Public Health Nursing Population Centered Health Care in the Community 9th Edition by Marcia Stanhope – Test Bank

Public Health Nursing Population Centered Health Care in the Community 9th Edition by Marcia Stanhope – Test Bank

Chapter 11: Genomics in Public Health Nursing

Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition

MULTIPLE CHOICE

1. The increasing knowledge about genetics and genomics will influence nursing practice by changing how:

a.

nurses collect and use health histories.

b.

nursing students complete clinical experiences.

c.

referrals to other disciplines are made.

d.

ethical dilemmas are solved.

ANS: A

Genetics and genomics will change future practice in several areas including: how students are educated, how nurses collect and use health histories, how nurses learn and apply innovative biotechnology, how prevention and health education is provided, administration of new therapies, and public health debates.

DIF: Cognitive level: Understanding REF: p. 243

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. A nurse learns more about the Human Genome Project to better counsel families about the process of genetic testing. Which of the following terms best describes what the nurse is learning?

a.

Genetics

b.

Genomics

c.

Genes

d.

Genetic susceptibility

ANS: B

Genomics refers to the study of individual genes to understand the structure of the genome, including the mapping of genes and sequencing the DNA. Genetics refers to the study of the function and effect of single genes that are inherited by children from their parents. Genes are the DNA segments that carry the genetic information. Genetic susceptibility is the likelihood of developing a disease based on the presence of a genetic mutation.

DIF: Cognitive level: Applying REF: pp. 243-244

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. The father of genetics is:

a.

Charles Darwin.

b.

Gregor Mendel.

c.

James Watson.

d.

Francis Galton.

ANS: B

Gregor Mendel is considered to be the father of genetics. Charles Darwin expounded on theories of evolution. Francis Galton performed family studies using twins to understand the influence of heredity on various human characteristics. James Watson was the co-discoverer of DNA.

DIF: Cognitive level: Remembering REF: p. 243

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. One of the main goals of the Human Genome Project was:

a.

providing physicians with a national database for information related to genetic disorders.

b.

developing new medications that can be used in genetics research.

c.

addressing ethical, legal, and social issues related to this research.

d.

improving the ability to accurately test for genetic disorders.

ANS: C

The goals of the Human Genome Project were to determine the sequences of the base pairs in human DNA; improve tools for data analysis; transfer related technologies to the private sector; and address the ethical, legal, and social issues that may arise. The Human Genome Project did not provide physicians with a national database of information for genetic disorders, develop new medications related to genetics research, or improve the ability to accurately test for genetic disorders.

DIF: Cognitive level: Understanding REF: p. 244

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. The blueprint or code that is used to construct other components of cells is called the:

a.

DNA.

b.

gene.

c.

chromosome.

d.

base.

ANS: A

The DNA is the chemical inside the nucleus of the cell that has the genetic instructions for making living organisms. This can be compared to a blueprint or code that is used to construct other components of cells. Genes are the DNA segments that carry the genetic information. DNA is organized into long structures called chromosomes within the cells. DNA is comprised of four bases.

DIF: Cognitive level: Remembering REF: p. 245

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6. Which statement regarding mutations is true?

a.

Mutations in the DNA sequence occur on a regular basis.

b.

Mutagens are a result of a mutation.

c.

Environmental factors can be linked to many mutations.

d.

Spontaneous mutations occur because of environmental exposure.

ANS: C

A large number of agents are known to cause mutations. These mutations are attributed to known environmental causes. DNA replication is very accurate, thus, mutations do not occur on a regular basis. Mutagens are the factors that cause mutations. Spontaneous mutations occur naturally during DNA replication.

DIF: Cognitive level: Understanding REF: p. 245

TOP: Nursing process: Evaluation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

7. A nurse is counseling a client who is considering having genetic testing completed to determine whether she is a carrier of the gene linked to Huntington’s disease. Which of the following would be the first step the nurse would take when assessing this client?

a.

Assess vital signs

b.

Assess family history of this disorder

c.

Assess client’s past medical history

d.

Assess current medications

ANS: B

Taking a family history is a useful place to begin when considering a genetic connection prior to the onset of testing. The best way to identify whether there is a mutation in a family where a hereditary disease is suspected is to test the person who displays the most evidence of being a mutation carrier. This would take precedent over assessing vital signs, current medications, and past medical history.

