Ricci → Ch. 1: Perspectives on Maternal and Child Health Care PrepU

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After teaching nursing students about the trends in women and cancer in the United States, the nurse educator concludes that learning has taken place when the students make which statements? Select all that apply.

Cancer is the second leading cause of death among women. African American women are more likely than white women to get breast cancer. Lung cancer is the number-one killer of women in the United States. Lung cancer has the lowest survival rate in the United States of any cancer.

Which statement best describes the pattern of maternal mortality since World War II?

It has steadily decreased. Improved prenatal care and early ambulation after birth are factors that have decreased maternal death rates following birth. Page 11

A nurse is trying to reduce a mother's anxiety about her child being in the hospital. What would be the best way to accomplish this?

Include the mother in the medical decision-making.

The nurse is assessing a 9 year old boy with pneumonia. Which finding is a factor for this child's mortality? -child's height and weight are not average for his age -the child has a normal WBC count -the child is in a boy scout troop -the child has a history of asthma

The child's history of asthma is a morbidity factor for additional childhood illness, particularly respiratory illness.

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 best choice?

Obstetrician

A group of nursing students are reviewing information about factors affecting maternal, newborn, and women's health. The students demonstrate understanding of the information when they identify which of the following deficiencies as being associated with poverty? Select all that apply. A) Literacy B) Employment opportunities C) Mobility D) Political representation E) Skills

A) Literacy B) Employment opportunities C) Mobility D) Political representation E) Skills

The nurse is working with a group of community health members to develop a plan to address the special health needs of women. Which of the following conditions would the group address as the major problem? A)Smoking B)Heart disease C)Diabetes D)Cancer

B)Heart disease

A nurse is assigned to care for an Asian American client. The nurse develops a plan of care with the understanding that based on this clients cultural background, the client most likely views illness as which of the following? A) Caused by supernatural forces. B) A punishment for sins. C) Due to spirits or demons. D) From an imbalance of yin and yang

D) From an imbalance of yin and yang

When preparing a teaching plan for a group of first-time pregnant women, the nurse expects to review how maternity care has changed over the years. Which of the following would the nurse include when discussing events of the 20th century? A)Epidemics of puerperal fever B)Performance of the first cesarean birth C)Development of the x-ray to assess pelvic size D)Creation of free-standing birth centers

D)Creation of free-standing birth centers

When assessing a family for possible barriers to health care, the nurse would consider which factor to be most important? A)Language B)Health care workers attitudes C)Transportation D)Finances

D)Finances

Variability

Fluctuations in the fetal heart rate that are a push and pull effect from the parasympathetic and sympathetic systems appear as

What societal issues greatly influence delivery of maternal and pediatric health care? Select all that apply.

Low income of families Cost of health care Increased cultural and ethnic diversity of clients

Cervix

Lower part of the uterus that opens to the vagina

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

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? A) epidemics of puerperal fever B) performance of the first cesarean birth C) X-ray developed to assess pelvic size D) development of free-standing birth centers

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

health promotion

A nurse informs a 19-year-old client that she is pregnant. The client immediately states that she plans to have an abortion. What would be the most appropriate response from the nurse to this client?

"I'll put together the information that you will need."

Number of deaths per 1000 live births beginning when the fetus reaches 500g and ending 28 days after birth

Perinatal death rate

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:

Maternal mortality rate

A nurse is teaching a parenting class about key issues that threaten children's health today. Which statements by the participants would indicate comprehension of those key issues? (Select all that apply.)

Unintentional injuries are a leading cause of injury after 1 year of age. Childhood obesity is a continuing threat to children's health. Allergies are a serious threat to childhood health.

Fourteen

What day in a 28 day cycle does ovulation usually occur

A 15-year-old client has just given birth and states that she does not want her infant to receive any newborn vaccines. What is the appropriate action for the nurse to take?

Withhold the vaccines.

The maternal child health nurse provides care to which client populations working within an appropriate scope of practice? Select all that apply.

a 52-year-old posthysterectomy client a 14-year-old primigravida client a 2-week-old preterm infant

The 5-year-old in the emergency room is having glass removed from a wound. Which action constitutes ethical behavior by the nurse?

Holding the child's hand in order to facilitate removal of the glass

Which physician is known as the "Father of Pediatrics"?

Abraham Jacobi

FSH

Hormone secreted from anterior pituitary gland responsible for ovarian follicle maturation

Which statement best describes the pattern of maternal mortality since World War II?

It has steadily decreased.

follicular phase

Ovarian cycle phase when follicles in the ovary grow and form a mature egg

The nurse is talking with the mother of a 2-year-old girl during a scheduled visit. Which teaching subject best supports the emphasis on preventive care?

Showing the mother how to teach hand washing to her child

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 -meeting with a gynecologist yearly -signs/symptoms of respiratory tract infection

weight control and being knowledgeable about family history of cardiovascular disease

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

A nurse informs a 19-year-old client that she is pregnant. The client immediately states that she plans to have an abortion. What would be the most appropriate response from the nurse to this client?

"I'll put together the information that you will need." The nurse should not respond to this client with any judgment or biased information. The client does not have to notify the father, and the other responses show the nurse's personal bias. If a nurse has an ethical issue with this procedure, she should address it with her managers, not the client. Page 28

The nurse is presenting to a shelter for abused women and children and is asked by a participant, "What does the No Child Left Behind Act mean?" How should the nurse best respond?

"It is a Federal program that will ensure all children in classrooms receive up-to-date research-based curriculum."

The nurse is presenting to a shelter for women and children who experienced intimate partner or family violience and is asked by a participant, "What does the No Child Left Behind Act mean?" How should the nurse best respond?

"It is a Federal program that will ensure all children in classrooms receive up-to-date research-based curriculum."

A nurse receives a phone call from the neighbor of the laboring client she is caring for, inquiring on the status of the baby. Which is the appropriate response by the nurse?

"Let me transfer you to the client."

A nurse is determining whether or not informed consent has been obtained from the family of a child who is going to have abdominal surgery. Which statement by the family would lead the nurse to suspect that informed consent is lacking?

"We had to sign the form right away so the surgery could get scheduled."

The nurse is caring for several families enrolled in Medicaid in the prenatal settinng. Which statement by an expectant mother would alert the nurse to assess the family further?

"We just moved here from another state and I am still getting used to the new town."

The nurse is caring for a child who says, "I'm tired being in the hospital and I miss my own home." Which response by the nurse is most appropriate?

"What can we do to make your room seem more like home?"

A nursing student asks an experienced nurse to explain the role of evidence-based practice on the maternal child unit. Which statement by the experienced nurse is most appropriate?

"Women have been able to be successful at having a natural birth after a cesarean birth."

A nurse informs a 19-year-old client that she is pregnant. The client immediately states that she plans to have an abortion. What would be the most appropriate response from the nurse to this client?

'll put together the information that you need." it is important to not respond to this client with any judgement or biased information.

Healthy People 202 initiative was created by the federal government partly to improve maternal-child care. Which statements describe the initiative? (select all that apply) -the initiative will take into consideration the environment in which people live. The initiative will collect data on the number of children in families. -The initiative will assess the age of individuals in quality of life data. -The initiative will consider the ease of access to health services -The initiative will utilize genetics of individuals as an influence of health.

