Maternity Nursing 8th ed By Lowdermilk, Perry, Cashion -Test Bank

Maternity Nursing 8th ed By Lowdermilk, Perry, Cashion -Test Bank

 

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Lowdermilk: Maternity Nursing, 8th Edition

 

Chapter 05: Genetics, Conception, and Fetal Development

 

Test Bank

 

MULTIPLE CHOICE

 

1. 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 response by the nurse is most accurate?

a.	“Good planning; you need to take advantage of the odds in your favor.”
b.	“I think you’d better check with your doctor first.”
c.	“You are both carriers, so each baby has a 25% chance of being affected.”
d.	“The ultrasound indicates a boy, and boys are not affected by PKU.”

 

ANS: C

 

	Feedback
A	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.
B	These parents need to discuss their options with their physician. However, an opportune time has presented itself for the couple to receive correct teaching about inherited genetic risks.
C	The chance is one in four that each child produced by this couple will be affected by PKU disorder.
D	No correlation exists between gender and inheritance of the disorder, because PKU is an autosomal recessive disorder.

 

DIF:   Cognitive Level: Application        REF:  147

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

2. With regard to the structure and function of the placenta, the maternity nurse should be aware that:

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 such as cigarette smoke to which the mother is exposed.
d.	Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

 

ANS: B

 

	Feedback
A	The placenta widens until week 20 and continues to grow thicker.
B	The placenta produces four hormones necessary to maintain the pregnancy.
C	Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus.
D	Optimal circulation occurs when the woman is lying on her side.

 

DIF:   Cognitive Level: Comprehension  REF:  156

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment

 

3. The nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should:

a.	Tell the couple they need to have an abortion within 2 to 3 weeks.
b.	Explain that the fetus has a 50% chance of having the disorder.
c.	Discuss options with the couple, including amniocentesis to determine whether the fetus is affected.
d.	Refer the couple to a psychologist for emotional support.

 

ANS: C

 

	Feedback
A	The couple should be given information about the likelihood of having another baby with this disorder so that they can make an informed decision.
B	A genetic counselor is the best source for determining genetic probability ratios.
C	Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected.
D	The couple eventually may need emotional support, but the status of the pregnancy must be determined first.

 

DIF:   Cognitive Level: Comprehension  REF:  144, 145

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Planning, Implementation

 

4. In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as:

a.	Anxiety and altered family relationships.
b.	Denial of insurance benefits.
c.	High false positives associated with genetic testing.
d.	Ethnic and socioeconomic disparity associated with genetic testing.

 

ANS: B

 

	Feedback
A	These factors may be difficulties associated with genetic testing, but they are not risks associated with testing.
B	Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits.
C	This factor may be a difficulty associated with genetic testing, but it is not a risk associated with testing.
D	This factor may be a difficulty associated with genetic testing, but it is not a risk associated with testing.

 

DIF:   Cognitive Level: Comprehension  REF:  142, 143

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

5. 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. Which response by the nurse is most accurate?

a.	“We don’t really know when such defects occur.”
b.	“It depends on what caused the defect.”
c.	“They occur between the third and fifth weeks of development.”
d.	“They usually occur in the first 2 weeks of development.”

 

ANS: C

 

	Feedback
A	This is an inaccurate statement.
B	Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks.
C	The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week.
D	This is an inaccurate statement.

 

DIF:   Cognitive Level: Application        REF:  158

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Evaluation

 

6. A key finding from the Human Genome Project is:

a.	Approximately 30,000 to 40,000 genes make up the genome.
b.	All human beings are 80.99% identical at the DNA level.
c.	Human genes produce only one protein per gene; other mammals produce three proteins per gene.
d.	Single gene testing will become a standardized test for all pregnant patients in the future.

 

ANS: A

 

 

	Feedback
A	Approximately 30,000 to 40,000 genes make up the human genome; this is only twice as many as make up the genomes of roundworms and flies.
B	Human beings are 99.9% identical at the DNA level.
C	Most human genes produce at least three proteins.
D	Single gene testing (e.g., alpha-fetoprotein) is already standardized for prenatal care.

 

DIF:   Cognitive Level: Knowledge        REF:  140

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment

 

7. You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant?

a.	Disturbed body image
b.	Interrupted family processes
c.	Anxiety
d.	Risk for injury

 

ANS: B

 

	Feedback
A	Women commonly experience body image disturbances in the postpartum period, but this is unrelated to giving birth to a child with Down syndrome.
B	This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder.
C	The mother likely will have a mix of emotions that may include anxiety, guilt, and denial, but this is not the most essential nursing diagnosis for this family.
D	This nursing diagnosis is not applicable.

 

DIF:   Cognitive Level: Application        REF:  146

OBJ:  Client Needs: Psychosocial Integrity                                       TOP:   Nursing Process: Diagnosis

 

8. The nurse caring for the laboring woman should know that meconium is produced by:

a.	Fetal intestines.
b.	Fetal kidneys.
c.	Amniotic fluid.
d.	The placenta.

