The parent of a child profoundly affected by a gene alteration says, "I don't understand how something so small can cause such problems." How should the nurse respond?
1. "The effects depend on the environment in which the child is raised."
2. "Some children are affected even more than your child."
3. "The degree of effect depends on which gene is damaged and what kind of damage is done."
4. "We don't think about how we are potentially changing our genes when we expose ourselves to chemical substances."
3
Rationale 1: Genetic defects cause physical changes that are independent of environmental influences.
Rationale 2: It is not therapeutic to tell a parent that other children are more severely affected. This parent is concerned about his or her child, not other children.
Rationale 3: Effects depend on which gene is altered and how much, the locus of the gene, whether material is lost or gained, and how the chromosome is rearranged.
Rationale 4: This is a true statement, but it implies that the child's disorder was caused by some action by the parents. This may also be true, but it is not therapeutic to place blame in this situation.
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