*Important* maternal

Which interventions would help alleviate the problems associated with access to health care for maternity patients (Select all that apply)? a. Provide transportation to prenatal visits. b. Provide childcare so that a pregnant woman may keep prenatal visits. c. Mandate that physicians make house calls. d. Provide low-cost or no-cost health care insurance. e. Provide job training.

Answer: A, B, D Lack of transportation to visits, lack of childcare, and lack of affordable health insurance are prohibitive factors associated with lack of prenatal care. House calls are not a cost-effective approach to health care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote.

What does the comprehensive standardized language developed by the nurses from University of Iowa describe? a. Details of perinatal patients b. Interventions by specialist nurses c. Perinatal terms and complications d. Beneficial and ineffective care practices

b. Interventions by specialist nurses The Nursing Interventions Classification includes a comprehensive standardized language that describes interventions that are performed by generalist or specialist nurses. These interventions are commonly used by maternal child nurses to support the family and provide childbearing and after-birth care. The details of perinatal patients are documented in the medical records. The nurse can use reference books and journals to understand perinatal terms and complications. The Cochrane Pregnancy and Childbirth Database contains studies that evaluate beneficial and ineffective care practices.

The nurse is teaching pre-pregnancy planning to a borderline obese patient. Which maternal risk factors associated with obesity does the nurse caution the patient about? Select all that apply. a. Septicemia b. Miscarriage c. Hypertension d. Gestational diabetes e. Congenital anomalies

b. Miscarriage c. Hypertension d. Gestational diabetes e. Congenital anomalies Obesity during pregnancy increases the risk of miscarriage, hypertension, diabetes, and congenital anomalies. Such patients may need increased health care services and longer hospital stays. Septicemia is a pregnancy complication and is not associated with obesity.

Which type of health care includes aromatherapy and massage in conjunction with a pharmaceutical agent? a. Holistic b. Integrative c. Alternative d. Complementary

b. Integrative Aromatherapy and massage therapies in conjunction with a pharmaceutical agent is an example of integrative health care, which encompasses complimentary and alternative therapies in combination with conventional Western modalities of treatment. Holistic care is focused on treating the whole patient, not just the symptoms or disease. Alternative and complementary therapies are components of integrative health care.

Recent trends in childbirth practices in the United States indicate that: a. More than 15% of mothers had late or no prenatal care. b. The percentage of Hispanics, non-Hispanic African Americans, and Caucasians who received prenatal care was essentially the same. c. Births occurring in the hospital accounted for 99% of births. d. Cesarean births have been declining as a percentage of live births.

c. Births occurring in the hospital accounted for 99% of births. Almost all births occur within the hospital setting. Only 5.2% of Caucasians mothers had either late care or no care. There are disparities in the receipt of prenatal care by ethnicity: 12.2% of Hispanic women and 11.8% of non-Hispanic black women received either late or no prenatal care. The percentage of cesarean births is increasing.

What is the primary role of practicing nurses in the research process? a. Designing research studies b. Collecting data for other researchers c. Identifying researchable problems d. Seeking funding to support research studies

c. Identifying researchable problems When problems are identified, research can be conducted properly. Research of health care issues leads to evidence-based practice guidelines. Designing research studies is only one factor of the research process. Data collection is one factor of research. Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.

Alternative and complementary therapies: a. Replace conventional Western modalities of treatment. b. Are used by only a small number of American adults. c. Recognize the value of clients' input into their health care. d. Focus primarily on the disease an individual is experiencing.

c. Recognize the value of clients' input into their health care. Many popular alternative healing modalities offer human-centered care based on philosophies that recognize the value of the patient's input and honor the individual's beliefs, values, and desires. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of American adults are seeking alternative and complementary health care options. Alternative healing modalities offer an holistic approach to health, focusing on the whole person, not just the disease.

What resource does the nurse use to understand the effectiveness of care provided to a patient? a. The Nursing Interventions Classification (NIC) b. The American Nurses Association (ANA) standards c. The Outcome and Assessment Information Set (OASIS) d. The Agency for Healthcare Research and Quality (AHRQ)

c. The Outcome and Assessment Information Set (OASIS) The OASIS is an outcome system that measures the effectiveness of care by using quality indicators. It helps the nurse determine whether a patient benefits from the care provided. AHRQ is an organization that uses evidence-based practice to recommend best nursing practices for effective care. The NIC includes interventions for patient care that are performed by nurses. The ANA publishes standards for maternal-child health.

