Exam 1
Infant mortality is a standard measurement of the quality of health care in the country. Which factors contribute to the high numbers of deaths in the United States? Select all that apply. A) preterm births B) maternal age 30 to 34 years of age C) female 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 incompetent cervix, 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 school nurse is trying to get consent to care for an 11-year-old boy with diabetic ketoacidosis. His parents are out of town on vacation and the child is staying with a neighbor. Which action would be the priority? A) Getting telephone consent, with two people listening to the verbal consent B) Providing emergency care without parental consent C) Contacting the child's aunt or uncle to obtain consent D) Advocating for parents patriae to proceed with care for the child
Ans: A Feedback: The priority action would be to contact the neighbor for an emergency number to reach the parents and get their verbal consent, with two witnesses listening simultaneously. If the nurse cannot reach the parents and there is no relative or other person with written authorization to act on the parent's behalf, then the physician may initiate emergency care without the parent's consent. Parents patriae would be reserved for situations in which the parents are neglectful, irresponsible, or incompetent, for example, if the parents refuse treatment and the health care team feels the treatment is reasonable and warranted.
The nurse working in a free community clinic knows that access to health care is affected negatively by lack of health insurance. Which of the following accurately describe the effect of lack of insurance on family health? Select all that apply. A) Parents with uninsured children often delay care and are less likely to take their children to a doctor or dentist for preventive care. B) The percentage of children without health insurance is beginning to decrease slightly from previous years. C) Currently, the states have improved enrollment in Medicaid and the State Children's Health Insurance Program (SCHIP). D) Despite state efforts to ensure all children, nearly two-thirds of children eligible for these public programs are not enrolled. E) In most states, men and women of the same health status and age are charged similar rates for the same individual health insurance policy.
Ans: A, C, D Feedback: Parents with uninsured children often delay care for their children, and are less likely to take their children to a doctor or dentist for preventive care. The percentage of children without health insurance is rising. Despite efforts by the states to improve enrollment in Medicaid and State Children's Health Insurance Program (SCHIP), nearly two-thirds of children eligible for these programs remain uninsured. Additionally, in most states, a man and woman of the same age and health status will be charged different rates for exactly the same individual health insurance policy.
After teaching a group of nursing students about pregnancy-related mortality, the instructor determines that additional teaching is necessary when the students identify which condition as a leading cause? A) Hemorrhage B) Embolism C) Hypertension D) Infection
Ans: B Feedback: Most pregnancy-related complications are preventable. The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor, and unsafe abortion. Embolism is not a leading cause.
The United States ranks 50th in the world for maternal mortality and 41st among industrialized nations for infant mortality rates. When developing programs to assist in decreasing theses rates, which factor would most likely need to be addressed as having the greatest impact? A) Resolving all language and cultural differences B) Ensuring early and adequate prenatal care C) Providing more extensive women's shelters D) Encouraging all women to eat a balanced diet
Ans: B Feedback: The lack of prenatal care during pregnancy is a major factor contributing to a poor outcome. Prenatal care is well known to prevent complications of pregnancy and to support the birth of healthy infants. Infant mortality commonly includes problems occurring at birth or shortly thereafter. Thus, ensuring early and adequate prenatal care would have the greatest impact on decreasing these rates. Resolving all language and cultural differences would be helpful but is unrealistic. Providing more extensive women's shelters would be helpful for women who are victims of abuse. Encouraging all women to eat a balanced diet is helpful but would not decrease infant mortality rates.
A nurse is assessing a family for barriers to health care. Which factor would the nurse identify to be most important? A) Language B) Health care workers' attitudes C) Transportation D) Finances
Ans: D Feedback: Financial barriers are one of the most important factors that limit care. Families may not have any medical insurance, may not have enough insurance to cover the services they need, or may not be able to pay for services. Language, health care workers' attitudes, and transportation are also barriers to health care but are not as fundamentally important as finances.
The nurse is caring for a 12-year-old child hospitalized for internal injuries following a motor vehicle accident. For which of the following medical treatments would the nurse need to obtain an informed consent beyond the one signed at admission? A) Diagnostic imaging B) Cardiac monitoring C) Blood testing D) Spinal tap
Ans: D Feedback: Most care given in a health care setting is covered by the initial consent for treatment signed when the child becomes a patient at that office or clinic or by the consent to treatment signed upon admission to the hospital or other inpatient facility. Certain procedures, however, require a specific process of informed consent, including major and minor surgery; invasive procedures such as lumbar puncture or bone marrow aspiration; treatments placing the child at higher risk, such as chemotherapy or radiation therapy; procedures or treatments involving research; photography involving children; and applying restraints to children.
A 9-month-old with glaucoma requires surgery. The infant's parents are divorced. To obtain informed consent, which action would be most appropriate? A) Contacting the father for informed consent B) Obtaining informed consent from the mother C) Seeking a court ruling on the course of care D) Determining if there is parental sole or joint custody
Ans: D Feedback: The most appropriate action would be to determine legal custody by court decree. If the parents have joint custody, then either parent may give consent, but it is always best to have consent given by both parents. The parent with only physical custody may give consent for emergency care. The last resort is getting a court ruling; usually this is not necessary unless the parents disagree about the care of the child.
A client, 6 hours post-birth, has a severe postpartum hemorrhage that the health care providers are unable to control. She succumbed to the hemorrhage in the intensive care unit. The client's death would become part of the: A) neonatal morbidity rate. B) neonatal mortality rate. C) maternal mortality rate. D) maternal morbidity rate.
C) maternal mortality rate. The maternal mortality ratio is the annual number of deaths from any cause related to or aggravated by pregnancy or its management. Morbidity refers to diseases. The infant mortality rate is the number of deaths occurring in the first 12 months of life. Neonatal mortality is reflected in the infant mortality rate.
A nurse is developing a prenatal education program for the local health clinic. The nurse plans to emphasize the need for maintaining routine prenatal visits based on the understanding that most pregnancy-related complications can be: a. Better controlled b. Treated earlier c. Prevented d. Predicted
Prevented Most pregnancy-related complications are preventable. The top 5 leading causes are: embolism (20%)hemorrhage (17%)preeclampsia & eclampsia (16%)infection (13%)cardiomyopathy (8%)
After teaching a prenatal class about maternal mortality rates, the nurse determines that the teaching has been effective when the participants identify which ethnic group as having the highest ratio of maternal mortality? a. African American mothers b. White mothers c. Hispanic mothers d. Asian mothers
a. African American mothers In the United States, the maternal mortality ratio is mixed depending on ethnic background. African American women suffer maternal mortality ratios far higher than any other ethnic group. The risk of maternal mortality has remained about three to four times higher among Black women when compared to White women during the past six decades. White women have a rate of 12.5, and Hispanics have a rate of 8.9. Asian mothers are lower than Black mothers.
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. weight control and being knowledgeable about family history of cardiovascular disease b. regular neurologic exams to note any cognitive or behavioral changes early c. prompt attention to respiratory tract infections d. yearly gynecological exams
a. 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's disease, although impacting the mortality rates of women, is not the greatest cause of death.
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 solids by age 4 months d. give the infant liquid vitamins daily
b. Breast-feed the infant Breast-feeding 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 solids early is not recommended and has no affect on prevention of infections. Vitamins will not prevent infections by themselves and only help meet daily nutritional requirements and may not be necessary.
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.