Chapter 1: Perspectives on Maternal, Newborn, and Women's Health Care

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? a. "The rate includes accidental causes for deaths." b. "It addresses pregnancy-related causes." c. "The duration of the pregnancy is a concern." d. "The time frame is typically for a specified year."

a. "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 providing care to several clients. Which client would the nurse identify as being unable to provide consent for health care? a. 14-year-old male b. 17-year-old married female c. 20-year-old male d. 24-year-old pregnant female

a. 14-year-old male Generally, only people over the age of majority (18 years of age) can legally provide consent for health care, except in the case of an emancipated minor (a person who is no longer subject to parental control, e.g., one who marries).

A nurse who specializes in maternal and child health care performs many varied functions in diverse settings over the course of a year. Which action would be outside the nurse's scope of practice? a. Assist in the treatment and recovery of a woman with ovarian cancer. b. Provide preconceptual health care to a client. c. Discuss methods of alleviating morning sickness with a client in her first trimester. d. Read a recent journal article on breastfeeding and its benefits for new mothers.

a. Assist in the treatment and recovery of a woman with ovarian cancer. The primary goal of both maternal and child health nursing can be stated simply as the promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing. Assisting in the treatment and recovery of a woman with ovarian cancer is the least likely function of a nurse specializing in this type of nursing. Preconceptual care, care of a woman during her first trimester, and reading journal articles regarding breastfeeding are all within the scope of practice of maternal and child health nursing.

A nurse is preparing a breast cancer presentation for a health forum. Which fact would the nurse expect to address in this presentation? a. Breast cancer is more advanced in Black women when found. b. Black women have the BRCA1 and BRCA2 gene. c. More Hispanic women smoke, which increases their risk. d. White women respond better to breast cancer treatment.

a. Breast cancer is more advanced in Black women when found. White women get breast cancer at a higher rate than Black women; however, Black women are more likely to die because they get breast cancer before 40 years of age, cancer is more advanced when found, and survival at every cancer stage is worse among Black women. Black women are not at greater risk due to the BRCA1 or BRCA2 genes that cause breast cancer. There is no evidence that Hispanic women smoke more, placing them at risk. White women do not respond better to cancer treatment.

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? a. Check the medical record for written client approval with whom to share information. b. Ask the partner for identification first before sharing any information. c. Answer the partner's questions honestly and without hesitation. d. Tell the partner that no information can be shared with him or her at this time.

a. 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.

The nurse is caring for a 14-year-old girl with multiple health problems. Which activity would best reflect evidence-based practice by the nurse? a. Following blood pressure monitoring recommendations b. Determining how often the vital signs are monitored c. Using hospital protocol for ordering diagnostic tests d. Deciding the prescribed medication dose

a. Following blood pressure monitoring recommendations Using hospital protocol for ordering a diagnostic test, determining how often the vital signs are monitored, and deciding the medication dose ordered would be the health care provider's responsibility. However, following blood pressure monitoring recommendations would be part of evidence-based practice reflected in the nursing care delivered.

The nurse working in labor and birth explains that the historical rationale for performing an amniocentesis in 1966, when this procedure was introduced, was to accomplish which assessment? a. assess fetal growth b. assess the sex of the baby c. assess the health of the mother d. predict the volume of amniotic fluid

a. assess fetal growth Amniocentesis was first performed in 1966 to assess fetal growth. It was not used to assess the sex of the baby or the health of the mother. It also does not predict the volume of amniotic fluid.

A new mother who is nervous about her baby developing sudden infant death syndrome (SIDS) asks the nurse how to prevent it. Which suggestion would be most appropriate for the nurse to make? a. Lay the newborn on her back, not the stomach, to sleep. b. Keep the newborn on his side as much as possible when sleeping. c. Place the newborn on her stomach with the face turned to one side. d. Let the newborn sleep in the bed with the parents.

a. Lay the newborn on her back, not the stomach, to sleep. Health promotion strategies can significantly improve an infant's health and chances of survival. Evidence has shown that placing an infant on his or her back to sleep will reduce the incidence of SIDS. There is no evidence to support the use of the side-lying position to prevent SIDS. Sleeping on the stomach (prone) may limit the newborn's ability to move her head, which increases the chance of suffocation. Allowing the newborn to sleep in the bed with the parents is dangerous because the parent could inadvertently move and injure or possibly crush the baby.