During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-old Hispanic patient with limited English proficiency. It is important for the nurse to: a. Use maternity jargon in order for the patient to become familiar with these terms. b. Speak quickly and efficiently to expedite the visit. c. Provide the patient with handouts. d. Assess whether the patient understands the discussion.

d. Assess whether the patient understands the discussion. Nurses contribute to health literacy by using simple, common words; avoiding jargon; and evaluating whether the patient understands the discussion. Speaking slowly and clearly and focusing on what is important increase understanding. Most patient education materials are written at too high a level

The nurse is caring for a patient who is newly pregnant and smokes one pack of cigarettes per day. What is important for the nurse to understand prior to providing smoking cessation information? a. Smoking is linked to preeclampsia. b. Smoking is related to fetal anemia. c. Smoking is attributed to gestational diabetes. d. Smoking can cause intrauterine growth restriction.

d. Smoking can cause intrauterine growth restriction. Prior to providing smoking cessation information, it is important that the nurse understand that smoking can cause intrauterine growth restriction (IUGR) due to its effect on the placental vasculature. Smoking also contributes to low birth weight, prematurity, and IUGR, but it is not directly linked to preeclampsia, fetal anemia, or gestational diabetes. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

What technique is commonly used by the maternity nurse to communicate with the team of primary health care providers? a. Telehealth b. TeamSTEPPS c. Nursing Intervention Classification (NIC) d. The situation-background-assessment-recommendation (SBAR) technique

d. The situation-background-assessment-recommendation (SBAR) technique The nurse uses the SBAR technique to communicate critical information that warrants prompt attention by the primary health care provider. Telehealth is a communication technology that provides health care for patients who are separated by distance. TeamSTEPPS is a system that helps medical teams to improve their communication skills and teamwork. The NIC is a comprehensive standardized language describing interventions performed by a generalist or specialist nurse.

Which statements by the student nurse indicate effective learning of the concept of the standard of care? Select all that apply. a. The standard of care should be agreed on by experts. b. The standard of care should reflect current knowledge. c. The standard of care helps to determine legal negligence. d. The standard of care should be validated by the American Nurses Association (ANA). e. The standard of care is a level of practice that a nurse provides in similar circumstances

A, B, C, E The standard of care reflects current knowledge and can be used for clinical benchmarking. The standard is agreed on by experts and leaders in a specialty. In legal terms, a standard of care is a level of practice that a nurse should provide in similar circumstances. The nurse can refer to the agency procedure book to understand the standard of care in a specific circumstance. L

Which of the following statements indicate that the nurse is practicing appropriate family-centered care techniques (Select all that apply)? a. The nurse commands the mother to do as she is told. b. The nurse allows time for the partner to ask questions. c. The nurse allows the mother and father to make choices when possible. d. The nurse informs the family about what is going to happen. e. The nurse tells the patient's sister, who is a nurse, that she cannot be in the room during the delivery.

Answer: B, C Including the partner in the care process and allowing the couple to make choices are important elements of family-centered care. The nurse should never tell the mother what to do. Family-centered care involves collaboration between the health care team and the client. Unless an institutional policy limits the number of attendants at a delivery, the client should be allowed to have whomever she wants present (except when the situation is an emergency and guests are asked to leave).

Which Healthy People 2020 objectives for maternal, infant, and child health does the nurse need to consider when creating a plan of care for a pregnant patient? Select all that apply. a. Eliminate disparities in health care. b. Reduce the rate of fetal and infant deaths. c. Increase the proportion of infants who are breastfed. d. Attain longer lives free of disease and premature death. e. Reduce the incidence of very low-birth-weight (VLBW) infants. 6. Create social and physical environments that promote good health.

Answer: B, C, E One of the goals of Healthy People 2020 is to reduce the rate of fetal and infant deaths. Another goal that the nurse should consider while making a plan of care is to increase the proportion of infants who are breastfed and reduce dependence on infant formula feeding. The nurse can implement nutritional interventions and other health promotion activities to reduce the incidence of VLBW infants. Achieving health equity by eliminating health care disparities, attaining longer lives free of disease and premature death, and creating social and physical environments that promote good health are the broader goals of Healthy People 2020 for improving the health of all Americans.

Which fetal complications does the nurse need to be alert for while providing care to a pregnant patient? Select all that apply. a. Eclampsia b. Amniotic fluid embolism c. Prolapsed umbilical cord d. Uterine hyperstimulation e. Nonreassuring fetal heart rate

Answer: C, D, E A prolapsed umbilical cord decreases the blood and oxygen supply to the fetus, warranting prompt delivery. Uterine hyperstimulation may lead to nonreassuring fetal heart rate and pattern. Nonreassuring fetal heart rate and pattern may warrant interventions such as immediate delivery or intrauterine fetal resuscitation. Eclampsia and amniotic fluid embolism are maternal complications.

Which statements by the student nurse about interprofessional perinatal care indicate effective learning? Select all that apply. a. "Doulas provide super-specialty care." b. "Obstetricians provide specialty care." c. "Obstetricians can manage maternal complications." d. "Certified nurse-midwives cannot provide basic care." e. "Maternal-fetal specialists provide subspecialty care."

