Ricci Chapter 10 - Test Bank - 4th Edition

1. The nurse is teaching a couple about the pros and cons of genetic testing. Which statement by

the nurse best describes the limits of genetic testing?

A. "Various genetic tests help the primary care provider choose appropriate treatments."

B. "Genetic testing helps couples avoid having children with fatal diseases."

C. "Genetic tests identify people at high risk for preventable conditions."

D. "Some genetic tests can give a probability for developing a disorder."

Answer: D

Rationale: The fact that some tests only provide a probability for developing a disorder raises a

problem. A serious limitation of these susceptibility tests is that some people who carry a

disease-associated mutation never develop the disease. Choosing appropriate treatments,

avoiding having children with fatal diseases, and identifying those at high risk affirm the value of

genetic tests.

. The nurse is counseling a couple who suspect that they could bear a child with a genetic

abnormality. What would be most important for the nurse to do when working with this family?

A. Gather information for three generations.

B. Inform the family of the need for information.

C. Maintain the confidentiality of the information.

D. Present the information in a factual, nondirective manner.

Answer: D

Rationale: It is essential to respect client autonomy and present information in a factual,

nondirective manner. In these situations, the nurse needs to understand that the choice is the

couple's to make. Gathering information for three generations obtains a broad overview of what

has been seen in both sides of the family. Maintaining confidentiality of the information is as

important as with any other client information gathered. Informing the family of the need for

information is necessary because of its personal nature.

3. The nurse is teaching a couple about X-linked disorders because they are concerned that they

might pass on hemophilia to their children. Which response indicates the need for further

teaching?

A. "The father can't be a carrier if he doesn't have hemophilia."

B. "If the father doesn't have it, then his kids won't either."

C. "If the mother is a carrier, her daughter could be one too."

D. "If the mother is a carrier, her sons will have hemophilia."

Answer: B

Rationale: Males are more affected than females. A male has only one X chromosome, and all

the genes on his X chromosome will be expressed whereas a female will usually need both X

chromosomes to carry the disease. There is no male-to-male transmission (since no X

chromosome from the male is transmitted to male offspring), but any man who is affected will

have carrier daughters. If a woman is a carrier, there is a 50% chance that her sons will be

affected and a 50% chance that her daughters will be carriers.

4. A pregnant woman undergoes a triple screen at 16 to 18 weeks' gestation. What would the

nurse suspect if the woman's estriol and alpha-fetoprotein levels are decreased with high hCG

levels?

A. Down syndrome

B. sickle-cell anemia

C. cardiac defects

D. respiratory disorders

Answer: A

Rationale: Decreased levels might indicate Down syndrome or trisomy 18. Sickle cell anemia

may be identified by chorionic villus sampling. Levels would be increased with cardiac defects,

such as tetralogy of Fallot. It does not detect respiratory disorders.

5. The nurse is conducting a presentation for a young adult community group about fetal

development and pregnancy. The nurse determines that the teaching was successful when the

group identifies that the sex of offspring is determined at which time?

A. during meiosis cell division

B. at fertilization

C. when the morula forms

D. during oogenesis

Answer: B

Rationale: Sex determination occurs at the time of fertilization. Meiosis refers to cell division

resulting in the formation of an ovum or sperm with half the number of chromosomes. The

morula develops after a series of four cleavages following the formation of the zygote.

Oogenesis refers to the development of a mature ovum, which has half the number of

chromosomes.

6. During a prenatal visit, a pregnant woman says, "I know the amniotic fluid is important, but

can you tell me more about it?" When describing amniotic fluid to a pregnant woman, which

description would the nurse most likely include?

A. "This fluid acts as transport mechanism for oxygen and nutrients."

B. "The fluid is mostly protein to provide nourishment to your baby."

C. "This fluid acts as a cushion to help to protect your baby from injury."

D. "The amount of fluid remains fairly constant throughout the pregnancy."

Answer: C

Rationale: Amniotic fluid protects the floating embryo and cushions the fetus from trauma. The

placenta acts as a transport mechanism for oxygen and nutrients. Amniotic fluid is primarily

water with some organic matter. Throughout pregnancy, amniotic fluid volume fluctuates.

7. Assessment of a pregnant woman reveals oligohydramnios. The nurse would be alert for the

development of which condition?