 

ANS: A

 

	Feedback
A	As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium.
B	Meconium is an accumulation of fetal waste products found in the intestines.
C	Meconium is an accumulation of fetal waste products found in the intestines.
D	Meconium is an accumulation of fetal waste products found in the intestines.

 

DIF:   Cognitive Level: Knowledge        REF:  160

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment

 

9. In practical terms regarding genetic health care, nurses should be aware that:

a.	Genetic disorders affect equally people of all socioeconomic backgrounds, races, and ethnic groups.
b.	Genetic health care is more concerned with populations than individuals.
c.	The most important of all nursing functions is providing emotional support to the family during counseling.
d.	Taking genetic histories is the province of large universities and medical centers.

 

ANS: C

 

	Feedback
A	Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups.
B	Genetic health care is highly individualized because treatments are based on the phenotypic responses of the individual.
C	Nurses should be prepared to help with a variety of stress reactions from a couple facing the possibility of a genetic disorder.
D	Individual nurses at any facility can take a genetic history, although larger facilities may have better support services.

 

DIF:   Cognitive Level: Comprehension  REF:  137

OBJ:  Client Needs: Psychosocial Integrity                                       TOP:   Nursing Process: Planning

 

10. With regard to prenatal genetic testing, nurses should be aware that:

a.	Maternal serum screening can determine whether a pregnant woman is at risk of carrying a fetus with Down syndrome.
b.	Carrier screening tests 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

 

	Feedback
A	Maternal serum screening identifies the risk for the neural tube defect and the specific chromosome abnormality involved in Down syndrome.
B	Carriers of some diseases such as sickle cell disease do not display symptoms.
C	Predisposition testing determines susceptibility such as for breast cancer; presymptomatic testing indicates that, if the gene is present, symptoms are certain to appear.
D	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:  142

OBJ:  Client Needs: Physiologic Integrity                                         TOP:   Nursing Process: Planning

 

11. A woman who is 8 months pregnant asks the nurse, “Does my baby have any antibodies to fight infection?” The most appropriate response by the nurse is:

a.	“Your baby has all the immune globulins (Ig) necessary: IgG, IgM, and IgA.”
b.	“Your baby won’t receive any antibodies until he is born and you breastfeed him.”
c.	“Your baby does not have any antibodies to fight infection.”
d.	“Your baby has IgG and IgM.”

 

ANS: D

 

	Feedback
A	During the third trimester, the only Ig that crosses the placenta, IgG, provides passive acquired immunity to specific bacterial toxins. The fetus produces IgM by the end of the first trimester. IgAs are not produced by the baby.
B	By the third trimester, the fetus has IgG and IgM. Breastfeeding supplies the baby with IgA.
C	This is not an accurate statement. By the third trimester, the fetus has IgG and IgM.
D	During the third trimester, the only Ig that crosses the placenta, IgG, provides passive acquired immunity to specific bacterial toxins. The fetus produces IgM by the end of the first trimester.

 

DIF:   Cognitive Level: Application        REF:  162

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

12. Regarding the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that:

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

 

	Feedback
A	In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (one in two).
B	An autosomal recessive disease carries a one in four chance of recurrence.
C	Subsequent children would be at risk only if the mother continued to take drugs; the rate of risk would be difficult to calculate.
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.

 

DIF:   Cognitive Level: Comprehension  REF:  140

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Diagnosis

 

13. The nurse must be cognizant that an individual’s genetic makeup is known as his or her:

a.	Genotype.
b.	Phenotype.
c.	Karyotype.
d.	Chromotype.

 

ANS: A

 

	Feedback
A	The genotype comprises all the genes the individual can pass on to a future generation.
B	The phenotype is the observable expression of an individual’s genotype.
C	The karyotype is a pictorial analysis of the number, form, and size of an individual’s chromosomes.
D	Genotype refers to an individual’s genetic makeup.

 

DIF:   Cognitive Level: Knowledge        REF:  144

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment

 

14. A pregnant woman at 25 weeks of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate?

a.	“That must have been a coincidence; babies can’t respond like that.”
b.	“The fetus is demonstrating the aural reflex.”
c.	“Babies respond to sound starting at about 24 weeks of gestation.”
d.	“Let me know if it happens again; we need to report that to your midwife.”

ANS: C

 

	Feedback
A	This statement is inaccurate. Fetuses respond to sound by 24 weeks. Acoustic stimulations can evoke a fetal heart rate response.
B	There is no such thing as an aural reflex.
C	This statement is accurate.
D	This statement is not appropriate; it gives the impression that something is wrong.

 

DIF:   Cognitive Level: Application        REF:  160

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Evaluation

 

15. At approximately _____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g.

a.	20
b.	24
c.	28
d.	30

 

ANS: C

 

	Feedback
A	These milestones in human development occur at approximately 28 weeks.
B	These milestones in human development occur at approximately 28 weeks.
C	These are all milestones that occur at 28 weeks.
D	These milestones in human development occur at approximately 28 weeks.