-The initiative will take into consideration the environment in which people live. -The initiative will assess the age of individuals in quality of life data. -The initiative will consider the ease of access to health services. -The initiative will utilize genetics of individuals as an influence of health.

The nurse knows that children can give assent (agree) to participate in research. At what intellectual age does the American Academy of Pediatrics suggest minors may first do this?

7 years

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.

A nurse is preparing a presentation for a local women's group about heart disease and women. Which of the following would the nurse expect to address when discussing measures to promote health. A) Women have similar symptoms as men for a heart attack. B) Heart disease is no longer viewed as a man's disease. C) Women experiencing a heart attack are at greater risk for dying. D) Heart attacks in women are more easily diagnosed.

C) Women experiencing a heart attack are at greater risk for dying.

A nurse is reviewing a labor plan with an admitting client to the labor and birth unit. The client states that she has been drinking a significant amount of herbal teas lately to help with uterine contractions. Which is the priority action by the nurse?

Determine the type of herbal teas recently consumed.

A nurse is providing cardiopulmonary resuscitation (CPR) to an infant with chronic health problems when the mother of the child tells the nurse to discontinue CPR. Which is the most appropriate action by the nurse?

Discontinue all resuscitation efforts.

The nursing student correctly identifies which statement to be the contributing factor that made hospitals more attractive for births in the early 1900s?

Giving birth in a hospital suggested affluence, and the hospital provided pain management. In the early 1900s many women were attracted to hospitals because this showed affluence and hospitals provided pain management. Nurse midwives were not located in hospitals at this time and birth classes did not evolve until the late 1950s when "natural birth" became popular again. The father was prohibited in the birth room until much later. pg 6

Cost containment in the health care field has become a sought-after necessity because of rising costs and the influence of managed care. Nurses are instrumental in assisting with cost containment of health care by prioritizing which strategy?

Health Promotion

The nurse is caring for a 7-year-old boy with cystic fibrosis whose parents are intensely interested in all aspects of his condition and care. Which is the most effective way of advocating for this child and family?

Helping parents access the area's multidisciplinary cystic fibrosis clinic

A nurse is caring for a 31-year-old pregnant client who is subjected to intimate partner violence. The client has developed a feeling of hopelessness and does not feel confident in dealing with the situation at home, which makes her feel suicidal. Which nursing intervention should the nurse offer to help the client deal with her situation?

Provide emotional support to empower the client to help herself.

A nurse is investigating an outbreak of syphilis at the local college. Which is the appropriate first action by the nurse to reduce further spread of the infection?

Provide free condoms and educational materials.

The nurse is focusing on health promotion for a 6-year-old girl. Which intervention best supports Healthy People goals?

Recommending a helmet for biking.

The nursing instructor is introducing students to Healthy People 2020, which highlights the major health indicators of the 21st century that need to be addressed. The nurse informs the students that this includes national health goals for maternal, infant, and child health. Which goals would be included? Select all that apply.

Reduce fetal and infant death rates. Reduce maternal deaths. Increase infant birth weights. Reduce preterm births. Chapter 1: Perspectives on Maternal, Newborn, and Women's Health Care: p. 11.

Baseline

Refers to an average fetal heart rate that occurs over a 10 minute period

While preparing to teach a group of nursing students the history of maternity care, which factor will the instructor include to explain as the etiology of most infections in females after birthing in the 1700s?

Reproductive tract infection

A pregnant woman comes to the clinic for a visit. The nurse screens the client for possible abuse using the RADAR tool. Place the components below in the order in which the nurse would complete them. All options must be used.

Routinely screen every client for abuse. Affirm feelings and assess abuse. Document findings. Assess for client's safety. Page 21

Estrogen

Secreted by the ovaries

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.

The nurse is caring for a 5-year-old girl with meningitis. What action by the nurse may be considered ethical behavior?

Starting intravenous fluids even though the child protests

A nurse is faced with an ethical conflict involving the care of a child. The child's parents disagree with the physician about the use of a feeding tube. The nurse sees the benefits and limitations of both parties' views. What action would be most appropriate?

Take the issue to the Institutional Ethics Committee for advice.

The family is the basic unit of society. Which statement correctly illustrates the importance of this concept related to how society functions? A) Healthy, well-functioning families provide members of all ages with fulfilling, supporting relationships. B) The family serves as a place that encourages members to autonomously function in pursuit of personal pleasures. C) Society functions best when families determine how they will interface with others without having to deal with the overall consequences. D) Work is an important part of family function but is not necessary for success if one member can fulfill multiple roles

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

The nurse is admitting a client to the emergency clinic and notes that the client's gender expression is different than the gender noted in the driver's license and insurance documentation. What is the nurse's best response?

The nurse should communicate with the client based on the client's preferred pronoun.

The nurse is caring for a 17-year-old who is scheduled to undergo surgery. What are the nurse's responsibilities with regard to obtaining consent? (Select all that apply.)

The nurse will witness the parent sign the consent forms. The nurse will ensure the parents understand the information contained in the consent. The nurse will ensure the parent signing the consent has the legal authority to do so.

A, B, E

The nursing student correctly identifies African Americans to have consistently higher infant mortality rates than other ethnic groups. What factors that contribute to this problem can nurses have the greatest impact upon? (Check all that apply.) A) Encouraging regular maternal prenatal visits B) Nutritional teaching prior to and during pregnancy C) Improving maternal educational levels D) Supporting maternal choices for alternative birthing methods E) Discouraging use of tobacco and non-prescribed medications during pregnancy.

A 15-year-old with leukemia tells the nurse that she wants to file for emancipation in order to control her own treatment plan. How does the nurse explain the process? Select all that apply.

The process is governed by individual state laws. The minor must be at least 14 years of age. The minor must demonstrate the ability to manage financial affairs.

A nurse admits a young boy who lives in a homeless shelter with his pregnant teenage mother. What would nurse realize to be a priority when planning his case management?

The toddler's situation puts him at risk for higher incidence of disease and limited access to appropriate care.

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.

A healthy client without a primary care provider is exploring the options available for a health care provider to assist with her pregnancy. Which health care provider can the nurse point out as a best option? -certified midwife -lay midwife -NP -RN

certified midwife

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?

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. page 31

health promotion.

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.

Infants in the United States are at highest risk for death statistically in comparison to other modernized countries. Which initiative, if implemented, would have the greatest impact on improving these numbers?

improving accessibility to postnatal health care for infants Making postnatal health care available and affordable would have the greatest impact on improving infant health and reducing the number of infant deaths. Spending more money on healthcare has proven to not improve infant survival rates postnatally. Although provision of mothering classes and improving maternal nutrition would be a good idea, these measures will not positively impact infant survival rates.

The nursing faculty is teaching students about maternal mortality and morbidity rates for African American women, noting that they are often three to four times higher than for white women. This fact can most accurately be contributed to which reason?

lack of access to adequate prenatal care The maternal mortality and morbidity rates for African American women have been three to four times higher than for non-Hispanic white women. Researchers do not entirely understand what accounts for this disparity but recognize that there are a number of factors that increase the incidence such as lack of prenatal care, obesity, and hypertension during pregnancy Chapter 1: Perspectives on Maternal, Newborn, and Women's Health Care: p. 11.

