Solution Manual for Genetics and Genomics for Nursing

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Kenner/Lewis:Genetics and Genomics for Nursing,1eChapter 1: Genetics and Genomics: Definitions and TrendsCase StudyQuestionsGenetic Biomarker (GB) testing is becoming more popular as the cost and relevancy ofpharmacogenomics testing becomes better known and easily applicable to clinical practice. A sitereferencing required, recommended, or for information only testing is available on the FDA websiteat www.fda.gov/Drugs/ScienceResearch/ResearchAreas/Pharmacogenetics/ucm083378.htm. Thiswill assist in answering the following questions:A registered nurse is assigned to care for three patients who are receiving medications that areknown to be associated with genetic traits or GB(s) that could alter the effect of the drug. Identify ifthe GB has required, recommended, or for information only status for testing.This activity contains 3 questions.1.L.L. is a 52-year-old Caucasian female being treated with Herceptin for her recently diagnosedher2/neu positive breast cancer.Answer:Required. The breast cancer tumor must be tested for the presence of the her2/neureceptor in order to receive Herceptin.2.R.N. is a 62-year-old male with a new diagnosis of rheumatoid arthritis and has beenprescribed Celebrex 200mg b.i.d.Answers:Recommended if PM status suspected. Poor metabolizers (PM) of Celebrex should havedosage reduced by 50%. If this patient is a PM the dose should be reduced to 100mg b.i.d. andmonitored for side effects.www.accessdata.fda.gov/drugsatfda_docs/label/2011/020998s033,021156s003lbl.pdf3.M.G. is a 26-year-old Ethiopian new mom who delivered her first child by a caesarean section.She was prescribed codeine 30mg p.o. and is breastfeeding her newborn.Answers: Because of her Ethiopian ancestry, M.G. could be an Ultra-rapid metabolizer and shouldreceive a non-codeine analgesic.www.accessdata.fda.gov/drugsatfda_docs/label/2012/022402s003lbl.pdf

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Kenner/Lewis:Genetics and Genomics for Nursing,1eChapter 1: Genetics and Genomics: Definitions and TrendsCase StudyQuestionsGenetic Biomarker (GB) testing is becoming more popular as the cost and relevancy ofpharmacogenomicstesting becomes better known and easily applicable to clinical practice. A sitereferencing required, recommended, or for information only testing is available on the FDA websiteat www.fda.gov/Drugs/ScienceResearch/ResearchAreas/Pharmacogenetics/ucm083378.htm. Thiswill assist in answering the following questions:A registered nurse is assigned to care for three patients who are receiving medications that areknown to be associated with genetic traits or GB(s) that could alter the effect of the drug. Identify ifthe GB has required, recommended, or for information only status for testing.This activity contains 3 questions.1.L.L. is a 52-year-old Caucasian female being treated with Herceptin for her recently diagnosedher2/neu positive breast cancer.2.R.N. is a 62-year-old male with a new diagnosis of rheumatoid arthritis and has beenprescribed Celebrex 200mg b.i.d.3.M.G. is a 26-year-old Ethiopian new mom who delivered her first child by a caesarean section.She was prescribed codeine 30mg p.o. and is breastfeeding her newborn.

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Kenner/Lewis:Genetics and Genomics for Nursing,1eChapter 1: Genetics and Genomics: Definitions and TrendsNCLEXReview QuestionsThis activity contains 8questions.1.How would the nurse know that the new graduate has attained the required information inthe field of genetics to care for a client population? Select all that apply.Note: Credit will be given only if all correct choices and no incorrect choices are selected.Answers:The nurse is familiar with the specialized information needed to practice in the neonatalunit, where the nurse is assigned.The nurse knows the basic concepts for practicing in a general medical-surgical unit.2.The nurse is assigned a group of clients new to the health clinic for their first prenatal visit. Forwhich client would the nurse recommend a consultation for genetic testing? Select all that apply.Note: Credit will be given only if all correct choices and no incorrect choices are selected.Answers:The client has a sibling with known hereditary defect.A client four months pregnant whose spouse has a hereditary conditionThe client has a known genetic disorder and is already under care.3.What question is best for a nurse to ask to solicit information regarding genetic screening ortesting?Answer:“Have you ever been tested for a genetic or hereditary condition?”4.While the nurse is teaching a group of clients about their genetic condition, one clientreports having an illness due to environmental causes. What would be the best approach in dealingwith this situation at this time?Answer:Inform the clients that some genetic illnesses can be affected by the environment.5.The quality assurance personnel conducted a review of actions by the nurses on a generalmedical unit. Which documented action indicates that educational intervention on genetics andgenomics is required?Answer: All of the clients were referred for genetic screening.6.Why is specific genetic and genomics knowledge considered a core competency for nurses?

