Introduction to maternity nursing: Reproduction and the antepartum

What is the percent chance of a parent with a abnormal autosomal dominant gene passing on to children

50%

What are the 3 stages of fetal development?

Pre-embryonic-first 2 weeks post fertilization Embryonic-3-8 weeks Fetal-9 weeks until birth

A prenatal nurse is preparing 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. A. According to their scope of practice, midwives are the primary obstetrical care providers. B. Midwives have postgraduate training in the care of normal pregnancy and birth. C. Midwives scope of practice allows them to assist only in the labor process. D. Midwives have a certified designation from accredited bodies identifying their scope of practice. E. Midwives do not perform any clinical or medical tasks in their scope of practice.

A, B D. CNM offer care for all women throughout their life cycle. A doula is a non medical birth companion who do not perform clinical or medical tasks.

The Healthy People 2020 initiative was created by the federal government partly to improve maternal child care. Which statements describe this initiative? Select all that apply. A. The initiative will assess the age of individuals in quality of life data. B. The initiative will utilize the genetics of individuals as an influence of health. C. The initiative will consider the ease of access to health services. D. The initiative will take into consideration the environment in which people live. E. The initiative will collect data on the number of children in families.

A, B, C, D. This initiative has four foundation health measures, including personal, social, economic and environmental factors that influence health status.

When utilizing a doula during labor, the client would expect which services to be included? Select all that apply. A. The doula will act as a non-medical companion B. The doula will provide emotional, physical and educational support. C. The doula provides support in the antepartum period only. D. The doula will provide emotional support only. E. The doula performs necessary medical tasks.

A, B. A doula is a non-medical birth companion who provides continuous emotional, physical and educational support to woman and family during childbirth and the postpartum period.

A nurse in a women's shelter is counseling a client who has been a victim of abuse. What type of prevention is this treatment? A. Tertiary B. Primary C. Community-based D. Secondary

A. Primary Prevention is health promotion before the development of a disease or disorder. Secondary is early detection and treatment f a condition Tertiary is to reduce progression of a disease or disability.

Define the following terms: Abortion Stillbirth IUFD Term Pregnancy Early Term Full Term Late Term Post Term

Abortion is pregnancy ending either in spontaneous loss or therapeutic induction before 20 weeks Stillbirth is an infant born deceased after 20 weeks gestation IUFD is Intrauterine fetal demise or fetal death occurs throughout fetal stage at any point Term is 37-42 weeks Early is 37 0/7 to 38 6/7 Full term is 39 0/7 to 40 6/7 Late term is 41 0/7 to 41 6/7 Post term is 42 0/7 and greater.

Explain Nagele's Rule

Add one year from LMP, subtract 3 months and add 7 days.

A nurse is preparing a presentation on current American trends in maternal morbidity and mortality in order to lobby for program funding. Which statements would the nurse include? Select all that apply. A. Most pregnancy-related complications women experience are not preventable. B. The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor and unsafe abortion. C. The United States ranks 48th in rates of maternal deaths. D. Most of pregnancy-related complications respond well to proper care. E. Each year, 100 to 200 women die as a result of childbirth complications.

B, C, D. 700-800 women die each year Most pregnancy related complications are preventable and respond to treatment.

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. A. Primary care providers remain the safest birth attendants for most women. B. The infant mortality rate in the US is approximately 6.17 in 1,000 live births. C. The US ranks 15th in the world for infant mortality. D. Certified nurse midwives assist with births safely in many settings. E. One in Three women in the US undergoes a surgical birth, (cesarean).

B, D, E. The US ranks 55th in world compared to 224 other countries. Research shows that midwives are the safest birth attendants for most women, with lower mortality and maternal rates.

The nurse teaching an introductory preconception health class includes discussion on the health of the U.S. Which statement made by the participants would best indicate an understanding of the content? A. "Healthy People 2020 data is used to measure health in the U.S." B. "The infant mortality rate is the barometer of the country's overall health." C. "The perinatal mortality rate is the barometer of the country's overall health." D. "Women's Health Indicators are the basis of measuring health in the U.S."

B. The infant mortality rate is used as an index of general health of a country. Generally, this statistic is one of the most significant measures of children's health.

The nurse is providing care to a pregnant woman who speaks a different language form that of the nurse. When communicating with this client, the nurse demonstrates best practice by which action? A. Standing close to the client while using a strong emphatic tone B. Arranging for an interpreter to be present during any communication C. Speaking to the client in a loud voice at a slow pace D. Having a family member communicate the information to the client

B. The nurse should arrange for an interpreter when communicating with a client who speaks another language.

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? A. Discussing family health history B. Observing the mother/child interaction C. Assessing the child's cognitive level. D. Obtaining food stamps for the family.

B. 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 if likely to preceded formal assessments, such as cognitive assessment and family health history. At this point, it is not known if food stamps are needed. Assessment if priority.

A nurse educator is preparing for a class discussion on the high mortality rate in the 17th and 18th centuries. Which information would the nurse likely include in the discussion? Select all that apply. A. Postpartum hemorrhages were handled proficiently. B. Preeclampsia is a concern of the 20th century. C. Exhaustion during labor occurred, resulting in death. D. Infections were not common. E. Women giving birth often died from dehydration.

C, E. During this period, women giving birth often died as a result of severe exhaustion from protracted labor and they would succumb to dehydration during long labor.

After teaching a prenatal class about maternal mortality rates, the nurse determines that the teaching has been effective when the participants identify which ethnic group as having the highest ratio of maternal mortality? A. White mothers B. Hispanic mothers C. African American mothers D. Asian mothers

C. In US, the maternal mortality ratio is mixed depending on ethnic background. African American women suffer maternal mortality ratios far higher than any other ethnic group.

A nursing instructor conducting a class on the history of maternity care discusses how there was a shift from home to hospital births prior to WWII. Which primary reason for the shift would the instructor likely include in the discussion? A. Hospital births at the time offered rooming in with their newborn. B. There were no other options for women as many could not afford midwives. C. Hospital delivery settings would provide with natural births. D. Women were convinced that hospitals deliveries would improve birth outcomes.

D. American women at this tie moved from home to hospital for birth in part because they were convinced that setting would improve birth outcomes.

What does "G T P A L" mean?

G = number of times pregnant T = number of term babies greater than 37 weeks. P = number of preterm births 20 weeks to 36 6/7 weeks. A = number ending in either spontaneous or therapeutic abortion (less than 20 weeks) L= number of living children delivered.

When should the following tests be done? Gestational Diabetes GBS

GD should be done by 28 weeks GBS should be done between 35-37 weeks.

When should prenatal testing begin? What method can be done in what time frame?

Nuchal Translucency 10-14 weeks MSAFP 16-18 weeks Quad/Tetra Screen 15-20 weeks CVS 10-13 weeks Amniocentesis 15-18 weeks

What are the TORCH infections?

Toxoplasmosis Other (syphilis) Rubella CMV Herpes

After teaching nursing students about the history of past child health practices that led to a high mortality rate, the instructor determines that the teaching was successful when the students make which statements? Select all that apply. A. It was thought that the main role of a child was to share in the work. B. During this time, it was thought children were easily replaced. C. Food sources for children were extremely unsanitary. D. Public schools were well established to assist in child health E. The court system viewed children as having many rights. F. Childhood epidemics of contagious diseases were a major cause of death.

A, B, C, F. Public schools were established after this period and court system viewed children as minors. Infectious disease was rampant, food sources were severely unsanitary, children were considered a commodity and were expected to share in the work and children were thought to be easily replaceable.

Which are potential capabilities of umbilical cord blood? Select all that apply. A. If a family member develops a disease, umbilical cord blood can be used in treatment. B. It is not yet approved as a source of stem cells. C. Transfusion therapies use umbilical cord blood in various treatments D. Umbilical cord blood is used for admission laboratory studies in newborns. E. It can be used to treat inborn errors of metabolism.

A, C, D. Umbilical cords are used for a source of stem cells and cannot treat inborn errors of metabolism.

Which statement about maternal mortality and morbidity rates for African American women indicate understanding of the issue? Select all that apply. A. Bias among health care providers towards the African American population fosters distrust. B. Many African American women are unmarried when pregnant. C. African American women have a genetic link to high-risk pregnancies. D. Quality obstreical health care may not be available in the community E. Many African American women have low socioeconomic status. F. African American women often have limited or no health care insurance coverage.

A, D, E, F. Mortality and morbidity rates or 3-4 times higher than for whites, researchers suspect causes of higher maternal mortality rates is due to low socioeconomic status, limited or not insurance coverage and bias among health care providers which fosters distrust and the quality of care available in the community. There is not a genetic link to higher risk pregnancies for this group. Marital status is not a factor.

A nurse is reading a journal article about the state of newborn and infant health. When reviewing information about infant mortality, the nurse would most likely find which condition as the leading cause of infant mortality in the U.S.? A. Congenital abnormalities B. Respiratory Distress Syndrome C. Prematurity D. Low birth weight

A. Congenital abnormalities remain the leading cause of infant mortality in the U.S.

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 ICU. Which statistic would her death become part of? A. Maternal mortality rate B. Neonatal mortality rate C. Maternal morbidity rate D. Neonatal morbidity rate

A. The maternal mortality ratios is the annual number of deaths from any cause related to or aggravated by pregnancy or its management. Morbidity refers to diseases.

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? A. "I'll put together the information that you will need." B. "Are you sure you want to do that?" C. "Have you notified the father?" D. " I don't know of any doctors who will perform them."

A. The nurse should not respond to this client with any judgement or biased information. If the nurse has an ethical issue with this procedure she should address it with her managers, not the client.

A nurse if 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? A. Promoting healthy sleep and rest habits. B. Screening for diabetes and malnutrition. C. Cautioning the parents about home safety issues. D. Educating parents about preventative care.

B. Preventative care is consistent with a health promotion approach that aims to prevent illnesses and health disorders before they develop.

The obstetrical nurse notes that a Muslim client has not been eating any of the meals supplied to her. Which actions performed by the nurse best demonstrate cultural competence? A. The nurse recognizes that Muslim clients prefer rest, which encourages appetite. B. The nurse becomes familiar with the Muslim clients meal practices. C. The nurse recognizes that Muslim clients do not have an interest in food. D. A referral will be made to the dietitian to assess the Muslim client's preferences.

B. The steps to developing cultural competence is to acquire cultural knowledge about the group.

A prenatal nurse is developing a plan of care for an African American woman who is at 34 weeks's gestation and visting the community health clinic for the first time. Which factor would be a priority for the nurse to incorporate into the plan of care? A. The client's socioeconomic status B. The ethnicity of the client C. The client's level of formal education D. The client's marital status

B. In the U.S., African American women suffer maternal mortality ratios far higher than any other ethnic group, about three to four times higher.

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? A. Illness is an opportunity to develop the soul with no treatment sought. B. Healing will come through prayer and spiritual regeneration only. C. Fasting will establish health back to normal. D. Illness comes from the violating dietary restrictions, and no treatment will be sought.

B. Christian Scientists view disease of error of the human mind that can be dispelled by spiritual truth.

A nurse if 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. A. The environmental toxin threat to children's health is improving. B. Unintentional injuries are a leading cause of injury after 1 year of age. C. Mental health issues for children are not a concern until young adulthood. D. Allergies are a serious threat to childhood health. E. Childhood obesity is a continuing threat to children's health.

B, D, E. Unintentional injuries are a leading cause of injury after 1 year of age, childhood obesity is a continuing threat to children's health and allergies are a serious threat to childhood health.

A nurse if developing a plan of care for a client of muslim faith. Which action demonstrates an understanding of providing culturally competent care? A. The client will be referred to the hospital chaplain for spiritual support. B. The client is asked to encourage family members to bring in special foods. C. The client's traditional healing and health practices will be assessed for implementation D. The client is asked if there are any meal preferences to be included in the care plan

B. Diets may be different and need to be considered during the process of determining the appropriate course of treatment.

When providing care to a child, the nurse should consider which aspect of informed consent as most important? A. Determining if the child is emancipated. B. Knowing the laws in the state where care is being provided. C. Contacting the parents prior to giving emergency care. D. Establishing if the parents are competents.

B. Knowing the laws in the state where the care is being given is the most important consideration because laws vary from state to state. All other choices may be judged differently depending on the laws of different states.

When describing births during the 18th century, which description would be most accurate regarding maternal care during pregnancy and birth? A. Heavy doses of narcotics were used during labor B. Strep was identified as the major cause of puerperal fever. C. The majority of births occurred in the home with female midwives in attendance. D. Books on childbirth education became readily available

C. Louis Pasteur did not discover strep until the 19th century, narcotics for labor were not used until the 20th century and books were not readily available until the 20th century

The nurse is caring for a five year old hispanic boy and his family. Which action best demonstrates cultural competence? A. Promoting good medicine over prayers B. Checking with the father to approve care C. Coordinating care through the mother D. Discouraging use of complementary modalities

C. In hispanic families, the mother makes the decisions about health care, so all care should be coordinated through her.

What is the percent chance of an abnormal autosomal recessive gene being passed onto children?

both, 25%, 50% of child will be carrier