Chapter 1: Perspectives on Maternal and Child Health Care - ML8

A nurse informs a 19-year-old client that she is pregnant. The client immediately states that she plans to have an abortion (elective termination of pregnancy). What would be the most appropriate response from the nurse to this client? "I'll put together the information that you will need." "Have you notified the father?" "Are you sure you want to do that?" "I don't know of any health care providers who will perform them."

"I'll put together the information that you will need." The nurse should not respond to this client with any judgment or biased information. The client does not have to notify the father, and the other responses show the nurse's personal bias. If a nurse has an ethical issue with this procedure, she should address it with her managers, not the client.

A nurse is conducting an in-service program for a group of nurses on the health of women and their families, incorporating information from Healthy People 2030. The nurse determines that additional discussion and clarification is needed when the group makes which statement? "Maintaining a physically active lifestyle is strongly encouraged." "Environmental quality is directly related to health care." "Immunizations may be the cause of some illnesses being seen currently." "Obesity, drug use, and smoking are major problems."

"Immunizations may be the cause of some illnesses being seen currently." Obesity, drug use, and smoking are major concerns. Physical activity and environmental quality are also on the list of leading health indicators in Healthy People 2030. The students who have determined that immunizations are the causes of diseases need clarification since maintenance of immunizations is one of the health indicators listed in the report.

The nurse is presenting to a shelter for women and children who experienced intimate partner violence and is asked by a participant, "What does the No Child Left Behind Act mean?" How should the nurse best respond? "It has led to increased research and treatment of major health issues concerning children." "Nutritional supplementation and education to low-income families and pregnant women will be provided." "This act provides increased funding for newborn screening grants and neonatal education." "It is a federal program that will ensure all children in classrooms receive up-to-date, research-based curriculum."

"It is a federal program that will ensure all children in classrooms receive up-to-date, research-based curriculum." Since 2002, the No Child Left Behind Act ensures that all children in all classrooms receive research-based curriculum, well-prepared teachers, and a safe learning environment. The other options describe other federal programs available.

A recently licensed nurse is orienting to a pediatric unit in an acute care facility. The nurse is discussing causes of infant mortality with the preceptor. Which statement by the preceptor most accurately addresses this problem? "Most of the infant deaths I have seen are related to sudden infant death syndrome (SIDS)." "The most common cause of infant deaths is chromosomal abnormalities and congenital anomalies, which we have no control over." "Most infants that die during infancy are victims of violence and neglect." "Infant death rates combine deaths from birth through the first year of life. That is why the numbers are so high."

"The most common cause of infant deaths is chromosomal abnormalities and congenital anomalies, which we have no control over." Congenital anomalies and chromosomal abnormalities are the leading cause of infant mortality in the United States. Violence and neglect can be contributory to infant deaths but are not major predictors of infant mortality. SIDS is a cause of infant mortality, but it is not the greatest cause. Infant mortality statistics go from age one month to one year of age, not starting at birth

After teaching a group of students about the concept of maternal mortality, the instructor determines that additional teaching is needed when a student makes which statement? "The duration of the pregnancy is a concern." "The time frame is typically for a specified year." "It addresses pregnancy-related causes." "The rate includes accidental causes for deaths."

"The rate includes accidental causes for deaths." The maternal mortality ratio is the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 live births, for a specified year.

A nurse is determining whether or not informed consent has been obtained from the family of a child who is going to have abdominal surgery. Which statement by the family would lead the nurse to suspect that informed consent is lacking? "He might miss some school afterwards, but he'll be feeling much better." "We had to sign the form right away so the surgery could get scheduled." "Although there are risks involved, our son needs the surgery to cure the problem." "We are amazed that he'll be up and walking around the day after surgery."

"We had to sign the form right away so the surgery could get scheduled." The statement about signing the form right away suggests that the family was coerced into agreeing to the surgery without being fully informed about the risks and benefits. The key ethical issues related to informed consent for treatment have similarities to those required for research participation: Consent must be voluntary and based upon shared information about the risks and benefits of the treatment. Furthermore, the parent must understand the information and be cognitively and mentally competent to make the decision. The statements about risks, activity limitations, and postoperative care indicate that information was shared with them and that they understood it.

The nurse is caring for several families enrolled in Medicaid in the prenatal setting. Which statement by an expectant mother would alert the nurse to assess the family further? "My sister-in-law is due to have her baby the same month as our baby is due." "In my culture, we have family help us care for the baby in our home for several months." "I plan to give birth in a hospital setting with my family at my side." "We just moved here from another state and I am still getting used to the new town."

"We just moved here from another state and I am still getting used to the new town." Medicaid is a financial assistance program for low income families and varies from state to state in terms of eligibility and application process. When a family has moved from one state to another, there may be delays in getting Medicaid established in the new state. Hospital births are typically covered by Medicaid. Family helping with the newborn is a benefit, and would not affect Medicaid resources. The mother's sister-in-law giving birth in the same month would not be a situation the nurse would need to assess further, especially regarding Medicaid resources.

The nurse is working with the parents of an infant and a toddler in the clinical setting. What statement by the parent would alert the nurse to assess the children further? "We live in an old house, and we are planning to renovate it when the kids are older." "We enjoy taking walks in the park and playing outside as much as possible." "We have baby gates installed at the top and bottom of our stairs in our home." "We have to hire babysitters sometimes because our parents are not able to help babysit."

