A 36 year old client with a gestational age of 11 weeks has been referred to genetic counseling based on a family history of an inheritable problem and advanced maternal age.
The client is concerned because they believe that genetic counseling will favor abortion if studies reveal a defective fetus. Which response would the nurse provide to the client regarding genetic counseling?
Abortion is suggested only when the fetus is found to have a severe defect that is not compatible with life.
Recommendations are made to consider adoption when defects are predicted.
After the probability of a defect is determined, the couple's own primary health care provider helps the couple decide on the appropriate action.
Families are counseled to understand the diagnosis, the probable cause and how the condition can be managed.
The Correct Answer is D
Choice A rationale
Genetic counseling is a non-directive process where the counselor provides comprehensive information about potential fetal conditions, including severity, inheritance patterns, and management options. Suggesting abortion, regardless of the defect's compatibility with life, is a directive approach that violates the core ethical principle of autonomy and the non-directive nature of genetic counseling. The couple makes the final informed decision, not the counselor.
Choice B rationale
Genetic counselors focus on providing accurate risk assessment, diagnostic information, and all available options, including continuation of pregnancy, adoption, or termination, but they do not make recommendations or push for any specific option. Non-directive counseling supports the client's autonomous decision-making; suggesting adoption as a primary course of action would constitute a violation of this ethical and professional standard.
Choice C rationale
Genetic counselors are experts who facilitate understanding of the medical and genetic implications. While they often coordinate care, the primary role is information provision and emotional support, not decision-making assistance from another provider. The counselor determines the probability and explains it, and then the client (the couple) makes the fully informed, autonomous decision based on their values, religious beliefs, and ethics.
Choice D rationale
This response accurately describes the core mission of non-directive genetic counseling, which is to provide education regarding the diagnosis, explore the etiology (probable cause), discuss the prognosis, and review all available management and reproductive options. This comprehensive approach empowers the clients to make an informed, autonomous decision that aligns with their personal and ethical framework.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Hegar's sign is a probable sign of pregnancy. It is the softening of the lower uterine segment or isthmus, typically occurring about 6-12 weeks gestation due to increased vascularity and fluid accumulation. Probable signs are objective, detectable by a provider, but can be caused by conditions other than pregnancy, making them less definitive than positive signs.
Choice B rationale
Quickening is the mother's first perception of fetal movement, usually felt between 16-20 weeks gestation. This is considered a presumptive sign of pregnancy. Presumptive signs are the subjective changes experienced and reported by the woman, suggesting pregnancy, but they can be attributed to many other conditions (e.g., gas, peristalsis), hence they are the least reliable indicators.
Choice C rationale
Chadwick sign is a probable sign of pregnancy. It is the deep, dusky-blue coloration of the vaginal and cervical mucosa due to increased blood flow (hyperemia) and vascularity, often observable from 6-8 weeks gestation. Probable signs are objective changes noted by a provider but are not absolutely specific to pregnancy, as other conditions could cause pelvic vascular congestion.
Choice D rationale
A Positive pregnancy test (urine or serum) is considered a probable sign of pregnancy. These tests detect the presence of Human Chorionic Gonadotropin (hCG). While highly reliable, conditions like hydatidiform mole or certain medications can cause a false positive result, preventing it from being a definitive positive sign, which only includes visualization of the fetus, fetal heart tones, or palpation of fetal movement by an examiner.
Correct Answer is ["A","B","D","E"]
Explanation
Choice A rationale
Internal fetal monitoring, specifically using an intrauterine pressure catheter (IUPC), directly measures the intensity of the contraction in millimeters of mercury (mmHg). This provides a precise quantitative measure of the force exerted by the uterine muscle, which is crucial for assessing labor progress and the risk of uterine hyperstimulation, something external monitoring cannot accurately provide.
Choice B rationale
The IUPC measures the resting tone between contractions, which is the baseline uterine pressure when the uterus is relaxed. A normal resting tone is typically 8–12 mmHg. An elevated resting tone (hypertonus) can decrease uteroplacental blood flow and oxygen exchange, leading to fetal distress, thus requiring careful monitoring.
Choice C rationale
The client's position during contraction and labor is an external observation and does not require or necessitate the use of an internal fetal monitoring device. Fetal monitoring primarily focuses on the physiological parameters of uterine activity and the fetal heart rate, not the mother's physical positioning or movement.
Choice D rationale
An internal fetal scalp electrode (FSE) is the most accurate method for continuously monitoring the fetal heart rate during labor. It attaches directly to the fetal scalp, providing a high-fidelity, beat-to-beat recording that is not affected by maternal or fetal movement, ensuring the most precise assessment of fetal well-being.
Choice E rationale
While the IUPC primarily measures pressure, it also allows for the accurate determination of the frequency of the contraction, measured from the beginning of one contraction to the beginning of the next. This precise timing is essential for calculating the contraction pattern and assessing the adequacy of labor and potential for hyperstimulation.
Choice F rationale
The client's response to the contraction, such as their pain level or need for comfort measures, is a subjective, behavioral observation. It is part of the overall nursing assessment but is not a physiological parameter directly measured or characterized by the internal fetal monitoring devices (IUPC or FSE).
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