Chapter 1 - Maternity and Women's Health Care Today (1)
After teaching a group of nursing students about pregnancy-related mortality, the instructor determines that additional teaching is necessary when the students identify which condition as a leading cause? A) Hemorrhage B) Embolism C) Hypertension D) Infection
Ans: B Feedback: Most pregnancy-related complications are preventable. The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor, and unsafe abortion. Embolism is not a leading cause.
When discussing fetal mortality with a group of students, a nurse addresses maternal factors. Which of the following would the nurse most likely include? Select all that apply. A) Chromosomal abnormalities B) Malnutrition C) Preterm cervical dilation D) Underlying disease condition E) Poor placental attachment
Ans: B, C, D Feedback: Fetal mortality may be attributable to maternal factors (e.g., malnutrition, disease, or preterm cervical dilation) or fetal factors (e.g., chromosomal abnormalities or poor placental attachment).
The nurse is caring for a 12-year-old child hospitalized for internal injuries following a motor vehicle accident. For which of the following medical treatments would the nurse need to obtain an informed consent beyond the one signed at admission? A) Diagnostic imaging B) Cardiac monitoring C) Blood testing D) Spinal tap
Ans: D Feedback: Most care given in a health care setting is covered by the initial consent for treatment signed when the child becomes a patient at that office or clinic or by the consent to treatment signed upon admission to the hospital or other inpatient facility. Certain procedures, however, require a specific process of informed consent, including major and minor surgery; invasive procedures such as lumbar puncture or bone marrow aspiration; treatments placing the child at higher risk, such as chemotherapy or radiation therapy; procedures or treatments involving research; photography involving children; and applying restraints to children.
A 9-month-old with glaucoma requires surgery. The infant's parents are divorced. To obtain informed consent, which action would be most appropriate? A) Contacting the father for informed consent B) Obtaining informed consent from the mother C) Seeking a court ruling on the course of care D) Determining if there is parental sole or joint custody
Ans: D Feedback: The most appropriate action would be to determine legal custody by court decree. If the parents have joint custody, then either parent may give consent, but it is always best to have consent given by both parents. The parent with only physical custody may give consent for emergency care. The last resort is getting a court ruling; usually this is not necessary unless the parents disagree about the care of the child.
The nurse caring for families in crisis assesses the affective function of an immigrant family consisting of a father, mother, and two school-age children. Based on Friedman's structural functional theory, which of the following would the nurse identify as defining the family component? A) Meeting the love and belonging needs of each member B) Teaching children how to function and assume adult roles in society C) Ensuring the family has necessary resources with appropriate allocation D) Involving the provision of physical care to keep the family healthy
Ans: A Feedback: According to Friedman's structural functional theory, the affective function involves meeting the love and belonging needs of each member. Teaching children how to function and assume adult roles in society is the socialization and social placement function. Ensuring the family has necessary resources with appropriate allocation is related to the economic function, and involving the provision of physical care to keep the family healthy involves the health care function.
A mother confides to the nurse that she is thinking of divorce. Which suggestion by the nurse would be most helpful in minimizing the effects of the divorce on the couple's son? A) "Tell him together, using appropriate terms." B) "Reassure him that no one loves him more than you." C) "Do special things with him to make up for the divorce." D) "Share your feelings about your spouse with the child."
Ans: A Feedback: Both parents should tell the child about the divorce together, using appropriate terms. The other responses are unacceptable behaviors for the mother, such as competing with the spouse and using the child as a confidant.
After interviewing the mother of an 8-year-old girl with a broken arm, the nurse identifies the mother as the nurturer in the family. When developing the teaching plan for the girl and her mother, the nurse integrates knowledge of this role and focuses the teaching on which of the following? A) Teaching proper care procedures B) Dealing with insurance coverage C) Determining success of treatment D) Transmitting information to family members
Ans: A Feedback: The mother is the nurturer and thus the primary caregiver, so she would be the best family member to learn proper care procedures. Dealing with insurance coverage is the responsibility of the family's financial manager, transmitting information to family members is the gatekeeper's duty, and determining the success of treatment would likely fall to the family decision maker.