"We live in an old house, and we are planning to renovate it when the kids are older." Older homes are at risk for having lead-based paint (usually those built before the mid to late 1970s) and lead pipes used in plumbing. The nurse would further assess for the children's exposure to lead pipes, paint, paint chips, lead dust, and soil containing lead dust and paint chips. Additionally, during a renovation, the children will be exposed to areas with lead paint and/or dust. The other options are appropriate and demonstrate information only and not a need to further assess.

The nurse is caring for a child who says, "I'm tired of being in the hospital and I miss my own home." Which response by the nurse is most appropriate? "I am sorry you feel that way." "What can we do to make your room seem more like home?" "Can you tell me more about how you feel?" "Once you are better you can go home."

"What can we do to make your room seem more like home?" It is important to promote the involvement of the child in the plan of care and involve the child in decision-making to foster his empowerment. The hospitalized child is away from home and should be encouraged to participate in the care and the development of the room's environment. Asking what can be done to promote improved feelings makes the child a part of the team. Telling the child that he will go home when he is better does not address the concerns. Offering sympathy does not attempt to address the concerns. Asking about feelings in this manner is a closed question and does not solicit information from the child.

A nursing student asks an experienced nurse to explain the role of evidence-based practice on the maternal child unit. Which statement by the experienced nurse is most appropriate? "Women should lie flat with their legs in the lithotomy position to give birth to a baby." "We were trained to take a manual blood pressure, so I never use an automatic one." "Women have been able to be successful at having a natural birth after a cesarean birth." "Only women need to experience bonding with the infant for the first 3 months of life."

"Women have been able to be successful at having a natural birth after a cesarean birth." Evidence-based practice brings together research, clinical expertise, and client preference to increase nursing outcomes. The research has increasingly indicated that it is safe for women to give birth vaginally following a cesarean birth (VBAC).

The nurse is teaching a birthing class to expectant fathers. A father wants to know how he can directly help his partner. How should the nurse respond? Select all that apply. "Learning about the labor process is important for supporting your partner." "You can be supportive by encouraging your partner during labor." "Providing a back rub helps with pain and provides relaxation." "Be aware that hormonal changes may make your partner have some behavior changes temporarily." "Involving yourself in infant care provides for better family bonding."

"You can be supportive by encouraging your partner during labor." "Providing a back rub helps with pain and provides relaxation." "Be aware that hormonal changes may make your partner have some behavior changes temporarily." "Involving yourself in infant care provides for better family bonding." Fathers began to be part of the birthing process and postpartum care in the 1970s. It was also during this time that education began to play a larger role in maternity care. Maternity nurses involved themselves in teaching fathers how to be birthing partners, how to be supportive of their partners during labor and during the postpartum period, and how to be more involved in their infant's care to promote bonding. Teaching the father to do simple things like giving back rubs, being positive and supportive during labor and understanding their partners mental health due to the hormonal changes of pregnancy and the postpartum period became important parts of the education. A father could learn about the birthing process to be more educated, but this knowledge only helped the partner indirectly.

A nurse is conducting a monthly chart audit in the newborn nursery. Which finding could indicate an ethical consideration of practice? 200% increase in IV cath attempts Change in bottle feeding protocol Overall 2% decrease in length of stay 7% increase in the number of clients

200% increase in IV cath attempts With such a significant increase in the number of IV catheter attempts versus the number of clients, this warrants a further investigation as to why such a large change. This could be an ethical consideration in weighing the amount of pain the infant experiences during the procedure.

Which physician is known as the "Father of Pediatrics"? Ren Spitz Joseph Brennaman Abraham Jacobi John Bowlby

Abraham Jacobi Many view Abraham Jacobi, a Prussian-born physician, as the father of pediatrics.

After teaching nursing students about the trends in women and cancer in the United States, the nurse educator concludes that learning has taken place when the students make which statements? Select all that apply. Lung cancer has the highest survival rate of any cancer for women. Cancer is the second leading cause of death among women. Women living in North America have the lowest rate of breast cancer in the world. African American women are more likely than white women to get breast cancer. Lung cancer has the lowest survival rate in the United States of any cancer.

African American women are more likely than white women to get breast cancer. Lung cancer has the lowest survival rate in the United States of any cancer. Cancer is the second leading cause of death among women. Cancer is the second leading cause of death among women. Lung cancer has the lowest survival rate of any cancer as more than 90% of people who get lung cancer die from it. Women living in North America have the highest rate of breast cancer in the world. 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 reach 40.

The nurse is reviewing the medical records of several infants. Which infant is at highest risk for death according to the infant mortality rate in the United States? An infant born at a low birth weight An infant born at 38 weeks' gestation An infant born to a 43-year-old mother An infant born to adolescent parents

An infant born at a low birth weight Infant mortality in the United States is associated with low birth weight, prematurity, and congenital abnormalities, among other concerns. An infant born to young or older parents, or at 38 weeks' gestation, would not be considered low birth weight or premature nor considered to be at higher risk for congenital abnormalities.

A client who has just given birth is concerned about the high rate of infant mortality in the United States. She is anxious about the health of her child and wants to know ways to keep her baby healthy. Which recommendation would best meet this goal? Give the infant liquid vitamins daily. Breastfeed the infant. Place the infant on his or her back to sleep. Begin feeding of solid food by age 4 months.

Breastfeed the infant. Breastfeeding reduces the rates of infection in infants and helps to improve long-term maternal health. Placing the infant on his or her back to sleep prevents SIDS but does not prevent infections in the infant. Feeding solid foods early is not recommended and has no effect on prevention of infections. Vitamins will not prevent infections by themselves and only help the client meet daily nutritional requirements; they also may not be necessary.

