Deck 14: Risk Assessment

Question 1

The clinic nurse is planning to assess female clients using the Gail breast cancer risk model.Which clients should be eliminated from the assessment?

A)A 30-year-old African American
B)A client with a first-degree relative with breast cancer
C)A 42-year-old Caucasian woman
D)A 35-year-old Hispanic woman with a history of breast biopsy
E)A 40-year-old Asian-American woman whose paternal aunt had breast cancer

Answer 1

A 35-year-old Hispanic woman with a history of breast biopsy
A 40-year-old Asian-American woman whose paternal aunt had breast cancer

Question 2

A client states,"I know I have a risk of developing heart disease.Why do we need to spend time doing a risk assessment?" How should the nurse respond?

A)"A risk assessment will help the rest of your family."
B)"Having a risk assessment will help us devise a personalized plan of care for you."
C)"We need to determine just how bad your risk is."
D)"We need to find out what cultural practices you might need to change."

Answer 2

"Having a risk assessment will help us devise a personalized plan of care for you."

Question 3

Which statement by a bedside nurse would indicate the best understanding of the advancements being made in caring for clients with genetic disorders?

A)"My client is at risk for developing breast cancer,so we have discussed her need for more frequent screening visits."
B)"It wasn't until after my client's child was diagnosed with cystic fibrosis,genetic studies found that my client was a carrier."
C)"Because of my client's ethnicity,he will be transferred to a genetics center for testing."
D)"We didn't know that this client had a genetic risk for heart disease until he had a myocardial infarction."

Answer 3

"My client is at risk for developing breast cancer,so we have discussed her need for more frequent screening visits."

Question 4

The nurse is assessing a client's risk for developing a heritable disease.Which options reflect parts of this process?

A)The nurse identifies symptoms of this disease reported by several of the client's relatives.
B)The nurse collaborates regularly with the health care team that provides primary care for this client.
C)The nurse is constructing a three-generation pedigree from information provided by the client and relatives.
D)The nurse contacts the client's employer,insurance company,and friends for information about the client's personal habits.
E)The nurse actively looks for "red flags" in the client's family history.

Question 5

The nurse notices that a female client has a dark,even tan.When asked,the client says,"I spend several hours a week working on my tan.The men in my family have always liked their women tanned." What should the nurse consider before responding?

A)It will be difficult to convince this client that sun exposure can be detrimental to skin health.
B)The women in this client's family are likely subservient to men.
C)This client is likely to discount the nurse's attempts at educating in regard to sun exposure.
D)There is no reason to spend time trying to teach this client about the adverse effects of sun exposure.
E)The nurse should focus on trying to educate the woman to keep her daughters out of the sun.

Question 6

A client says,"I am interested in recording my family health history,but I don't know where to begin.Would you recommend the Surgeon General's Family History tool as a beginning?" How should the nurse respond?

A)"Using this tool is a very good way to encourage your relatives to participate in collecting your family health history."
B)"The problem with this tool is that is has not been updated or changed since it was first introduced."
C)"Family health history is so complicated that it is best to leave collection to someone with special training."
D)"You are taking the risk with this tool that someone will hack the storage site and have access to your information."

Question 7

After genetic testing is completed,the client is found to be at "population risk" for development of a disorder.How should the nurse explain this risk to the client?

A)"Population risk means that you are in a population of people who will likely develop this disease."
B)"Because you are at population risk,we advise that you follow standard screening for this disease."
C)"You have no environmental risks for developing this disease."
D)"You do not have to worry about ever developing this disease."
E)"You have moderate risk for developing this disease,so frequent screening is necessary."

Question 8

The nurse learns that many of a client's relatives have Type 2 diabetes.How can the nurse best follow up on this information with the client?

A)"Do you know how many people in your family have diabetes?"
B)"I would think you would not want to risk kidney failure or blindness."
C)"Let's talk about ways to help you avoid developing diabetes."
D)"Your risk of developing diabetes is very high and you should take steps to prevent it."

Question 9

Which statement reflects one of the biggest reasons clients are concerned about having genetic screening?

A)"I don't want to contact my father's family to ask them questions."
B)"I don't want to know what I am at risk of developing."
C)"I'm not really sure my husband is my daughter's father."
D)"I don't want to change my life."

Question 10

At an early prenatal office visit the client says,"I don't know if my mother had any miscarriages,but I will call her and ask.Why is that important to me?" How should the nurse respond?

A)"We always want to know your full history."
B)"A woman's obstetric experiences are often like her mother's."
C)"Miscarriages and stillbirths are often due to a genetic problem."
D)"If your mother had miscarriages,you are more likely to have one."

Question 11

The nurse is considering using the Claus model to assess the breast cancer risk in clients in a free clinic.What is the primary reason this is not a good model choice?

A)This model does not consider the age of the client.
B)Paternal family history is not included in the assessment.
C)In this setting the model is likely to substantially underestimate risk.
D)The health of second-degree relatives is not considered.

Question 12

The nurse notices that two brothers are phenotypically very different.What is the likely explanation?

A)The paternity of one of the brothers should be suspect since brothers are phenotypically similar.
B)The brothers were probably not raised together in the same household.
C)Environmental and genetic factors worked together to create phenotypically different individuals.
D)Their genotypes would be very similar,but environmental factors have caused phenotypic differences.

Question 13

The nurse is planning to assess clinic clients with the Framingham Risk Assessment tool.Which clients should the nurse exclude from this assessment?

A)A 23-year-old woman whose father had a myocardial infarction 10 years ago
B)A 36-year-old male with documented diabetic peripheral neuropathy
C)A 58-year-old postmenopausal woman
D)A 63-year-old client who retired two years ago due to hypertension refractory to standard treatment
E)A 48-year-old client with confirmed genital herpes

Question 14

A client says,"Why can't you just look at all my genes and see what I am at risk for instead of doing all this history?" How should the nurse respond?

A)"The process necessary to do that is still very expensive."
B)"It will still be necessary to collect a history."
C)"That probably will not happen in either of our lifetimes."
D)"It is going to take a long time for most health care providers to understand the use of genetics."
E)"That is not possible."