Chapter 4 - Perinatal Nursing (QUESTIONS)

Which is a characteristic of integrative healing? a. It replaces conventional Western modalities of treatment. b. It is used by only a small number of Canadian adults. c. It supports the patients' belief systems. d. It focuses primarily on the disease an individual is experiencing.

ANS: C Integrative healing recognizes the contributions of traditional and integrative healers who support the belief systems and enhance health practices of child-bearing women and their families. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of Canadian adults are seeking alternative and complementary health care options. Alternative healing modalities offer a holistic approach to health, focusing on the whole person, not just the disease.

What information is a component of the midwifery care model? a. Midwifery care is not a choice for women in Canada. b. Using controlled second-stage pushing c. Encouraging fluid and nutritional intake as needed d. Her delivery can take place only at home or in a birth centre.

ANS: C Part of this model is to encourage fluid intake and nourishment as needed during labour. A component of the midwifery care model includes encouraging spontaneous second-stage pushing in the woman's preferred position rather than controlled pushing. Although Canada has a very low percentage of well-woman care provided by midwives, these services are available. Midwives can provide care and delivery at home, in freestanding birth centres, and in community and teaching hospitals.

Which medical risk factor contributes to a higher infant mortality rate? a. Diabetes mellitus b. Mitral valve prolapse (MVP) c. Chronic hypertension d. Anemia

ANS: C Poor maternal health or chronic conditions such as hypertension are important contributors to a high infant mortality rate. Although diabetes mellitus, MVP, and anemia are concerns in pregnancy, they are not one of the most frequently reported maternal medical risk factors that contribute to a higher infant mortality.

Which reflects a future goal for perinatal nursing? a. Limiting multiprofessional teams b. Maintaining existing power structures c. Advocating for an increased number of Caesarean sections d. Addressing health inequities by creating healthy public policies

ANS: D Addressing health inequities by creating health policy and services that focus on both resources needed for health and access to health services is a future goal of perinatal nurses. Nurses should be expanding multiprofessional teams rather than limiting their existence. Existing power structures and practices need to be disrupted rather than maintained. Advocating for an increased number of Caesarean births is not a future goal for perinatal nursing.

What is required for women and their families to make informed health care choices? a. A patient-centred care approach b. Information and accurate knowledge c. Fewer multidisciplinary care teams d. Standardized maternal and newborn care

ANS: B To make informed choices, women and their families require knowledge about their care. A family-centred approach is to be practiced. More, rather than fewer, multidisciplinary teams can provide better holistic care. Maternal and newborn care is to be individualized, not standardized.

Which factor is mainly responsible for the steady increase in Caesarean birth? a. Higher rate of primary Caesarean births b. Higher rate of vaginal birth after Caesarean birth c. Increased nicotine use in pregnancy d. Lower medical indications for Caesarean birth

ANS: A Caesarean birth has increased steadily, from 17.6% in 1995 to 28% in 2010-11 (PHAC, 2013). Most of this increase is due to a higher rate of primary (first-time) Caesarean births. The vaginal birth after Caesarean (VBAC) rate has decreased over the same time period, not increased. Low medical indications would not increase the Caesarean birth rate.

From the nurse's perspective, what measure should be the focus of the health care system to further reduce the rate of infant mortality? a. Implementing programs that focus on health promotion and preventive care b. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days c. Expanding the number of neonatal intensive care units (NICUs) d. Mandating that all pregnant women receive care from an obstetrician

ANS: A To address factors that are associated with infant mortality, there needs to be a shift from the current emphasis on highly technological medical intervention toward a focus on health promotion and preventive care. An increased length of stay has been shown to foster improved self-care and parental education; however, it does not prevent the incidence of leading causes of infant mortality rates such as low birth weight. NICUs offer care to high-risk infants after they are born; therefore, expanding the number of NICUs would offer better access for high-risk care, but this factor is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetrical care would be nearly impossible to enforce.