B, C, E Obstetricians provide fetal diagnostic testing and management of obstetric and medical complications in addition to providing basic care. Maternal-fetal medicine specialists provide subspecialty care such as genetic testing, advanced fetal therapies, and management of severe maternal and fetal complications. Obstetricians are specialists and can manage severe maternal and fetal complications. Doulas are trained and experienced labor attendants who provide care in a perinatal setting only for the labor and birth process. Basic perinatal care is provided by certified nurse-midwives and primary health care providers apart from obstetricians and other advanced practice clinicians approved by local governance. Test-Taking Tip: Avoid choosing answers that use words such as always, never, must, all, and none. If you are confused about the question, read the choices, label them true or false, and choose the answer that is the odd one out (i.e., the one false one or the one true one). When a question is framed in the negative, such as "When assessing for pain, you should not," the false option is the correct choice.

The hospital risk management nurse is providing annual in-service training at the obstetric unit staff meeting. The risk management nurse should discuss which conditions included on the National Quality Forum list that pertain to maternity nursing? Select all that apply. a. Air embolism b. Falls and trauma c. Blood incompatibility d. Foreign objects retained after surgery e. Incidence of urinary tract infections with catheter use

Conditions on the National Quality Forum list that might pertain to maternity nursing include all five of these: a foreign object retained after surgery, air embolism, blood incompatibility, falls and trauma, and catheter-associated urinary tract infections.

Which statement by the student nurse about the significance of telehealth indicates effective learning? a. "Telehealth helps deliver health care to patients who are separated by distance." b. "Telehealth helps us link with other nurses to share insights about patient care." c. "Telehealth is used to report a critical situation to the primary health care provider." d. "Telehealth is a user-friendly device that helps patients makes health care decisions.

a. "Telehealth helps deliver health care to patients who are separated by distance." Telehealth is the use of communication technologies and electronic information to provide health care to patients who are separated by distance. Internet-based technologies and social media allow nurses to link with other nurses and share insights about patient care. Telehealth is not used by patients to make health care decisions but to get in touch with specialists and health care providers when distance separates them. The nurse uses the situation-background-assessment-recommendation technique to report critical situations. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.

What does the nurse tell a pregnant patient about self-management during maternity care? a. "Your health care costs will decrease." b. "You may not need to learn any nursing interventions." c. "You can obtain self-management information on any website." d. "Correct self-management may result in a poor pregnancy outcome."

a. "Your health care costs will decrease." Pregnancy is primarily health focused and hence more suited to self-management. It also helps to reduce costs because hospitalization is not needed. The patient is taught different interventions such as nutrition education, stress management, and parenting education, which the patient needs to implement to reduce risks. Self-management does not result in poor pregnancy outcomes if the pregnant patient implements health and illness interventions effectively. The nurse does not instruct the patient to obtain information from any website because the information may be inaccurate.

A newly graduated nurse is attempting to understand the reason for increasing health care spending in the United States. Her research finds that these costs are much higher compared with other developed countries as a result of: a. A higher rate of obesity among pregnant women. b. Limited access to technology. c. Increased usage of health care services along with lower prices. d. Homogeneity of the population.

a. A higher rate of obesity among pregnant women. Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.4% of the gross domestic product is spent on health care. Higher spending in the United States compared with 12 other industrialized countries is related to higher prices and readily accessible technology along with greater obesity rates among women. More than one third of women in the United States are obese. Of the U.S. population, 16% is uninsured and has limited access to health care. Maternal morbidity and mortality are directly related to racial disparities.

Which term does the nurse use while documenting or writing out instructions to a patient? a. At (at) b. > (greater than) c. IU (International Unit) d. Q.O.D. (every other day)

a. At (at) The symbol "@" can be mistaken for the number "2." Therefore, the nurse uses at for documenting or writing instructions. For the same reason, the abbreviation Q.O.D. should not be used because it may be mistaken for Q.D. (daily) or Q.I.D. (four times daily). Instead, the nurse must use the term every other day to prevent errors. The symbol ">" should be written as greater than because ">" can be mistaken for the number "7." The nurse uses the term International Unit instead of I.U. because it could be easily misread as I.V. (intravenous) or the number "10." Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

The nurse caring for a pregnant client should be aware that the U.S. birth rate shows which trend? a. Births to unmarried women are more likely to have less favorable outcomes. b. Birth rates for women 40 to 44 years old are beginning to decline. c. Cigarette smoking among pregnant women continues to increase. d. The rates of maternal death owing to racial disparity are elevated in the United States.

a. Births to unmarried women are more likely to have less favorable outcomes. Low-birth-weight infants and preterm birth are more likely because of the large number of teenagers in the unmarried group. Birth rates for women in their early 40s continue to increase. Fewer pregnant women smoke. In the United States, there is significant racial disparity in the rates of maternal death.