A. maternal diabetes

B. placental insufficiency

C. neural tube defects

D. fetal gastrointestinal malformations

Answer: B

Rationale: A deficiency of amniotic fluid, oligohydramnios, is associated with uteroplacental

insufficiency and fetal renal abnormalities. Excess amniotic fluid is associated with maternal

diabetes, neural tube defects, and malformations of the gastrointestinal tract and central nervous

system.

8. A couple comes to the clinic for preconception counseling and care. As part of the visit, the

nurse teaches the couple about fertilization and initial development, stating that the zygote

formed by the union of the ovum and sperm consists of how many chromosomes?

A. 22

B. 23

C. 44

D. 46

Answer: D

Rationale: With fertilization, the ovum, containing 23 chromosomes, and the sperm, containing

23 chromosomes, join, forming a zygote with a diploid number or 46 chromosomes.

9. After teaching a pregnant woman about the hormones produced by the placenta, the nurse

determines that the teaching was successful when the woman identifies which hormone produced

as being the basis for pregnancy tests?

A. human placental lactogen (hPL)

B. estrogen (estriol)

C. progesterone (progestin)

D. human chorionic gonadotropin (hCG)

Answer: D

Rationale: The placenta produces hCG, which is the basis for pregnancy tests. This hormone

preserves the corpus luteum and its progesterone production so that the endometrial lining is

maintained. Human placental lactogen modulates fetal and maternal metabolism and participates

in the development of the breasts for lactation. Estrogen causes enlargement of the woman's

breasts, uterus, and external genitalia and stimulates myometrial contractility. Progesterone

maintains the endometrium.

10. When describing genetic disorders to a group of couples planning to have children, the nurse

would identify which as an example of an autosomal dominant inheritance disorder?

A. Huntington disease

B. sickle cell disease

C. phenylketonuria

D. cystic fibrosis

Answer: A

Rationale: Huntington disease is an example of an autosomal dominant inheritance disorder.

Sickle cell disease, phenylketonuria, and cystic fibrosis are examples of autosomal recessive

inheritance disorders.

11. Which mother is in the fetal stage of development?

A. a pregnant mother who is one week pregnant

B. a pregnant mother who is five weeks' pregnant

C. a pregnant mother who is seven weeks' pregnant

D. a pregnant mother who is thirty weeks' pregnant

Answer: D

Rationale: The fetal stage of development during pregnancy occurs at the end of the eighth week

and continues through to birth. The mother at one week gestation is in the preembryonic stage.

The mothers at five weeks and seven weeks are in the embryonic stage.

12. Which event will result in zygote formation?

A. The nucleus of the ovum and sperm make contact and combine chromosomes.

B. The nucleus of the ovum carries forth the genetic information at implantation.

C. The nucleus of the sperm and the fallopian tube make contact and combines chromosomes.

D. The nucleus of the sperm carries forth the genetic information at implantation.

Answer: A

Rationale: When the nucleus from the ovum and the nucleus of the sperm make contact, they

lose their respective nuclear membranes and combine their maternal and paternal chromosomes.

Because each nucleus contains a haploid number of chromosomes (23), this union restores the

diploid number (46). The resulting zygote begins the process of a new life.

13. When describing gender determination at a prenatal class, the nurse would include which

statement?

A. "Gender is determined when the primary oocyte completes its first mitotic division."

B. "Gender is determined when the sperm and the oocyte undergo the process of mitosis."

C. "Gender is determined when the ovum and the spermatozoon undergo the process of meiosis."

D. "Gender is determined at fertilization when the ovum is fertilized."

Answer: D

Rationale: Gender is determined at fertilization and depends on whether the ovum is fertilized by

a Y-bearing sperm or an X-bearing sperm. Approximately half of sperm carry the XX

chromosome, and the other half carries XY. An XX zygote will become a female, and an XY

zygote will become a male. X- and Y-bearing sperm determine the gender.

14. During a prenatal class, the nurse is describing what happens when the ovum is fertilized by

the sperm. Which statement would the nurse most likely include?

A. The zygote is transported into the uterine cavity.

B. The embryo is transported into the uterine cavity.

C. Genetic material is shared with the embryo upon implantation.

D. The placenta begins to form in the fallopian tube.

Answer: A

Rationale: When the ovum is fertilized by the sperm (now called a zygote), the zygote is

transported into the uterine cavity. The resulting zygote is not yet an embryo to be transported,

nor is genetic material shared with an embryo. The placenta does not form in the fallopian tube.

15. Which processes that occur after fertilization would lead to a normal pregnancy? Select all

that apply.