Which best describes a doula? a. Advanced practice labour and delivery nurse b. A trained and experienced female labour attendant c. Clinical nurse specialist in neonatal and postpartum care d. Leader of a multidisciplinary, intrapartum health care team

ANS: B A doula is a trained and experienced female labour attendant and may provide continuous one-on-one caring presence throughout the labour and birth. A doula does not need to be a nurse. An advanced practice labour and delivery nurse is not a doula. A clinical nurse specialist in neonatal and postpartum care is not a doula. A doula is not a leader of a multidisciplinary intrapartum health care team.

Which have contributed to decreasing maternity-related health care costs? a. Prolonged postpartum hospital stays b. Portable care technology c. The reduction in acceptable genetic screening options d. Rural health services outreach clinics

ANS: B Some women who experience pregnancy complications are now cared for in the home by antepartum home care nurses, thus decreasing maternity-related health care costs. This is a direct result of having access to portable fetal monitors and other forms of technology that previously were available only in the hospital but now are portable and can be used in the patient's home. Prolonged postpartum hospital stays have increased costs, not decreased them. Genetic screening options have increased, not decreased, and they affect the ways in which women and their families experience pregnancy. Outreach clinics have increased health care costs as compared to the cost of home-based care.

Which time frame range is the perinatal continuum of care? a. 9-10 months b. 12-14 months c. 15-16 months d. 18-24 months

ANS: B The perinatal continuum of care is 12 to 14 months.

Which woman would be most at risk for the poorest perinatal outcome? a. A 25-year-old single mother on maternity leave with two existing children b. An unemployed 32-year-old lawyer in an inner city neighbourhood c. An Indigenous woman in her mid-20s with no high school education d. A 19-year-old college student who lives at home with her parents

ANS: C Both the Canadian Perinatal Surveillance System (CPSS) and the Maternity Experiences Survey note that poor women, Indigenous women, and young women with less education consistently have the poorest perinatal outcomes.

Which indicates that teaching to promote healthy living has been effective? a. Asking the nurse what to do b. Indicating that she can't quit smoking c. Exercising three times a week d. Questioning what healthy living behaviours are

ANS: C Exercising three times a week indicates the patient's willing participation and understanding of healthy living behaviours. Doing is different from comprehension. The goal of teaching about healthy living is to make sure the patient understands the factors associated with her care. Smoking cessation is only one behaviour associated with healthy living in pregnancy. The patient's asking the nurse what to do indicates that she does not understand what measures she can take to practice healthy living behaviours.

Which is the main characteristic of the evolved role of the professional perinatal nurse? a. Providing care to patients directly at the bedside b. Planning patient care to cover longer hospital stays c. Developing models and guidelines for multidisciplinary health care providers d. Managing care to cure health problems once they have occurred

ANS: C Professional nurses are part of the team of health and social care providers who collaboratively care for perinatal patients and their families. Perinatal nurses have helped to develop models and guidelines for multidisciplinary teams of professionals who work with child-bearing women and their families. Providing care to patients directly at the bedside is one of a nurse's tasks, but it does not encompass the concept of the evolved professional nurse. Patient hospital stays are decreasing in length of time rather than becoming longer stays. Nurses do not cure health problems; they work to promote well-being.

The focus of the fifth Millennium Development Goal is aimed at decreasing which rate? a. Fertility rate b. Infant mortality rate c. Maternal mortality rate d. Perinatal mortality rate

ANS: C The fifth Millennium Development Goal is to improve maternal health and reduce the maternal mortality rate by 75% between 1990 and 2015.

Which recent trend in childbirth practices in Canada is accurate? a. Older women tend not to seek prenatal care. b. Indigenous women have a decreased incidence of perinatal mood disorders. c. The majority of births occurred in the hospital. d. Immigrant and refugee women have a lower rate of chronic disease.

ANS: C The majority of births occur in the hospital. Older women tend to seek early prenatal care. Indigenous women tend to have an increased incidence of perinatal mood disorders. Immigrant and refugee women have a higher rate of chronic disease.