When providing care for a pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is: a. Diabetes mellitus. b. Mitral valve prolapse (MVP). c. Chronic hypertension. d. Anemia.

a. Diabetes mellitus. The most frequently reported maternal medical risk factors are diabetes and hypertension associated with pregnancy. Both of these conditions are associated with maternal obesity. There are no studies that indicate MVP is among the most frequently reported maternal risk factors. Hypertension associated with pregnancy, not chronic hypertension, is one of the most frequently reported maternal medical risk factors. Although anemia is a concern in pregnancy, it is not one of the most frequently reported maternal medical risk factors in pregnancy.

Which standards of care does the nurse implement while providing care to a pregnant patient? Select all that apply. a. Diagnosis b. Evaluation c. Assessment d. Resource utilization e. Practice environment

a. Diagnosis b. Evaluation c. Assessment Diagnosis is a standard of care wherein the nurse needs to analyze data and determine the nursing diagnosis for implementing proper interventions. Evaluation is another standard wherein the nurse is responsible for evaluating the effectiveness of an intervention. Assessment is a standard whereby the nurse collects relevant data from the patient. These standards define the nurse's responsibility toward the patient. Resource utilization and practice environment are the standards of professional performance that define the roles and behaviors for which nurses are accountable.

Which standards of performance published by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) define the role for which the nurse is accountable? Select all that apply. a. Education b. Quality of care c. Resource utilization d. Outcome identification e. Performance appraisal

a. Education b. Quality of care c. Resource utilization e. Performance appraisal The AWHONN has set standards of performance that delineate the roles and behaviors of the nurses in perinatal care. The nurse should participate in ongoing educational activities to maintain a current level of knowledge for practice. The nurse should perform a systemic evaluation of the nursing practice to ensure quality of care. The nurse should use resources in a cost-effective manner and at the same time consider safety and effectiveness while delivering care to the patient. The nurse should continuously evaluate and improve practice standards by comparing them to the standards and guidelines defined by AWHONN. Outcome identification is a standard that defines the nurse's responsibility to the patient.

In the United States, what are the possible barriers that a patient may face while accessing health care? Select all that apply. a. Inadequate transportation b. Lack of insurance policies c. Inability to pay medical costs d. Lack of neonatal intensive care units e. Lack of providers for low-income women

a. Inadequate transportation b. Lack of insurance policies c. Inability to pay medical costs e. Lack of providers for low-income women Inability to pay medical costs, lack of insurance, and a lack of health care providers for low-income women are some of the barriers to accessing health care in the United States. Lack of transportation also hampers access to health care. Improvements in technology have resulted in greater availability of neonatal intensive care units in hospitals.

Which are leading causes of maternal mortality in the United States? Select all that apply. a. Infection b. Diabetes c. Lack of prenatal care d. Cardiovascular disease e. Low educational attainmen

a. Infection d. Cardiovascular disease Two leading causes of maternal mortality in the United States include infection and cardiovascular disease. Diabetes is not a specific cause of maternal mortality. Lack of prenatal care and low educational attainment are factors that are strongly related to maternal mortality but are not the leading causes.

Which nursing actions are necessary to prepare a perinatal patient for research? Select all that apply. a. Obtain consent from the patient. b. Inform the patient about her rights. c. Conceal the benefits of the research. d. Conceal the adverse effects of the research. e. Suggest the patient read research information online

a. Obtain consent from the patient. b. Inform the patient about her rights. The nurse must inform the patient about her rights as a research subject. This helps the patient determine whether the benefits of research outweigh the risks to the fetus. An informed consent must be obtained from the patient who participates in the research as it indicates the patient's willingness to participate. The nurse needs to inform the patient about the benefits and the adverse effects that may result from research so that the patient can make an informed decision. The nurse does not suggest that the patient collect research information online as some part of the information may be inaccurate.

Which type of patient management is most effective in the reduction of health care costs for the maternity patient? a. Self-management b. Risk management c. Community-based care d. Risk-oriented prenatal care

a. Self-management Self-management is the most effective method in the reduction of health care costs for the maternity patient. Maternity care is especially suited to self-management because childbearing is primarily health focused, women are usually well when they enter the system, and visits to health care providers can present the opportunity for health and illness interventions. Risk management works to evaluate risks and prevent incidents from occurring that cause harm. Community-based care is a type of health care that occurs in an ambulatory or home setting. Risk-oriented prenatal care is a type of care delivered to the patient by a health care provider but is less effective than self-management when it comes to health care costs.

Which term defines a neonatal death caused by a birth weight greater than 2500 g? a. Sentinel event b. Ethical dilemma c. Failure to rescue d. Legal negligence

a. Sentinel event A sentinel event is an unexpected occurrence involving death or serious injury. Events like maternal death during delivery or perinatal death which is not related to any congenital disease is a sentinel event. Such events need to be attended to promptly. Failure to rescue is the failure to recognize or act on early signs of distress. Legal negligence is established by comparing the level of care provided against the accepted standards of care. A perinatal death does not represent an ethical dilemma.

How can the nurse best contribute to the patient's health literacy when providing medication teaching? Select all that apply. a. Speaking clearly b. Using simple words c. Providing written material d. Referring the patient to a website e. Reviewing all aspects of the medication

a. Speaking clearly b. Using simple words The nurse can best contribute to the patient's health literacy when providing medication teaching by speaking clearly and using simple words followed by assessing whether the patient understood the discussion. Providing written material does not always contribute to the health literacy because most educational materials are written at too high of a level for the average adult. Referring the patient to a website does not offer the opportunity for the nurse to assess the patient's understanding of the information. Focusing on what is important for the patient to understand about the medication alleviates overloading the patient with information rather than reviewing every detail.

Healthy People 2020 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and providing care across the perinatal continuum. Therefore it is important for the nurse to be aware that significant progress has been made in: a. The reduction of fetal deaths and use of prenatal care. b. Low birth weight and preterm birth. c. Elimination of health disparities based on race. d. Infant mortality and the prevention of birth defects.

a. The reduction of fetal deaths and use of prenatal care. Trends in maternal child health indicate that progress has been made in relation to reduced infant and fetal deaths and increased prenatal care. Notable gaps remain in the rates of low birth weight and preterm births. According to the March of Dimes, persistent disparities still exist between African Americans and non-Hispanic Caucasians. Many of these negative outcomes are preventable through access to prenatal care and the use of preventive health practices. This demonstrates the need for comprehensive community-based care for all mothers, infants, and families.

The level of practice a reasonably prudent nurse provides is called: a. The standard of care. b. Risk management. c. A sentinel event. d. Failure to rescue.

a. The standard of care. Guidelines for standards of care are published by various professional nursing organizations. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events are unexpected negative occurrences. They do not establish the standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the standard of care.

Through the use of social media technology, nurses can link with other nurses who may share similar interests, insights about practice, and advocate for patients. The most concerning pitfall for nurses using this technology is: a. Violation of patient privacy and confidentiality. b. Institutions and colleagues may be cast in an unfavorable light. c. Unintended negative consequences for using social media. d. Lack of institutional policy governing online contact.

a. Violation of patient privacy and confidentiality. The most significant pitfall for nurses using this technology is the violation of patient privacy and confidentiality. Furthermore, institutions and colleagues can be cast in unfavorable lights with negative consequences for those posting information. Nursing students have been expelled from school and nurses have been fired or reprimanded by their Board of Nursing for injudicious posts. The American Nurses Association has published six principles for social networking and nurses. All institutions should have policies guiding the use of social media, and nurses should be familiar with these guidelines.

Which maternal complication is the nurse alert for in order to prevent a failure to rescue in a perinatal setting? a. Unstable fetal heart rate b. Amniotic fluid embolism c. Prolapsed umbilical cord d. Uterine hyperstimulation

b. Amniotic fluid embolism The nurse is alert for maternal complications such as amniotic fluid embolism, placental abruption, hemorrhage after birth, uterine rupture, and eclampsia in order to prevent a failure to rescue. In such cases the health care team needs to initiate appropriate interventions quickly to prevent harm to the patient. An unstable fetal heart rate and pattern, prolapsed umbilical cord, and uterine hyperstimulation are fetal complications in a perinatal setting.

Which actions does the perinatal nurse take to minimize harm or prevent a failure to rescue in an obstetric emergency? Select all that apply. a. Use telehealth services. b. Assess the patient for risks. c. Implement interventions quickly. d. Document the patient's condition. e. Identify complications immediately.

b. Assess the patient for risks. c. Implement interventions quickly. e. Identify complications immediately. The nurse regularly assesses the patient for risks to be alert to any complications. This will help prevent a failure to rescue. In case of an obstetric emergency, the health care team needs to implement interventions quickly to minimize harm. This is possible with a timely identification of complications. Implementing interventions quickly for the patient's safety is more important than documenting the patient's condition. Telehealth services are used only when the patient is separated by distance from a health care provider.

An important development that affects maternity nursing is integrative health care, which: a. Seeks to provide the same health care for all racial and ethnic groups. b. Blends complementary and alternative therapies with conventional Western treatment. c. Focuses on the disease or condition rather than the background of the client. d. Has been mandated by Congress.

b. Blends complementary and alternative therapies with conventional Western treatment. Integrative health care tries to mix the old with the new at the discretion of the client and health care providers. Integrative health care is a blending of new and traditional practices. Integrative health care focuses on the whole person, not just the disease or condition. U.S. law supports complementary and alternative therapies but does not mandate them

The nurse receives a prescription that includes the abbreviation MS. What action does the nurse take? a. Consults a colleague for explanation b. Consults the primary health care provider c. Obtains morphine sulphate from the pharmacy d. Obtains magnesium sulfate from the pharmac

b. Consults the primary health care provider The Joint Commission has issued a "Do Not Use" list that contains abbreviations and acronyms that should not be used while writing instructions. MS can mean morphine sulphate or magnesium sulphate. Therefore, the nurse needs to consult with the primary health care provider and obtain the proper drug name. The nurse should not obtain the drug from the pharmacy without verifying that it is the right drug. The nurse should not ask colleagues because they may not give the correct answer. STUDY TIP: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience.

What are the main causes of maternal death in the United States? Select all that apply. a. Stillbirths b. Hemorrhage c. Preterm births d. Pulmonary embolism e. Gestational hypertension

b. Hemorrhage d. Pulmonary embolism e. Gestational hypertension Maternal mortality is a significant problem in the United States, although the overall number of maternal deaths is small. The three main causes of maternal mortality in the United States today are hemorrhage, pulmonary embolism, and gestational hypertension. Stillbirths and preterm births are not related to maternal mortality.

What action does the nurse take to provide perinatal care that is based on information gained through research and clinical trials? a. Use telehealth technology. b. Refer to evidence-based practice. c. Refer to the Nursing Intervention Classification (NIC). d. Refer to the Cochrane Pregnancy and Childbirth Databas

b. Refer to evidence-based practice. Evidence-based practice is based on the knowledge gained from research and clinical trials. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Standards and Guidelines for Professional Nursing Practice in the Care of Women and Newborns (AWHONN, 2009) and the Standards for Professional Perinatal Nursing Practice and Certification in Canada (AWHONN, 2002) include an evidence-based approach to practice. Telehealth is the use of communication technologies to provide health care to patients who are separated by distance from health care providers. The NIC is a method of standardizing and categorizing the language used in care. The Cochrane Pregnancy and Childbirth Database is an up-to-date, systematic review of randomized controlled trials of health care. Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option.

To ensure optimal outcomes for the patient, the contemporary maternity nurse must incorporate both teamwork and communication with clinicians into her care delivery, The SBAR technique of communication is an easy-to-remember mechanism for communication. Which of the following correctly defines this acronym? a. Situation, baseline assessment, response b. Situation, background, assessment, recommendation c. Subjective background, assessment, recommendation d. Situation, background, anticipated recommendation

b. Situation, background, assessment, recommendation The situation, background, assessment, recommendation (SBAR) technique provides a specific framework for communication among health care providers. Failure to communicate is one of the major reasons for errors in health care. The SBAR technique has the potential to serve as a means to reduce errors.

During a prenatal intake interview, the client informs the nurse that she would prefer a midwife to provide her care during pregnancy and deliver her infant. What information would be most appropriate for the nurse to share with this patient? a. Midwifery care is available only to clients who are uninsured because their services are less expensive than an obstetrician. Costs are often lower than an obstetric provider. b. The client will receive fewer interventions during the birth process. c. The client should be aware that midwives are not certified. d. Delivery can take place only at the client's home or in a birth center.

b. The client will receive fewer interventions during the birth process. This patient will be able to participate actively in all decisions related to the birth process and is likely to receive fewer interventions during the birth process. Midwifery services are available to all low-risk pregnant women, regardless of the type of insurance they have. Midwifery care in all developed countries is strictly regulated by a governing body, which ensures that core competencies are met. In the United States, this body is the American College of Nurse-Midwives. Midwives can provide care and delivery at home, in freestanding birth centers, and in community and teaching hospitals.

A nurse caring for a laboring patient initiates intrauterine resuscitation measures upon the recognition of a nonreassuring fetal heart rate tracing. After initiating the interventions, the nurse notes the tracing remains nonreassuring, and the provider is immediately notified. After providing a phone report to the provider using the SBAR tool, the provider states to the nurse, "It is 2 in the morning; I will be in around 7," and hangs up the telephone. What is the nurse's priority action? a. Call the provider back. b. File an occurrence report. c. Initiate the chain of command. d. Reevaluate the tracing in an hour.

c. Initiate the chain of command. The nurse's priority action is to initiate the chain of command as reflected by the standard of care for the agency. By initiating the chain of command, the nurse is attempting to obtain appropriate medical intervention in a timely manner. Calling the provider back, filling out an occurrence report, and reevaluating the fetal heart rate tracing in an hour further delay the necessary medical interventions needed to prevent a potential failure to rescue and a sentinel event.

