Nur 107 Chap 1, 2, 3, 10 Ricci Maternity and Pediatric Nursing, Fourth Edition
A nursing student is preparing a presentation illustrating the Human Genome Project. Which function will the student point out as being the primary focus?
Identification of human genes and functions Explanation: The Human Genome Project was founded in 1990 and its primary purpose was to identify and label all human genes and their functions. Information from the HGP may eventually be used in genetic testing, the detection of mutations or variations in children, and gene therapy.
What is a current trend in child health care?
Health promotion rather than health restoration is stressed. Explanation: It is recognized that keeping individuals well is more cost effective for a system than helping ill individuals return to wellness.
A parent brings a foster child to the clinic for immunizations. What is the first responsibility of the nurse?
verify legal documentation Explanation: 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.
Which physician is known as the "Father of Pediatrics"?
Abraham Jacobi Explanation: Many view Abraham Jacobi, a Prussian-born physician, as the father of pediatrics.
The nurse is reviewing the nursing care plan on a pediatric client admitted to the hospital with a respiratory illness. Which goal is written correctly?
The client will have an oxygen saturation of greater than 95% on room air within 8 hours. Explanation: Goals must be specific, measurable, and have a time frame. The goal identified as "The client will have an oxygen saturation of greater than 95% on room air within 8 hours" includes both measurable, objective information (the oxygen saturation on room air and a time frame). It is client-centered and appropriate. The goals of "breathing better" and "better respiratory rate and oxygen saturation" are vague and do not have a measurable outcome. What is considered "better" is subjective and not measurable. Not having a time frame makes the goal inaccurate as well. The goal of the client walking a specific distance on room air would be a good goal if a date/time frame were included in the goal.
What nursing intervention by the maternity nurse is the most important in providing family-centered care?
promoting uninterrupted infant bonding Explanation: Since World War II many changes and innovations have occurred in maternity care and how nurses provide this care. The evolution has gone from task-oriented nursing services, to providing education and promoting breastfeeding, to family-centered care. Promoting uninterrupted infant bonding has been identified as a priority in the development of the family unit. Allowing doulas in the delivery room, having siblings at the bedside and providing early discharge are all parts of family-centered care, but establishing bonding between the infant and the family unit is the priority.
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?
weight control and being knowledgeable about family history of cardiovascular disease Explanation: 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 educator is conducting a class on intimate partner violence for a group of new graduate nurses during orientation. Which statement by the educator best reflects current practice regarding these problems in women's health?
"The nurse should screen for these problems at every client encounter." Explanation: Both child and intimate partner violence is increasing in incidence. Families are more mobile than in the past. Screening for child abuse (child maltreatment) or intimate partner violence should be included in all family contacts. Nurses must be aware of the legal responsibilities for reporting violence.
The nurse is working with the parents of an infant and a toddler in the clinical setting. What statement by the parent would alert the nurse to assess the children further?
"We live in an old house, and we are planning to renovate it when the kids are older." Explanation: Older homes are at risk for having lead-based paint (usually those built before the mid to late 1970s) and lead pipes used in plumbing. The nurse would further assess for the children's exposure to lead pipes, paint, paint chips, lead dust, and soil containing lead dust and paint chips. Additionally, during a renovation, the children will be exposed to areas with lead paint and/or dust. The other options are appropriate and demonstrate information only and not a need to further assess.
The nurse is reviewing the medical records of several infants. Which infant is at highest risk for death according to the infant mortality rate in the United States?
An infant born at a low birth weight Explanation: 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.