DIF: Cognitive level: Analyzing REF: p. 246

TOP: Nursing process: Implementation

MSC: NCLEX: Health Promotion and Maintenance

8. While collecting a medical history, a client reports having a family history positive for Huntington’s disease. However, the client states he does not want to have genetic testing performed. Which of the following best describes why the client may refuse genetic testing?

a.

Impact it may have on obtaining health insurance in the future

b.

Legal consequences that may result

c.

Inaccuracy of the results that are obtained

d.

Decreased quality of life that may occur if the results are positive

ANS: D

Barriers to genetic testing are: some individuals do not have an insurance carrier that reimburses for genetic testing, a high-deductible insurance policy, and feelings that testing may decrease the quality of life and increase anxiety for the future if the results were positive. Others may also feel guilty about passing along a disease to children and grandchildren. Health insurance cannot be denied to individuals because of genetic testing results. There are no legal implications for genetic testing. There is not a high inaccuracy of results that are obtained through genetic testing.

DIF: Cognitive level: Applying REF: p. 246

TOP: Nursing process: Evaluation MSC: NCLEX: Psychosocial Integrity

9. A nurse is caring for a client who has been diagnosed with a multifactorial disease. Which of the following best describes the client’s diagnosis?

a.

Measles

b.

Hepatitis B

c.

Eczema

d.

Type I diabetes

ANS: D

Disorders that are influenced by multiple factors including genetics/genomics, environment, lifestyle, and other factors are considered to be multifactorial. Type I diabetes is considered to be a multifactorial disease. The others are not multifactorial diseases.

DIF: Cognitive level: Applying REF: p. 247 (Box 11-1)

TOP: Nursing process: Diagnosis

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

10. A nurse is eliciting information about a client’s genetic history. Which of the following questions would be most appropriate for the nurse to ask?

a.

“Have any of your family members ever completed genetic testing?”

b.

“Do any of your family members have a genetic disorder?”

c.

“What medical problems have your parents and grandparents experienced?”

d.

“What environmental exposures have you had?”

ANS: C

A client’s family medical history is important to obtain in order to consider the client’s potential risk for genetic diseases and disorders. The best way to obtain this information is to ask an open-ended question about past medical history of parents and grandparents. Asking about completion of genetic testing by others, familial history specific only to genetic disorders, and environmental exposures do not address the importance of obtaining a family history.

DIF: Cognitive level: Analyzing REF: p. 246

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

11. A nurse is counseling a client who is considering purchasing a genetic testing kit from a vendor advertised on the Internet. Which of the following would be the response by the nurse?

a.

“It is illegal to purchase genetic testing kits from Internet vendors.”

b.

“It will be important to follow up with a health care provider after receiving your results.”

c.

“Many times online vendors experience inaccuracies with their results.”

d.

“Internet vendors use the latest technology to perform these tests.”

ANS: B

The most important aspect of genetic testing is the counseling that occurs with the testing. Purchasing genetic testing kits on the Internet makes it easy for the public to access, but leaves a health care professional out of the testing process. Meeting with a health care professional is important to counsel a client about the implications and indications for such testing. It is not illegal to purchase genetic testing kits from the Internet. The accuracy and technology used by the Internet vendor may vary depending on the vendor that is used.

DIF: Cognitive level: Analyzing REF: p. 247

TOP: Nursing process: Planning

MSC: NCLEX: Health Promotion and Maintenance

12. A public health nurse (PHN) is implementing the objectives related to genetics from Healthy People 2020. Which of the following best describes the action that is being taken by the nurse?

a.

Educating clients that multiple factors influence the development of disease

b.

Counseling clients about the results of genetic testing

c.

Lobbying for legislation to support genetic research

d.

Providing screening and genetic testing for specific groups of individuals

ANS: D

The objectives of Healthy People 2020 related to genetics suggest that screening and genetic testing for specific groups still remain the standard of practice while other routine screenings or tests are questioned for their impact on morbidity and mortality. Healthy People 2020 objectives do not address client education, client counseling, or legislation for genetics.

DIF: Cognitive level: Analyzing REF: p. 248

TOP: Nursing process: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

13. The Genetic Information Nondiscrimination Act (GINA):

a.

protects individuals from discrimination based on their genetic information.

b.

allows health insurance companies to deny coverage for preexisting conditions.

c.

states employers may collect genetic information from employees as needed.

d.

requires employees to report genetic disorders to their employer.

ANS: A

GINA was designed to prohibit the improper use of genetic information in health insurance and employment. It protects individuals from discrimination based on their genetic information, prevents denial of coverage based solely on genetic predisposition to disease, and limits disclosure of genetic information.

DIF: Cognitive level: Understanding REF: p. 248

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

14. A clinic nurse working in the 1970s was employed by a primary care physician. Which of the following describes how the nurse would have applied genetic concepts?

a.

Providing genetic counseling to those with genetic disorders

b.

Educating clients about using genetic testing for risk identification

c.

Explaining the purposes of the Human Genome Project to clients

d.

Facilitating referrals for specialized genetic services for clients

ANS: A

In the 1970s, nurses working in genetics provided genetic counseling to persons with genetic diseases or risk factors for such disorders. The other activities performed by the nurse did not occur until the 1990s.

DIF: Cognitive level: Applying REF: p. 250

TOP: Nursing process: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

15. A PHN reports that she is able to demonstrate the minimum competencies set forth by the National Coalition of Health Professional Education in Genetics (NCHPEG). Which of the following describes the action that is taken by the nurse?

a.

Organizing a meeting to discuss the care of cystic fibrosis clients

b.

Making a referral to a genetics specialist

c.

Advocating for legislation to support stem cell research

d.

Educating a client about the results of genetic testing

ANS: B

The minimum competencies for health care professionals set forth by NCHPEG are: be able to examine competence of practice, understand the social and psychological implications of health-related genetic information, and know how and when to make referrals to a genetics professional. Making a referral is the only example that is described in these competencies.

DIF: Cognitive level: Analyzing REF: p. 249

TOP: Nursing process: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

16. A nurse understands the significant impact that genetic testing can have on an individual and family. This competency is best described by which of the following organizations?

a.

NCHPEG

b.

Centers for Disease Control and Prevention (CDC)

c.

American Nurses Association

d.

International Council of Nurses

ANS: A

The NCHPEG identifies one competency of health care professionals as being able to understand that health-related genetic information can have social and psychological implications for individuals and families. The CDC, American Nurses Association, and International Council of Nurses do not address any competencies specifically related to genetic testing.

DIF: Cognitive level: Applying REF: p. 249

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

17. A nurse is using the Codes of Ethics developed by the International Council of Nurses and the American Nurses Association. Which of the following describes the action being taken by the nurse?

a.

Providing confidential genetic testing for a client

b.

Advocating for the inclusion of genetic content in a nursing curriculum

c.

Considering the pros and cons of an ethical dilemma

d.

Becoming competent in genomics

ANS: A

The Codes of Ethics include in this mandate the right that people have to seek and receive genomic heath care that is nondiscriminatory, confidential, private, and that enables those served to make informed decisions. Being competent in genomics, considering pros and cons of ethical dilemmas, and advocating for the inclusion of genetic content in a nursing curriculum are not part of the Code of Ethics.

DIF: Cognitive level: Analyzing REF: p. 248

TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity

18. A nurse is applying genetic and genomic knowledge when completing a client assessment. Which of the following actions is most likely being taken by the nurse?

a.

Constructing a pedigree from a collected family history

b.

Identifying a client who may benefit from genetic counseling

c.

Referring a client to specialized genetic services

d.

Incorporating knowledge of genomic risk factors

ANS: A

Constructing a pedigree from a collected family history demonstrates assessment in the nursing process. Identification is demonstrated by identifying a client who may benefit from genetic counseling. Referral is demonstrated by referring a client to specialized genetic services. Provision of education, care, and support is demonstrated by incorporating knowledge of genomic risk factors.

DIF: Cognitive level: Applying REF: p. 251

TOP: Nursing process: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

19. A nurse considers that clients may not want to have genetic testing done because of the impact that it may have on future life decisions. Which of the following best describes how the nurse is incorporating genetics/genomics into practice?

a.

Assessment

b.

Identification

c.

Referral

d.

Provision of education, care, and support

ANS: B

One of the ways that a nurse uses identification is by identifying ethical, cultural, and societal issues related to genetic and genomic information and technologies. Assessment is not being performed here because the nurse is not assessing a particular client’s needs or history. Referral is not taking place, nor is education, care, or support of a patient.