 

DIF:   Cognitive Level: Knowledge        REF:  165

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment

 

16. The _____ is/are responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream.

a.	Decidua basalis
b.	Blastocyst
c.	Germ layer
d.	Chorionic villi

 

ANS: D

 

	Feedback
A	The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach.
B	The blastocyst is the embryonic development stage after the morula. Implantation occurs at this stage.
C	The germ layer is a layer of the blastocyst.
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.

 

DIF:   Cognitive Level: Comprehension  REF:  153

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment

 

17. Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), “How does my baby get air inside my uterus?” The correct response is:

a.	“The baby’s lungs work in utero to exchange oxygen and carbon dioxide.”
b.	“The baby absorbs oxygen from your blood system.”
c.	“The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream.”
d.	“The placenta delivers oxygen-rich blood through the umbilical artery to the baby’s abdomen.”

 

ANS: C

 

	Feedback
A	The fetal lungs do not function for respiratory gas exchange in utero.
B	The baby does not simply absorb oxygen from a woman’s blood system. Blood and gas transport occur through the placenta.
C	The placenta functions by supplying oxygen and excreting carbon dioxide to the maternal bloodstream.
D	The placenta delivers oxygen-rich blood through the umbilical vein and not the artery.

 

DIF:   Cognitive Level: Application        REF:  155

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

18. 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

 

	Feedback
A	Amniotic fluid also cushions the fetus and helps maintain a constant body temperature.
B	The volume of amniotic fluid changes constantly.
C	Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities.
D	Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

 

DIF:   Cognitive Level: Knowledge        REF:  154

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment

 

19. Regarding the development of the respiratory system, maternity nurses should be aware that:

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

 

	Feedback
A	Development of the respiratory system begins during the embryonic phase and continues into childhood.
B	The infant’s lungs are mature when the L/S ratio is 2:1, at about 35 weeks.
C	A reduction in placental blood flow stresses the fetus and increases blood levels of corticosteroids, thus accelerating lung maturity.
D	Lung movements have been seen on ultrasound scans at 11 weeks.

 

DIF:   Cognitive Level: Knowledge        REF:  158

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Diagnosis

 

20. Many parents-to-be have questions about multiple births. Maternity nurses should be able to tell them that:

a.	Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing.
b.	Dizygotic twins (two fertilized ova) have the potential to be conjoined twins.
c.	Identical twins are more common in Caucasian families.
d.	Fraternal twins are the same gender, usually male.

 

ANS: A

 

 

	Feedback
A	If the parents-to-be are older and have taken fertility drugs, they would be very interested in this information.
B	Conjoined twins are monozygotic; they are from a single fertilized ovum in which division occurred very late.
C	Identical twins show no racial or ethnic preference; fraternal twins are more common among African-American women.
D	Fraternal twins can be different genders or the same gender. Identical twins are the same gender.

 

DIF:   Cognitive Level: Knowledge        REF:  162

OBJ:  Client Needs: Health Promotion and Maintenance: Family Planning

TOP:  Nursing Process: Planning

 

21. 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:

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

 

	Feedback
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.
B	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.
C	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.
D	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:  157

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Evaluation

 

MULTIPLE RESPONSE

 

1. Congenital disorders refer to conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant patient, she should understand the significance of exposure to known human teratogens. These include (choose all that apply):

a.	Infections.
b.	Radiation.
c.	Maternal conditions.
d.	Drugs.
e.	Chemicals.

 

ANS: A, B, C, D, E

 

	Feedback
Correct	Exposure to radiation and a number of infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, cytomegalovirus, and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics, as well as chemicals, including lead, mercury, tobacco, and alcohol, also may result in structural and functional abnormalities.
Incorrect	None

 

DIF:   Cognitive Level: Comprehension  REF:  148

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment

 

COMPLETION

 

1. ____________________ twins is another term for fraternal twins. These twins may be the same or different sexes and genetically are no more alike than siblings born at different times.

 

ANS:

Dizygotic

 

Identical or monozygotic twins develop from one fertilized ovum, which then divides. They are the same sex and the same genotype. When two mature ova are produced in one ovarian cycle, both have the potential to be fertilized by separate sperm. This results in two zygotes, or dizygotic twins.

 

DIF:   Cognitive Level: Comprehension  REF:  162

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Diagnosis

 

2. Very fine hairs, called ____________________, appear first at 12 weeks of gestation on the fetus’s eyebrows and upper lip. By 20 weeks they cover the entire body.

 

ANS:

Lanugo

 

By 28 weeks the scalp hair is longer than these fine hairs, which thin and may disappear by term gestation.

 

DIF:   Cognitive Level: Comprehension  REF:  162

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment

 

TRUE/FALSE

 

1. The fetal concentration of glucose is lower than the glucose level in the maternal blood because of the rapid metabolism by the fetus.

 

ANS: T

This fetal requirement demands larger concentrations of glucose than simple diffusion can provide. Therefore maternal glucose moves into the fetal circulation by active transport.

 

DIF:   Cognitive Level: Comprehension  REF:  161

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Assessment