The school nurse is trying to get consent to care for an 11-year-old boy with diabetic ketoacidosis. His parents are out of town on vacation and the child is staying with a neighbor. Which action would be the priority? A) Getting telephone consent, with two people listening to the verbal consent B) Providing emergency care without parental consent C) Contacting the child's aunt or uncle to obtain consent D) Advocating for parens patriae to proceed with care for the child
Ans: A Feedback: The priority action would be to contact the neighbor for an emergency number to reach the parents and get their verbal consent, with two witnesses listening simultaneously. If the nurse cannot reach the parents and there is no relative or other person with written authorization to act on the parent's behalf, then the physician may initiate emergency care without the parent's consent. Parens patriae would be reserved for situations in which the parents are neglectful, irresponsible, or incompetent, for example, if the parents refuse treatment and the health care team feels the treatment is reasonable and warranted.
The nurse is counseling a young couple who in 2 months are having their third baby. The nurse uses Von Bertalanffy's (1968) general system theory applied to families to analyze the family structure. Which of the following best describes the main emphasis of this theory and its application to family dynamics? A) It emphasizes the family as a system with interdependent, interacting parts that endure over time to ensure the survival, continuity, and growth of its components. B) It emphasizes the social system of family, such as the organization or structure of the family and how the structure relates to the function. C) It emphasizes the developmental stages that all families go through, beginning with marriage; the longitudinal career of the family is also known as the family life cycle. D) It addresses the way families respond to stress and how the family copes with the stress as a group and how each individual member copes.
Ans: A Feedback: Von Bertalanffy emphasizes the family as a system with interdependent, interacting parts that endure over time to ensure the survival, continuity, and growth of its components. Friedman emphasizes the social system of family, such as the organization or structure of the family and how the structure relates to the function. Duvall emphasizes the developmental stages that all families go through, beginning with marriage; the longitudinal career of the family is also known as the family life cycle. The family stress theory addresses the way families respond to stress and how the family copes with the stress as a group and how each individual member copes.
The nurse is working with a group of community leaders to develop a plan to address the special health needs of women. Which of the following conditions would the group address as the major problem? A) Smoking B) Heart disease C) Diabetes D) Cancer
Ans: B Feedback: The group needs to address cardiovascular disease, the number-one cause of death in women regardless of racial or ethnic group. Smoking is related to heart disease and cancer, although heart disease and cancer can occur in any woman regardless of her smoking history. Cancer is the second leading cause of death, with women having a one in three lifetime risk of developing cancer. Diabetes is another important health condition that can affect women, but it is not the major health problem that heart disease is.
A nurse is working to develop a health education program for a local community to address breast cancer awareness. Which of the following would the nurse expect to include when describing this problem to the group? Select all that apply. A) White women have higher rates of breast cancer than African American women. B) African American women are more likely to die from breast cancer at any age. C) Survival at any stage is worse among White women. D) Women living in South America have the highest rates of breast cancer. E) Breast cancer is the leading cause of cancer mortality in women.
Ans: A, B, E Feedback: White women get breast cancer at a higher rate than African American women, but African American women are more likely to get breast cancer before they are 40, and are more likely to die from it at any age. This is likely because the cancer is more advanced when it is found in African American women, and because survival at every cancer stage is worse among African American women. Women living in North America have the highest rate of breast cancer in the world. At this time there are about 2.6 million breast cancer survivors in the United States. It is the most common malignancy in women and second only to lung cancer as a cause of cancer mortality in women.
The nurse working in a free community clinic knows that access to health care is affected negatively by lack of health insurance. Which of the following accurately describe the effect of lack of insurance on family health? Select all that apply. A) Parents with uninsured children often delay care and are less likely to take their children to a doctor or dentist for preventive care. B) The percentage of children without health insurance is beginning to decrease slightly from previous years. C) Currently, the states have improved enrollment in Medicaid and the State Children's Health Insurance Program (SCHIP). D) Despite state efforts to ensure all children, nearly two-thirds of children eligible for these public programs are not enrolled. E) In most states, men and women of the same health status and age are charged similar rates for the same individual health insurance policy.