certified nurse midwife (CNM)
postgraduate training in the care of normal pregnancy and delivery and is certified by the American College of Nurse-Midwives (ACNM). Midwives are primary care providers for women with a special emphasis on pregnancy, childbirth, and reproductive health. They are committed to providing ethical, individualized, evidence-based care for all women throughout their life cycle
BOX 1.1 Childbirth in America: A Time Line
BOX 1.1 Childbirth in America: A Time Line 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. 1800s There is a shift from using midwives to doctors among middle-class women. The word obstetrician was formed from the Latin, meaning "to stand before." Puerperal (childbed) fever was occurring in epidemic proportions. Louis Pasteur demonstrated that streptococci were the major cause of puerperal fever that was killing mothers after delivery. The first cesarean section was performed in Boston in 1894. The x-ray was developed in 1895 and was used to assess pelvic size for birthing purposes. 1900s Twilight sleep (a heavy dose of narcotics and amnesiacs) was used on women during childbirth in the United States. The United States was 17th out of 20 nations in infant mortality rates. Of all women, 50% to 75% gave birth in hospitals by 1940. Nurseries were started because mothers could not care for their baby for several days after receiving chloroform gas. Dr. Grantley Dick-Reed (1933) wrote Childbirth Without Fear, which reduced the "fear-tension-pain" cycle women experienced during labor and birth. Dr. Fernand Lamaze (1984) wrote Painless Childbirth: The Lamaze Method, which advocated distraction and relaxation techniques to minimize the perception of pain. Amniocentesis was first performed to assess fetal growth in 1966. In the 1970s the cesarean section rate was about 5%. In 2011 it rose to 32%, where it stands currently. The 1970s and 1980s see a growing trend to return birthing back to the basics—nonmedicated, nonintervening childbirth. In the late 1900s, freestanding birthing centers—LDRPs—were designed, and the number of home births began to increase. 2000s One in three women undergoes a surgical birth (cesarean). CNMs once again assist couples at home, in hospitals, or in freestanding facilities with natural childbirths. Research shows that midwives are the safest birth attendants for most women, with lower infant mortality and maternal rates, and fewer invasive interventions such as episiotomies and cesareans. Childbirth classes of every flavor abound in most communities. According to the latest available data, the United States ranks 48th in the world in maternal deaths. The maternal mortality ratio is approximately 28 in 100,000 live births. According to the latest available data, the United States ranks 55th in the world (compared to 224 other countries) in infant mortality rates. The infant mortality rate is approximately 6.17 in 1,000 live births.
In an effort to improve the health status of women and their children, several national campaigns have been implemented. The campaign that reduced the incidence of sudden infant death syndrome (SIDS) by 50% was the:
Back to Sleep Campaign. Explanation: Another success is the 50% reduction in cases of sudden infant death syndrome (SIDS) after initiation of the "Back to Sleep" campaign.
A public health nurse is developing a plan to implement strategies to assist in lowering maternal and infant mortality rates for Black women in the United States. Which factor should not be included in the plan?
Black women have adequate obstetrical insurance coverage. Explanation: The maternal mortality and morbidity rates for black women in the Unites States have been three to four times higher than for white women. This difference in the pregnancy-related mortality ratio is the largest disparity in the area of maternal and child health. Researchers do not entirely understand what accounts for this disparity, but some suspected causes of the higher maternal mortality rates for minority women include low socioeconomic status, limited or no insurance coverage, bias among health care providers, and quality of care available in the community.
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?
Check the medical record for written client approval with whom to share information. Explanation: 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.
What societal issues greatly influence delivery of maternal and pediatric health care? Select all that apply.
Cost of health care Low income of families Increased cultural and ethnic diversity of clients Explanation: Demographic trends such as a decreased number children being born, combined with an increase in a multicultural society seeking health care, are affecting the delivery of maternal-child health care. Poverty and the cost of health care also play a major role in influencing health care delivery for both women and children.
A nurse compares the average length of stay of postpartum women of today with the past and notes the stay is shorter. Which factor has most influenced this trend of shorter hospital stays?
Efforts to contain health care costs Explanation: Providing comprehensive prenatal care can help reduce potential problems, which helps reduce the high cost of specialized care in situations which can be avoided. There has been a factor of wellness focus within the health care system but that is not the main factor in this case.
Morbidity rates among children are most highly associated with which cause?
Environmental factors Explanation: The factors most commonly associated with child morbidity are environmental and socioeconomic problems. The more difficult the societal issues and the more marked the environmental poverty, the higher the illness rates and childhood morbidity. Firearms, violence in schools, homicide, and suicide are all factors in morbidity, but they are not strictly related to children.
A young mother with an ill child tells the visiting nurse that she belongs to the Christian Scientist religious group and will not seek medical attention for the child. Which statement best reflects the mother's religion's beliefs about health?
Healing will come through prayer and spiritual regeneration only. Explanation: Christian Scientists view disease as error of the human mind that can be dispelled by spiritual truth. Health is viewed within a spiritual framework; healing will come through prayer and spiritual regeneration with no medical intervention. There is general opposition to human interventions with drugs or other therapies except for legally required immunizations in the Christian Scientist church, and Christian Scientists usually do not use blood or blood components, seek transplants or act as donors, or seek biopsies or physical examination.
The nursing instructor is teaching a group of students about the history of maternity and family care. The instructor determines the session is successful when the students correctly choose which major change resulting from research by Klaus and Kennell?
Family-centered care of today Explanation: Klaus and Kennell conducted studies and determined the optimal outcomes for children occurred when parents had more contact and interaction with the child in the hospital. Limiting visits has detrimental effects on infant development. Rooming-in was not as well received, as patients were not comfortable with the loss of privacy. Isolation of children with infections is still a proper precaution.
A group of nurses are discussing the most recent statistics on death due to prematurity in the United States. Which action, if implemented, would have the greatest impact on improving outcomes?