The nurse is updating the records of a woman who recently gave birth to a healthy 7-lb (3,175-g) newborn. Which action could jeopardize the privacy of the woman's medical records?

letting another nurse use the nurse's login session It is important to log off whenever leaving the computer. The person who shares the nurse's login session may get called away from the computer, leaving the nurse responsible for any breach in security. Keeping IDs and passwords confidential is basic computer security. Page 32

maternal mortality rate.

nausea unbalanced pain in the right arm

nausea unbalanced pain in the right arm The nurse should look beyond the obvious "crushing chest pain" symptom that heralds a heart attack in men. Clinical manifestations of a heart attack observed in women include nausea, dizziness, irregular heartbeat, unusual fatigue, sleep disturbances, indigestion, anxiety, shortness of breath, pain or discomfort in one or both arms. Chest pain is the most common heart attack symptom, but some women may experience it differently than men. Bradycardia is defined as the heart beating fewer than 60 times a minute. page 14

A 33-week gestation infant 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

A 33-week gestation infant 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 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. Page 12

A new single mother is sharing her concerns about the cost of daycare with her nurse. She is new to the area. The nurse recognizes that which trend is contributing to this client's concerns? Select all that apply.

the increase in the number of single parent families the increased tendency for families to move from one part of the country to another ninety percent of women working outside the home fewer extended family members to help care for a child

weight control and being knowledgeable about family history of cardiovascular disease

First-time parents are discussing temperament with the nurse. They describe their child as easily frustrated by his toys and withdrawing from anything new. Overall, he is quite physically active and can become irritated easily. The nurse interprets this information as suggesting the child's temperament would be categorized as which of the following? a. Difficult b. Intolerant c. Easy d. Slow to warm-up

a. Difficult (Rationale: Difficult children are irritable, highly active and intense. They react to new experiences by withdrawing and are frustrated easily. The easy child is even-tempered, predictable, and positive. The slow-to-warm-up child can be moody and moderately active and may need time to adjust to something new while doing so with mild resistance. Intolerant is not a category of temperament.)

The nurse is assessing a 4-year-old boy who is living permanently with his grandparents. Which of the following would the nurse anticipate as being unique to this family structure? a. Physical and financial stress on the grandparents b. Getting the grandparents to agree about treatments c. Difficulties in obtaining informed consent for treatment d. Difficulty in obtaining accurate health history and records

a. Physical and financial stress on the grandparents (Rationale: Grandparents, who are usually older adults and may have limited incomes, are at increased risk for physical, financial, and emotional stresses. Difficulty obtaining an accurate health history or records is more common in foster families. Difficulties in obtaining informed consent for treatment and agreement between caregivers may be problems in binuclear families where issues of custody may be involved.)

When reviewing information about infant mortality among different ethnic groups, which of the following would the nurse expect to find as having higher infant mortality rates than other groups? a. American Indians b. Native Alaskans c. African Americans d. Asian Americans

c. African Americans (Rationale: Non-Hispanic African American infants have consistently higher infant mortality rates than other ethnic groups.)

When describing childbirth during the 18th century, which of the following would the nurse include? a. The majority of births occurred in the home with female midwives. b. Books on childbirth education became readily available. c. Streptococci were identified as the major cause of puerperal fever. d. Heavy doses of narcotics were used during labor.

a. The majority of births occurred in the home with female midwives. (Rationale: During the 18th century [1700s], female midwives attended the majority of all births, and these births occurred in the home. Louis Pasteur demonstrated that streptococci were the major cause of puerperal fever during the 19th century [1800s]. The use of twilight sleep, in which heavy doses of narcotics were used during labor, occurred during the early 20th century [1900s]. Books on childbirth education became readily available during the 20th century [1900s].)

During an assessment, the nurse asks a patient from a non-English-speaking culture which types of home remedies and herbs the patient uses for health care. What is the purpose of asking the patient this question?

analyze for herb-drug interactions

The nurse is caring for a 5-year-old Hispanic boy and his family. Which action best demonstrates cultural competence? a. Promoting good medicine over prayers b. Coordinating care through the mother c. Checking with the father to approve care d. Asking about complementary modalities used

b. Coordinating care through the mother (Rationale: In Hispanic families, the mother makes the decisions about health, so all care should be coordinated through her. Promoting good medicine over the power of prayer, checking with the father to approve care, and asking about complementary modalities used are inappropriate to this culture.)

During a parenting class, the nurse gives examples of extinction as a form of discipline. Which of the following would be an example of this technique? a. Praising desired behavior b. Ignoring a temper tantrum c. Using verbal reprimand d. Spanking a toddler

b. Ignoring a temper tantrum (Rationale: The goal of extinction is to reduce parental attention [reinforcement]. Ignoring a temper tantrum does that. Loss of privileges and time-out also are extinction techniques. Praising is positive reinforcement. Spanking is corporal punishment, whereas verbal reprimand is verbal punishment.)

The nurse is updating the electronic medical record of a 10-year-old boy who had his appendix removed. Which action by the nurse could jeopardize the privacy of the child's medical records? a. Encrypting any e-mail transmissions b. Letting another nurse use the nurse's log-in session c. Changing identification and passwords regularly and according to institutional policy d. Closing files before stepping away from the computer

b. Letting another nurse use the nurse's log-in session (Rationale: It is important to log off whenever leaving the computer. A person who shares the nurse's log-in session may get called away from the computer, leaving the nurse responsible for any breech in security. Keeping identification and passwords confidential is basic computer security. Closing files before leaving the computer helps ensure privacy. Encrypting e-mail transmissions is considered safe.)

A nurse is working in an ambulatory health care clinic in a poor neighborhood. The majority of families are living in poverty. Which nursing intervention would most likely provide the greatest benefit for the children seen at this clinic? a. Cautioning them about home safety issues b. Providing drug samples for prescribed therapy c. Promoting healthy sleep and rest habits d. Educating the parents about preventative care

b. Providing drug samples for prescribed therapy (Rationale: People who live in poverty and many who live on very low incomes do not have enough money to afford medications needed for therapy. Providing them with drug samples is a common intervention. Preventative care, home safety, and proper sleep and rest are not as important as ensuring that the child gets the medicine needed.)

The nurse in a school housing kindergarten through grade 12 has identified signs of stress in the students that may indicate exposure to intimate partner violence or child abuse. Which of the following would the nurse have assessed? Select all that apply. a. Developmental assertiveness and complacency b. Truancy and absenteeism c. Bullying and poor social skills d. Complaints of headaches, stomach aches, and enuresis e. Early-age smoking and drug abuse

b. Truancy and absenteeism c. Bullying and poor social skills d. Complaints of headaches, stomach aches, and enuresis e. Early-age smoking and drug abuse (Rationale: Short-term problems suggesting exposure to intimate partner violence or child abuse include headaches, stomach aches, enuresis, aggressive behaviors such as increased peer aggression and bullying, decreased social competencies, withdrawal, avoidance attachment, developmental regression, fears, anxiety, and learning problems. Long-term problems may include poor school performance, truancy, absenteeism, and difficulty with adult relationships and tasks. A strong correlation exists between the number of exposures to adverse events and negative behaviors such as early initiation of smoking, sexual activity, illicit drug use, adolescent pregnancies, and suicide attempts. The younger the child is and the longer the exposure, the more serious the problems seem.)