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Kenner/Lewis:Genetics and Genomics for Nursing,1eAnswer:It can help in planning care regarding a client’s health and illness.7.When was mapping completed in the Human Genome Project?Answer:In 20038.What was the aim of the Human Genome Project? Select all that apply.Answers:To map the entire gene sequence in humansTo determine the key components of genes that cause cancer

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Kenner/Lewis:Genetics and Genomics for Nursing,1eChapter 1: Genetics and Genomics: Definitions and TrendsNCLEXReview QuestionsThis activity contains 8questions.1.How would the nurse know that the new graduate has attained the required information inthe field of genetics to care for a client population? Select all that apply.Note: Credit will be given only if all correct choices and no incorrect choices are selected.•The nurse knows the basic concepts for practicing in a general medical-surgical unit.•The nurse knows the list of genetic tests that can be afforded by the poor.•The nurse is familiar with the specialized information needed to practice in the neonatalunit, where the nurse is assigned.•The nurse can list the test that will be reimbursed by health insurance coverage.•The nurse is familiar with the governmental policies for genetic screening of individuals.2.The nurse is assigned a group of clients new to the health clinic for their first prenatal visit. Forwhich client would the nurse recommend a consultation for genetic testing? Select all that apply.Note: Credit will be given only if all correct choices and no incorrect choices are selected.•A client four months pregnant whose spouse has a hereditary condition•The client has occasionally taken a nonprescribed medication during the early pregnancy.•The client has a sibling with known hereditary defect.•The client has a known genetic disorder and is already under care.•The client requests genetic screening without known risk by assessment.3.What question is best for a nurse to ask to solicit information regarding genetic screening ortesting?•“Have you ever had special testing done?”•“Has anyone ever discussed genetic testing with you?”•“Have your parents been genetically screened?”•“Have you ever been tested for a genetic or hereditary condition?”

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Kenner/Lewis:Genetics and Genomics for Nursing,1e4.While the nurse is teaching a group of clients about their genetic condition, one clientreports having an illness due to environmental causes. What would be the best approach in dealingwith this situation at this time?•Ask that the client not be a part of the group, as the client’s condition differs.•Inform the clients that some genetic illnesses can be affected by the environment.•Arrange for a team meeting to discuss this client’s issues.•Recommend that the client have a conversation with the doctor.5.The quality assurance personnel conducted a review of actions by the nurses on a generalmedical unit. Which documented action indicates that educational intervention on genetics andgenomics is required?•Clients with visible physical defects suspected of a hereditary condition were referred fortesting.•All of the clients were referred for genetic screening.•The nurse documented the pedigree chart on all admitted clients.•None of the clients was referred for genetic testing.6.Why is specific genetic and genomics knowledge considered a core competency for nurses?•It can determine which clients should be screened for cancer.•It can help to isolate families that have a genetic condition.•It can help in planning care regarding a client’s health and illness.•It is important across all generations of clients.7.When was mapping completed in the Human Genome Project?•In 1990•In 1953•In 2003•In 1805

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Kenner/Lewis:Genetics and Genomics for Nursing,1e8.What was the aim of the Human Genome Project? Select all that apply.•To determine the key components of genes that cause cancer•To map the entire gene sequence in humans•To identify the causes of the illness•To advance the science regarding animal diseases