An Indigenous woman is pregnant with her first child. Based on the statistics for infant mortality, which intervention is most important for the nurse to implement? a. Perform a nutrition assessment. b. Refer the woman to a social worker. c. Advise the woman to see an obstetrician, not a midwife. d. Explain to the woman the importance of keeping her prenatal care appointments.

ANS: D Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation. The patient may need assistance from a social worker at some time during her pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, her health care may need to be provided by a physician. However, it cannot be assumed that all Indigenous women have high-risk issues. In addition, advising the woman to see an obstetrician is not the most important aspect on which the nurse should focus at this time.

Which trend has a positive impact on the infant mortality rate? a. Delayed second-stage pushing is now discouraged in labour. b. Episiotomy rates are increasing. c. Midwives perform more episiotomies than physicians. d. Newborn infants remain with the mother and are encouraged to breastfeed.

ANS: D Infants are encouraged to remain with their mother to assist in keeping them warm, and breastfeeding is encouraged immediately after birth. Delayed pushing is encouraged for several reasons, not discouraged. Episiotomy rates are declining, rather than increasing. Midwives perform fewer episiotomies than do physicians.

Which factor is associated with higher infant mortality rates? a. Advanced maternal education b. Maternal age greater than 35 years c. Access to prenatal care d. Poverty

ANS: D Limited maternal education, young maternal age, poverty, and the lack of prenatal care appear to be associated with higher infant mortality rates.

While obtaining a detailed history from a woman who has recently emigrated from Somalia, the nurse realizes that the patient has undergone female genital mutilation (FGM). Which is the nurse's best response based on? a. FGM is abnormal and rarely seen in Canada. b. Gathering information on who performed the FGM c. Restoration plans for FGM after delivery d. The extent of FGM will affect potential for complications.

ANS: D The extent of FGM will affect the potential for complications and is the most appropriate information on which the nurses' response should be based. The patient may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. With the growing number of immigrants from countries where FGM is practiced, nurses will increasingly encounter women who have undergone the procedure. Responding that this is a very abnormal practice rarely seen in Canada is culturally insensitive. The infibulation may have occurred during infancy or childhood. The patient will have little to no recollection of the event. She would have considered this to be a normal milestone during her growth and development. The International Council of Nurses has spoken out against this procedure as harmful to a woman's health and a violation of human rights.

When managing health care for pregnant women at a prenatal clinic, which barrier to access prenatal care is considered most significant? a. Age b. Minority status c. Educational level d. Geographic location

ANS: D The most significant barrier to health care access is geographic location. Inequities in access to good-quality prenatal care have developed particularly in rural, remote, inner city, and Indigenous communities. Although adolescent pregnant patients statistically receive less prenatal care, age is not the most significant barrier. Significant disparities in morbidity and mortality rates exist for minority women; however, minority status is not the most significant barrier to access of care. Disparities in educational level are associated with morbidity and mortality rates; however, educational level is not the most significant barrier to access of care.

Which is the correct definition of the perinatal mortality rate? a. Number of live births in 1 year per 1000 population b. Number of deaths of infants under 1 year of age per 1000 live births c. Number of deaths of infants under 28 days of age per 1000 live births d. Number of stillbirths and neonatal deaths per 1000 live births

ANS: D The perinatal mortality rate is the number of stillbirths and neonatal deaths per 1000 live births. The number of live births in 1 year per 1000 population is the birth rate. Number of deaths of infants under 1 year of age per 1000 live births is the infant mortality rate. Number of deaths of infants under 28 days of age per 1000 live births is the neonatal mortality rate.

Which is the leading cause of maternal death? a. Hypertension b. Obesity c. Gestational diabetes d. Hemorrhage

ANS: D Worldwide, approximately 800 women die each day of problems related to pregnancy or childbirth, with hemorrhage being the leading cause of death.

What is the term used to describe legal and professional responsibility for maintaining standards of practice? a. Collegiality b. Ethics c. Evaluation d. Accountability

ANS: D Accountability refers to perinatal nurses acting with integrity and in a manner consistent with their professional responsibilities and standards of practice. Collegiality refers to a working relationship with one's colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes.