NSG 333 Ch 1- Perspectives on Maternal & Child Heath Care

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

Abraham Jacobi Explanation: Many view Abraham Jacobi, a Prussian-born physician, as the father of pediatrics.

A nurse is reviewing a labor plan with a client who has been admitted 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. Explanation: Certain herbal teas can be used during pregnancy, and most are made with flower or berries that are safe for both mother and fetus. To determine if the herbal tea is safe or has had any effect on the status of the birth, it is important for the nurse to find out what type of tea the client has been consuming and in what quantities.

A client learns she is 6 weeks' pregnant and asks the nurse for the name of the local abortion clinic. What is the most appropriate response by the nurse?

Provide the client with the requested information. Explanation: The nurse should provide information to the client regardless of his or her own personal views.

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. Explanation: The client would frequently be considered emancipated and therefore legally able to make legal decisions regarding the health care of the infant. The nurse should withhold the vaccines but inquire as to the reason for no vaccination.

The United States lags behind other industrialized countries regarding infant mortality. The main factor that contributes to this is:

the large number of preterm births in the U.S. Explanation: Two factors that contribute to the fact that the United States lags behind other industrialized countries are the large number of preterm births and the differences in reporting live births in various countries.

When preparing a teaching plan for a group of women during their first pregnancy, the nurse reviews how maternity care has changed over the years. Which information would the nurse include when discussing events occurring in the 20th century?

development of birthing centers Explanation: In the 20th century (1900s), birth centers were developed. Puerperal fever epidemics, the first cesarean birth, and X-ray to assess pelvic size were events occurring during the 19th century (1800s).

A nurse is conducting a presentation for a group of pregnant women about appropriate health promotion strategies to address issues related to infant mortality. Which strategy would the nurse encourage to reduce the infant's risk for infection after birth?

breastfeeding Explanation: After birth, other health promotion strategies can significantly improve an infant's health and chances of survival. Breastfeeding has been shown to reduce rates of infection in infants and to improve long-term health. Emphasizing the importance of placing an infant on his or her back to sleep will reduce the incidence of SIDS. Newborn development support groups will help provide education about normal child development and child rearing. Folic acid supplementation is used during pregnancy to prevent neural tube defects.

A nurse witnesses a peer tell a client, "You are a mother now and you have to do what is best for you baby. You have to breastfeed her!" Which is the best action by the nurse?

Pull the nurse aside and inquire as to the content of the conversation. Explanation: The nurse overheard just a small portion of the conversation between the client and the peer nurse. The best action would be to inquire as to the content of the conversation and then determine if the peer nurse's comments were appropriate. If the comments were inappropriate, the nurse would then need to fill out an incident report.

Parents who recently experienced the death of their unborn child ask the nurse, "What is a fetal death?" What is the nurse's best response?

"It refers to the intrauterine fetal death at any time during pregnancy." Rationale: Fetal death refers to the spontaneous intrauterine death of a fetus at any time during pregnancy. Fetal deaths later in pregnancy (after 20 weeks of gestation) are referred to as stillbirths, and deaths earlier than 20 weeks are referred to as a miscarriage.

When teaching a parenting class on childhood discipline, the nurse is asked by a parent, "How long do I place my child in time-out?" How should the nurse best respond?

"Use 1 minute per year of age, but do not exceed 5 minutes." Rationale: Another form of discipline is extinction, which focuses on reducing or eliminating the positive reinforcement for inappropriate behavior. Examples are "time-out." When using time-out, use 1 minute per year of the child's age (a 3- year-old would have time-out for 3 minutes). Do not exceed 5 minutes.

A client, 6 hours postpartum, has a severe postpartum hemorrhage that the health care providers are unable to control. She succumbed to the hemorrhage in the intensive care unit. The client's death would become part of the:

maternal mortality rate. Explanation: The maternal mortality ratio is the annual number of deaths from any cause related to or aggravated by pregnancy or its management. Morbidity refers to diseases. The infant mortality rate is the number of deaths occurring in the first 12 months of life. Neonatal mortality is reflected in the infant mortality rate.