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Kenner/Lewis:Genetics and Genomics for Nursing,1eChapter 2: Why Basic Concepts in Genetics and Genomics Are Part of EveryType of Nursing PracticeCase StudyQuestionsJimis a 67-year-old African-American man who has arrived for his annual physical. Jim is inseemingly good health for his age. While you are taking his family medical history, Jim mentions thathe is having tremors in his hands and it is becoming increasingly annoying to him when he tries towrite or drink coffee. When asked if there is a family history of Parkinson’s disease, Jim says hedoesn’t know. Jim wants to know how he will know if he has Parkinson’s and what types oftreatment are available.This activity contains 3 questions.1.Ask Jim some questions to further evaluate the tremors that he is having.Suggested Answer: Examples of questions to ask are:Do you have tremors in your hands when you are resting?Have you or your family noticed changes in the way you move, walk?Have you had changes in your bowel movements, such as diarrhea or constipation?2.Please let Jim know what types of testing are available for Parkinson’s and what types oftreatment are recommended.Suggested Answer: There are no diagnostic tests that specifically identify Parkinson’s disease. Jimwill be referred to a neurologist for further evaluation. There is no cure for Parkinson’s disease, butthe progression of symptoms can be delayed based on individual response. Some of the commontreatments are Carbidopa/Levodopa therapy, Dopamine agonists, Anticholinergics, or MAO-Binhibitors.After further evaluation, Jim returns for a follow-up appointment. His neurologist has sent overnotes that suggest that he does have Parkinsonian symptoms. Jim realizes that this is a progressivedisease and expresses that he is an advocate for scientific research and wants to know if any clinicaltrials are available that he could participate in. Jim is a talkative man and also indicates that he is anorgan donor and begins wondering if there are any organ donation programs specific for people withParkinson’s disease, so that he can make preparations for his family.

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Kenner/Lewis:Genetics and Genomics for Nursing,1e3.Please share with Jim information about a clinical trial and whom he should contact, and findout if there is an organ donation program or brain bank that Jim could apply for. (You may find thefollowing websites helpful: www.clinicaltrials.gov or www.intbbn.org/registry-of-brain-banks.aspx).Suggested Answer: The answer should include a clinical trial either at a local facility or from thewebsite provided and the listing of an organ donation program or brain bank.

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Kenner/Lewis:Genetics and Genomics for Nursing,1eChapter 2: Why Basic Concepts in Genetics and Genomics Are Part of EveryType of Nursing PracticeCase StudyQuestionsJimis a 67-year-old African-American man who has arrived for his annual physical. Jim is inseemingly good health for his age. While you are taking his family medical history, Jim mentions thathe is having tremors in his hands and it is becoming increasingly annoying to him when he tries towrite or drink coffee. When asked if there is a family history of Parkinson’s disease, Jim says hedoesn’t know. Jim wants to know how he will know if he has Parkinson’s and what types oftreatment are available.This activity contains 3 questions.1.Ask Jim some questions to further evaluate the tremors that he is having.2.Please let Jim know what types of testing are available for Parkinson’s and what types oftreatment are recommended.3.Please share with Jim information about a clinical trial and whom he should contact, and findout if there is an organ donation program or brain bank that Jim could apply for. (You may find thefollowing websites helpful: www.clinicaltrials.gov or www.intbbn.org/registry-of-brain-banks.aspx).

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Kenner/Lewis:Genetics and Genomics for Nursing,1eChapter 2: Why Basic Concepts in Genetics and Genomics Are Part of EveryType of Nursing PracticeNCLEXReview QuestionsThis activity contains 8questions.1.A nurse manager is evaluating a staff nurse’s demonstration of essential competencies ingenetics. Which situations would the manager recognize as meeting one of these competencies?Select all that apply.Note: Credit will be given only if all correct choices and no incorrect choices are selected.Answers: The nurse constructed a three-generation family health history on a newly admitted client.The nurse asked to be transferred off a case in which a client requested to abort a pregnancy aftergenetic testing.The nurse asked to attend a conference on diversity.The nurse advocated for transfer to a specialized genetic service for a client with complex needs.2.How would the nurse determine that the family needed care related to genetic counseling?Select all that apply.Note: Credit will be given only if all correct choices and no incorrect choices are selected.Answers: A family member has been told he has a genetic illness.The client has agreed to undergo genetic testing.3.Who developed the monograph related to genetics and genomics competencies for nursing?Answer: Group of nurse clinicians, leaders, educators, and researchers4.What is the best inference that can be made if the nurse included the pharmacist in thediscussion of care for a client who is being treated for a genetic condition?Answer: There are possible pharmacogenetic implications to the treatment.5.What step would the nurse take first when prioritizing care for the family that refuses for theirchild with mental retardation to be genetically tested?Answer: Discuss the pros and cons of genetic testing.