A. The morula divides into specialized cells that will form fetal structures.

B. Within the morula is a blastocyst that will form the embryo.

C. The morula develops into the embryonic membranes, the chorion, and placenta.

D. The morula enters the uterine cavity about 72 hours after fertilization.

E. The blastocyst reaches the uterine cavity immediately after fertilization.

Answer: A, B, D

Rationale: With additional cell division, the morula divides into specialized cells that will later

form fetal structures. Within the morula, an off-center, fluid-filled space appears, transforming it

into a hollow ball of cells called a blastocyst. The outer layer of cells surrounding the blastocyst

cavity is called a trophoblast, which develops into one of the embryonic membranes, the chorion,

and helps to form the placenta. The morula reaches the uterine cavity about 72 hours after

fertilization.

16. Which processes, if they occur during the formation of the placenta, would lead to a

successful pregnancy? Select all that apply.

A. Implantation of the trophoblast occurs in the upper uterus.

B. Three days after conception, the trophoblast makes human chorionic gonadotropin (hCG).

C. The trophoblast attaches to the fallopian tube for nourishment.

D. The placenta is fully developed by the end of fourth week.

E. The trophoblast develops into the placenta.

Answer: A, B, E

Rationale: Implantation occurs in the upper uterus (fundus), where a rich blood supply is

available. As early as 3 days after conception, the trophoblasts make human chorionic

gonadotropin (hCG). By the end of the second week, the placenta is developing. The precursor

cells of the placenta, the trophoblasts, first appear 4 days after fertilization. The trophoblast

attaches to the wall of the uterus, not the fallopian tube.

17. Which characteristics about amniotic fluid would alert the prenatal nurse to further

investigate? Select all that apply.

A. Oligohydramnios is noted on assessment.

B. The amount of amniotic fluid fluctuates at each checkup.

C. Polyhydramnios is noted on assessment.

D. The client has approximately 2 L of amniotic fluid at term.

E. The client has approximately 1 L of amniotic fluid at term.

Answer: A, C, D

Rationale: Amniotic fluid surrounds the embryo and increases in volume as the pregnancy

progresses, reaching approximately 1 L at term. Its volume changes constantly as the fetus

swallows and voids. Oligohydramnios is too little amniotic fluid (500 mL at term) and is

associated with uteroplacental insufficiency, fetal renal abnormalities, and a higher risk of

surgical births and low birth weight infants. Too much amniotic fluid (2,000 mL at term), termed

polyhydramnios, is associated with maternal diabetes, neural tube defects, chromosomal

deviations, and malformations of the central nervous system and/or gastrointestinal tract that

prevent normal swallowing of amniotic fluid by the fetus.

18. A client's recent prenatal ultrasound assessment reveals a normal placenta. Which outcomes

would the nurse expect? Select all that apply.

A. The placenta will filter out toxins that the mother ingests.

B. The hormones made by the placenta support fetal growth.

C. The placenta removes the fetal waste products such as stool.

D. The placenta protects the fetus from an immune attack created by the mother.

E. The placenta produces hormones that ready the fetus for extrauterine life.

Answer: B, D, E

Rationale: The placenta will not filter out all toxins. The placenta begins to make hormones that

control the basic physiology of the mother so the fetus is supplied with the nutrients and oxygen

needed for growth. The placenta also protects the fetus from immune attack by the mother and

removes waste products from the fetus. The placenta produces hormones that ready fetal organs

for life outside the uterus.

19. A prenatal nurse is conducting a class on healthy pregnancy and explains the role of placental

hormones. Which statements would the nurse make? Select all that apply.

A. Human chorionic gonadotropin is the basis for pregnancy tests.

B. Human placental lactogen participates in the development of maternal breasts for lactation.

C. Thyroxin modulates fetal and maternal metabolism.

D. Progesterone stimulates maternal metabolism and breast development.

E. Relaxin causes enlargement of a woman's breasts, uterus, and external genitalia.

F. Estrogen causes enlargement of a woman's breasts.

Answer: A, B, D, F

Rationale: Human chorionic gonadotropin is the basis for pregnancy tests. Human placental

lactogen modulates fetal and maternal metabolism and participates in the development of

maternal breasts for lactation. Estrogen (estriol) causes enlargement of a woman's breasts, uterus,

and external genitalia and stimulates myometrial contractility. Progesterone (progestin)

maintains the endometrium, decreases the contractility of the uterus, and stimulates maternal

metabolism and breast development. Relaxin acts with progesterone to maintain pregnancy and

causes relaxation of the pelvic ligaments. Progesterone maintains the endometrium, decreases the

contractility of the uterus, and stimulates maternal metabolism and breast development. Thyroxin

is not a placental hormone.