What statements best describe giving birth to a child in 1700s America? Select all that apply.

Men did not attend births because it was considered indecent. Women faced birth with the fear of death. Female midwives attended the majority of all births at home. Explanation: In the 1700s men did not attend births because it was considered indecent. Women faced birth not with joy and ecstasy but with fear of death. Female midwives attended the majority of all births at home. The other options did not occur during the 1700s.

A nurse is preparing for a health promotion presentation for new mothers. Which topics would be appropriate for the nurse to include in the presentation? Select all that apply.

Breastfeeding encouragement Proper infant sleep position Infants in smoke-free environments Rationale: Health promotion strategies can significantly improve an infant's health and chances of survival. Breastfeeding has been shown to reduce rates of infection in infants and to improve their long-term health. Emphasizing the importance of placing an infant on his or her back to sleep will reduce the incidence of sudden infant death syndrome (SIDS). Parents/partners should not share a bed with an infant younger than 12 weeks old and should avoid exposing the infant to tobacco smoke. Encouraging mothers to join support groups to prevent postpartum depression will improve the health of both mothers and their infants. Swaddling an infant and bed sharing is discouraged due to SIDS.

Infant mortality continues to be a concern. What factor has done the most to reduce infant mortality?

breastfeeding Explanation: After birth, health promotion strategies increase the infant's health and improve the chances of survival. Breastfeeding the infant has had the greatest impact on survival rates. Breastfeeding promotes maternal−infant bonding, decreases the rates of infant infections, and decreases the rates of allergic and autoimmune diseases. In the long term, it reduces obesity and the complications associated with obesity. Having a safe birth in the hospital does not impact what happens to the infant after hospital discharge. Better prenatal care improves the status for the mother and the outcome for the newborn, but does not guarantee the safety of the infant. Parental education impacts care to parents, but many do not have the resources to carry out these instructions after the infant's birth.

In order to advocate for children and families, the nurse must first acknowledge that the basic system in which health behavior and care are organized, secured, and performed is the:

family. Explanation: The family is the basic system in which health behavior and care are organized, secured, and performed. In most families, the parents or guardians, as advocates for their child, provide health promotion and health prevention care, as well as primary management of care when the child is sick. Parents and guardians have the prime responsibility for initiating and coordinating services rendered by health professionals.

The pediatric nurse would be participating in the role of advocate when completing which action?

Contributing input on a task force with the aim to reduce the rate of mortality of infants and children Rationale: The role of advocacy is being fulfulled when the nurse works to safeguard and advance the interest of children and infants through many means, including contributing to the learning and application of a task force aimed at reducing infant and children mortality. The actions of instructing about side effects, explaining the purposes of medications, and teaching about medication safelty would fall under the role of educator.

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.

Increased participation of women in prenatal care Use of ultrasound to detect disorders Closer monitoring for complications associated with hypertension of pregnancy Better management of hemorrhage and infection Rationale: The following factors have contributed to the decline in the maternal mortality rate: increased participation of women in prenatal care; greater detection of disorders such as ectopic pregnancy or placenta previa; prevention of related complications through the use of ultrasound; increased control of complications associated with hypertension of pregnancy; and decreased use of anesthesia with birth.

The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation?

Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved. Explanation: When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct.

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 priority condition?

Heart disease Rationale: The group needs to address cardiovascular disease, the number one cause of death in women regardless of racial or ethnic group. Smoking is related to heart disease and the development of cancer. However, heart disease and cancer can occur in any woman regardless of her smoking history. Cancer is the second leading cause of death, with women having a one in three lifetime risk of developing cancer. Diabetes is another important health condition that can affect women. However, it is not the major health problem that heart disease is.

The nurse working in a maternity clinic suspects that a client and her children are in a violent relationship. While waiting for test results, the nurse decides to teach the client about intimate partner violence. What would be the best rationale for the nurse's decision?

