hard · NCLEX-RN health-promotion

Sarah and Samantha, age 28, are monozygotic (identical) twins who have presented to the Neuro-Genetics Center. Their paternal uncle was diagnosed with Huntington's disease (HD), and their father recently died of the disease before undergoing genetic testing. Sarah has requested predictive genetic testing because she wants to plan her future. However, Samantha is adamantly opposed to testing and states, 'I absolutely do not want to know my status; I cannot live with that shadow.' The twins share 100% of their genetic material. Which actions are appropriate for the clinic nurse to take? Select all that apply.

1. Counsel Samantha that because her twin is being tested, she is legally required to sign an agreement acknowledging her potential genetic status.
2. Encourage Sarah to undergo testing secretly under an assumed name to protect Samantha's peace of mind.
3. Refer both sisters to a multidisciplinary team including a genetic counselor, ethicist, and psychologist before proceeding.
4. Advise Sarah that she must obtain Samantha's signed legal authorization before the clinic can perform her genetic test.
5. Inform Sarah that her results will be kept strictly confidential and will not be shared with Samantha without Sarah's explicit written consent.
6. Explain to Sarah that because they are identical twins, her decision to test will directly impact Samantha's right 'not to know' her genetic status.

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