Improve women's access to receiving prenatal care. Explanation: The best way to have a positive impact on perinatal outcomes and reduce prematurity is to improve women's access to prenatal care. Tracking the incidence of violent crime does not give information on how to improve outcomes, nor does examining health disparities between ethnic groups or identifying specific national goals related to maternal and infant care without acting on the information. None of these address the true problem.
In 2007 the World Factbook published statistics that showed the United States still lagged behind other industrialized nations in the incidence of infant mortality. What is one reason that the United States has a higher infant mortality rate than other countries?
Low birth weight Explanation: Many factors may be associated with high infant mortality rates and poor health. Low birth weight and late or nonexistent prenatal care are the main factors in the poor rankings in infant mortality.
The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation?
Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved. Explanation: When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct.
A young female client is pregnant for the first time and is uncertain who to seek prenatal care from. The nurse should point out which health care provider as the likely choice?
Obstetrician Explanation: The obstetrician is the common choice for prenatal care through labor and delivery. Perinatologists may care for women who have a high-risk pregnancy, and neonatologists provide care to infants. Family practitioner physicians may provide care but are less likely to attend in labor and delivery.
A nurse at a prenatal class discusses the evolution of obstetrical care. Which statements would best describe birth in America presently? Select all that apply.
One in three women in the United States undergoes a surgical birth (cesarean). Certified nurse midwives (CNMs) assist with births safely in many settings. The infant mortality rate in the United States is approximately 6.17 in 1,000 live births. Explanation: One in three women undergoes a surgical birth (cesarean). CNMs may once again assist couples at home, in hospitals, or in freestanding facilities with natural childbirths. The United States ranks 55th in the world (compared to 224 other countries) in infant mortality rates. The infant mortality rate is approximately 6.17 in 1,000 live births. Research shows that midwives are the safest birth attendants for most women, with lower infant mortality and maternal rates.
A nurse witnesses a peer tell a client, "You are a mother now and you have to do what is best for you baby. You have to breastfeed her!" Which is the best action by the nurse?
Pull the nurse aside and inquire as to the content of the conversation. Explanation: The nurse overheard just a small portion of the conversation between the client and the peer nurse. The best action would be to inquire as to the content of the conversation and then determine if the peer nurse's comments were appropriate. If the comments were inappropriate, the nurse would then need to fill out an incident report.
The nurse is caring for a 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?
Refer the client to a midwife in preparation for a birth in a birthing center. Explanation: 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.
A nurse is conducting a teaching session on sudden infant death syndrome (SIDS) for expectant parents. Which information should the nurse include? Select all that apply.
Sharing a room allows for monitoring of the infant. Place the infant on his or her back to sleep. Maintain neutral temperatures and avoid overheating. Explanation: Sharing of a room allows for monitoring and bonding of the infant as well as ease of feeding. Placing the infant on his or her back to sleep is the recommended sleeping position for all infants until 12 months of age, or until they can change their own position during sleep. Infants are not able to regulate their temperature; therefore, overheating can increase their risk for SIDS. Co-bedding increases the risk for accidental suffocation, and allowing an infant to sleep with a bottle increases risk for aspiration and infection.
To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups?
Teach injury prevention and proper safety practices. Explanation: The leading cause of death throughout childhood is unintentional injury.
Consent for urgent treatment is needed for a minor. The parents are unable to be at the hospital. What action by the nurse constitutes informed consent?
Telephone consent with two witnesses listening simultaneously. Explanation: Telephone consent documented with two witness signatures is appropriate. None of the other options constitutes informed consent.
An older couple approaches the nurse's station seeking information about their hospitalized grandchild. What should be the nurse's response?
Tell the couple to seek information directly from the child's parents. Explanation: To protect the child's privacy, information can be shared only with legal guardians, parents, or those identified in writing. "Looking busy" only temporarily avoids confronting the privacy rights.
The nurse is running an education program for early grade-school children. Which topic would address the number one cause of death for this age group?
The importance of crossing streets safely Explanation: Motor-vehicle accidents are a leading cause of death in this age group.
Before World War II women moved from home to hospital births. What was the primary reason for that shift in maternity care?
They were convinced that setting would improve birth outcomes. Explanation: 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.
The maternal-child health nurse provides care to which client populations working within an appropriate scope of practice? Select all that apply.
a 2-week-old preterm infant a 14-year-old primigravida client
Doula
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
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?
breastfeeding Explanation: 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 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?
congenital abnormalities Explanation: 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.
When preparing a teaching plan for a group of women during their first pregnancy, the nurse reviews how maternity care has changed over the years. Which information would the nurse include when discussing events occurring in the 20th century?
development of birthing centers Explanation: In the 20th century (1900s), birth centers were developed. Puerperal fever epidemics, the first cesarean birth, and X-ray to assess pelvic size were events occurring during the 19th century (1800s).