The nurse knows that children exposed to family violence are likely to be victims of abuse. Rationale: Children exposed to family violence are more likely to be physically, sexually, or emotionally abused themselves. Children have died from family violence and neglect when no one has intervened on their behalf. Children who are exposed to stressors such as family violence or who are victims of childhood violence or neglect are at high risk for short- and long-term problems. Witnessing and being exposed to violence in childhood results in a higher tolerance, and greater use, of violence as an adult. The nurse may feel an ethical responsibility towards clients, but the nurse does not have a legal responsibility to protect clients. Women being the weaker sex is a myth.

The nurse is caring for a child brought to the emergency department by a babysitter. The child needs an emergency appendectomy and the parents cannot be contacted. What would be the nurse's best response to this situation?

Document failed attempts to obtain consent to allow emergency care. Rationale: Health care providers can provide emergency treatment to a child without consent if they have made reasonable attempts to contact the child's parent or legal guardian (American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, 2007). If the parent is not available, then the person in charge may give consent for emergency treatment if that person has a signed form from the parent or legal guardian allowing him or her to do so. During an emergency situation, a verbal consent via the telephone may be obtained. In urgent or emergent situations, appropriate medical care never should be delayed or withheld due to an inability to obtain consent.

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. Explanation: In cases of intimate partner violence, nurses can serve their clients best by not trying to rescue them but by helping them build on their strengths, providing support, and empowering them to help themselves. Counseling the client's partner against violence, helping the client know the legal impact of her situation, and introducing the client to a women's rights group to garner support are not the best ways of serving the client.

A program designed to decrease the infant mortality rate in the United States would probably make the greatest impact if it focused on which aspect of care?

increasing the number of women receiving prenatal care Explanation: Receiving prenatal care has proven to be a major strategy for reducing infant mortality. The other interventions will not directly impact infant mortality rates to the degree that prenatal care will.

A nurse is preparing a class discussion on the clinical manifestations of a heart attack observed in women. Which symptoms would the nurse include as key assessment data? Select all that apply.

unusual fatigue sleep disturbances arm pain Rationale: Nurses need to go beyond the obvious crushing chest pain textbook symptom that indicates 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, and weakness.

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?

ways to adopt a heart-healthy lifestyle Rationale: The group needs to address cardiovascular disease, the number one cause of death in women regardless of racial or ethnic group. Thus, education for adopting a heart-healthy lifestyle would be the priority. Smoking is related to heart disease and the development of cancer. However, heart disease and cancer can occur in any woman regardless of her smoking history. Cancer is the second leading cause of death, with women having a one in three lifetime risk of developing cancer. Diabetes is another important health condition that can affect women. However, it is not the major health problem that heart disease is, and thus educational programs focusing on smoking cessation, cancer screening and early detection, and diabetes risk reduction would be lesser priorities.

Which statement made by a nursing student would best indicate that her education on family-centered care was fully understood?

"Childbirth affects the entire family, and relationships will change." Rationale: Childbirth affects the entire family, and relationships will change. Childbirth is viewed as a normal life event, not a medical procedure. Families are very capable of making health care decisions about their own care with proper information and support.

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

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

A nurse is making a presentation at a parenting class dealing with divorce. A participant asks the nurse, "How should a parent handle telling the children about a divorce?" Which statements are the most helpful? Select all that apply.

"Tell your children about the divorce and the reasons for it." "Reassure your children that the divorce is not their fault." "Inform them in advance of someone moving out of the family home." Rationale: Rules for divorcing parents suggest to tell the children about the divorce and the reasons for the divorce in terms that they can understand; reassure the children that the divorce is not their fault; inform the children about the family structure after the divorce; inform them in advance of any changes in the household (i.e., someone moving out); do not discuss money or finances with your children; and maintain rules and routines.