Ans: A, C, D Feedback: Parents with uninsured children often delay care for their children, and are less likely to take their children to a doctor or dentist for preventive care. The percentage of children without health insurance is rising. Despite efforts by the states to improve enrollment in Medicaid and State Children's Health Insurance Program (SCHIP), nearly two-thirds of children eligible for these programs remain uninsured. Additionally, in most states, a man and woman of the same age and health status will be charged different rates for exactly the same individual health insurance policy.
The neonatal nurse researches the neonatal mortality rate in the United States. Which of the following accurately describes this measurement of child health? Select all that apply. A) Neonatal mortality is the number of infant deaths occurring in the first 28 days of life per 1,000 live births. B) The infant mortality rate refers to the number of deaths occurring in the first 6 months of life. C) Neonatal mortality is documented as the number of deaths in relation to 1,000 live births. D) The infant mortality rate is used as an index of the general health of a country. E) In 2010, the U.S. infant mortality rate for White infants was greater than that for Black infants per 1,000 live births.
Ans: A, D Feedback: Neonatal mortality is the number of infant deaths occurring in the first 28 days of life per 1,000 live births. The infant mortality rate refers to the number of deaths occurring in the first 12 months of life and is documented as the number of deaths in relation to 1,000 live births. The infant mortality rate is used as an index of the general health of a country; generally, this statistic is one of the most significant measures of children's health. In 2010, the infant mortality rate in the United States was 6.14 for White infants and 11.61 for Black infants per 1,000 live births. In 2005, the infant mortality rate in the United States was 6.86 per 1,000 live births.
Parents are complaining about the amount of time their 14-year-old girl spends on the Internet. Which of the following would be most important to address with the parents? A) "Limit her use of the Internet to an hour per day." B) "Does she do her homework and socialize in person?" C) "Can you place the computer where you can keep an eye on her?" D) "You need to warn her about protecting her identity."
Ans: B Feedback: Although having the computer in a family area is better than putting it in her room, and warning her about protecting her identity is key, it is important to determine if the child is neglecting responsibilities, schoolwork, household activities, friends, or other forms of personal interaction. Once this is determined, then reasonable time limits for the child's use of the Internet can be established.
A mother of four children is being interviewed by the nurse. She states: "Whatever my husband and I say goes and the kids need to follow our rules without complaining about them." The nurse interprets this as which parenting style? A) Authoritative B) Authoritarian C) Permissive D) Rejecting-neglecting
Ans: B Feedback: Four major parenting styles seen in our society are authoritarian, authoritative, permissive, and rejecting-neglecting. The authoritarian parent expects obedience from the child and discourages the child from questioning the family's rules. The authoritative or democratic parent shows some respect for the child's opinions. Permissive or laissez-faire parents have little control over the behavior of their children. Rejecting or neglecting parents are indifferent or uninvolved.
The nurse is teaching discipline strategies to the parents of a 12-year-old girl. Which of the following topics is an example of positive reinforcement discipline? A) Unplugging the DVD player for the weekend B) Taking a chore away from the child for a week C) Having her clean up the kitchen for a week D) Ignoring her request if she doesn't say "please"
Ans: B Feedback: Taking a chore away from the child for a week is an excellent way to reward her for positive behavior. Unplugging the DVD player and assigning an extra chore are examples of negative reinforcement. Ignoring her until she uses good manners is an example of extinction.
A preschool child is scheduled to undergo a diagnostic test. Which action by the nurse would violate a child's bill of health care rights? A) Arranging for her mother to be with her B) Telling the child the test will not hurt C) Assuring the child that the test will be done quickly D) Introducing the child to the lab technicians
Ans: B Feedback: Telling the child the test will not hurt lacks veracity or truth. It is not a lie, but it does not honor the child's right to be educated honestly about his or her health care. Arranging for the mother to be with the child, assuring the child that the test will be done quickly, and introducing the child to the lab technicians are actions that honor the child's bill of health care rights.
The United States ranks 50th in the world for maternal mortality and 41st among industrialized nations for infant mortality rates. When developing programs to assist in decreasing theses rates, which factor would most likely need to be addressed as having the greatest impact? A) Resolving all language and cultural differences B) Ensuring early and adequate prenatal care C) Providing more extensive women's shelters D) Encouraging all women to eat a balanced diet
Ans: B Feedback: The lack of prenatal care during pregnancy is a major factor contributing to a poor outcome. Prenatal care is well known to prevent complications of pregnancy and to support the birth of healthy infants. Infant mortality commonly includes problems occurring at birth or shortly thereafter. Thus, ensuring early and adequate prenatal care would have the greatest impact on decreasing these rates. Resolving all language and cultural differences would be helpful but is unrealistic. Providing more extensive women's shelters would be helpful for women who are victims of abuse. Encouraging all women to eat a balanced diet is helpful but would not decrease infant mortality rates.