DIF: Cognitive level: Applying REF: p. 250

TOP: Nursing process: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

20. A nurse is assisting a family in compiling a family health history. Which of the following statements would be most appropriate for the nurse to make?

a.

“When you have completed this history, it will not need to be updated.”

b.

“Looking back at two generations of biological relatives will be sufficient.”

c.

“The purpose of completing a family history is to decrease genetic susceptibility.”

d.

“A family history is a useful tool when considering your future health risks.”

ANS: D

A family history is a useful tool to help families know about their health risks and prevent disease in themselves and their close relatives. It is recommended that families develop a three generation history and update it on a regular basis. Completion of a family history will not decrease genetic susceptibility; rather it will make families more aware of what that susceptibility may be.

DIF: Cognitive level: Analyzing REF: p. 251 (How to Box)

TOP: Nursing process: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

21. A nurse is counseling a client whose genetic test results show a genetic susceptibility for breast cancer. Which of the following would be the most appropriate statement by the nurse?

a.

“You should discuss hormone replacement therapy with your physician.”

b.

“You are at an increased risk to develop breast cancer.”

c.

“You should have a bilateral mastectomy as soon as possible.”

d.

“You should tell all of your siblings and children to get tested.”

ANS: B

Persons with a genetic susceptibility are at increased risk for developing the disease. Although the client may choose to have a bilateral mastectomy and recommend genetic testing to other family members, the most important thing to relay to the client is that having a genetic susceptibility does not mean that one will automatically have the disease.

DIF: Cognitive level: Analyzing REF: p. 245 & p. 250

TOP: Nursing process: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

22. A nurse is considering seeking employment in a career as a genomic nurse. Which of the following roles would be most important role of the nurse in this setting?

a.

Direct caregiver

b.

Educator

c.

Advocate

d.

Referral agent

ANS: C

Although the nurse will use all of these roles when providing genomic nursing care, the most important role will be that of advocate. Nurses will increasingly provide guidance on policy discussions and ethical issues that relate to confidentiality, privacy, and commercialization. This is the nursing role of advocate.

DIF: Cognitive level: Analyzing REF: p. 253

TOP: Nursing process: Evaluation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

MULTIPLE RESPONSE

1. A nurse is studying the recent increase in Type I diabetes in the community. Which of the following factors should the nurse consider when examining the development of disease? (Select all that apply.)

a.

Genetics

b.

Lifestyle

c.

Environment

d.

Technology

e.

Communication patterns

ANS: A, B, C

The knowledge of human genetics can improve the safety, quality, and effectiveness of care for clients. It is important for nurses to understand the predisposition to disease as well as the impact of behavior and social conditions on overall community health and wellbeing. Many genetic disorders have an environmental link. Technology and communication patterns do not have a strong association with the development of genetic disorders.

DIF: Cognitive level: Applying REF: pp. 247-248

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. A nurse is counseling a client who has just learned that she is a carrier of the BRCA-2 gene. Which of the following best describes potential reactions by this client? (Select all that apply.)

a.

Feelings of guilt

b.

Fear of loss of insurance coverage

c.

Feelings of anxiety

d.

Fear for children

e.

Feelings of insecurity

ANS: A, C, D

Feelings of guilt, anxiety, and fear for future susceptibility for children are all potential reactions this client may have. The GINA protects clients from losing insurance benefits based upon genetic information. The feeling of insecurity is not a common reaction experienced from those diagnosed with a genetic disorder.

DIF: Cognitive level: Applying REF: p. 246

TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity

3. According to the CDC’s “Genomic competencies for the public health workforce,” which of the following should all public health workers be able to do? (Select all that apply.)

a.

Demonstrate basic knowledge of the role that genomics play in disorders.

b.

Make appropriate referrals to those with more genomic experience.

c.

Counsel individuals about their genetic susceptibility for particular disorders.

d.

Recommend appropriate genetic screening tests for clients.

e.

Plan appropriate care for those who have positive genetic tests.

ANS: A, B

The CDC’s “Genomic competencies for the public health workforce” apply to all public health professionals. All public health workers should demonstrate basic knowledge and be able to make appropriate referrals. The other statements would not be true of competencies of all public health workers.

DIF: Cognitive level: Understanding REF: p. 249

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care