A perinatal nurse is interviewing a group a women in the community about health care services. Assessment of these services reveals that many of them are being underutilized. Which statement from the women would assist the nurse in identifying potential reasons for this underutilization? Select all that apply.

"The services are hard to get to by public transportation." "The clinic is only open during the morning hours." "The staff seems to look down on us when we do come in." "You need insurance to go to the clinic." Rationale: Access to care can be jeopardized by lower incomes and greater responsibilities when juggling work and family. Lack of finances or transportation, geographic misdistribution of health care providers, no babysitters, language or cultural barriers, distrust of health care providers, inconvenient clinic hours, and the poor attitudes of health care workers often discourage clients from seeking health care. Having staff that speak the language of the client population would be helpful in encouraging clients to use the services.

After teaching a group of parents on childhood discipline, the nurse understands that which statement, made by a parent, demonstrates an understanding of spanking as a form of discipline?

"Use methods other than spanking to respond to inappropriate behavior." Rationale: Some research says spanking provides children with a model of aggressive behavior as a solution for conflict, is associated with increased aggression in children, and can lead to an altered parent-child relationship. Because of the negative consequences of spanking, and because it has been shown to be no more effective than other methods for managing inappropriate behavior, it is recommended that parents use methods other than spanking to respond to inappropriate behavior.

The nurse is caring for several families enrolled in Medicaid in the prenatal setting. 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." Explanation: Medicaid is a financial assistance program for low income families and varies from state to state in terms of eligibility and application process. When a family has moved from one state to another, there may be delays in getting Medicaid established in the new state. Hospital births are typically covered by Medicaid. Family helping with the newborn is a benefit, and would not affect Medicaid resources. The mother's sister-in-law giving birth in the same month would not be a situation the nurse would need to assess further, especially regarding Medicaid resources.

What is a current trend in child health care?

Health promotion rather than health restoration is stressed. Explanation: It is recognized that keeping individuals well is more cost effective for a system than helping ill individuals return to wellness.

The nurse is running an education program for early grade-school children. Which topic would address the number one cause of death for this age group?

The importance of crossing streets safely Explanation: Motor-vehicle accidents are a leading cause of death in this age group.

The nurse knows that the emancipated minor is considered to have the legal capacity of an adult and may make his or her own health care decisions. Which child would potentially be considered an emancipated minor?

A minor who is pregnant Rationale: Emancipation may be considered in any of the following situations, depending on the state's laws: membership in a branch of the armed services, marriage, court-determined emancipation, financial independence and living apart from parents, college attendance, pregnancy, mother younger than 18 years of age, and a runaway.

When assessing a family for barriers to health care, the nurse documents the psychosocial barriers. What is an example of this type of health care deficit?

Academic difficulties Rationale: Environmental and psychosocial factors are now an identified area of concern in children. They include academic differences, complex psychiatric disorders, self-harm and harm to others, use of firearms, hostility at school, substance use disorder, HIV/AIDS, and adverse effects of the media. Respiratory illness and inherited diseases are health problems, and poor sanitation is an environmental factor.

A terminally ill 15-year-old tells the nurse that she wants to stop all treatments and go home despite her parents' directives to provide extraordinary means to keep their child alive. What is the best resource available to this nurse to help solve this dilemma?

An institutional ethics committee Explanation: Every institution has an Institutional Ethics Committee (IEC), which is required by the Joint Commission. The IEC should always be consulted in difficult or unusual cases when conflict and lack of agreement exists between parents and physicians or among the professional staff as to the course of action that is in the best interests of the child.

Which aspect of client wellness has not been a focus of health during the 21st century ?

Analysis of morbidity and mortality Rationale: The focus on health has shifted to disease prevention, health promotion, and wellness. In the last century, much of the focus was on analyzing morbidity and mortality rates.

A pregnant woman is to undergo an invasive procedure to evaluate the status of her fetus. To ensure informed consent, which action would be the priority responsibility of the nurse providing care to this woman?