What statements best describe giving birth to a child in 1700s America? Select all that apply. a. Men did not attend births because it was considered indecent. b. Women faced birth with the fear of death. c. The Lamaze Method of birth was introduced. d. Female midwives attended the majority of all births at home. e. The first cesarean birth was performed. f. Twilight sleep was used during birth in the United States.

a. Men did not attend births because it was considered indecent. b. Women faced birth with the fear of death. d. Female midwives attended the majority of all births at home. In the 1700s men did not attend births because it was considered indecent. Women faced birth not with joy and ecstasy but with fear of death. Female midwives attended the majority of all births at home. The other options did not occur during the 1700s.

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? a. Practicing high standards of infection control. b. Monitoring maternal glucose levels in mothers with type 1 diabetes. c. Referring to a cardiologist for any arrhythmias. d. Administering oxytocic medications for increased postpartum bleeding. e. Beginning antibiotics prior to birth for a febrile mother.

a. 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 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. a. Preterm births b. Maternal age 30 to 34 years c. Male gender of infant d. Maternal complications e. Congenital deformities and chromosomal abnormalities

a. Preterm births d. Maternal complications e. Congenital deformities and chromosomal abnormalities 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 nursing instructor is introducing students to Healthy People 2030, which highlights the major health indicators that need to be addressed. The nurse informs the students that this includes national health goals for maternal, infant, and child health. Which goal(s) would be included? Select all that apply. a. Reduce infant death rates. b. Reduce maternal weight gain. c. Reduce the rate of fetal deaths at 20 or more weeks of gestation. d. Increase infant birth weights. e. Reduce preterm births. f. Increase the number of scheduled cesarean births.

a. Reduce infant death rates. c. Reduce the rate of fetal deaths at 20 or more weeks of gestation. d. Increase infant birth weights. e. Reduce preterm births. The National Health Goals identified by Healthy People 2030 for maternal, infant, and child health are numerous. Some of these include reducing the number of fetal and infant deaths, reducing the incidence of low birth weight, reducing preterm labor, and decreasing the number of cesarean births.

The nurse is caring for a pregnant client in a prenatal clinic who states, "I want to view this labor and delivery as a natural process....not like an illness." How will the nurse respond? a. Refer the client to a midwife in preparation for a birth in a birthing center. b. Schedule the client for a tour of the women's unit at a large urban hospital. c. Offer education regarding how to best utilize pharmacologic pain medication during labor. d. Provide the names of several obstetricians in the local area for consideration.

a. Refer the client to a midwife in preparation for a birth in a birthing center. The nurse recognizes the client is seeking a birth with little intervention. This client would benefit from a consultation with a midwife in preparation for a home birth or in a birthing center birth. An obstetrician would be beneficial for a woman seeking specialized care with more interventions, not less. A tour of the local hospital would be beneficial if the woman was planning a hospital birth with interventions traditionally available at a hospital. Pain control during labor is considered an intervention and would not benefit a woman wanting limited intervention.

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

a. The doula will act as a nonmedical companion. c. The doula will provide emotional, physical, and educational support. 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.

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

a. 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 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? a. breastfeeding b. sleeping on the back c. folic acid supplementation d. newborn development support groups

a. 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 nurse is working as part of a multidisciplinary group tasked with creating programs to address the major health issues affecting women. The group would most likely focus their efforts on which condition? a. cardiovascular disease b. lung cancer c. breast cancer d. AIDS

a. cardiovascular disease Although cancer is the second leading cause of death for women and AIDS is a major health issue, cardiovascular disease ranks as the number one cause of death for women, regardless of racial or ethnic group. Therefore, efforts would most likely be focused on this condition.

A nurse is working as part of an interdisciplinary team providing care to women and children at a local community center. The nurse advocates for and provides comprehensive care to the clients across the continuum of care. The nurse is acting as: a. case manager. b. education manager. c. quality control monitor. d. case evaluator.

a. case manager. Case management is the interdisciplinary collaborative type of care that involves the collaborative process of assessment, planning, application, coordination, follow-up, and evaluation of options and services required to meet the individual's health care needs. When the nurse effectively functions as the case manager, client and family satisfaction is increased, fragmentation of care is decreased, and outcome measurement for a homogenous group of clients is possible. Although education, evaluation, and quality control may be aspects of the role, the nurse is functioning as the case manager.

The labor and birth nurse is precepting a nursing student. The preceptor informs the student that there are indicators for increased infant mortality. She includes which as predictors of higher infant mortality? Select all that apply. a. chromosomal abnormalities b. high birth weight c. prematurity d. first born e. cesarean birth

a. chromosomal abnormalities c. prematurity Chromosomal anomalies remain the leading cause of infant mortality, but prematurity is also a significant predictor of infant mortality. Being the first baby born to a mother is not indicative of a problem nor is the method of delivery.