Which health care system encompasses complementary and alternative therapies in combination with conventional Western modalities of treatment? a. TeamSTEPPS b. Cochrane Database c. Integrative health care d. Evidence-based practice

c. Integrative health care Integrative health care combines conventional Western modalities of treatment with the complementary and alternative therapies that offer human-centered care. TeamSTEPPS is a teamwork system for health professionals to provide higher-quality, safer patient care. The Cochrane Database contains up-to-date, systematic reviews of randomized controlled trials. Evidence-based practice provides care based on the evidence gained through research and clinical trials.

To ensure patient safety, the practicing nurse must have knowledge of the current Joint Commission's "Do Not Use" list of abbreviations. Which of the following is acceptable for use? a. q.o.d. or Q.O.D. b. MSO4 or MgSO4 c. International Unit d. Lack of a leading zero

c. International Unit The abbreviations "i.u." and "I.U." are no longer acceptable because they could be misread as "I.V." or the number "10." The abbreviation "q.o.d. or Q.O.D." should be written out as "every other day." The period after the "Q" could be mistaken for an "I"; the "o" could also be mistaken for an "i." With MSO4 or MgSO4, it is too easy to confuse one medication for another. These medications are used for very different purposes and could put a client at risk for an adverse outcome. They should be written as morphine sulfate and magnesium sulfate. The decimal point should never be missed before a number to avoid confusion (i.e., 0.4 rather than .4).

What resources does the nurse utilize in order to obtain information related to nursing interventions for maternal-child, perinatal, and neonatal health care? Select all that apply. a. The Joint Commission's "Do Not Use" list b. American Nurses Association (ANA) Code of Ethics c. National Association of Neonatal Nurses (NANN) standards of practice d. Situation-background-assessment-recommendation (SBAR) framework e. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) standards

c. National Association of Neonatal Nurses (NANN) standards of practice e. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) standards NANN publishes standards of practice that contain current knowledge for neonatal care by specialists. The standards define acceptable levels of care in nursing practice and are also used for clinical benchmarking. The nurse can refer to standards published by AWHONN to understand perinatal care practices. The Joint Commission's "Do Not Use" list contains abbreviations that should be avoided to reduce risk of errors in medication administration. The ANA Code of Ethics helps the nurse ensure the ethical conduct of research. The SBAR report illustrates the technique for communication between the primary health care providers.

The role of the professional nurse caring for childbearing families has evolved to emphasize: a. Providing care to patients directly at the bedside. b. Primarily hospital care of maternity patients. c. Practice using an evidence-based approach. d. Planning patient care to cover longer hospital stays.

c. Practice using an evidence-based approach. Professional nurses are part of the team of health care providers who collaboratively care for patients throughout the childbearing cycle. Providing care to patients directly at the bedside is one of the nurse's tasks; however, it does not encompass the concept of the evolved professional nurse. Throughout the prenatal period, nurses care for women in clinics and physician's offices and teach classes to help families prepare for childbirth. Nurses also care for childbearing families in birthing centers and in the home. Nurses have been critically important in developing strategies to improve the well-being of women and their infants and have led the efforts to implement clinical practice guidelines using an evidence-based approach. Maternity patients have experienced a decreased, rather than an increased, length of stay over the past 2 decades.

Which reference material does the nursing instructor suggest to the students to help them acquire competencies for improved care practices? a. Objectives of Healthy People 2020 b. Standards of practice for neonatal care c. Quality and Safety Education for Nurses (QSEN) d. Situation-background-assessment-recommendation (SBAR) technique

c. Quality and Safety Education for Nurses (QSEN) QSEN identifies the competencies that the nurse needs to acquire to improve health care. They are patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. The nurse needs to acquire knowledge, skills, and attitude for each competency. Healthy People 2020 objectives aim to improve the health of all Americans. Standards of practice for neonatal care published by the National Association of Neonatal Nurses lay down standards for neonatal nurses, reflecting current knowledge that can be used for clinical benchmarking. The SBAR technique gives a specific framework for communication between primary health care providers.

A 38-year-old Hispanic woman delivered a 9-pound, 6-ounce girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds would the woman potentially have a legitimate legal case for negligence? a. She is Hispanic. b. She delivered a girl. c. The standards of care were not met. d. She refused fetal monitoring.

c. The standards of care were not met. Not meeting the standards of care is a legitimate factor for a case of negligence. The client's race is not a factor for a case of negligence. The infant's gender is not a factor for a case of negligence. Although fetal monitoring is the standard of care, the client has the right to refuse treatment. This refusal is not a case for negligence; however, informed consent should be properly obtained, and the client should sign an against medical advice form for refusal of any treatment that is within the standard of care.