Asking relevant questions to determine the client's understanding Rationale: The nurse's responsibilities related to informed consent include: Ensuring 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 she is signing by asking her pertinent questions. The physician, 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.

When integrating the principles of family-centered care into the birthing process, the nurse would base care upon which belief?

Birth results in changes in relationships. Rationale: Family-centered care is based on the following principles: Birth affects the entire family, and relationships will change; birth is viewed as a normal, healthy event in the life of the family; and families are capable of making decisions about their own care if given adequate information and professional support.

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 Black women when found. Rationale: White women get breast cancer at a higher rate than Black women; however, Black women are more likely to die becuase they get breast cancer before 40 years of age, cancer is more advanced when found, and survival at every cancer stage is worse among Black women. Black women are not at greater risk due to the BRCA1 or BRCA2 genes that cause breast cancer. There is no evidence that Hispanic women smoke more, placing them at risk. White women do not respond better to cancer treatment.

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. Lung cancer has the lowest survival rate in the United States of any cancer. Explanation: Cancer is the second leading cause of death among women. Lung cancer has the lowest survival rate of any cancer as more than 90% of people who get lung cancer die from it. Women living in North America have the highest rate of breast cancer in the world. White women get breast cancer at a higher rate than black women, but black women are more likely to get breast cancer before they reach 40.

A public health nurse visits the home of a young toddler. What aspect of the home environment would the nurse expect to address with the parents?

Cartoons playing on a television in the child's room Rationale: The nurse is encouraged to ask questions regarding the amount of recreational screen time and if the child has a television or Internet-connected device in his or her bedroom. The American Academy of Pediatrics discourages any screen media before the age of 2. The nurse would question why the TV is being used in the child's room. The family dog may be a threat to observe during the visit, but having a TV in the child's room indicates that it is being exposed to earlier than advised screen time. Pot handles are in the appropriate position. Cords are plugged into capped outlets, which is safe.

A client with a history of type 1 diabetes mellitus is confirmed to be pregnant. The nurse determines this client will be best cared for under which practice model?

Case management Explanation: Case management is a system that integrates management and coordination of care with financing in an attempt to improve cost-effectiveness, use, quality, and outcomes. The nursing process involves the practice of nursing; it is not a means of cost saving for the client. The clinical pathway is a treatment regimen. HMOs are insurance organizations.

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 nurse midwife Explanation: A certified nurse midwife is a nurse with advanced practice training in the care of women, specific to pregnancy and birth. A women's health NP would not be able to deliver the infant. A CNS is an advanced practice role but not specific to the care of pregnancy women. The lay midwife has no formal education.

The nurse is providing care to a woman who has just given birth to a healthy term neonate. The woman's partner arrives and asks about the neonate's status. Which action by the nurse would be appropriate?

Check the medical record for written client approval with whom to share information. Explanation: In maternal and newborn health care, information is shared only with the client, legal partner, parents, legal guardians, or individuals as established in writing by the client or the child's parents. This law promotes the security and privacy of health care and health information for all clients. Therefore, the nurse needs to check the medical record for written documentation that allows the partner to have this information. Any other action would be inappropriate.

A 9-month-old with glaucoma requires surgery. The infant's parents are divorced. To obtain informed consent, which action would be most appropriate?

Determining sole or joint custody by the parents Rationale: The most appropriate action would be to determine legal custody by court decree. If the parents have joint custody, then either parent may give consent, but it is always best to have consent given by both parents. The parent with only physical custody may give consent for emergency care. The last resort is getting a court ruling; usually this is not necessary unless the parents disagree about the care of the child.

A public health nurse is preparing a presentation for a parenting class with the focus on childhood discipline. Which principles of childhood discipline would the nurse expect to emphasize? Select all that apply.