A nurse is providing care to a 10-month-old infant who is brought to the free clinic by her 18-year-old mother. Which action by the nurse would be the priority at this initial visit? a. conducting an assessment of the infant's cognitive milestones b. interviewing the mother about her beliefs c. observing the interaction between the mother and infant d. obtaining a pregnancy history from the mother

a. conducting an assessment of the infant's cognitive milestones Assessment is the priority. A single mother using a free clinic suggests that she is living in poverty and that the child could be malnourished. Children living in poverty are more likely than other children to experience poor nutrition and inadequate health care. This could affect the child's cognitive development. Information about the mother's beliefs, mother-infant interaction, and maternal pregnancy history would be information that could be evaluated at a later time.

A nurse is analyzing a journal article presenting statistics concerning newborn and infant health. Which condition has been determined to be the most likely cause of infant mortality in the United States? a. congenital abnormalities b. increased birth weight c. breech presentation d. shoulder dystocia

a. congenital abnormalities The main causes of early infant death in the United States include problems occurring at birth or shortly thereafter such as prematurity, low birth weight, congenital and chromosomal anomalies, sudden infant death syndrome (SIDS), respiratory distress syndrome, unintentional injuries, bacterial sepsis, and necrotizing enterocolitis. Increased birth weight, breech presentation, and shoulder dystocia are not recognized as potential causes.

A nurse has started working at a new clinic that treats local immigrants. Which factor about the clients would be most important for the nurse to acknowledge when caring for them? a. differences in culture b. ethnic background c. language d. level of enculturation

a. differences in culture Although an understanding of the groups ethnicity, language, and level of enculturation may be helpful, it is important for nurses to recognize the various cultural differences among the clients. It is important to recognize their traditions and practices as a point of congruence rather than a potential source of conflict. With today's changing demographic patterns, nurses must be able to assimilate cultural knowledge into their interventions so they can care for culturally diverse women, children, and families. Nurses must be aware of the wide range of cultural traditions, values, and ethics. Cultural competence is the ability to apply knowledge about a client's culture so that the health care provided can be adapted to meet his or her needs.

The nurse is organizing health information to teach a client basic principles that will help maintain wellness in the family. Which actions should the nurse prioritize in this teaching? a. encouraging yearly checkups for all clients. b. teaching insulin injection techniques c. medication administration d. assisting in understanding a treatment

a. encouraging yearly checkups for all clients. The current movement in health care is to focus on health promotion and thereby prevent future illness and diseases. Encouraging yearly checkups would assist with finding problems before they become serious. Prevention, treatment, and rehabilitation are all processes of care. Teaching a client how to give injections, administer medication, or understand a treatment would occur after a specific health issue but not prevent these issues from occurring.

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? a. Women's health nurse practitioner (NP) b. Certified nurse midwife c. Lay midwife d. Clinical nurse specialist (CNS)

b. 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.

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? a. health insurance b. transportation c. language d. low health literacy

a. 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 speaking with a client who has just learned that she is pregnant with her first child. The nurse reads in the client's chart that she does not drink alcohol on a regular basis. However, the nurse decides to go ahead and warn the client about the dangers of drinking alcohol while pregnant. Which phase of health care would this action be classified as? a. health promotion b. health maintenance c. health restoration d. health rehabilitation

a. health promotion This action is an example of health promotion, which may be defined as educating parents and children to follow sound health practices through teaching and role modeling. Health maintenance is intervening to maintain health when risk for illness is present. Health restoration is using conscientious assessment to be certain symptoms of illness are identified and interventions are begun to return the client to wellness most rapidly. Health rehabilitation is helping prevent complications from illness, helping a client with residual effects achieve an optimal state of wellness and independence, and helping a client to accept inevitable death.

The nursing faculty is teaching students about maternal mortality and morbidity rates for black women in the United States, noting that they are often three to four times higher than for white women. This fact can most accurately be contributed to which reason? a. lack of access to adequate prenatal care b. poor nutrition during the pregnancy c. weight gain of 25 lb (11.4 kg) or less d. low socioeconomic status

a. lack of access to adequate prenatal care The maternal mortality and morbidity rates for black women in the United States have been three to four times higher than for non-Hispanic white women. Researchers do not entirely understand what accounts for this disparity but recognize that there are a number of factors that increase the incidence such as lack of prenatal care, obesity, and hypertension during pregnancy.

