The clinic nurse is reviewing charts on prenatal clients. Which ...

[jrubin]

The clinic nurse is reviewing charts on prenatal clients. Which client histories should the nurse understand that a referral to a genetic counselor is warranted? (Select all that apply.)
 
  a. A father who is aged 35
  b. A client having a first baby at age 30
  c. A family history of unexplained stillbirths
  d. A client with a family history of birth defects
  e. A client who is a carrier of an X-linked disorder

Question 2

The patient indicates to the clinic nurse that she is trying to become pregnant. The clinic nurse reviews the patient's chart and notes the following laboratory values: blood type O-, RPR nonreactive, rubella nonimmune, HCT 35.
 
  Which laboratory value is most concerning to the nurse?
 
  a. HCT 35
  b. Blood type O-
  c. RPR nonreactive
  d. Rubella nonimmune

[upturnedfurball]

Answer to Question 1

ANS: C, D, E
Reasons for a referral to a genetic counselor include family history of unexplained stillbirths, family history of birth defects, and a woman who is a carrier of an X-linked disorder. Pregnant women who will be 35 years of age or older when the infant is born and men who father children after age 40 constitute reasons for referral to a genetic counselor. The client who is 30 and the father who is aged 35 would not warrant a referral to a genetic counselor.

Answer to Question 2

ANS: D
Rubella nonimmune indicates that the patient does not have immunity against rubella and is therefore susceptible to the infection. Exposure to rubella, or German measles, in the first trimester is associated with fetal congenital anomalies. The client needs a rubella immunization and must not become pregnant within the next 28 days. Although a HCT of 35 is low, women of childbearing age may have mild anemia associated with menstruation. A blood type of O- means that the client will require RhoGAM but is not of concern in the preconception period. A nonreactive RPR indicates that the patient has not been exposed to syphilis.

[jrubin]

Excellent

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