A healthy client without a primary care provider is exploring the options available for a health care provider to assist with her pregnancy. Which health care provider can the nurse point out as a best option? Women's health nurse practitioner (NP) Clinical nurse specialist (CNS) Lay midwife Certified nurse midwife

Certified nurse midwife A certified nurse midwife is a nurse with advanced practice training in the care of women, specific to pregnancy and birth. A women's health NP would not be able to deliver the infant. A CNS is an advanced practice role but not specific to the care of pregnancy women. The lay midwife has no formal education.

The nurse is providing care to a woman who has just given birth to a healthy term neonate. The woman's partner arrives and asks about the neonate's status. Which action by the nurse would be appropriate? Tell the partner that no information can be shared with him or her at this time. Check the medical record for written client approval with whom to share information. Answer the partner's questions honestly and without hesitation. Ask the partner for identification first before sharing any information.

Check the medical record for written client approval with whom to share information. In maternal and newborn health care, information is shared only with the client, legal partner, parents, legal guardians, or individuals as established in writing by the client or the child's parents. This law promotes the security and privacy of health care and health information for all clients. Therefore, the nurse needs to check the medical record for written documentation that allows the partner to have this information. Any other action would be inappropriate.

A nurse is reviewing a labor plan with a client who has been admitted to the labor and birth unit. The client states that she has been drinking a significant amount of herbal teas lately to help with uterine contractions. Which is the priority action by the nurse? Determine the type of herbal teas recently consumed. Prepare the client for a fetal nonstress test. Ask the client when she last ate or drank anything. Ask about other complementary and alternative therapies.

Determine the type of herbal teas recently consumed. Certain herbal teas can be used during pregnancy, and most are made with flower or berries that are safe for both mother and fetus. To determine if the herbal tea is safe or has had any effect on the status of the birth, it is important for the nurse to find out what type of tea the client has been consuming and in what quantities.

A nurse is providing cardiopulmonary resuscitation (CPR) to an infant with chronic health problems when the mother of the child tells the nurse to discontinue CPR. Which is the most appropriate action by the nurse? Continue CPR until help arrives. Stop and call 911. Discontinue all resuscitation efforts. Continue chest compression only.

Discontinue all resuscitation efforts. The parents of the child can determine if they wish for resuscitation efforts to continue. The nurse should stop CPR when told so by the parents.

The nurse is caring for a minor child who has voiced an interest in becoming emancipated. What information can the nurse provide to the client? Select all that apply. An emancipated minor needs to be self-supporting. Emancipation requires a minor to live apart from his or her parents. The process to become emancipated will be very expensive. Parents must provide the initial request on behalf of the child to become emancipated. The courts will have to approve the request for emancipation.

Emancipation requires a minor to live apart from his or her parents. An emancipated minor needs to be self-supporting. The courts will have to approve the request for emancipation. Emancipated minors are considered adults in the eyes of the law and may make their own health care decisions. Laws about this topic will vary from state to state. The emancipated minor generally lives apart from the parents and is financially independent. Courts grant emancipation.

Morbidity rates among children are most highly associated with which cause? Firearms at home Suicide and homicide Environmental factors School violence

Environmental factors The factors most commonly associated with child morbidity are environmental and socioeconomic problems. The more difficult the societal issues and the more marked the environmental poverty, the higher the illness rates and childhood morbidity. Firearms, violence in schools, homicide, and suicide are all factors in morbidity, but they are not strictly related to children.

The nursing instructor is teaching a group of students about the history of maternity and family care. The instructor determines the session is successful when the students correctly choose which major change resulting from research by Klaus and Kennell? Family-centered care of today Rooming-in for maternity patients Limited family visits for children in the hospital Isolation of children with infections

Family-centered care of today Klaus and Kennell conducted studies and determined the optimal outcomes for children occurred when parents had more contact and interaction with the child in the hospital. Limiting visits has detrimental effects on infant development. Rooming-in was not as well received, as patients were not comfortable with the loss of privacy. Isolation of children with infections is still a proper precaution.

Which nursing intervention would best demonstrate evidence-based practice in maternal-child health care? Family-centered pediatric care Minimizing parental interaction with preterm infants Placing adults and children with similar diseases on the same unit Decentralizing care to allow clients to be closer to home

Family-centered pediatric care Evidence-based practice has become the standard that nurses are to strive for in caring for their clients. By involving the family in caring for ill children, the child and the family are better served and have improved outcomes. Parental interaction is encouraged for preterm infants to foster bonding. Children and adults need to be separated on inpatient units to ensure that the caregivers have a clear understanding of each client's needs, since children are not small adults. Centralized care has proved to be most beneficial to client outcomes by providing resources and specialists in one location.

A young mother with an ill child tells the visiting nurse that she belongs to the Christian Scientist religious group and will not seek medical attention for the child. Which statement best reflects the mother's religion's beliefs about health? Illness is an opportunity to develop the soul with no treatment sought. Illness comes from violating dietary restrictions, and no treatment will be sought. Healing will come through prayer and spiritual regeneration only. Fasting will establish health back to normal.

Healing will come through prayer and spiritual regeneration only. Christian Scientists view disease as error of the human mind that can be dispelled by spiritual truth. Health is viewed within a spiritual framework; healing will come through prayer and spiritual regeneration with no medical intervention. There is general opposition to human interventions with drugs or other therapies except for legally required immunizations in the Christian Scientist church, and Christian Scientists usually do not use blood or blood components, seek transplants or act as donors, or seek biopsies or physical examination.