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Kenner/Lewis:Genetics and Genomics for Nursing,1e6.What is the minimum familial generation history needed to be collected on a client who wasadopted in order to determine whether appropriate genetic and genomic assessment of the clientwas completed?Answer: Three generations of family history7.Which activity is consistent with the role of the registered nurse who is participating in geneticand genomic primary preventative care?Answer: The nurse teaches pregnant mothers over age 40 years about common birth defects.8.What is the role of genetic/genomic bio-banking in delivering health care to clients at high riskfor genetic disease?Answer: The stored genetic material can help determine which illnesses are in the client’s gene pool.

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Kenner/Lewis:Genetics and Genomics for Nursing,1eChapter 2: Why Basic Concepts in Genetics and Genomics Are Part of EveryType of Nursing PracticeNCLEXReview QuestionsThis activity contains 8questions.1.A nurse manager is evaluating a staff nurse’s demonstration of essential competencies ingenetics. Which situations would the manager recognize as meeting one of these competencies?Select all that apply.Note: Credit will be given only if all correct choices and no incorrect choices are selected.•The nurse advocated for transfer to a specialized genetic service for a client with complexneeds.•The nurse asked to attend a conference on diversity.•The nurse constructed a three-generation family health history on a newly admitted client.•The nurse asked to be transferred off a case in which a client requested to abort a pregnancyafter genetic testing.•The nurse’s care plans seldom mention genetic or genomic assessment.2.How would the nurse determine that the family needed care related to genetic counseling?Select all that apply.Note: Credit will be given only if all correct choices and no incorrect choices are selected.•The breadwinner of the family was diagnosed with a genetic illness.•More than one member of the family is affected by the genetic condition.•The client has agreed to undergo genetic testing.•The newborn infant was diagnosed with a genetic condition.•A family member has been told he has a genetic illness.3.Who developed the monograph related to genetics and genomics competencies for nursing?•Group of geneticists from the United States and Canada•Members of the American Medical Association

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Kenner/Lewis:Genetics and Genomics for Nursing,1e•Group of nurse clinicians, leaders, educators, and researchers•Members of the American Association of Colleges of Nursing4.What is the best inference that can be made if the nurse included the pharmacist in thediscussion of care for a client who is being treated for a genetic condition?•The nurse is involving interdisciplinary team members.•The client is unfamiliar with the medication being administered.•The nurse is breaking the laws of confidentiality.•There are possible pharmacogenetic implications to the treatment.5.What step would the nurse take first when prioritizing care for the family that refuses for theirchild with mental retardation to be genetically tested?•Complete a detailed assessment of the psychological impairment of the child.•Discuss the pros and cons of genetic testing.•Encourage the family to seek care for the sorrow they are experiencing.•Inform the family that there are environmental causes of mental retardation.6.What is the minimum familial generation history needed to be collected on a client who wasadopted in order to determine whether appropriate genetic and genomic assessment of the clientwas completed?•One generation of family health history•No familial history, as the client is adopted•Three generations of family history•Two generations of family health history7.Which activity is consistent with the role of the registered nurse who is participating in geneticand genomic primary preventative care?•The nurse teaches pregnant mothers over age 40 years about common birth defects.•The nurse participates in post-test genetic counseling of families with a positive result on aconfirmatory test.

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Kenner/Lewis:Genetics and Genomics for Nursing,1e•The nurse teaches the client with a genetic condition how to minimize disability.•The nurse discusses financial assistance with the family to minimize the burden of healthcare.8.What is the role of genetic/genomic bio-banking in delivering health care to clients at high riskfor genetic disease?•To collect and store genes from every organ in the human body•Results from the stored samples can help determine the length of time the client will livewith her condition.•The information from material stored can help only the family from which it was collected.•The stored genetic material can help determine which illnesses are in the client’s gene pool.

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