While obtaining a detailed history from a woman who has recently emigrated from Somalia, the nurse realizes that the client has undergone female genital mutilation (FGM). The nurse's best response to this patient is: a. "This is a very abnormal practice and rarely seen in the United States." b. "Do you know who performed this so that it can be reported to the authorities?" c. "We will be able to restore your circumcision fully after delivery." d. "The extent of your circumcision will affect the potential for complications."

d. "The extent of your circumcision will affect the potential for complications." The extent of your circumcision will affect the potential for complications" is the most appropriate response. 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. Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Responding with, "This is a very abnormal practice and rarely seen in the United States" is culturally insensitive. The infibulation may have occurred during infancy or childhood. The client 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.

Which instruction does the nurse provide to an obese pregnant patient? a. "You need to learn aerobic exercises." b. "You need to increase your fluid intake." c. "You need to consult with a nurse-midwife." d. "There is an increased chance of complications.

d. "There is an increased chance of complications. Obesity increases the risk for hypertension related to pregnancy and diabetes in pregnant women. Miscarriage and fetal death are also other risks that may result from obesity. Hence the nurse needs to inform the patient about these complications to prevent risks. The nurse needs to instruct the all patients, not only obese ones, to increase fluid intake in case of dehydration. Aerobic exercises are prescribed for diabetic patients and not for pregnant women. The patient may choose to consult a nurse-midwife regarding childbirth decisions, but obesity does not make that a necessity.

The term used to describe legal and professional responsibility for practice for maternity nurses is: a. Collegiality. b. Ethics. c. Evaluation. d. Accountability.

d. Accountability. Accountability refers to legal and professional responsibility for 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.

Which statement by the student nurse explains the term abortus effectively? a. An expelled fetus that weighs more than 500 g b. An infant who at birth demonstrates no signs of life c. An embryo that is removed after 20 weeks of gestation d. An embryo or fetus that is removed or expelled from the uterus

d. An embryo or fetus that is removed or expelled from the uterus The term abortus means an embryo or fetus that is removed or expelled from the uterus. In biostatistical terminology, the term stillbirth refers to an infant who at birth demonstrates no signs of life. The term abortus refers to an embryo that is removed at 20 weeks of gestation or less, weighs 500 g or less, and measures 25 cm or less.

When the nurse is unsure about how to perform a patient care procedure, the best action would be to: a. Ask another nurse. b. Discuss the procedure with the patient's physician. c. Look up the procedure in a nursing textbook. d. Consult the agency procedure manual and follow the guidelines for the procedure.

d. Consult the agency procedure manual and follow the guidelines for the procedure. It is always best to follow the agency's policies and procedures manual when seeking information on correct patient procedures. These policies should reflect the current standards of care and state guidelines. Each nurse is responsible for her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe client care delivery. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or individual state or hospital policies.

What is the process of obtaining information through research and clinical trials called? a. Safe practice b. Point-of-care testing c. Performance appraisal d. Evidence-based practice

d. Evidence-based practice To obtain information through research and clinical trials is called evidence-based practice. Safe practice refers to a nursing practice that is implemented for efficient health care. Point-of-care testing is a diagnostic process. Performance appraisal is a standard of professional performance.

A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan 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

d. Explain to the woman the importance of keeping her prenatal care appointments 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 woman may need assistance from a social worker at some time during her pregnancy, but this 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 African-American women have high-risk issues. Additionally, this is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a woman is to receive. Test-Taking Tip: Many times the correct answer is the longest alternative giv

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

d. Implementing programs to ensure women's early participation in ongoing prenatal care Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. 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. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high risk infants after they are born. Expanding the number of NICUs offers better access for high-risk care, but this is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetric care would be n

When managing health care for pregnant women at a prenatal clinic, the nurse should recognize that the most significant barrier to access to care is the pregnant woman's: a. Age. b. Minority status. c. Educational level. d. Inability to pay.

d. Inability to pay. The most significant barrier to health care access is the inability to pay for services; this is compounded by the fact that many physicians refuse to care for women who cannot pay. Although adolescent pregnant clients 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.

What is the biostatistical term for the number of deaths of infants less than 1 year of age per 1000 live births? a. Doula b. Stillbirth c. Standard of care d. Infant mortality rate

d. Infant mortality rate The number of deaths of infants younger than 1 year of age per 1000 live births is called the infant mortality rate. Doulas are trained and experienced female labor attendants. A stillborn infant is one who at birth demonstrates no signs of life such as breathing, heartbeat, or voluntary muscle movements. Standard of care is a level of practice that is provided in the same or similar circumstances.

Recent trends in childbirth practice indicate that: a. Delayed pushing is now discouraged in the second stage of labor. b. Episiotomy rates are increasing. c. Midwives perform more episiotomies than physicians. d. Newborn infants remain with the mother and are encouraged to breastfeed.

d. Newborn infants remain with the mother and are encouraged to breastfeed. Breastfeeding is encouraged for newborns immediately after birth. Delayed pushing is encouraged for several reasons. Episiotomy rates are declining. Midwives perform fewer episiotomies than physicians.