Cost containment in the health care field has become a sought-after necessity because of rising costs and the influence of managed care. Nurses are instrumental in assisting with cost containment of health care by prioritizing which strategy? Health promotion Alternative birth systems Client teaching Quality improvement

Health promotion Specific cost-containment strategies that nurses have been instrumental in implementing include health promotion, case management, and critical care paths. Health promotion is accomplished by methods such as using alternative birth systems, providing client teaching, and quality improvement.

The nurse is caring for a 7-year-old boy with cystic fibrosis whose parents are intensely interested in all aspects of his condition and care. Which is the most effective way of advocating for this child and family? Teaching the parents how to perform chest physiotherapy Helping parents access the area's multidisciplinary cystic fibrosis clinic Locating the best price on a high-frequency chest compression vest Assisting the parents in getting the child on a lung transplant list

Helping parents access the area's multidisciplinary cystic fibrosis clinic Accessing the cystic fibrosis clinic where specialists collaborate with the child and family to provide information, direct care, and services empowers the family with tools to meet their needs. Chest physiotherapy will be a known skill since it is nearly certain the child has been diagnosed with this genetic disease for a number of years. Lung transplant may be a future treatment option but is probably not under present consideration. Helping save money on a treatment device is considerate but not the most effective advocacy method.

A nursing student is preparing a presentation illustrating the Human Genome Project. Which function will the student point out as being the primary focus? Detection of genetic mutations in children Treatment of gene mutations Genetic testing in adults Identification of human genes and functions

Identification of human genes and functions The Human Genome Project was founded in 1990 and its primary purpose was to identify and label all human genes and their functions. Information from the HGP may eventually be used in genetic testing, the detection of mutations or variations in children, and gene therapy.

A group of nurses are discussing the most recent statistics on death due to prematurity in the United States. Which action, if implemented, would have the greatest impact on improving outcomes? Identify specific national health goals related to maternal and infant health. Track the incidence of violent crime against pregnant women. Examine health disparities between ethnic groups. Improve women's access to receiving prenatal care.

Improve women's access to receiving prenatal care. The best way to have a positive impact on perinatal outcomes and reduce prematurity is to improve women's access to prenatal care. Tracking the incidence of violent crime does not give information on how to improve outcomes, nor does examining health disparities between ethnic groups or identifying specific national goals related to maternal and infant care without acting on the information. None of these address the true problem.

The nurse is updating the records of a 10-year-old girl who had her appendix removed. Which action could jeopardize the privacy of the child's medical records? Letting another nurse use the nurse's log-in session. Changing identification and passwords monthly. Closing files before stepping away from computer. Printing out confidential information for transmittal.

Letting another nurse use the nurse's log-in session. It is important to log off whenever leaving the computer. The person that shares the nurse's log-on session may get called away from the computer, leaving the nurse responsible for any breach in security. Keeping IDs and passwords confidential is basic computer security. Email is not a safe way to transmit confidential information. Printing is safer. Closing client files before stepping away from the computer helps ensure privacy.

What societal issues greatly influence delivery of maternal and pediatric health care? Select all that apply. Low income of families Increased cultural and ethnic diversity of clients Increase in surrogacy and adoption Increased number of children born in the U.S. Cost of health care

Low income of families Increased cultural and ethnic diversity of clients Cost of health care Demographic trends such as a decreased number children being born, combined with an increase in a multicultural society seeking health care, are affecting the delivery of maternal-child health care. Poverty and the cost of health care also play a major role in influencing health care delivery for both women and children.

A nursing instructor is teaching a session investigating infant mortality as a standard measurement of the quality of health care in the country. The instructor determines the session is successful when the students correctly choose which factors as contributing to the high numbers of deaths in the United States? Select all that apply. Maternal complications Congenital deformities and chromosomal abnormalities Maternal age 30 to 34 years Preterm births Male gender of infant

Maternal complications Congenital deformities and chromosomal abnormalities Preterm births Many factors contribute to the high infant mortality rates in the United States. Some of the most common factors are low gestational age and prematurity, congenital deformities and chromosomal abnormalities, and maternal complications such as cervical insufficiency, multiple births, and premature rupture of membranes. Female infants have lower mortality rates than males, and the best outcomes are in mothers who give birth between 30 and 34 years of age.

The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation? Reassure the family that the doctor is acting in their best interests and they should reconsider the treatment. Tell the doctor that the procedure is not in the best interests of this girl and ask him to respect the rights of the family. Tell the parents to state in writing that they will not participate in the treatment and give the letter to their physician. Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved.

Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved. When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct.

The nurse researcher investigates the morbidity rate in the United States. Which statement accurately reflects this concept? Morbidity is presented in rates per 100,000 population. Morbidity statistics are revised more frequently because of the ease in defining or obtaining the information. Morbidity measures the prevalence of a specific illness in a population at a particular time. In general, 76% of children in the United States enjoyed excellent health and 27% had very good health in a 2007 report.

Morbidity measures the prevalence of a specific illness in a population at a particular time. Morbidity is the measure of prevalence of a specific illness in a population at a particular time. It is presented in rates per 1,000 population. Morbidity is often difficult to define and record because the definitions used vary widely. For example, morbidity may be defined as visits to the physician or diagnosis for hospital admission. Also, data may be difficult to obtain. Morbidity statistics are revised less frequently because of the difficulty in defining or obtaining the information. In general, 56% of children in the United States enjoyed excellent health and 27% had very good health as reported in a summary of health statistics for children in 2007.