The nurse providing care to a family and an ill child in a hospital setting reflects on the focus of the health care provided in today's society. Which of the following statements best describes the current definition of health? A) Health is described as "an absence of disease." B) Health is measured by monitoring the mortality and morbidity of a group. C) Health is a state of complete physical, mental, and social well-being. D) Technological gains made in health care are shared equally among all children.
Ans: C Feedback: In the past, health was defined simply as the absence of disease; health was measured by monitoring the mortality and morbidity of a group. Over the past century, however, the focus of health has shifted to disease prevention, health promotion, and wellness. The World Health Organization (2012) defines health as "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity." The gains in child health have been huge, but, unfortunately, these gains are not shared equally among all children.
The nurse is teaching discipline strategies to the parents of a 4-year-old boy. Which response by the parents indicates a need for more teaching? A) "We should remove temptations that lead to bad behavior." B) "We need to explain how we expect him to behave." C) "We should tell him we get angry when he's bad." D) "We must praise the child for good behavior."
Ans: C Feedback: Telling the child that the parents get angry when he is bad would be inappropriate. This response indicates the need to restate that it is important to let the child know that it is not him but rather his behavior that is bad. Removing temptations, setting expectations, and praising good behavior are important concepts the parents need to learn.
A group of students is reviewing historical aspects about childbirth. The students demonstrate understanding of the information when they identify the use of twilight sleep as a key event during which time frame? A) 1700s B) 1800s C) 1900s D) 2000s
Ans: C Feedback: Twilight sleep, or the use of a heavy dose of narcotics and amnesiacs, was used on women during childbirth in the United States during the 1900s. Female midwives attended the majority of births during the 1700s. Care shifted to doctors among middle-class women during the 1800s. Certified nurse midwives and childbirth classes characterize the 2000s.
A nurse is preparing a presentation for a local women's group about heart disease and women. Which of the following would the nurse expect to address when discussing measures to promote health? A) Women have similar symptoms as men for a heart attack. B) Heart disease is no longer viewed as a "man's disease." C) Women experiencing a heart attack are at greater risk for dying. D) Heart attacks in women are more easily diagnosed.
Ans: C Feedback: Women who have a heart attack are more likely than men to die. Heart attacks in women are often more difficult to diagnose than in men because of their vague and varied symptoms. Heart disease is still thought of as a "man's disease," and thus a heart attack may not be considered in the differential diagnosis when a woman presents to the emergency room. Nurses need to look beyond the obvious "crushing chest pain" textbook symptom that heralds a heart attack in men. Manifestations of heart disease differ between men and women.
A nurse is assigned to care for an Asian American client. The nurse develops a plan of care with the understanding that based on this client's cultural background, the client most likely views illness as which of the following? A) Caused by supernatural forces B) A punishment for sins C) Due to spirits or demons D) From an imbalance of forces
Ans: D Feedback: Asian Americans believe that illness is caused by an imbalance of forces, specifically yin and yang. Native Americans believe that illness is caused by supernatural forces, and African Americans may believe that illness is caused by spirits or demons.
After describing the procedure and medical necessity, the nurse asks a 14-year-old child to assent to a skin graft. Which of the following statements accurately describes the requirements for this type of assent? A) The age of assent occurs at 12 years old. B) It is not necessary to obtain assent from a minor for a procedure. C) A minor can dissent to a procedure but his or her wishes are not binding. D) In some cases, such as cases of significant morbidity or mortality, dissent may need to be overridden.
Ans: D Feedback: Assent means agreeing to something. In pediatric health care, the term assent refers to the child's participation in the decision-making process about health care (McCullough & Stein, 2010). In some cases, such as cases of significant morbidity or mortality, dissent may need to be overridden. The age of assent depends on the child's developmental level, maturity, and psychological state. The converse of assent, dissent (disagreeing with the treatment plan), when given by an adolescent 13 to 17 years of age, is considered binding in some states. The American Academy of Pediatrics proposes that a child with an intellectual age of 7 years or older is competent to understand participation in research and therefore provide assent (Sirbaugh & Diekema, 2011).
