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What is the nurses best response?
- A. I am ethically bound to tell your family and your fianc.
- B. Your information will remain confidential until the geneticist reviews everything. Then he or she will have to tell your family.
- C. Have you thought about what this disease will do to the person you are going to marry and any children you may have?
- D. I will respect your wishes and keep your information confidential. I do wish you would reconsider though.
Correct Answer: D
Rationale: The nurse must honor the patient's wishes while explaining the potential benefit this information may have for other family members. Breaching confidentiality or suggesting mandatory disclosure by a geneticist is incorrect. Encouraging reflection is secondary to respecting confidentiality.
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What legislation has as its purpose to protect Americans against improper use of genetic and genomic information?
- A. Genetic Information Nondiscrimination Act
- B. Genetic Confidentiality Agreement
- C. The White Paper on Genetic Testing Results
- D. Genetic Equity Act
Correct Answer: A
Rationale: The Genetic Information Nondiscrimination Act (GINA), signed into law in 2008, protects Americans against improper use of genetic and genomic information in insurance and employment decisions. The other options do not exist.
This nurse has consequently completed the first step in what process?
- A. Establishing the pattern of inheritance
- B. Influencing the clients genetic future
- C. Answering the clients genetic questions
- D. Answering the clients relational questions
Correct Answer: A
Rationale: Nursing assessment of the patient's health includes obtaining and recording family history information in the form of a pedigree. This is a first step in establishing the pattern of inheritance. It does not directly answer questions or influence genetic outcomes.
What action should a nurse who practices in the area of genetics prioritize?
- A. Teaching families about the different patterns of inheritance
- B. Gathering relevant family and medical history information
- C. Providing advice on termination of pregnancy
- D. Discouraging females from conceiving after the age of 40 years
Correct Answer: B
Rationale: The nurse's role in genetic counseling is to provide information, collect relevant data, offer support, and coordinate resources. Gathering family and medical history is a priority to establish patterns of inheritance and assess risks, unlike the other options, which are either inappropriate or secondary.
According to this legislation, insurers may use genetics testing as a justification for what action?
- A. Denying the patient health insurance
- B. Charging the patient higher insurance premiums
- C. Requiring the patient to enroll in Medicaid
- D. Requiring the patient to carry out a health promotion plan
Correct Answer: B
Rationale: HIPAA prohibits the use of genetics information to establish insurance eligibility. However, it does not prohibit group plans from increasing premiums, excluding coverage for a specific condition, or imposing a lifetime cap on benefits. Mandating Medicaid enrollment or health promotion plans is not allowed.
What is important for the nurse to explain to the couple?
- A. Retinoblastoma is an autosomal recessive inheritance in which each parent carries the gene mutation.
- B. Retinoblastoma is an X-linked inheritance and all males inherit an X chromosome from their mothers.
- C. Retinoblastoma is an autosomal dominant inheritance that has incomplete penetrance and can skip a generation.
- D. Retinoblastoma is a pattern that is more horizontal than vertical; relatives of a single generation tend to have the condition.
Correct Answer: C
Rationale: Retinoblastoma is an autosomal dominant inheritance that has incomplete penetrance, and the gene appears to skip a generation, thus leading to errors in interpreting family history and in genetic counseling. Autosomal recessive conditions have a pattern that is more horizontal than vertical; relatives of a single generation tend to have the condition. X-linked conditions may be inherited in recessive or dominant patterns, but retinoblastoma is not X-linked.