patient terminate the pregnancy.

Rationale 3: The assumption that the patient will be able to handle the baby’s health condition just because she is young is dismissive of the very real challenges the baby will present.

Rationale 4: Stating that all life is precious is judgmental and should be avoided by the nurse.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-6

Question 9

Type: MCSA

A patient planning to be married tells the nurse that she has a strong family history of Huntington’s chorea but does not plan to let her fiancé know. How should the nurse respond?

  1. “Is there any reason you do not want your fiancé to know about your genetic illness?”
  2. “It is probably best that he is not aware of the disease.”
  3. “Are you afraid he will not want to marry you if he knows?”
  4. “There are worse disease processes than Huntington’s chorea.”

Correct Answer: 1

Rationale 1: The nurse needs to support the patient in ethical and social issues. The best response would be to try to discover the patient’s reason for wanting to keep her genetic illness a secret.

Rationale 2: Agreeing that the fiancé should not be made aware would be an inappropriate response.

Rationale 3: Suggesting that the fiancé might not want to marry the patient if he was aware of the genetic disease is an inappropriate response.

Rationale 4: The nurse should not make this judgment about the patient’s illness.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-6

Question 10

Type: MCSA

A patient planning to have genetic testing prior to having children tells the nurse that she is fearful that people will learn about the testing and the results. How should the nurse respond to this concern?

  1. “The results of the tests are confidential, and no one can see them without your permission.”
  2. “Most insurance companies will want the results before paying for the tests.”
  3. “The results will be available to anyone who reviews your medical record.”
  4. “The doctor will most likely use the results when planning care and treatment for other patients with the same genetic disorder.”

Correct Answer: 1

Rationale 1: The nurse should explain that the results of genetic testing are confidential.

Rationale 2: Insurance companies do not need the results before paying for the tests.

Rationale 3: The results are confidential and not accessible by anyone who reviews the patient’s medical record.

Rationale 4: The patient’s physician cannot use the test results for this purpose.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-6

Question 11

Type: MCSA

A patient is having difficulty achieving adequate anticoagulation with prescribed doses of warfarin. What information should the nurse offer this patient?

  1. “Some people metabolize medications differently because of their genetic makeup.”
  2. “You are probably not taking the medication correctly.”
  3. “There must be something you are eating that is interfering with the drug.”
  4. “Something in your lifestyle is interfering with the action of the medication.”

Correct Answer: 1

Rationale 1: One use of genetic testing involves predicting or studying the patient’s response to particular medications.

Rationale 2: There is no evidence that the patient is not taking the medication correctly.

Rationale 3: There could be a dietary component influencing action of warfarin, but this would be unlikely to result in a total inability to achieve adequate anticoagulation.

Rationale 4: An analysis of the patient’s lifestyle will not help determine why successful anticoagulation has not been achieved.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7-7

Question 12

Type: MCSA

A baby is born with a genetic disorder that did not affect either of the parents. What would the nurse deduce about this situation?

  1. The mother is the carrier of the disorder.
  2. The father is the carrier of the disorder.
  3. The father is not the biological father of the baby.
  4. Both parents are carriers of the disorder.

Correct Answer: 4

Rationale 1: If only one parent was affected, the child would not be born with the disorder but simply be a carrier as well.

Rationale 2: If only one parent was affected, the child would not be born with the disorder but simply be a carrier as well.

Rationale 3: There is no evidence to contradict the father’s paternity.

Rationale 4: A child born with a recessive condition has inherited one altered gene from the mother and one from the father. In most cases neither parent is affected; therefore, each parent must have a single gene alteration on one chromosome of a pair and the normal, wild-type, or unaltered form of the gene on the other chromosome. These parents are carriers and do not usually exhibit any signs and symptoms of the condition.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7-5

Question 13

Type: MCSA

Upon the completion of genetic testing for breast cancer, a patient is happy to learn that the test results are negative. What information should the nurse provide?

  1. “You should be relieved to know you will never experience breast cancer.”
  2. “None of your children will be at risk for breast cancer either.”
  3. “Your children will be at risk for breast cancer only if there is a random change in a chromosome.”
  4. “There is no guarantee that you will never experience breast cancer.”