A nurse is working as part of a team to address health literacy issues in the community. Which indicators would the team use to determine that efforts are effective in addressing these issues? Select all that apply. a. lower morbidity rates b. decreased number of health care visits c. increased use of preventive services d. improved health outcomes e. decreased emergency department visits

a. lower morbidity rates c. increased use of preventive services d. improved health outcomes e. decreased emergency department visits Low health literacy is associated with poor health outcomes, increased emergency room visits, higher morbidity and mortality rates, and less use of preventive health services. Thus, effective programs would reverse these events.

A nurse is conducting an in-service program for a group of maternal-neonatal nurses about factors affecting maternal and newborn health. As part of the presentation the nurse describes how the family has changed over the years. The nurse determines that the teaching was successful when the group identifies which family structure as having been considered the traditional structure? a. nuclear b. binuclear c. single-parent d. blended

a. nuclear The way that families are defined has changed. In years past, the nuclear family was once considered the traditional family structure. However, this structure is now less common due to increased divorce rates and child-rearing by unmarried persons.

A nurse is reviewing the client population at a local community health clinic. The nurse identifies which groups as being vulnerable for low health literacy? Select all that apply. a. older adults b. recent immigrants c. ethnic minorities d. low-income families e. adolescents

a. older adults b. recent immigrants c. ethnic minorities d. low-income families Vulnerable populations for low health literacy include older adults, immigrants, minorities, and low-income populations.

A nurse is providing care to a client who has just found out that she is pregnant. The client's history reveals that she is obese. The nurse develops a plan of care for this client based on the understanding that this client is at risk for which complications? Select all that apply. a. thrombosis b. gestational hypertension c. postterm birth d. macrosomia e. hydramnios

a. thrombosis b. gestational hypertension d. macrosomia Obesity by itself increases the risk of blood clots, surgical births, preterm birth (not postterm birth), macrosomia, diabetes, gestational hypertension, and postpartum infections. Hydramnios is not associated with obesity and pregnancy.

A parent brings a foster child to the clinic for immunizations. What is the first responsibility of the nurse? a. verify legal documentation b. confirm identity with foster agency c. have case worker present d. obtain authorization to treat

a. verify legal documentation When a child is placed in foster care the foster parents are given legal documentation of this placement and of their ability to seek and consent to treatment. This documentation should be confirmed before any treatment is rendered. A child placed with a foster parent is not required to have a case manager present at medical visits. The foster parent can take the child for care whenever needed. The authorization to treat is part of the legal documentation provided to the foster parent, so it is not necessary to obtain a new consent at every clinic visit.

The nurse knows that the emancipated minor is considered to have the legal capacity of an adult and may make his or her own health care decisions. Which child would potentially be considered an emancipated minor? a. A minor with financial independence who is living with his parents b. A minor who is pregnant c. A child older than 13 years of age who asks for emancipation d. A minor who puts his or her medical decisions in writing

b. A minor who is pregnant Emancipation may be considered in any of the following situations, depending on the state's laws: membership in a branch of the armed services, marriage, court-determined emancipation, financial independence and living apart from parents, college attendance, pregnancy, mother younger than 18 years of age, and a runaway.

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? a. Place the infant on his or her back to sleep. b. Breastfeed the infant. c. Begin feeding of solid food by age 4 months. d. Give the infant liquid vitamins daily.

b. 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 woman comes to the prenatal clinic for a follow-up visit. During the assessment, the nurse notes multiple bruises over the client's arms, thighs, and back that are in various stages of healing. Which action would be most appropriate? a. Question the client about the pregnancy. b. Document the findings. c. Report the client's spouse to law enforcement authorities. d. Send the client to local women's shelter.

b. Document the findings. Nurses serve their clients best not by trying to rescue them but by helping them build on their strengths and providing support. The first step is to document the findings, then alerting others. Using a screening tool like "RADAR" can prove beneficial in assessing potential violence. (R: routinely screen every client for abuse; A: affirm feelings and assess abuse; D: document the findings; A: assess for the client's safety; R: review options and make referrals).

The nurse is functioning in the primary role to care for a 12-year-old boy with metastatic cancer in the liver. Which activity is typical of advocacy? a. Instructing parents about proper home care b. Educating the family about choices they have c. Telling parents about clinical guidelines d. Teaching the family about types of cancers

b. Educating the family about choices they have Educating the family about choices they have regarding therapies for the cancer in the child's liver is an example of advocacy, in which the nurse advances the interests of the child and family by informing them of options and assisting them to make informed decisions. Telling parents about proper home care, clinical guidelines, and the types of cancers are all done in the primary role of educator.