The nurse is providing care to a 10-year-old boy of Arab American descent who is recovering from an appendectomy. Which nursing intervention would the nurse consider as being most important to the child and parents? a. Scheduling the follow-up visit with the surgeon b. Bringing immunizations up to date c. Providing immediate and effective pain control d. Receiving home care instructions

c. Providing immediate and effective pain control (Rationale: Pain is viewed as unpleasant and needing control as soon as possible by the culture. Little emphasis tends to be placed on preventative care by Arab Americans. Although the family will likely comply with home care instructions and surgical follow-up, neither of these are the priority at the present time.)

When providing care to a child, which aspect would be most important for the nurse to consider related to informed consent? a. Establishing if the parents are competent b. Contacting the parents prior to giving emergency care c. Knowing the laws in the state where the care is being provided d. Determining if the child is emancipated

c. Knowing the laws in the state where the care is being given (Rationale: Knowing the laws in the state where the care is being given is the most important consideration because laws vary from state to state. Establishment of parental competency is a legal consideration that may be judged differently by laws of different states. Contacting the parents prior to emergency care is a legal consideration that may be judged differently by laws of different states. Emancipation is a legal consideration that is viewed differently by laws of different states.)

Consent for urgent treatment is needed for a minor. However, his parents are several hours away at a business meeting. Which actions would reflect informed consent? a. Explaining the needed treatment to the minor and documenting this action b. Contacting the institution's attorney to provide and document consent c. Obtaining telephone consent with two witnesses listening simultaneously d. Treating the minor and obtaining written permission later when the parents arrive

c. Obtaining telephone consent with two witnesses listening simultaneously (Rationale: Telephone consent documented with two witness signatures is appropriate. Explaining the needed treatment to the minor, contacting the institution's attorney, or treating the minor and getting written permission later when the parents arrive would be inappropriate.)

The public health nurse is developing a teaching program for the local high schools about teenagers and suicide, as suicide in teens is a significant health issue. Which child is most at risk? Select all that apply. a. The overweight 16-year-old Caucasian girl b. The 11-year-old Asian American boy who is smaller than his peers c. The 12-year-old Alaskan Native boy living in an extended family d. The 17-year-old Native American boy e. The 15-year-old African American girl who did not make the cheerleading squad

c. The 12-year-old Alaskan Native boy living in an extended family d. The 17-year-old Native American boy (Rationale: Cultural variations in youth suicide rates are present. Native Americans and Alaskan Natives have the highest youth suicide rates. Male rates exceed those of females. Suicide is the third-leading cause of death in 10- to 24-year-olds.)

A nurse is explaining the concept of family-centered care to a group of pregnant women at the clinic. Which component would the nurse emphasize?

care that is based on mutual trust and collaboration of all involved Family-centered care is the delivery of safe, satisfying, high-quality health care that focuses on and adapts to the physical and psychosocial needs of the family. It is based on mutual trust and collaboration among the woman, her family, and the health care provider. It is a partnership approach of families and their caregivers that recognizes the strength and integrity of the family. With family-centered care, birth is considered a normal, healthy event in the life of a family; families are capable of making decisions about their own care if given adequate information and professional support. Page 8

The nurse is providing care to a pregnant client from the Middle East. The client tells the nurse that she will not make a decision without her husband's approval. The nurse interprets this statement as reflecting:

cultural difference. Different social groups have a specific view of the world and set of traditions that guide their actions, beliefs, and interactions with others. It is important that the nurse recognize these cultural differences and work with them when providing care. The client's statement reflects the specific cultural view, not a religious idea, family preference, or traditional value. Page 21

People tell the nurse that they respect and elicit their three children's ideas. They enjoy their differing interests and personalities. The family has set rules the children are expected to follow; punishment is not emphasized. Their parenting style is which of the following? a. Authoritarian b. Laissez-faire c. Permissive d. Authoritative

d. Authoritative (Rationale: The parents use the authoritative or democratic style and will likely raise self-confident, responsible children. Permissive parents [laissez-faire] have few or inconsistent rules while maintaining little control of their children's behavior. Authoritarian parents expect obedience to strictly set rules. Nonadherence results in punishment, which can be severe. These parents often raise followers or aggressive children.)

The nurse is preparing a teaching program for parents at a local elementary school. Which of the following would the nurse mention as a leading cause of childhood mortality? a. Preterm birth b. Congenital anomalies c. Low birth weight d. Motor vehicle accidents

d. Motor vehicle accidents (Rationale: Although the childhood mortality rate has decreased, unintentional injury such as motor vehicle accidents remains the leading cause of mortality in children from ages 1 through 14 years of age. Congenital anomalies remain the leading cause of infant mortality in the United States. In addition, preterm birth and low birth weight are major indicators of infant health and significant predictors of infant mortality.)

An older couple approaches the nurse's station. They identify themselves as the grandparents of the young girl in room 2210 and are seeking information about their hospitalized grandchild. Which response by the nurse would be most appropriate? a. Assume "busy-looking" behaviors and move away. b. Answer the grandparents' questions in a less public place. c. Ask to see identification from the two individuals. d. Tell the couple to seek information directly from the child's parents.

d. Tell the couple to seek information directly from the child's parents. (Rationale: To protect the child's privacy, information can be shared only with legal guardians, parents, or those identified in writing. Giving the grandparents information without permission of the legal guardians is inappropriate and violates the child's privacy. Asking to see identification is of no purpose. "Looking busy" only temporarily avoids confronting the privacy rights.)

After teaching a group of students about pregnancy-related mortality, the nurse determines that additional teaching is needed when the students identify which condition as a leading cause?

embolism 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. Chapter 1: Perspectives on Maternal, Newborn, and Women's Health Care: p. 11.

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.

preterm births maternal complications 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. Page 11

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:

prevented. Most pregnancy-related complications are preventable. Adequate prenatal care includes education and assessments aimed at avoiding these complications. The top five leading causes of pregnancy-related mortality are embolism (20%); hemorrhage (17%); preeclampsia and eclampsia (16%); infection (13%); and cardiomyopathy (8%). page 11

After teaching a group of students about the concept of maternal mortality, the instructor determines that additional teaching is needed when the students state which of the following? A) The rate includes accidental causes for deaths. B) It addresses pregnancy-related causes. C) The duration of the pregnancy is not a concern. D) The time frame is typically for a specified year.

A) The rate includes accidental causes for deaths.

A nursing instructor is preparing a class discussion on the trends in health care and health care delivery over the past several centuries. When discussing the changes during the past century, which of the following would the instructor be least likely to include? A) Disease prevention B) Health promotion C) Wellness D) Analysis of morbidity and mortality

D) Analysis of morbidity and mortality

Health promotion

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.

wellbeing

Moderate variability is a good sign of fetal

A nursing instructor is teaching a session investigating infant mortality as a standard measurement of the quality of health care in the country. The instructor determines the session is successful when the students correctly choose which factors as contributing to the high numbers of deaths in the United States? Select all that apply.

Preterm births Maternal complications Congenital deformities and chromosomal abnormalities

The nursing instructor is teaching students about the types of anesthesia used historically during labor and birth. She informs the students that in the 1900s, women often were placed in "twilight sleep" during birth. This type of anesthesia would be described as:

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

A 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?

breast feed the infant.