The nurse is assessing a 9-year-old boy during a back-to-school checkup. Which finding is a factor for childhood injury? Mother reports she has used alcohol and drugs. Records show child weighed 2,450 g at birth. Mother reports the child is hostile to other children. The parents adopted the boy from Guatemala.

Mother reports she has used alcohol and drugs. One of the factors associated with childhood injuries is parental drug or alcohol use. This is the leading cause for child mortality. Low-birth-weight babies are at higher risk for infant mortality. Foreign-born adoption is a factor for childhood morbidity. The child's hostility toward other children may be an environmental or psychosocial factor for childhood morbidity.

A nurse at a prenatal class discusses the evolution of obstetrical care. Which statements would best describe birth in America presently? Select all that apply. One in three women in the United States undergoes a surgical birth (cesarean). Primary care providers remain the safest birth attendants for most women. The infant mortality rate in the United States is approximately 6.17 in 1,000 live births. The United States ranks 15th in the world for infant mortality rates. Certified nurse midwives (CNMs) assist with births safely in many settings.

One in three women in the United States undergoes a surgical birth (cesarean). Certified nurse midwives (CNMs) assist with births safely in many settings. The infant mortality rate in the United States is approximately 6.17 in 1,000 live births. One in three women undergoes a surgical birth (cesarean). CNMs may once again assist couples at home, in hospitals, or in freestanding facilities with natural childbirths. The United States ranks 55th in the world (compared to 224 other countries) in infant mortality rates. The infant mortality rate is approximately 6.17 in 1,000 live births. Research shows that midwives are the safest birth attendants for most women, with lower infant mortality and maternal rates.

A nurse is conducting a teaching session on sudden infant death syndrome (SIDS) for expectant parents. Which information should the nurse include? Select all that apply. Sharing a room allows for monitoring of the infant. Allow the infant to sleep with a bottle. Place the infant on his or her back to sleep. Co-bedding or sharing a bed creates parental bonding. Maintain neutral temperatures and avoid overheating

Place the infant on his or her back to sleep. Maintain neutral temperatures and avoid overheating. Sharing a room allows for monitoring of the infant. Sharing of a room allows for monitoring and bonding of the infant as well as ease of feeding. Placing the infant on his or her back to sleep is the recommended sleeping position for all infants until 12 months of age, or until they can change their own position during sleep. Infants are not able to regulate their temperature; therefore, overheating can increase their risk for SIDS. Co-bedding increases the risk for accidental suffocation, and allowing an infant to sleep with a bottle increases risk for aspiration and infection.

A nurse is doing a literature search on maternal mortality and finds that direct causes comprise the majority of maternal deaths. Direct causes are noted to be unpredictable reasons. Which action would be most appropriate to implement that would have the greatest impact on reducing these numbers? Beginning antibiotics prior to birth for a febrile mother. Referring to a cardiologist for any arrhythmias. Practicing high standards of infection control. Monitoring maternal glucose levels in mothers with type 1 diabetes. Administering oxytocic medications for increased postpartum bleeding.

Practicing high standards of infection control. Few women die giving birth in a developed countries, but it still happens. Health care providers can have the greatest impact on reducing these numbers by implementing good infection control measures, appropriate use of antibiotics during labor and postpartum periods, and use of oxytocics for maternal bleeding to prevent hemorrhage. Diabetes and cardiac arrhythmias are not considered direct causes (i.e., they are known and predictable).

A nurse is caring for a 31-year-old pregnant client who is subjected to intimate partner violence. The client has developed a feeling of hopelessness and does not feel confident in dealing with the situation at home, which makes her feel suicidal. Which nursing intervention should the nurse offer to help the client deal with her situation? Provide emotional support to empower the client to help herself. Introduce the client to a women's rights group. Counsel the client's partner to refrain from subjecting his partner to violence. Help the client understand the legal impact of her situation to help protect her.

Provide emotional support to empower the client to help herself. In cases of intimate partner violence, nurses can serve their clients best by not trying to rescue them but by helping them build on their strengths, providing support, and empowering them to help themselves. Counseling the client's partner against violence, helping the client know the legal impact of her situation, and introducing the client to a women's rights group to garner support are not the best ways of serving the client.

A nurse witnesses a peer tell a client, "You are a mother now and you have to do what is best for you baby. You have to breastfeed her!" Which is the best action by the nurse? Fill out an incident report to go in the nurse's personnel file. Immediately interrupt the conversation and reprimand the nurse. Approach the client later and provide correct information. Pull the nurse aside and inquire as to the content of the conversation.

Pull the nurse aside and inquire as to the content of the conversation. The nurse overheard just a small portion of the conversation between the client and the peer nurse. The best action would be to inquire as to the content of the conversation and then determine if the peer nurse's comments were appropriate. If the comments were inappropriate, the nurse would then need to fill out an incident report.

The nurse is caring for a 5-year-old girl with meningitis. What action by the nurse may be considered ethical behavior? Scheduling a laboratory procedure at lunchtime Starting intravenous fluids even though the child protests Telling her an intramuscular injection won't hurt Referring to the child as "her" when she is present

Starting intravenous fluids even though the child protests Ignoring the child's dissent regarding proposed therapy is ethically sound. The treatment will benefit the child, and at 5 years of age the decision maker is nearly always the parent or legal guardian. However, the nurse must use developmentally appropriate techniques to inform the child about the therapy and to carry it out. Telling her an intramuscular injection won't hurt lacks veracity. Referring to the girl as "her" when she is present shows disrespect. Scheduling a laboratory procedure at lunchtime is unfair to the child and lacks justice.