The nursing student correctly identifies which statement to be the contributing factor that made hospitals more attractive for births in the early 1900s? a. Hospitals had nurse midwives in attendance for births. b. Giving birth in a hospital suggested affluence, and the hospital provided pain management. c. Mothers who planned hospital births were provided with birth classes. d. Hospitals allowed for the father to be involved in the birthing process.

b. Giving birth in a hospital suggested affluence, and the hospital provided pain management. In the early 1900s many women were attracted to hospitals because this showed affluence and hospitals provided pain management. Nurse midwives were not located in hospitals at this time and birth classes did not evolve until the late 1950s when "natural birth" became popular again. The father was prohibited in the birth room until much later.

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? a. Alternative birth systems b. Health promotion c. Client teaching d. Quality improvement

b. 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.

A preschool-age 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.

b. Telling the child the test will not hurt. Telling the child the test will not hurt lacks veracity. 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 nurse is reviewing a copy of the U.S. Surgeon General's Report, Healthy People 2030. Which nursing action reflects the nurse fostering this health care agenda? a. The nurse signs up for classes to obtain an advanced degree in nursing. b. The nurse volunteers at a local health care clinic providing free vaccinations for low-income populations. c. The nurse performs an in-service on basic hospital equipment for student nurses. d. The nurse compiles nursing articles on evidence-based practices in nursing to present at a hospital training seminar.

b. The nurse volunteers at a local health care clinic providing free vaccinations for low-income populations. Healthy People 2030 is a comprehensive health promotion and disease prevention agenda that is working toward improving the quantity and quality of life for all Americans. Overarching goals are to eliminate preventable disease, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; create physical and social environments that promote good health; and promote healthy development and behaviors across every stage of life. Volunteering at a local health care clinic directly reflects the goal of improving the health of all groups of people. Signing up for classes, performing in-services on equipment, and compiling nursing articles on evidence-based practices in nursing are all worthwhile activities that foster health care delivery, but are not as directly linked to the agenda of promoting health in the community.

A nurse is conducting a presentation for a group of pregnant women about factors affecting maternal and newborn health. When discussing the family as an influential factor, which information would the nurse need to keep in mind? a. Family structure has remained relatively constant over time. b. The uniqueness of families requires specific methods for support. c. Roles of family members exert minimal influence on a newborn's health status d. Family implies legal relationships of the people living together.

b. The uniqueness of families requires specific methods for support. The family greatly influences the development and health of its members. The family's structure, the roles assumed by family members, and social changes that affect the family's life can influence the woman's and newborn's health status. Families are unique, and every family has different views and requires distinct methods for support. The family is considered the basic social unit of our society. The way that families are defined has changed. The United States Census Bureau (2015) defines family as a group of two or more people related by birth, marriage, or adoption and living together. Earlier definitions of family emphasized the legal ties or genetic relationships of people living in the same household with specific roles.

The nursing instructor is teaching students about the types of anesthesia used historically during labor and birth. She informs the students that in the 1900s, women often were placed in "twilight sleep" during birth. This type of anesthesia would be described as: a. sleep induced by hypnosis. b. a heavy dose of anesthesia and amnesiacs. c. a hypnotic and spinal anesthesia. d. light sedation given at stage 2 of labor.

b. a heavy dose of anesthesia and amnesiacs. Twilight sleep (a heavy dose of opioids and amnesiacs) was used on women during birth in the United States in the 1900s. Hypnosis is a mental state or imaginative role, while light sedation involves the administration of small amounts of medication in order to deal with anxiety or agitation. A hypnotic used in coordination with spinal anesthesia was not used in birth in the 1900s.

A nurse has just started working at a clinic that has a large refugee client population. When providing care to this population group, which aspect would be most important for the nurse to recognize? a. ethnic background b. cultural differences c. language d. lack of understanding of American ways

b. cultural differences Although an understanding of the group's ethnicity, language, and understanding of American ways may be helpful, it is important for nurses to recognize the various cultural differences among the clients. It is important to recognize these traditions and practices as a point of congruence rather than a potential source of conflict. With today's changing demographic patterns, nurses must be able to assimilate cultural knowledge into their interventions so they can care for culturally diverse women, children, and families. Nurses must be aware of the wide range of cultural traditions, values, and ethics. Cultural competence is the ability to apply knowledge about a client's culture so that the health care provided can be adapted to meet his or her needs.