Correct Answer: 4

Rationale 1: A negative test result cannot guarantee that the disease will not develop in the future.

Rationale 2: The patient’s children may have random chromosomal abnormalities that are seen in the rest of the population.

Rationale 3: This is not necessarily true.

Rationale 4: A negative test result cannot guarantee that the disease will not develop in the future.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-4

Question 14

Type: MCSA

A patient is upset to hear the nurse say that the results of genetic testing revealed “wild-type” genes. What information should the nurse provide?

  1. “This term means your genes are unaltered and are considered the normal type.”
  2. “Your genes are considered normal for the most part but do have some limitations.”
  3. “We detected some abnormalities in your genes.”
  4. “The results of your genetic test were unexpected.”

Correct Answer: 1

Rationale 1: Wild-type genes are unaltered and are considered normal.

Rationale 2: Wild-type genes are normal, not “normal with limitations.”

Rationale 3: Wild-type genes are normal, not defective.

Rationale 4: Wild-type genes are normal, not unexpected.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7-3

Question 15

Type: MCMA

A pregnant woman reports a family history of cystic fibrosis. Which information should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The disorder will be transmitted to male children only.
  2. Each child will have a 25% chance of being affected.
  3. If the mother is does not have cystic fibrosis, her children will not have it either.
  4. The chances that children who do not manifest the disorder will be carriers are 2 out of 3.
  5. One of every four children will be affected by the disorder.

Correct Answer: 2,4

Rationale 1: Autosomal recessive disorders are not sex-linked.

Rationale 2: The chances that a specific child will be affected are 1 in 4.

Rationale 3: The mother could be a carrier for the disorder.

Rationale 4: Phenotypically normal children have a 2 out of 3 chance of being carriers.

Rationale 5: The risk applies equally to each child. If this mother has four children, each child carries equal risks of being affected, being a carrier, or not inheriting the mutant gene at all.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-5

Question 16

Type: MCMA

A newborn has been diagnosed with cri du chat syndrome. The parents request information about this syndrome. Which information should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Your baby’s chromosomal makeup is unbalanced.”
  2. “This condition occurred because your baby has too much material in a particular chromosome.”
  3. “This syndrome is genetically related to trisomy 21.”
  4. “Your baby’s syndrome is the result of a large amount of material missing from chromosome 5.”
  5. “We suspected this condition because of the sound of your child’s cry.”

Correct Answer: 1,4,5

Rationale 1: A chromosomal alteration that includes a missing or additional whole chromosome or segment of a chromosome is an unbalanced rearrangement.

Rationale 2: Cri du chat syndrome is caused by a gene deletion, not nondisjunction.

Rationale 3: Translocation between chromosomes 9 and 22 is responsible for trisomy 21 and is not associated with cri du chat syndrome.

Rationale 4: Cri du chat syndrome results from a large deletion on the short arm of chromosome 5.

Rationale 5: Patients with cri du chat syndrome have mental retardation, crying that sounds like a cat mewing, and low-set ears.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-5

Question 17

Type: MCMA

The nurse works in a geneticist’s office and is educating a new employee about human cells. Which statement by the employee indicates an understanding of the information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Every human cell has 23 pairs of chromosomes and a total of 46 chromosomes.”
  2. “Genes are found in the nucleus of all cells.”
  3. “Each human cell contains mitochondria.”
  4. “The 22nd pair of chromosomes determines the person’s gender.”
  5. “All human cells function in the same way regardless of their location.”

Correct Answer: 1,3

Rationale 1: Every human cell has 23 pairs of chromosomes. There are 46 chromosomes in each cell.

Rationale 2: Genes are found in the nucleus of all cells except red blood cells, which have no nucleus.

Rationale 3: Each human cell contains organelles such as mitochondria.

Rationale 4: The 23rd pair of chromosomes determines the person’s gender.