The nurse is organizing health information to teach a client basic principles that will help maintain wellness in the family. Which actions should the nurse prioritize in this teaching?

encouraging yearly checkups for all clients.

During a care conference, a nurse provides everyone with a copy of the latest research on improving the success of breastfeeding for first-time mothers. Which Quality & Safety Education for Nurses competency does this nurse's action support?

evidenced based practice

The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role?

facilitating return to school by working with the school nurse.

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

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 -government -healthcare services -family doctor

family

A nurse is providing care to an African-American woman who has just given birth to a healthy newborn boy. When planning culturally competent care for the woman and her baby, which practice would the nurse anticipate?

liberal use of oil on the baby's scalp and skin In the African American culture, oil is used liberally on the newborn's scalp and skin. Asian American mothers typically do not expose themselves to cold air or bathe themselves for the first month to avoid exposure to illness. Arab American mothers often delay breastfeeding for 2 to 3 days after birth and may be reluctant to bathe after birth because of beliefs that air gets into the mother and causes illness. Page 23

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. Page 11

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

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

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

nuclear The way that families are defined has changed. In years past, the nuclear family was once considered the traditional family structure. However, now, this structure is less common due to increased divorce rates and child rearing by unmarried persons. Page 16

In an attempt to control Medicare costs, the government developed a system that predetermines rates to be paid to the health care provider. The rates are paid regardless of the costs that the health care provider actually incurs. What is this system called?

prospective payment system A prospective payment system predetermines rates to be paid to the health care provider for clients with diseases in certain classifications. These rates are paid regardless of the costs that the health care provider actually incurs. Ambulatory payment classifications and DRGs are forms of prospective payments. Cost sharing refers to the costs that the client incurs when using his or her health insurance plan. Page 27

The nurse is providing care in an organization that supports the maternal and child care continuum. Which type of patient care area is an example of this approach?

Family centered care

Variable

Type of deceleration that is abrupt and does not always consistently correlate with a contraction

A national campaign to improve the health of the people in the United States has as one of its goals to "eliminate health disparities." What is the name of this national campaign?

Healthy People 2020 Healthy People 2020 outlines two basic goals for health promotion and disease prevention (Healthy People 2020, 2015): 1. Increase quality and years of healthy life 2. Eliminate health disparities

Late

Type of decelerations that occur after the peak of a contraction

The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role?

Facilitating return to school by working with the school nurse

The maternal child health nurse is providing care to the following clients. Which client would the nurse assess as being in the health restoration phase?

A 29-year-old G1P1L1 is assessed for ongoing complications from eclampsia, one week postpartum. Blood pressure is 128/92 mm Hg, heart rate 78 bpm, respiratory rate 22 breaths/min, temperature 98.8° F (37° C). Client states no headaches, no vision changes, and no seizure activity.

What makes the area of family nursing a difficult arena to provide care at times?

Family members who might not agree on treatments and plan of care.

Which nursing intervention would best demonstrate evidence-based practice in maternal-child health care?

Family-centered pediatric care

A group of nurses are discussing the reasons for the United States' low rankings for infant and maternal mortality (27% and 21% respectively) and what impact they could make on them in their practice. Which action could nurses implement to reduce these rates? A) ensuring that all pregnant clients receive their immunizations B) assuring early and adequate prenatal care C) providing more extensive women's shelters D) encouraging all women to eat a balanced

B, E

A group of students are reviewing an article describing information related to indicators for women's health and the results of a national study. Which would the students identify as being satisfactory for women? Select all that apply. A) Smoking cessation B) Colorectal cancer screening C) Violence against women D) Health insurance coverage E) Mammograms

A nurse is conducting a class about breast cancer for a group of young adult women. Which statements by the class indicates to the nurse that the teaching was successful? Select all that apply.

"My risk is increased if I had an irregular menstrual cycle starting at an early age." "A diet high in fat can be a risk factor for developing breast cancer." "If someone in the family has breast cancer, my risk would be increased." A positive family history of breast cancer, aging, and irregularities in the menstrual cycle at an early age are major risk factors. Other risk factors include excess weight, not having children, oral contraceptive use, excessive alcohol consumption, a high-fat diet, and long-term use of hormone replacement therapy. page 15

The nurse is reveiwing the medical records of several infants. Which would the nurse know is at highest risk for death according to the infant mortaility rate in the United States?

An infant born at a low birth weight

The nursing instructor is teaching a session comparing the various steps of the nursing process. The instructor determines the session is successful when the students correctly choose which step as the first one?

Assessment

A nurse who specializes in maternal and child health care performs many varied functions in diverse settings over the course of a year. Which action would be outside the nurse's scope of practice?

Assist in the treatment and recovery of a woman with ovarian cancer.

A nurse who specializes in maternal and child health care performs many varied functions in diverse settings over the course of a year. Which action would the nurse be least likely to do, as it would be outside the nurse's scope of practice?

Assist in the treatment and recovery of a woman with ovarian cancer. The primary goal of both maternal and child health nursing can be stated simply as the promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing. Assisting in the treatment and recovery of a woman with ovarian cancer is the least likely function of a nurse specializing in this type of nursing. Preconceptual care, care of a woman during her first trimester, and reading journal articles regarding breastfeeding are all within the scope of practice of maternal and child health nursing. Page 8

A group of students are reviewing an article describing information related to indicators for women's health and the results of a national study. Which of the following would the students identify as being satisfactory for women? Select all that apply. A) Smoking cessation B) Colorectal cancer screening C) Violence against women D) Health insurance coverage E) Mammograms

B) Colorectal cancer screening E) Mammograms

When discussing fetal mortality with a group of students, a nurse addresses maternal factors. Which of the following would the nurse most likely include? Select all that apply. A) Chromosomal abnormalities B) Malnutrition C) Preterm cervical dilation D) Underlying disease condition E) Poor placental attachment

B) Malnutrition C) Preterm cervical dilation D) Underlying disease condition

A group of students are reviewing the historical aspects about childbirth. The students demonstrate understanding of the information when they identify the use of twilight sleep as a key event during which time frame? A) 1700s B) 1800s C) 1900s D) 2000s

C) 1900s

A nurse is developing a plan of care for a woman to ensure continuity of care during pregnancy, labor, and childbirth. Which of the following would be most important for the nurse to incorporate into that plan? A) Adhering to strict, specific routines B) Involving a pediatric physician C) Educating the client about the importance of a support person D) Assigning several nurses as a support team

C) Educating the client about the importance of a support person

When integrating the principles of family-centered care, the nurse would include which of the following? A)Childbirth is viewed as a procedural event B) Families are unable to make informed choices C)Childbirth results in changes in relationships D)Families require little information to make appropriate decisions

C)Childbirth results in changes in relationships

Certified nurse midwife

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

A prenatal nurse is preparing a presentation on the trends in childhood mortality rates in order to strategize for program funding. Which statements would the nurse likely include in the presentation? Select all that apply.

Disparities exist by gender, age, race, and ethnicity. Leading causes of childhood mortality include suicide. Unintentional injury remains a leading cause of mortality in children. The childhood mortality rate in the United States has decreased significantly since 1980, but disparities by gender, age, race, and ethnicity persist. The leading cause of death is unintentional injuries followed by congenital malformations. For children ages 5 to 14 years the leading cause is unintentional injuries followed by cancer, suicide, homicide, diseases of the heart, influenza, and pneumonia. There is no evidence to suggest that having community services would decrease childhood mortality.