20. A client at a prenatal class requests information on how the gender of a baby is determined.

Which statement made by the nurse would be most accurate?

A. "Gender is determined by week 20 of gestation and depends on whether the ovum is fertilized

by a Y-bearing or an X-bearing sperm."

B. "Gender is determined as the embryo is fertilized by a Y-bearing or an X-bearing sperm."

C. "Gender is determined at conception and depends on whether the ovum is fertilized by a Ybearing

or an X-bearing sperm."

D. "Gender is determined at conception and depends on whether the sperm is fertilized by a Ybearing

or X-bearing ovum."

Answer: C

Rationale: Sex determination is also determined at fertilization and depends on whether the

ovum is fertilized by a Y-bearing sperm or an X-bearing sperm. Approximately half of sperm

carry the XX chromosome and the other half carries XY. An XX zygote will become a female,

and an XY zygote will become a male. That is why it is scientifically correct to say that the sex

of the infant is determined by the father and not by the mother. Gender is determined before the

embryo stage and at conception by sperm carrying Y- or X-bearing chromosomes.

21. A client who is six weeks' pregnant asks the prenatal nurse, "What development has taken

place with my baby by now?" Which information should the nurse include in the response?

Select all that apply.

A. "By week 3 there would be the beginning development of the brain, spinal cord, and heart."

B. "By week 4 the arms and legs begin to grow and develop."

C. "By week 5 the heart now beats and the eyes and ears can be seen."

D. "By week 6 the lungs begin forming and the baby circulation is established."

E. "By week 6 the baby makes active movements with sucking motions made with the mouth."

Answer: A, B, C, D

Rationale: By week 3 there is the beginning development of brain and spinal cord, and the heart

becomes more developed. Limb buds grow and develop at week 4. By week 5 the heart now

beats at a regular rhythm. Beginning structures of eyes and ears are seen. Week 6 shows the

lungs beginning to form and fetal circulation is established. At weeks 13 to 16 the fetus will

make active movement, not at week 6. Sucking motions are made with the mouth in week 12, not

in week 6.

22. At a prenatal class, the participants ask the nurse who would benefit from genetic counseling.

Which responses by the nurse are correct? Select all that apply.

A. "A woman who is a grand multigravida."

B. "A woman whose husband is age 50 years or older."

C. "A woman who has been exposed to teratogens."

D. "A young teenager experiencing her first pregnancy."

E. "A woman who receives an abnormal alpha-fetoprotein result."

Answer: B, C, E

Rationale: Those shown to benefit from genetic counseling are women over the maternal age 35

years or older when the baby is born; couples where the paternal age is 50 years or older; when a

pregnancy screening abnormality is noted, including the alpha-fetoprotein. Genetic screening is

encouraged where there has been teratogen exposure or risk. Teenage pregnancies or having

multiple pregnancies do not qualify for genetic counselling unless the above risks have been

identified.

23. In order for conception to take place, it is most common for a woman to get pregnant:

A. two weeks after her normal menstrual period.

B. two weeks before her normal menstrual period.

C. immediately after a normal menstrual period.

D. during her menstrual period.

Answer: A

Rationale: Fertilization is the union of ovum and sperm, which is the starting point of pregnancy.

Fertilization typically happens around 2 weeks after the last normal menstrual period in a 28-day

cycle.

24. A couple asks the nurse at a preconception class for information on becoming pregnant.

Which response made by the nurse is correct?

A. "The 200 million sperm in ejaculated semen are necessary for conception to take place."

B. "The 1 million sperm in ejaculated semen are necessary for conception to take."

C. "Fertilization will typically occur 2 weeks before your last normal menstrual period."

D. "Fertilization will typically occur 1 week after the last normal menstrual period."

Answer: A

Rationale: Although more than 200 million sperm/mL are contained in the ejaculated semen,

only one is able to enter the ovum to fertilize it. Fertilization would occur around 2 weeks after

the last normal menstrual period.

25. A couple attends genetic counseling. What are the chances that the couple will have a child

with Down syndrome?