A nurse is faced with an ethical conflict involving the care of a child. The child's parents disagree with the physician about the use of a feeding tube. The nurse sees the benefits and limitations of both parties' views. What action would be most appropriate? Contact the Institutional Review Board for guidelines as to how best to proceed. Support the parents' decision-making for their child regardless of the outcome. Provide care to the child without getting involved either way. Take the issue to the Institutional Ethics Committee for advice.

Take the issue to the Institutional Ethics Committee for advice. The values of the client and family must be ascertained and considered, and nursing input is important and often sought. Every institution has an Institutional Ethics Committee (IEC), which is required by The Joint Commission. The IEC should always be consulted in difficult or unusual cases when conflict and lack of agreement exist between parents and physicians or among the professional staff as to the course of action that is in the best interest of the child. The Institutional Review Board is involved in issues related to research. Although the nurse should support the parents and parents are the decision-makers for their child, a conflict is present that needs to be resolved to make sure that the child's best interests are addressed. The nurse must advocate for the child; therefore not getting involved would be impossible.

A 16-year-old child is admitted to the hospital for treatment after a motor vehicle crash. Review of the child's record reveals that the child is an emancipated minor. What does this mean? The nurse needs to check with the child to determine which parent has custody. A court-appointed guardian is needed to ensure that the child's rights are maintained. The child has the legal right to consent to and make decisions for treatment. The nurse must contact the child's guardian for consent to treatment.

The child has the legal right to consent to and make decisions for treatment. Emancipation is the process by which an individual becomes liberated from the authority and control of another person. In pediatric care, this term refers to the emancipation of a child from the authority and control of parents or other guardians. A minor who is recognized as emancipated by state-mandated criteria can consent to medical, dental, or psychiatric care without parental knowledge, consent, or liability.

When utilizing a doula during labor, the client would expect which services to be included? Select all that apply. The doula provides support in the antepartum period only. The doula will provide emotional support only. The doula will act as a nonmedical companion. The doula performs necessary medical tasks. The doula will provide emotional, physical, and educational support.

The doula will provide emotional, physical, and educational support. The doula will act as a nonmedical companion. A doula is a nonmedical birth companion who provides continuous emotional, physical, and educational support to the woman and family during childbirth and the postpartum period. Doulas do not perform clinical or medical tasks; they are there to comfort and support the mother and to enhance communication between the mother and medical professionals.

The nurse is running an education program for early grade-school children. Which topic would address the number one cause of death for this age group? The importance of crossing streets safely Exercise and good nutrition Prevention of infection and communicable disease The importance of immunizations

The importance of crossing streets safely Motor-vehicle accidents are a leading cause of death in this age group.

A nurse admits a young boy who lives in a homeless shelter with his pregnant teenage mother. What would the nurse realize is a priority when planning this boy's case management? The toddler's situation puts him at risk for higher incidence of disease and limited access to appropriate care. The toddler's visits to the emergency department assist in lowering his incidence of disease. Medicaid coordination of health services from the emergency visits will cause a lower incidence of disease. There will be adequate coordination of other available services with visits to the emergency department.

The toddler's situation puts him at risk for higher incidence of disease and limited access to appropriate care. Factors that may increase morbidity include homelessness, poverty, chronic health disorders, and barriers to health care. Children who live in poverty have a higher incidence of disease, limited coordination of health services, and limited access to health care, except for visits to the emergency department.

Before World War II women moved from home to hospital births. What was the primary reason for that shift in maternity care? They had no other options as many could not afford midwives. They were convinced that setting would provide them with natural birth. They were convinced that setting would lessen the pain of labor. They were convinced that setting would improve birth outcomes.

They were convinced that setting would improve birth outcomes. Prior to World War II, American women moved from home to the hospital for birth in part because they were convinced that setting would improve birth outcomes. Women who labored and gave birth at home were traditionally attended to by relatives and midwives. Many women were attracted to hospitals because this showed affluence and hospitals provided pain management, which was not available in home births.

A young couple are very excited to learn they are expecting their first child and question the nurse about which test they need to discover its gender. Which procedure will best provide this information to the couple? Amniocentesis HGP Ultrasound Chorionic villus sampling

Ultrasound Ultrasound is a visual method for assessing the fetus in the uterus and will provide information about the gender. Amniocentesis and chorionic villus sampling provide the entire genetic code of the fetus. HGP refers to the Human Genome Project, which can provide information regarding gene mutations and variations

A nurse is teaching a parenting class about key issues that threaten children's health today. Which statements by the participants would indicate comprehension of those key issues? Select all that apply. Mental health issues for children are not a concern until young adulthood. Unintentional injuries are a leading cause of injury after 1 year of age. Allergies are a serious threat to childhood health. The environmental toxin threat to children's health is improving. Childhood obesity is a continuing threat to children's health.

Unintentional injuries are a leading cause of injury after 1 year of age. Childhood obesity is a continuing threat to children's health. Allergies are a serious threat to childhood health. Unintentional injuries continue to be the leading cause of death in children greater than 1 year. Obesity, environmental toxins, allergies, and mental health problems are some of the key issues that endanger children's health today.

The client is a 1-year-old girl from a low-income family presenting with a vitamin D deficiency and anemia. What assistance program would you recommend to the child's young mother? WIC CHIP SCHIP ECI

WIC The special supplemental nutrition program for women, infants, and children (WIC) provides services to supply nutritional food to low-income women and their children. SCHIP or CHIP provides health insurance to newborns and children in low-income families who do not otherwise qualify for Medicaid and are uninsured. The Early Childhood Intervention (ECI) program, sponsored by Easter Seals, is available for the child with disabilities or developmental delays.