The nurse is in the process of administering medications to clients on the unit and notices one new mother is in the process of attempting to breast-feed her newborn infant. The nurse makes several suggestions to assist this mother. Which action should the nurse prioritize related to this interaction?

Document the care given

The nurse is providing care to a new mother and infant according to the Quality & Safety Education for Nurses competency approach. Which action should the nurse perform to demonstrate the skill for the competency of safety? -ensure ID bands are on the mother and child -ensure that the preference of personal values are known -introducing members of the health care team -documenting patient care using computerized spreadsheets.

Ensure the mother and newborn have intact identification bands.

Morbidity rates among children are most highly associated with which cause?

Environmental Causes

A nurse is working in a community designated as having low fertility rates. Which would be an appropriate first-level investigation by the nurse?

local dietary habits

A nurse is caring for a 31-year-old pregnant client who is subjected to abuse by her partner. The client has developed a feeling of hopelessness and does not feel confident in dealing with the situation at home, which makes her feel suicidal. Which nursing intervention should the nurse offer to help the client deal with her situation?

provide emotional support to empower the client to help protect herself.

A nurse is providing teaching to a parenting class on childhood mortality prevention. Which topic would be the priority for the nurse to include?

seat belt safety

The nurse has noticed a change in the type of care needed to support maternal and child health issues. What does the nurse realize as reasons for the changes in care? (Select all that apply.) -More single parent families -less domestic violence -more employed mothers -smaller families

smaller families, more employed mothers, more single-parent families.

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. 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. Page 6

A young couple are very excited to learn they are expecting their first child and question the nurse about which test they need to discover its gender. Which procedure will best provide this information to the couple?

Ultrasound

The mother of a 12-year-old boy is concerned about the dangers of the Internet and asks the nurse what she can do. What comment by the nurse would be most helpful? a. "Tell him to never share personal information online." b. "The Internet is a great place to do research for school." c. "Encourage him to talk with his friends on the phone." d. "Don't let him have a computer in his room."

a. "Tell him to never share personal information online." (Rationale: A priority aspect of computer safety is protecting personal information. A child should never share personal information with anyone online unless the parent is sure of the person and the child has the parent's permission to do so. Putting the computer somewhere other than in the child's room helps to limit the time spent on the computer, but it does not reduce the threats to the child's safety while online. Encouraging the child to talk with friends on the phone aids in limiting the time spent on the computer, but it does not reduce the threats to the child's safety. Researching school work is a good use of the computer, but this does not address the safety issue.)

The parents of a 7-year-old daughter and a 5-year-old son ask the nurse for suggestions about how to talk to their children about their plans for a divorce. Which statement by the nurse would be most appropriate? a. "Wait to tell the children until one of you is ready to move out." b. "Reassure the children that the divorce is not their fault." c. "Tell each child separately to minimize the upset." d. "Allow the children some flexibility with rules until things settle down."

b. "Reassure the children that the divorce is not their fault." (Rationale: Children need to reassured that the divorce is not their fault. This information needs to be repeated as often as possible and as necessary. When talking about divorce, both parents should be present, and they should tell the children all at the same time. When parents are divorcing, rules need to be maintained consistently. When parents are divorcing, they should tell the children well in advance of anyone moving out of the house [except when abuse is present or there are concerns for immediate safety].)

A nurse is conducting a presentation to a local women's community group about strategies to promote health and wellness and prevent illness. After the presentation, the nurse determines that the teaching was successful based on which statement by the group when describing health? A) "Health is the state of being completely disease free." B) "It is based on analysis of statistics about diseases and deaths." C) "Health is simply a state of overall wellness." D) It is complete physical, mental, and social well-being."

A, B, C, D, E

A nurse is working as part of group to develop programs that address factors affecting maternal, newborn, and women's health. The group demonstrates understanding of the information when they target programs to address which deficiencies? Select all that apply. A) literacy B) employment opportunities C) mobility D) political representation E) skills

A nurse is preparing a presentation for a local community group about health status and children's health. Which of the following would the nurse include as one of the most significant measures? A) Fetal mortality rate B) Neonatal mortality rate C) Infant mortality rate D) Maternal mortality rate

C) Infant mortality rate

An expectant mother has arranged for her massage therapist to provide gentle hand, arm, and neck massage for the client while she is in labor in the hospital. Which trend in today's health care environment is most related to this arrangement?

Increasing use of alternative treatment modalities.

A nurse is preparing a presentation for a local community group about health status and children's health. Which rate would the nurse include as one of the most significant measures? A) fetal mortality rate B) neonatal mortality rate C) infant mortality rate D) maternal mortality rate

When preparing a client for surgery, the nurse explains that the use of an antiseptic during the surgery has greatly improved client survival rates and was started by which physician?

Joseph Lister

The nurse is caring for a pregnant Arab American woman. Which statement most accurately describes the client's potential health care beliefs?

The husband makes all the health care decisions for the wife. In the Arab American culture, women often are subordinate to men. The nurse would deal directly and exclusively with the husband. Arab women are not comfortable in mixed gender birthing classes either. If they were to attend a birthing class, they would be accompanied by a female relative. Inquiring about folk remedies used may be appropriate with African American families but not Arab cultures. Use of birth control to limit the number of children in an Arab family is looked down upon because children are valued. Page 23

A nurse is admitting a female client to the cardiac unit diagnosed with a possible myocardial infarction. During the admission assessment, which symptoms would the nurse expect to find? Select all that apply -crushing chest pain -temperature above 38 Celsius -nausea -unbalanced -pain in the right arm

-nausea, unbalanced, and pain in right arm.

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.

A nursing instructor is preparing a class discussion on case management in maternal and newborn health care. Which of the following would the instructor include as a key component? Select all that apply. A) Advocacy B) Coordination C) Communication D) Resource management E) Event managed care

A) Advocacy B) Coordination C) Communication D) Resource management

An example of nurses' primary focus of health care education for clients would be demonstrated as:

encouraging yearly check-ups for all clients. The current movement in health care is to focus on health promotion and thereby prevent future illness and diseases. Prevention, treatment, and rehabilitation are all processes of care. In health care today, the treatments are based on prevention in order to save time, money, and improve the quality of life. page 10

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

A nurse is assigned to care for a pregnant woman of Native American descent who is experiencing an illness. The nurse develops a plan of care for this client integrating the client's cultural background and implementing interventions based on the understanding that this client most likely views illness as the result of: A) supernatural forces. B) inadequate diet. C) possession by spirits or demons. D) imbalance between external and internal energy

A nurse is assigned to care for an Asian American client. The nurse plans his care recognizing that which statement best explains an Asian American's view of illness? A) Illness is caused by supernatural forces. B) Illness is a punishment for sins. C) Illness may be caused by God's will or evil influences. D) Illness is due to an imbalance between yin and yang.

A nurse is conducting an in-service program for a group of nurses on the health of women and their families, incorporating information from Healthy People 2020. The nurse determines that additional discussion and clarification is needed when the group makes which statement? A) "Obesity, drug use, and smoking are major problems." B) "Maintaining a physically active lifestyle is strongly encouraged" C) "Immunizations may be the cause of some illnesses being seen currently." D) "Environmental quality is directly related to health care."