A group of nurses are working to provide quality care for their clients within the current health care environment of cost containment. Which strategy(ies) would be appropriate for the nurses to use? Select all that apply.
educating clients about seeking help for problems early on urging clients to participate in screening programs creating easy access programs for clients to receive immunizations Explanation: 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.
What makes the area of family nursing a difficult arena in which to provide care at times?
family members who might not agree on treatments and a plan of care Explanation: The family may not agree of the plan of care or treatment plans with each other or for their children. This is a difficult situation as the children do not have their rights to make their own decisions and the family needs to agree.
In order to advocate for children and families, the nurse must first acknowledge that the basic system in which health behavior and care are organized, secured, and performed is the:
family. Explanation: The family is the basic system in which health behavior and care are organized, secured, and performed. In most families, the parents or guardians, as advocates for their child, provide health promotion and health prevention care, as well as primary management of care when the child is sick. Parents and guardians have the prime responsibility for initiating and coordinating services rendered by health professionals.
The nurse works at the local public health office. Which is a major but often overlooked problem in this setting?
fetal mortality Explanation: Fetal mortality is a major, but often overlooked, public health problem. This refers to the spontaneous intrauterine death at any time during pregnancy, commonly referred to as a miscarriage. The fetal mortality rate in the United States is 6.2 per 1,000 live births. The impact of fetal mortality on families is considerable and provides a picture of the quality of maternal health and prenatal care.
A nurse is working as part of a larger community group to develop programs to address current barriers to health care being experienced by women. The community is in the city with a large population of low-income families. On which factor should the group focus their efforts to address a main barrier to access to care?
health insurance Explanation: Although transportation, language and culture, and low health literacy are barriers to health care, health insurance is a major factor affecting access to health care. The existence of financial barriers is one of the most important factors that limits access to care. Many families do not have health insurance so they cannot afford to see health care providers for maintenance and prevention services. Many do not have enough health insurance to cover services they need or cannot pay for services.
A nurse is reviewing the statistical outcomes related to fetal deaths nationwide and notes that the numbers have changed over the last several decades. The best explanation would be:
improved prenatal care has reduced the numbers of fetal deaths. Explanation: The number of fetal deaths in the United States has fallen. This has been attributed to the improvement in the delivery of prenatal care.
Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because:
increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. Explanation: Advances in health care have led to more children living with chronic illness or disability. The statements about genetic disease and older women may contain some truth but have only added a few people to the chronic illness total. Acute care pediatric nursing positions are decreasing in community hospitals but are more available in medical centers. Uninsured families may or may not be able to access nonhospital care.
A nurse working in a pediatrician's office has requested that a generic brand of cotton swabs be ordered in place of a more expensive brand name. Which trend in today's health care environment is most related to this nurse's action?
initiating cost containment Explanation: Cost containment refers to reducing the cost of health care by closely monitoring the costs of personnel, use and brands of supplies, length of hospital stays, number of procedures carried out, and number of referrals requested while still maintaining quality care. The other trends listed are not as directly related or are unrelated to this nurse's action.
The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained?
learning the mother is not the custodial parent Explanation: It would not be legal for this mother to give consent. A mother younger than 18 years of age or never married may not be a problem in most states because she would be considered autonomous. The physician or nurse could read the consent form to a mother who cannot read plus carefully explain the medical information in terms she understood.
A client, 6 hours postpartum, 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:
maternal mortality rate. Explanation: 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.
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?
neonatal death Explanation: The neonatal death rate is the number of deaths of an infant in the first 28 days of life. Gestational age is not a consideration when reporting deaths of infants. The other categories are not classifications for reporting infant deaths.
The nurse working in a free health clinic is providing care to a 1-year-old girl and her single teenage mother. Which action would be most important initially?
observing the mother/child interaction Explanation: The nurse's initial interactions with the parent and child can provide valuable insights into maternal-child attachment. This information can be used to inform other aspects of the health assessment. This observation is likely to precede formal assessments, such as cognitive assessment and family health history. At this point, it is not known if food stamps are needed. Assessment is the priority.
A nurse writes the following on a child's electronic medical record: "The child will state the signs and symptoms that indicate an exacerbation of asthma." The nurse is involved in which component of the nursing process?
outcome identification Explanation: The statement reflects an outcome. An outcome (goal) is client-focused (specific), stated in measurable terms, attainable, realistic, and includes a time frame in which the outcome should be accomplished. Writing outcomes is part of the outcome identification component of the nursing process. Assessment involves data collection. Implementation is the process of putting the nursing care plan into action. Evaluation measures if the nursing plan of care was successful or no
The nurse working in an obstetrician's office demonstrates case management when which action is completed?
scheduling an appointment with a counselor when a client reports martial concerns Explanation: 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.