A. Chromosomal abnormalities occur in about 1 in 150 live-born infants.

B. Chromosomal abnormalities cannot be inherited and occur at random.

C. If a woman is a carrier, there is a 25% chance that her daughter will be affected.

D. If a man is a carrier, there is a 25% chance that he will have an unaffected son.

Answer: A

Rationale: Chromosomal abnormalities occur in about 1 in 150 live-born infants according to the

March of Dimes. It is among the most common trisomies of chromosomes. Although some

chromosomal disorders can be inherited, most occur due to random events during early fetal

development.

26. The nurse is assessing a 12-hour-old newborn and hears a heart murmur. What initial action

should the nurse take?

A. Document the finding as normal for age

B. Report the finding to the health care provider

C. Assess the infant every 2 hours for worsening symptoms

D. Allow the infant to room in with the parents if temperature is stable

Answer: A

Rationale: The ductus arteriosus is a fetal shunt allowing blood to bypass the lungs. It closes

functionally within 72 hours of life and permanently by 3 to 4 weeks of life. On assessment a

murmur can be heard with delayed closure, but this murmur is not related to a cardiac issue. The

nurse should initially document the finding as normal for age. The information can be relayed to

the health care provider. The nurse should continue to assess the newborn during the hospital

stay and note any changes to the murmur. If the infant is stable, the infant should be allowed to

remain with the parents.

27. A client asks about a child inheriting an autosomal recessive disorder. What must occur for

an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance?

A. Both parents must be carriers.

B. One parent must have the disease.

C. One parent, usually the mother, must be a carrier.

D. One parent, usually the father, must not be a carrier or have the disease.

Answer: A

Rationale: Autosomal recessive inheritance occurs when two copies of the mutant or abnormal

gene in the homozygous state are necessary to produce the phenotype. In other words, two

abnormal genes are needed for the individual to demonstrate signs and symptoms of the disorder.

Both parents of the affected person must be carriers of the gene, either clinically normal or

expresses the disorder.

28. At prenatal classes a client asks the nurse how long it takes to actually become pregnant after

having sexual intercourse. What is the nurse's best response?

A. "Conception happens immediately after fertilization of the ovum."

B. "Conception happens about 12 hours after fertilization of the ovum."

C. "Conception happens about 24 hours after fertilization of the ovum."

D. "Conception happens about 72 hours after fertilization of the ovum."

Answer: A

Rationale: For conception to occur, a healthy ovum from the woman is released from the ovary,

passes into an open fallopian tube, and starts its journey downward. Sperm from the male is

deposited into the vagina and swims approximately 7 inches to meet the ovum at the outermost

portion of the fallopian tube, the area where fertilization takes place. This process occurs in

about an hour. When one spermatozoon penetrates the ovum's thick outer membrane, pregnancy

begins. All this activity takes place within a 5-hour time span.

29. A nurse teaching a couple says that when X-linked recessive inheritance is present in a

family, the genogram will reveal that:

A. mostly males in the family have the disorder.

B. the parents of the affected man have the disorder.

C. sons of an affected man are also affected.

D. all daughters and no sons will inherit the condition.

Answer: A

Rationale: In X-linked recessive pattern of inheritance, a genogram will reveal there are more

affected males than females because all the genes on a man's X chromosome will be expressed since a male has only one X chromosome. There is no male-to-male transmission (since no X

chromosome from the male is transmitted to male offspring), but any man who is affected with

an X-linked recessive disorder will have carrier daughters. If a woman is a carrier, there is a 25%

chance she will have an affected son, a 25% chance that her daughter will be a carrier, a 25%

chance that she will have an unaffected son, and a 25% chance her daughter will be a noncarrier.

With X-linked dominant inheritance, all of the daughters and none of the sons of an affected

male will inherit the condition, while both male and female offspring of an affected woman have

a 50% chance of inheriting the condition.

30. A woman visits the prenatal clinic and is noted to have oligohydramnios. The client asks,

"Why is this fluid important anyway?" Which statements would be included in the nurse's

response? Select all that apply.

A. "Amniotic fluid helps maintain your baby's body temperature."

B. "The fetus ingests amniotic fluid for its nourishment."

C. "Too little amniotic fluid is linked with placental problems."

D. "Amniotic fluid keeps your baby free from any teratogens."

E. "It acts like a cushion protecting your baby from trauma that may occur."

Answer: A, C, E

Rationale: Sufficient amounts of amniotic fluid help maintain a constant body temperature for

the fetus and cushion the fetus from trauma. Oligohydramnios is associated with placental

problems. The fetus does ingest amniotic fluid but not for nourishment. Amniotic fluid does not

protect the fetus from teratogens.