A 10-year-old girl who is living with a foster family is brought to the clinic for evaluation. When caring for this child, which intervention is a priority? A) Determining if the child is being bullied at school B) Dealing with mixed expectations of parents C) Establishing who the child's actual caretaker is D) Performing a comprehensive health assessment
Ans: D Feedback: Children in foster care are more likely to exhibit a wide range of medical, emotional, behavioral, or developmental problems. Although resilient, they may struggle with certain issues such as unmet health needs. Therefore a comprehensive physical health assessment would be a priority. Determining if the child is being bullied at school is not specific to any one family structure. Assessing for problems related to conflicting feelings toward parents would be more likely common in a blended family. Establishing who the caretaker is would be necessary with a communal family.
The nurse is assessing a toddler for temperament and documents a "difficult" temperament. Which of the following is a trait of this type of personality? A) Moodiness B) Irritability C) Even-temperedness D) Overly active
Ans: D Feedback: Children's temperaments may be categorized into three major groups: easy, difficult, and slow to warm up. Easy children are even-tempered and have regular biological functions, predictable behavior, and a positive attitude toward new experiences. Difficult children are irritable, overactive, and intense; they react to new experiences by withdrawing and are frustrated easily. Children in the slow-to-warm-up category are moody and less active and have more irregular reactions; they react to new experiences with mild but passive resistance and need extra time to adjust to new situations.
The nurse is performing a health assessment of a school-age child. Based on the child's developmental level, on which of the following problems would the nurse focus more attention? A) Infections B) Poisonings C) Risk-taking behaviors D) Accidents and injuries
Ans: D Feedback: Developmental level has a major impact on the health status of children. The physiologic immaturity of an infant's body systems increases the risk for infection. Ingestion of toxic substances and risk of poisoning are major health concerns for toddlers as they become more mobile and inquisitive. Because preschool- and school-age children are, generally, very active, they are more prone to injury and accidents. Adolescents are establishing their identity, which may lead them to separate from the family values and traditions for a period of time and attempt to conform to their peers. This journey may lead to risk-taking behaviors, resulting in injuries or other situations that may impair their health.
A nurse is assessing a family for barriers to health care. Which factor would the nurse identify to be most important? A) Language B) Health care workers' attitudes C) Transportation D) Finances
Ans: D Feedback: Financial barriers are one of the most important factors that limit care. Families may not have any medical insurance, may not have enough insurance to cover the services they need, or may not be able to pay for services. Language, health care workers' attitudes, and transportation are also barriers to health care but are not as fundamentally important as finances.
The student nurse is learning about the past history of child health and health care in the United States. Which of the following statements by the student indicates successful learning about the condition of health care in the past and current centuries? A) In past centuries in the United States, the health of the country was better than it is today due to the simpler style of living. B) In the current century, mortality rates are high, but life expectancy has increased due to technological advances. C) In the late 18th and early 19th centuries urban public health improvements made cities healthier places for growing children. D) By the end of the 20th century, unintentional injuries rather than infectious diseases had become the leading cause of death for children older than 1 year old.
Ans: D Feedback: In past centuries in the United States, the health of the country was poorer than it is today; mortality rates were high and life expectancy was short. Over the years the health of children received more and more attention, leading to a better understanding of sources of illness and improvements in sanitation, water, and nutrition. As a result, by the end of the late 20th century, unintentional injuries rather than infectious diseases had become the leading cause of death for children older than 1 year old.
When preparing a teaching plan for a group of first-time pregnant women, the nurse expects to review how maternity care has changed over the years. Which of the following would the nurse include when discussing events of the 20th century? A) Epidemics of puerperal fever B) First cesarean birth C) X-rays used to assess pelvic size D) Development of freestanding birth centers
Ans: D Feedback: In the 20th century (1900s), freestanding birth centers were developed. Puerperal fever epidemics, the first cesarean birth, and the use of x-rays to assess pelvic size were events occurring during the 19th century (1800s).