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. a. encouraging clients to consume organic foods to promote healthy lifestyle choices b. educating clients about seeking help for problems early on c. urging clients to participate in screening programs d. encouraging clients to use emergency services for minor problems e. creating easy access programs for clients to receive immunizations

b. educating clients about seeking help for problems early on c. urging clients to participate in screening programs e. creating easy access programs for clients to receive immunizations 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.

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: a. expectant mothers are seeking prenatal care later, resulting in decreases in the number. b. improved prenatal care has reduced the numbers of fetal deaths. c. increases are noted because of the growing number of pregnancies to teen mothers. d. increases are noted due the increasing number of older mothers becoming pregnant.

b. 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.

The nurse is reviewing the chart of a pediatric client (above). What data support a high risk for infant mortality? a. weight b. maternal factors c. nutrition d. prenatal care

b. maternal factors Infant mortality rates are affected by many factors, including several from the maternal aspect. Maternal HIV infection would put the infant at risk for mortality. The birth weight for this infant is average, and the infant is gaining weight as planned/expected, so nutrition is adequate, and weight does not support risk for infant mortality. A maternal age of less than 18 years or more than 40 years would put the infant at risk, as would lack of early or nonexistent prenatal care. Obtaining prenatal care at 10 weeks' gestation is a positive outcome. This mother is 38 years of age.

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? a. infant death under one month b. neonatal death c. preterm gestational death d. postneonatal death

b. 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.

A nurse is conducting research in preparation for developing programs to improve maternal and newborn health. The nurse is reviewing statistics revealing the number of infant deaths occurring in the first 28 days of life. The nurse is researching which rate? a. fetal mortality rate b. neonatal mortality rate c. infant mortality rate d. perinatal mortality rate

b. neonatal mortality rate The neonatal mortality rate is the number of infant deaths occurring in the first 28 days of life per 1,000 live births. Fetal mortality rate refers to the spontaneous intrauterine death of a fetus at any time during pregnancy per 1000 live births. Infant mortality rate is the number of deaths occurring in the first 12 months of life. The perinatal mortality rate is the total of the fetal and neonatal mortality rates.

The nurse working in an obstetrician's office demonstrates case management when which action is completed? a. offering the client education about disposable diaper and cloth diapers b. scheduling an appointment with a counselor when a client reports martial concerns c. encouraging the client to bring the partner to each prenatal office visit d. assisting the client in telling the partner about test results following an amniocentesis

b. scheduling an appointment with a counselor when a client reports martial concerns Case management is the act of monitoring and coordinating care for the client. The nurse is coordinating care by assuring an appointment is made for the client when the client expresses marital concerns. The nurse would provide the client with additional information about cloth and disposable diapers, but this action is not specific to case management. The nurse is acting as an advocate when assisting the client with discussing test results with the partner. The nurse is meeting the client's social needs by permitting and encouraging the client to bring the partner to each appointment.

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? a. "Obesity, drug use, and smoking are major problems." b. "Maintaining a physically active lifestyle is strongly encouraged." c. "Immunizations may be the cause of some illnesses being seen currently." d. "Environmental quality is directly related to health care."

c. "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 nursing student demonstrates an understanding of fetal mortality rates when compared to the other mortality rates when she correctly describes the fetal mortality rate by which statement? a. "Fetal mortality rates encompass the number of infant deaths occurring in the first 28 days of life per 1,000 live births." b. "The death of a fetus in the first 12 weeks of gestation per 1,000 live births comprises the fetal mortality rate." c. "The fetal mortality rate includes the intrauterine death of a fetus who is 20 weeks of gestation or more per 1,000 live births." d. "Statistically, fetal mortality rates are calculated based upon the number of infant deaths occurring in the first 3 months of life per 1,000 live births."

c. "The fetal mortality rate includes the intrauterine death of a fetus who is 20 weeks of gestation or more per 1,000 live births." The fetal mortality rate refers to the intrauterine death of a fetus who is 20 weeks of gestation or more per 1,000 live births. The infant mortality rate is the number of deaths occurring in the first 12 months of life while the neonatal rate is the number of infant deaths occurring in the first 28 days of life per 1,000 live births. Fetal loss during the first 12 weeks is a miscarriage.

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? a. "I plan to give birth in a hospital setting with my family at my side." b. "In my culture, we have family help us care for the baby in our home for several months." c. "We just moved here from another state and I am still getting used to the new town." d. "My sister-in-law is due to have her baby the same month as our baby is due."

c. "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.