A 15-year-old client has just given birth and states that she does not want her infant to receive any newborn vaccines. What is the appropriate action for the nurse to take? Withhold the vaccines. Administer the newborn vaccines. Call the primary care provider. Ask the grandparents for permission.

Withhold the vaccines. The client would frequently be considered emancipated and therefore legally able to make legal decisions regarding the health care of the infant. The nurse should withhold the vaccines but inquire as to the reason for no vaccination.

A nurse educator is preparing for a class discussion on the high mortality rate in the 17th and 18th centuries. Which information would the nurse likely include in the discussion? Select all that apply. Women giving birth often died from dehydration. Infections were not common. Preeclampsia is a concern of 20th century. Exhaustion during labor occurred, resulting in death. Postpartum hemorrhages were handled proficiently.

Women giving birth often died from dehydration. Exhaustion during labor occurred, resulting in death. During the 17th and 18th centuries, women giving birth often died as a result of severe exhaustion from protracted labor, and they would succumb to dehydration during long labor. Infection was a major cause of death as sepsis during labor and birth was common. Hemorrhages during or after birth were not well controlled. Seizures that happened as a result of untreated high blood pressure and preeclampsia would result in death of the mother.

The nurse giving a presentation on women's cancer risks concludes that teaching has been successful when the participants indicate that which disease rate has been lowered due to a decrease in long-term use of hormone therapy after menopause? ovarian cancer breast cancer dementia colorectal cancer cardiac disease

breast cancer Although a positive family history of breast cancer, aging, and irregularities in the menstrual cycle at an early age are major risk factors for breast cancer, the reduction of long-term use of hormone therapy after menopause has been shown to have decreased the numbers of women affected by breast cancer.

A nurse is conducting a presentation for a group of pregnant women about appropriate health promotion strategies to address issues related to infant mortality. Which strategy would the nurse encourage to reduce the infant's risk for infection after birth? newborn development support groups breastfeeding folic acid supplementation sleeping on the back

breastfeeding After birth, other health promotion strategies can significantly improve an infant's health and chances of survival. Breastfeeding has been shown to reduce rates of infection in infants and to improve long-term health. Emphasizing the importance of placing an infant on his or her back to sleep will reduce the incidence of SIDS. Newborn development support groups will help provide education about normal child development and child rearing. Folic acid supplementation is used during pregnancy to prevent neural tube defects.

A group of nurses are working to provide quality care for their clients within the current health care environment of cost containment. Which strategy(ies) would be appropriate for the nurses to use? Select all that apply. educating clients about seeking help for problems early on encouraging clients to use emergency services for minor problems creating easy access programs for clients to receive immunizations encouraging clients to consume organic foods to promote healthy lifestyle choices urging clients to participate in screening programs

creating easy access programs for clients to receive immunizations educating clients about seeking help for problems early on urging clients to participate in screening programs Nurses can be leaders in providing quality care within a limited-resource environment by emphasizing the importance of making healthy lifestyle and food choices, seeking early interventions for minor problems before they become major ones, and learning about health-related issues that affect clients. Mammograms, cervical cancer screenings, prenatal care, smoking cessation programs, and immunizations are a few examples of preventive care that yield positive outcomes and reduce overall health care costs. Prevention services and health education are the cornerstones of delivering quality maternal, newborn, and women's health care. Although organic foods may be considered healthy choices, they can be more costly. If encouraged, clients may opt to spend more for the organic foods, thereby limiting their choices for selecting other healthy foods. Using the emergency department for routine care would not be cost-effective.

When preparing a teaching plan for a group of women during their first pregnancy, the nurse reviews how maternity care has changed over the years. Which information would the nurse include when discussing events occurring in the 20th century? performance of the first cesarean birth x-ray developed to assess pelvic size epidemics of puerperal fever development of birthing centers

development of birthing centers In the 20th century (1900s), birth centers were developed. Puerperal fever epidemics, the first cesarean birth, and X-ray to assess pelvic size were events occurring during the 19th century (1800s).

In order to advocate for children and families, the nurse must first acknowledge that the basic system in which health behavior and care are organized, secured, and performed is the: health care facility. government. community. family.

family. The family is the basic system in which health behavior and care are organized, secured, and performed. In most families, the parents or guardians, as advocates for their child, provide health promotion and health prevention care, as well as primary management of care when the child is sick. Parents and guardians have the prime responsibility for initiating and coordinating services rendered by health professionals.

A nurse is working as part of a larger community group to develop programs to address current barriers to health care being experienced by women. The community is in the city with a large population of low-income families. On which factor should the group focus their efforts to address a main barrier to access to care? health insurance transportation language low health literacy

health insurance Although transportation, language and culture, and low health literacy are barriers to health care, health insurance is a major factor affecting access to health care. The existence of financial barriers is one of the most important factors that limits access to care. Many families do not have health insurance so they cannot afford to see health care providers for maintenance and prevention services. Many do not have enough health insurance to cover services they need or cannot pay for services

A nurse is reviewing the statistical outcomes related to fetal deaths nationwide and notes that the numbers have changed over the last several decades. The best explanation would be: expectant mothers are seeking prenatal care later, resulting in decreases in the number. improved prenatal care has reduced the numbers of fetal deaths. increases are noted because of the growing number of pregnancies to teen mothers. increases are noted due the increasing number of older mothers becoming pregnant.

improved prenatal care has reduced the numbers of fetal deaths. The number of fetal deaths in the United States has fallen. This has been attributed to the improvement in the delivery of prenatal care.

Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because: increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. more disabilities are occurring in children because many women are delaying pregnancy and giving birth to babies later in life. there are fewer positions for nurses in institutions providing acute care. uninsured families can access these services. disability and chronic illness have increased with the appearance of more genetic abnormalities.

increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. Advances in health care have led to more children living with chronic illness or disability. The statements about genetic disease and older women may contain some truth but have only added a few people to the chronic illness total. Acute care pediatric nursing positions are decreasing in community hospitals but are more available in medical centers. Uninsured families may or may not be able to access nonhospital care.

A nurse working in a pediatrician's office has requested that a generic brand of cotton swabs be ordered in place of a more expensive brand name. Which trend in today's health care environment is most related to this nurse's action? increasing use of technology increasing health insurance coverage cost increasing reliance on home care initiating cost containment

initiating cost containment Cost containment refers to reducing the cost of health care by closely monitoring the costs of personnel, use and brands of supplies, length of hospital stays, number of procedures carried out, and number of referrals requested while still maintaining quality care. The other trends listed are not as directly related or are unrelated to this nurse's action.

Morbidity data indicates that support is needed from pediatric nursing groups to establish improved and additional services for children with what health issues? digestive system problems mental health and behavioral disorders poor immunization status illnesses due to environmental toxins

mental health and behavioral disorders Morbidity findings show mental health, emotional, social, and behavioral disorders trending upward. Immunization status in childhood has been improving. Digestive system problems remain fairly static. Illness due to environmental toxins has not shown a significant increase; this may change.

A nurse is admitting a female client to the cardiac unit diagnosed with a possible myocardial infarction. During the admission assessment, which symptoms would the nurse expect to find? Select all that apply. temperature 40°C (104°F) unbalanced nausea pain in the right arm heart rate of 50 bpm crushing chest pain

nausea unbalanced pain in the right arm The nurse should look beyond the obvious "crushing chest pain" symptom that heralds a heart attack in men. Clinical manifestations of a heart attack observed in women include nausea, dizziness, irregular heartbeat, unusual fatigue, sleep disturbances, indigestion, anxiety, shortness of breath, and pain/discomfort in one or both arms. Chest pain is the most common heart attack symptom, but some women may experience it differently than men. Bradycardia is defined as the heart beating fewer than 60 times a minute.

An infant at 33 weeks' gestation dies after 1 week of life in the neonatal intensive care unit. This infant's death rate would be classified under which statistical category? infant death under one month neonatal death preterm gestational death postneonatal death

neonatal death The neonatal death rate is the number of deaths of an infant in the first 28 days of life. Gestational age is not a consideration when reporting deaths of infants. The other categories are not classifications for reporting infant deaths.

The nurse working in a free health clinic is providing care to a 1-year-old girl and her single teenage mother. Which action would be most important initially? discussing family health history assessing the child's cognitive level obtaining food stamps for the family observing the mother/child interaction

observing the mother/child interaction The nurse's initial interactions with the parent and child can provide valuable insights into maternal-child attachment. This information can be used to inform other aspects of the health assessment. This observation is likely to precede formal assessments, such as cognitive assessment and family health history. At this point, it is not known if food stamps are needed. Assessment is the priority.

A nurse is caring for a child. Which individual would the nurse identify as being primarily responsible for initiating and coordinating health care? case manager social worker Community parents

parents Parents and guardians have the primary responsibility for initiating and coordinating services rendered by health professionals. A social worker or case manager may be involved but are not primarily responsible for the child's care. The community provides programs to promote and support children's health.

The United States lags behind other industrialized countries regarding infant mortality. The main factor that contributes to this is: older mothers having babies. lack of available facilities for caring for the infants. the large number of preterm births in the U.S. more congenital anomalies in children born in the U.S.

the large number of preterm births in the U.S. Two factors that contribute to the fact that the United States lags behind other industrialized countries are the large number of preterm births and the differences in reporting live births in various countries.

A group of women are attending a community presentation regarding the leading health concerns of women. Which interventions should the nurse recommend to have the greatest impact on the leading cause of death? yearly gynecological exams prompt attention to respiratory tract infections regular neurologic exams to note any cognitive or behavioral changes early weight control and being knowledgeable about family history of cardiovascular disease

weight control and being knowledgeable about family history of cardiovascular disease Cardiovascular disease is the leading cause of death of women in the United States. Interventions that address reduction of this risk would be a priority. Elevations in death rates are in part attributed to the difficulty recognizing cardiovascular concerns in women. The second leading cause of death in women is cancer, specifically lung and cervical. Lower respiratory tract infections have increased over recent years as a cause of death in women, but they are not the number one cause. Alzheimer disease, although impacting the mortality rates of women, is not the greatest cause of death.

A school nurse is working with a group of adolescents. Which assessment findings might prompt the nurse to screen for eating disorders? Select all that apply. frequent nurse visits erosion of teeth weight fluctuation menstrual irregularity absence of hunger

weight fluctuation erosion of teeth menstrual irregularity Screening for eating disorders may be routine for a particular client population in some clinical settings or may be cued by clinical manifestations, such as weight fluctuation, teeth erosion, disruption of menstruation, chronic constipation, dehydration, gastric reflux, syncope, and others. Frequent nurse visits do not necessarily mean there is an eating disorder. Those with eating disorders still experience hunger but ignore it as well as signs of physical weakness and fatigue.