Author Question: A nurse obtains health histories when admitting clients to a medical-surgical unit. With which ... (Read 158 times)

shenderson6 · **on:** Jun 25, 2018

A nurse obtains health histories when admitting clients to a medical-surgical unit. With which client should the nurse discuss predisposition genetic testing?

a. Middle-aged woman whose mother died at age 48 of breast cancer
b. Young man who has all the symptoms of rheumatoid arthritis
c. Pregnant woman whose father has sickle cell disease
d. Middle-aged man of Eastern European Jewish ancestry

Question 2

A nurse cares for a client of Asian descent who is prescribed warfarin (Coumadin). What action should the nurse perform first?

a. Schedule an international normalized ratio (INR) test to be completed each day.
b. Initiate fall precautions and strict activity limitations.
c. Teach the client about bleeding precautions, including frequent checks for any bruising.
d. Confirm the prescription starts warfarin at a lower-than-normal dose.

Chocorrol77 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: A
A client with a family history of breast cancer should be provided information about predisposition testing. Predisposition testing should be discussed with clients who are at high risk of hereditary breast, ovarian, and colorectal cancers so that the client can engage in heightened screening activities or interventions that reduce risk. The client with symptoms of rheumatoid arthritis should be given information about symptomatic diagnostic testing. The client with a familial history of sickle cell disease and the client who is of Eastern European Jewish ancestry should be given information about carrier genetic testing.

Answer to Question 2

ANS: D
Most individuals of Asian heritage have a single nucleotide polymorphism in the CYP2C19 gene that results in low activity of the enzyme produced. This mutation greatly reduces the metabolism of warfarin, leading to increased bleeding risks and other serious side effects. Any person of Asian heritage who needs anticoagulation therapy should be started on very low dosages of warfarin and should have his or her INR monitored more frequently. The nurse can always teach about the risk of bleeding and can monitor for any bruising. The priority action is for the nurse to check the prescription and confirm the dose prior to administering the medication. It is not necessary to initiate fall precautions and to limit activity based on the administration of warfarin.