A group of students are reviewing the historical aspects of birth. 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

c. 1900s Twilight sleep, or the use of a heavy dose of opioids and amnesiacs, was used on women during birth 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 birth classes characterize the 2000s.

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? a. An infant born to adolescent parents b. An infant born at 38 weeks' gestation c. An infant born at a low birth weight d. An infant born to a 43-year-old mother

c. 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.

The nurse is caring for a child brought to the emergency department by a babysitter. The child needs an emergency appendectomy and the parents cannot be contacted. What would be the nurse's best response to this situation? a. Have the babysitter sign the consent form even if she does not have signed papers to do so. b. Have the primary care physician for the child sign the consent form. c. Document failed attempts to obtain consent to allow emergency care. d. Delay medical care until the child's next of kin can be contacted.

c. Document failed attempts to obtain consent to allow emergency care. Health care providers can provide emergency treatment to a child without consent if they have made reasonable attempts to contact the child's parent or legal guardian (American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, 2007). If the parent is not available, then the person in charge may give consent for emergency treatment if that person has a signed form from the parent or legal guardian allowing him or her to do so. During an emergency situation, a verbal consent via the telephone may be obtained. In urgent or emergent situations, appropriate medical care never should be delayed or withheld due to an inability to obtain consent.

The nursing instructor is discussing the infant mortality rate with a group of students. The instructor determines the discussion is successful when the students correctly choose which action as a priority to help decrease infant mortality in the United States? a. Improving maternal nutrition during pregnancy b. Spending more money on health care for infants and mothers c. Improving accessibility to postnatal health care for infants d. Mothering classes for all primiparous mothers

c. Improving accessibility to postnatal health care for infants Infant deaths are due to many factors, including congenital malformations, deformations, and chromosomal abnormalities; disorders related to short gestation and low birth weight; and newborns affected by maternal complications of pregnancy. The mother's nutritional status would affect a limited number of infants. Making postnatal health care available and affordable would have the greatest impact on improving infant health and reducing the number of infant deaths. Spending more money on health care has proven to not improve infant survival rates postnatally. Although providing for mothering classes and improving maternal nutrition would be a good idea, these measures will not positively impact infant survival rates.

The nursing faculty is explaining to her students the historical background regarding the reasoning for the introduction of nurseries in the 1900s. Which statement most accurately explains the reason for the nurseries? a. Mothers wanted to rest after 9 months of pregnancy and labor. b. Mothers could not care for their babies after receiving a spinal block. c. Mothers could not care for their babies due to chloroform gas. d. Nurses wanted to be the sole caregiver of the babies to promote better outcomes.

c. Mothers could not care for their babies due to chloroform gas. Nurseries were started in the 1900s because mothers could not care for their babies for several days after receiving chloroform gas. Spinal blocks were not being used at that time and would not have prevented the mother from caring for her baby. Wanting a rest would not preclude the mother from caring for her baby, and nurses asking to be the sole caregiver did not play a role in developing nurseries.

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? a. Counsel the client's partner to refrain from subjecting his partner to violence. b. Help the client understand the legal impact of her situation to help protect her. c. Provide emotional support to empower the client to help herself. d. Introduce the client to a women's rights group.

c. 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.

The nurse is administering a number of therapeutic interventions for neonates, infants, and children on the pediatric unit. Which intervention contributes to an increase in chronic illness seen in early childhood? a. Administering antibiotics to prevent lethal infections. b. Vaccinating children to prevent childhood diseases. c. Using mechanical ventilation for premature infants. d. Using corticosteroids as a treatment for asthma.

c. Using mechanical ventilation for premature infants. Using mechanical ventilation and medications to foster lung development in premature infants increases their survival rate. Yet the infants who survive are often faced with myriad chronic illnesses. Administering antibiotics to prevent lethal infections, vaccinating children to prevent childhood diseases, and using corticosteroids as a treatment for asthma may cause side effects, but do not contribute to chronic illness in children.

After teaching a group of students about pregnancy-related mortality, the nurse determines that additional teaching is needed when the students identify which condition as a leading cause? a. postpartum hemorrhage b. unsafe abortion (elective termination of pregnancy) c. anesthesia complications d. intra-amniotic infection

c. anesthesia complications Most pregnancy-related mortality is attributable to the physiologic changes associated with pregnancy. The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor, and unsafe abortion (elective termination of pregnancy). Anesthesia complications are not a leading cause.