When assessing a family for possible barriers to health care, the mother reports several problems she has been having when coming to her local clinic. The nurse would consider which reported problem as having the greatest impact on this family's health care? A) language barrier B) health care workers' attitudes C) transportation to the clinic D) family finances

A nurse is working in an ambulatory health care clinic located in a poor neighborhood. Which nursing intervention would provide the greatest benefit for the women and their children seen at this clinic?

Cautioning the parents about home safety issues

More nurses are stepping into the role of the advanced practice nurse. Which nurse's role would be to provide care for children under the age of 18?

Pediatric Nurse Practitoner

When assessing the postpartum client 2 hours after giving birth, which finding indicates the need for further action?

The fundus is firm and deviated sharply to the right side of the abdomen.

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.

low body weight multiple pregnancies Multiple pregnancies and low body weight are not considered risk factors associated with breast cancer. A positive family history of breast cancer, aging, and irregularities in the menstrual cycle at an early age are major risk factors. Other risk factors include excess weight, not having children, oral contraceptive use, excessive alcohol consumption, a high-fat diet, and long-term use of hormone replacement therapy. page 15

The nurse should not respond to this client with any judgment or biased information. The client does not have to notify the father, and the other responses show the nurse's personal bias. If a nurse has an ethical issue with this procedure, she should address it with her managers, not the client.

the new understanding of disease at cellular, individual, and societal levels The World Health Organization defines health as "a state of complete physical, mental, and social well-being." It is a complex definition, and it is not merely the absence of disease. The other ideas were part of the initial definition—environmental influences and mental health being seen as a state of well-being. The introduction of new cellular, individual, and societal levels of diseases has changed this era of health care. Page 10

A nurse is conducting an orientation program for a group of newly hired nurses. As part of the program, the nurse is reviewing the issue of informed consent. The nurse determines 6. that the teaching was effective when the group identifies which situation as a violation of informed consent? A) performing a procedure on a 15-year-old without parental consent B) serving as a witness to the signature process on an operative permit C) asking whether the client understands what she is signing following receiving education D) getting verbal consent over the phone for an emergency procedure from the spouse of a unconscious woman

A nurse is developing a plan of care for a pregnant client to address the continuum of care from pregnancy through childbirth. Which aspect would the nurse include as essential to enhancing the woman's birthing experience? A) ensuring adherence to strict specific routines B) involving a pediatric physician for care of the child after birth C) educating the client about the importance of a support person D) assigning several nurses to act as the woman's support team

A nurse is developing a plan of care for a woman to ensure continuity of care during pregnancy, labor, and childbirth. Which would be most important for the nurse to incorporate into that plan? A) Adhering to strict, specific routines B) Involving a pediatric physician C) Educating the client about the importance of a support person D) Assigning several nurses as a support team

A nurse is integrating information about family-centered care when developing a teaching plan for a pregnant woman and her family. Which statement by the woman indicates to the nurse that the teaching was effective? A) "It's not just me affected by the baby. My whole family will be affected." B) "This is a stressful time for our family, so we won't be making any of the health care decisions." C) "Since I'm the mother, this whole process of childbirth will affect me primarily." D) "Childbirth is a medical problem, so it can affect everyone.

A nurse is participating in an online continuing education course that addresses maternal and newborn health. The nurse is engaging in an interactive activity that requires checking off the causes associated with pregnancy-related mortality. Which condition if checked by the nurse as a cause indicates the need to go back and review the information? A) hemorrhage B) embolism C) precipitous labor D) infection

A nurse is providing family-centered care to a pregnant woman and her family. When implementing care, which action by the nurse would be most appropriate? A) making the decisions for the woman B) focusing on medical procedures associated with birth C) informing the woman what pain relief methods will be used during labor D) asking the woman about her plans for labor and birth

A nurse is reading a journal article about health status goals and how they have evolved 20. over the years. Which issue would the nurse most likely identify as the focus of these goals in the past century? A) disease prevention B) health promotion C) wellness D) morbidity and mortality analysis

A nurse is reading a journal article about the trends in health care and health care delivery over the past several centuries. When reading about the practices during the 18th century, which information would the nurse most likely find? A) use of physicians for birth B) epidemics of puerperal fever C) use of twilight sleep for childbirth D) absence of men attending childbirth

A nurse is working as part of a committee that is developing facility policies to enhance 22. family-centered care. The committee demonstrates application of the principles of this concept when they implement which guideline? A) Describe to each family that childbirth is a procedure requiring specific steps. B) Provide families with information to encourage them to make informed choices. C) Educate families about the need to maintain the status quo in relationships. D) Limit discussion of information about decision making to family requests for such.

A nurse manager is interviewing a potential candidate for employment in the perinatal clinic. During the interview, the nurse manager asks the nurse about her understanding of family-centered care. Which statement by the interviewee demonstrates understanding of this concept? A) "Families lack the ability to make health care decisions for themselves." B) "Childbirth rarely affects the relationships within a family." C) "Mothers are the family members affected by childbirth." D) "Sensitivity to and respect for the family's culture is important."

A, B, D, E

A nursing group is examining their hospital's maternal outcomes for the previous 5 years. Which identified factors have contributed to the decline in the maternal mortality rate? Select all that apply. A) Increased participation of women in prenatal care B) Use of ultrasound to detect disorders C) Increased use of anesthesia with childbirth D) Closer monitoring for complications associated with hypertension of pregnancy E) Better management of hemorrhage and infection

A pregnant client comes to the emergency department experiencing preterm labor with ruptured membranes. After obtaining the client's history, the nurse would identify which factor as most likely contributing to the possibility of a poor outcome for this client? A) lack of prenatal care B) lack of employment C) lack of adequate nutrition D) lack of formal education

A, C, D

The nurse instructs the new mother about some health promotion strategies that could significantly improve her infant's health and chance of survival. These would include which of the following? (Check all that apply.) A) breastfeeding B) placing infant on stomach to sleep C) placing infant on back to sleep D) mothers joining support groups E) formula feeding

A nurse is working to develop a health education program for a local community to address breast cancer awareness. Which of the following would the nurse expect to include when describing this problem to the group? Select all that apply. A) White women have higher rates of breast cancer than African American women. B) African American women are more likely to die from breast cancer at any age. C) Survival at any stage is worse among white women. D) Women living in South America have the highest rates of breast cancer. E) Breast cancer is the leading cause of cancer mortality in women.

A) White women have higher rates of breast cancer than African American women. B) African American women are more likely to die from breast cancer at any age.

After teaching nursing students about the basic concepts of family-centered care, the instructor determines that the teaching was successful when the students state which of the following? A)Childbirth affects the entire family, and relationships will change. B)Families are not capable of making health care decisions for themselves. C)Mothers are the family members affected by childbirth. D)Childbirth is a medical procedure.

A)Childbirth affects the entire family, and relationships will change.

The 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 childs aunt or uncle to obtain their consent D)Advocating for termination of parental rights for this situation

A)Getting telephone consent with two people listening to the verbal consent

After teaching a group of nursing students about the issue of informed consent. Which of the following, if identified by the student, would indicate an understanding of a violation of informed consent? A)Performing a procedure on a 15-year-old without consent B)Serving as a witness to the signature process C)Asking whether the client understands what she is signing D)Getting verbal consent over the phone for emergency procedures

A)Performing a procedure on a 15-year-old without consent

A prenatal nurse is preparing a presentation for clients on the various roles of a midwife in the management of their maternity care. Which information would the nurse include in the presentation to describe their role? Select all that apply.