Rationale 5: Human cells function very differently based on their location.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-2

Question 18

Type: MCMA

The patient has blue eyes. During the interview with the nurse at the geneticist’s office, the patient states that his mother has blue eyes and his father has brown eyes. Which statements by the nurse are accurate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “You have two identical alleles that are responsible for your eye color.”
  2. “The alleles responsible for your eye color are heterozygous.”
  3. “Your eye color is the result of an expressed gene.”
  4. “Alleles are forms of a gene.”
  5. “Your eye color is just one part of your phenotype.”

Correct Answer: 2,3,4,5

Rationale 1: This patient has a blue-eyed mother and a brown-eyed father, so the patient has two different forms of the gene responsible for his eye color.

Rationale 2: The patient’s alleles are heterozygous.

Rationale 3: The patient’s blue eyes are the result of an expressed gene. An expressed gene impacts the patient’s observable traits.

Rationale 4: Alleles are versions or forms of a gene. The patient’s eye color is part of his phenotype.

Rationale 5: The phenotype is the patient’s entire physical, biochemical, and physiologic makeup and is influenced by genetic and environmental factors.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-4

Question 19

Type: MCMA

A fetus is found to have an autosomal recessive condition. After genetic testing is completed, both parents are found to have the same genetic alteration. Which statements by a parent indicate that further education is required?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “This condition is related to a genetic alteration of the X chromosome.”
  2. “This condition is a Mendelian condition.”
  3. “So we are carriers of this condition because we don’t have any signs or symptoms of the condition.”
  4. “Our baby would have a better chance of living if we were both positive for an autosomal dominant condition.”
  5. “The problem is the result of an alteration of a single gene.”

Correct Answer: 1,4

Rationale 1: Genetic alterations of the X chromosome are referred to as X-lined recessive or X-linked dominant conditions, not autosomal recessive conditions.

Rationale 2: This is a Mendelian condition because it follows Mendel’s laws of inheritance.

Rationale 3: The parents deny having any clinical manifestations associated with the condition, so they are likely carriers of the condition.

Rationale 4: It is not necessarily true that the infant will die because of an autosomal recessive condition. The baby affected by a homozygous autosomal dominant condition is much more likely to die from problems associated with that type of condition.

Rationale 5: Autosomal recessive conditions are single-gene disorders.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-5

Question 20

Type: MCSA

A patient who has been diagnosed with Parkinson’s disease expresses hopelessness regarding the future. The nurse would consider which genetic technology when formulating a response?

  1. Gene therapy
  2. Real-time PCR
  3. Stem cell therapy
  4. Microarray analysis

Correct Answer: 3

Rationale 1: Gene therapy is the correction of a genetic mutation by the introduction of DNA into a cell to improve the patient’s health. Complications and ethical considerations have limited the use of gene therapy in clinical settings.

Rationale 2: Real-time PCR is an emerging technology that allows for the detection and quantification of a small fragment of replicating DNA during the amplification process and offers rapid and sensitive quantification of the gene of interest. Its current application is in research.

Rationale 3: Stem cells are unspecialized cells that have the potential to divide without limit and to develop into specialized cells. Stem cell technology is promising in the treatment of such diseases as cancer and Parkinson’s disease.

Rationale 4: Microarray analysis is primarily used in the research setting, specifically in the area of cancer prognosis and treatment stratification.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7-7

Question 21

Type: MCSA

While reviewing a male patient’s history in the chart, the nurse becomes concerned. The patient states, “I haven’t been to see a physician in years and it’s time for me to get a thorough check-up.” Based on the nurse’s understanding of genetically related diseases, which diagnostic screening examination may be ordered for this patient?

  1. Mammogram
  2. Prostate exam
  3. Colonoscopy
  4. Cardiovascular assessment

Correct Answer: 4

Rationale 1: This patient does not necessarily have an increased risk of breast cancer because the mother was diagnosed with breast cancer after the age of 50.

Rationale 2: The patient does not have an increased risk of prostate cancer because the uncle was diagnosed with prostate cancer after the age of 60.

Rationale 3: The patient does not have an increased risk of developing colon cancer because the sister was diagnosed with colon cancer after the age of 50.

Rationale 4: The patient has an increased risk of being diagnosed with a cardiovascular disease because two family members were diagnosed with cardiovascular disorders that developed early.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7-6

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