A nurse is preparing a presentation for a local community group about health status and children's health. Which measure would the nurse include as one of the most significant? a. fetal mortality rate b. neonatal mortality rate c. infant mortality rate d. maternal mortality rate

c. infant mortality rate 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.

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? a. yearly gynecological exams b. prompt attention to respiratory tract infections c. weight control and being knowledgeable about family history of cardiovascular disease d. regular neurologic exams to note any cognitive or behavioral changes early

c. 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 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? a. "Are you sure you want to do that?" b. "Have you notified the father?" c. "I don't know of any health care providers who will perform them." d. "I'll put together the information that you will need."

d. "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 pregnant client comes to the local health clinic for her scheduled prenatal visit. On her chart, the nurse notices that the client indicated that she resides in an extended family situation. Which arrangement would validate this information? a. She lives with her mother, stepfather, and his two sons. b. She lives with her best friend and her three children. c. She lives with her husband and her daughter and son, of whom she has joint custody. d. She lives with her grandmother, her uncle, her mother, and her younger sister.

d. She lives with her grandmother, her uncle, her mother, and her younger sister. Extended families consist of parents, children, aunts, uncles, and/or grandparents. Blended families consist of parents who have children from previous marriages and potentially children from the new marriage. Groups of individuals who are not necessarily related by blood ties but who are living together to raise their families are referred to as communal families. In the binuclear family, children are members of two families as a result of custody or "joint parenting" arrangements.

A child needs a consent form signed for a minor surgical procedure. Which statement accurately describes the responsibility of the physician or nurse when obtaining the consent? a. The physician is responsible for ensuring that the consent form is completed with signatures from the parents or legal guardians. b. The physician is responsible for serving as a witness to the signature process. c. The nurse is responsible for informing the child and family about the procedure and obtaining consent. d. The nurse is responsible for determining that the parents or legal guardians understand what they are signing by asking them pertinent questions.

d. The nurse is responsible for determining that the parents or legal guardians understand what they are signing by asking them pertinent questions. The nurse's responsibility related to informed consent includes the following: determining that the parents or legal guardians understand what they are signing by asking them pertinent questions, ensuring that the consent form is completed with signatures from the parents or legal guardians, and serving as a witness to the signature process. The physician or advanced practitioner providing or performing the treatment and/or procedure is responsible for informing the child and family about the procedure and obtaining consent by providing a detailed description of the procedure or treatment, the potential risks and benefits, and alternative methods available.

A nurse is providing care to a pregnant client who is to undergo an amniocentesis. Which action would be most appropriate for the nurse to perform related to the client's informed consent? a. explaining the potential risks and benefits b. providing information about alternative methods that are available c. describing the procedure in detail d. determining the client's understanding of the procedure

d. determining the client's understanding of the procedure The primary care provider or advanced practice nurse or midwife is responsible for informing the client about the procedure and obtaining consent by providing a detailed description of the procedure or treatment, its potential risks and benefits, and alternative methods available. The nurse's responsibilities related to informed consent include the following: ensuring that the consent form is completed with signatures from the client; serving as a witness to the signature process; and determining whether the client understands what he or she is signing by asking the client pertinent questions.

A program designed to decrease the infant mortality rate in the United States would probably make the greatest impact if it focused on which aspect of care? a. offering increased WICC availability b. reducing the number of home births c. increasing the education level of parents d. increasing the number of women receiving prenatal care

d. increasing the number of women receiving prenatal care Receiving prenatal care has proven to be a major strategy for reducing infant mortality. The other interventions will not directly impact infant mortality rates to the degree that prenatal care will.

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? a. discussing family health history b. assessing the child's cognitive level c. obtaining food stamps for the family d. observing the mother/child interaction

d. 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.

The World Health Organization's definition of health was approved in 1948 and included a definition of health as "a state of complete physical, mental, and social well-being." What data was not a part of this definition? a. the idea that access to health care and use of health care facilities are not the primary influence on current health b. mental health viewed as a state of well-being in a person who can cope with stress and be a contributing member of society c. the WHO's beliefs that the main determinants for health are our environment, who we are, what we do, and society in general d. the new understanding of disease at cellular, individual, and societal levels

d. the new understanding of disease at cellular, individual, and societal levels The World Health Organization defines health as "a state of complete physical, mental, and social well-being." It is a complex definition, and it is not merely the absence of disease. The other ideas were part of the initial definition—environmental influences and mental health being seen as a state of well-being. The introduction of new cellular, individual, and societal levels of diseases has changed this era of health care.