According to their scope of practice, midwives are the primary obstetrical care providers. Midwives have postgraduate training in the care of normal pregnancy and birth. Midwives have a certified designation from accredited bodies identifying their scope of

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?

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. Page 11

After teaching a group of students about the concept of maternal mortality, the instructor determines that additional teaching is needed when the students make which statement? A) "The rate includes accidental causes for deaths." B) "It addresses pregnancy-related causes." C) "The duration of the pregnancy is not a concern." D) "The time frame is typically for a specified year.

The United States ranks 50 th in the world for maternal mortality and 41 st among industrialized nations for infant mortality rate. When developing programs to assist in decreasing these rates, which factor would most likely need to be addressed as having the greatest impact? A)Resolving all language and cultural differences B)Assuring early and adequate prenatal care C)Providing more extensive women's shelters D)Encouraging all women to eat a balanced diet

B)Assuring early and adequate prenatal care

After teaching a group of students about pregnancy-related mortality, the instructor determines that additional teaching is needed when the students identify which condition as a leading cause? A)Hemorrhage B)Embolism C)Obstructed labor D)Infection

B)Embolism

A nurse is preparing a breast cancer presentation for a health forum. Which fact would the nurse expect to address in this presentation?

Breast cancer is more advanced in African American women when found. White women get breast cancer at a higher rate than African American women; however, African American women are more likely to die as they get breast cancer before 40 years of age, cancer is more advanced when found, and survival at every cancer stage is worse among African American women. African American women are not at greater risk due to the BRCA 1 and BRCA 2 gene that causes breast cancer. There is no evidence that Hispanic women smoke more, placing them at risk. White women do not respond better to cancer treatment. Page 15

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. Page 12

Breast-feed the infant.

A nurse is providing care to a woman who has just delivered a healthy newborn. Which action would least likely demonstrate application of the concept of family-centered care? A) Focusing on the birth as a normal healthy event for the family B) Creating opportunities for the family to make informed decisions C) Encouraging the woman to keep her other children at home D) Fostering a sense of respect for the mother and the family

C) Encouraging the woman to keep her other children at home

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

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. 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. Page 15

The nursing instructor is discussing the infant mortality rate with a group of students. The instructor determines the discussion is successful when the students correctly choose which action as a priority to help decrease infant mortality in the United States?

Improving accessibility to postnatal health care for infants

A nurse is doing a literature search on maternal mortality and finds that direct causes comprise the majority of maternal deaths. Direct causes are noted to be unpredictable reasons. Which action would be most appropriate to implement that would have the greatest impact on reducing these numbers?

Practicing high standards of infection control.

The nurse is caring for a pregnant Arab American woman. Which statement most accurately describes the client's potential health care beliefs? -the pregnant women would only attend birthing classes if the husband was present -the husband makes all health care decisions for the wife -they are more likely to engage in folk remedies.

The husband makes all the health care decisions for the wife.

When describing birth during the 18th century, which description would be most accurate regarding maternal care during pregnancy and birth?

The majority of births occurred in the home with female midwives in attendance.

The 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 their consent D) asking the courts to grant permission on the child's behalf

The nurse is working with a group of community health members to develop a plan to address the special health needs of women. The group would design educational programs to address which condition as the priority? A) smoking B) heart disease C) diabetes D) cancer

The nurse is working with a group of community health members to develop a plan to address the special health needs of women. Which educational program would the group most likely identify as the priority? A) risk reduction strategies for diabetes B) methods for smoking cessation C) ways to adopt a heart-healthy lifestyle D) importance of cancer screening and early detection

A nurse is conducting a presentation for a group of pregnant women about factors affecting maternal and newborn health. When discussing the family as an influential factor, which information would the nurse need to keep in mind?

The uniqueness of families requires specific methods for support. The family greatly influences the development and health of its members. The family's structure, the roles assumed by family members, and social changes that affect the family's life can influence the woman's and newborn's health status. Families are unique, and every family has different views and requires distinct methods for support. The family is considered the basic social unit of our society. The way that families are defined has changed. The United States Bureau of the Census (2015) defines family as a group of two or more people related by birth, marriage, or adoption and living together. Earlier definitions of family emphasized the legal ties or genetic relationships of people living in the same household with specific roles. Page 16

When integrating the principles of family-centered care into the birthing process, the nurse would base his or her care upon which belief? A) Birth is viewed as a medical event. B) Families are unable to make informed choices due to stress. C) Birth results in changes in relationships. D) Families require little information to make appropriate decisions for care.

The nurse is assessing a 5-year-old child and notes that he is approaching obesity. Which of the following would be a priority? a. Asking about culturally related eating habits b. Screening the child for metabolic disorders c. Assessing the diet of the child and family d. Determining the activity level of the child

c. Assessing the diet of the child and family (Rationale: For a child, the lifestyle of the parents is the lifestyle of the child. Therefore, assessing the diet of the child and family would be the priority. Once this is completed, then the nurse would determine the activity level of the child, looking for sedentary behaviors that could lead to weight gain. Asking about culturally related eating habits can shed some light on the family's eating patterns but not necessarily the actual diet of the family. Screening for metabolic disorders would be done only if additional findings suggested this as a possibility.)

When applying Friedman's structural functional theory related to families, the nurse would assess which of the following? a. Chronological stage of the family's development b. The family's interaction among its members and with society c. The family's organization and how needs are met d. The way the family rebounds from adversity

c. The family's organization and how needs are met (Rationale: Friedman's structural functional theory emphasizes the social system of the family, such as the organization and how structure relates to function. It also identifies five function aimed at meeting the needs of family members. The resiliency model of family stress, adjustment, and adaptation addresses the way families adapt to stress and are able to rebound from adversity. The family's chronological stage of development is a major component of Duvall's Developmental Theory. Von Bertalanffy's general system theory applied to families defines how families interact with and are influenced by members of their family and society.)

A nurse has started working at a new clinic that treats local immigrants. Which factor about the clients would be most important for the nurse to acknowledge when caring for them?

differences in culture Although an understanding of the groups ethinicity, language, and and level of enculturation may be helpful, it is important for nurses to recognize the various cultural differences among the clients. It is important to recognize their traditions and practices as a point of congruence rather than a potential source of conflict. With today's changing demographic patterns, nurses must be able to assimilate cultural knowledge into their interventions so they can care for culturally diverse women, children, and families. Nurses must be aware of the wide range of cultural traditions, values, and ethics. Cultural competence is the ability to apply knowledge about a client's culture so that the health care provided can be adapted to meet his or her needs. Page 21

health promotion This action is an example of health promotion, which may be defined as educating parents and children to follow sound health practices through teaching and role modeling. Health maintenance is intervening to maintain health when risk of illness is present. Health restoration is using conscientious assessment to be certain symptoms of illness are identified and interventions are begun to return the client to wellness most rapidly. Health rehabilitation is helping prevent complications from illness, helping a client with residual effects achieve an optimal state of wellness and independence, and helping a client to accept inevitable death. Page 10

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.

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. Page 14

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