Discipline methods should ensure the preservation of the child's self-esteem. Positive reinforcement will increase desirable behaviors. Maintain a positive, supportive, nurturing parent-child relationship. Rationale: Discipline should focus on the development of the child while ensuring to preserve the child's self-esteem and dignity. The American Academy of Pediatrics suggests three strategies for effective discipline: maintaining a positive, supportive, nurturing caregiver-child relationship; using positive reinforcement to increase desirable behaviors; and removing positive reinforcements or using punishment to reduce or eliminate undesirable behaviors. When using time-out, use 1 minute per year of the child's age (a 3-year-old would have time-out for 3 minutes). Do not exceed 5 minutes.

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. Explanation: The parents of the child can determine if they wish for resuscitation efforts to continue. The nurse should stop CPR when told so by the parents.

A nurse is planning a continuum of care for a client during pregnancy, labor, and childbirth. What is the most important factor in enhancing the birthing experience?

Educating the client about the importance of a support person Rationale: Educating the client about the importance of a support person during labor and delivery has been shown to improve and enhance the birthing experience.

The nurse is functioning in the primary role to care for a 12-year-old boy with metastatic cancer in the liver. Which activity is typical of advocacy?

Educating the family about choices they have Rationale: Educating the family about choices they have regarding therapies for the cancer in the child's liver is an example of advocacy, in which the nurse advances the interests of the child and family by informing them of options and assisting them to make informed decisions. Telling parents about proper home care, clinical guidelines, and the types of cancers are all done in the primary role of educator.

A nurse compares the average length of stay of postpartum women of today with the past and notes the stay is shorter. Which factor has most influenced this trend of shorter hospital stays?

Efforts to contain health care costs Explanation: Providing comprehensive prenatal care can help reduce potential problems, which helps reduce the high cost of specialized care in situations which can be avoided. There has been a factor of wellness focus within the health care system but that is not the main factor in this case.

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

Environmental factors Explanation: The factors most commonly associated with child morbidity are environmental and socioeconomic problems. The more difficult the societal issues and the more marked the environmental poverty, the higher the illness rates and childhood morbidity. Firearms, violence in schools, homicide, and suicide are all factors in morbidity, but they are not strictly related to children.

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

Family-centered pediatric care Explanation: Evidence-based practice has become the standard that nurses are to strive for in caring for their clients. By involving the family in caring for ill children, the child and the family are better served and have improved outcomes. Parental interaction is encouraged for preterm infants to foster bonding. Children and adults need to be separated on inpatient units to ensure that the caregivers have a clear understanding of each client's needs, since children are not small adults. Centralized care has proved to be most beneficial to client outcomes by providing resources and specialists in one location.

The nurse is caring for a 14-year-old girl with multiple health problems. Which activity would best reflect evidence-based practice by the nurse?

Following blood pressure monitoring recommendations Rationale: Using hospital protocol for ordering a diagnostic test, determining how often the vital signs are monitored, and deciding the medication dose ordered would be the health care provider's responsibility. However, following blood pressure monitoring recommendations would be part of evidence-based practice reflected in the nursing care delivered.

A nurse is preparing a class discussion on cardiovascular disease in women. When discussing the priority risk factors for this disease, which would the nurse least likely include? Select all that apply.

Gender Age Rationale: CVD is the leading cause of death in women. Risk factors of CVD differ between men and women with menopause, diabetes, and repeated weight losses and gains increasing the risk for coronary morbidity and mortality in women. Yo-yo dieting or yo-yo effect, also known as weight cycling is a major risk factor. Gender and age are not major risk factors and should not be considered in this list.

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 Explanation: Specific cost-containment strategies that nurses have been instrumental in implementing include health promotion, case management, and critical care paths. Health promotion is accomplished by methods such as using alternative birth systems, providing client teaching, and quality improvement.

The family is the basic unit of society. Which statement correctly illustrates the importance of this concept related to how society functions?

Healthy, well-functioning families provide members of all ages with fulfilling, supporting relationships. Rationale: The family is the basic unit of society. In order for this to work well, members of the family must work together. Families make a central contribution to enhance the quality of our society. Families must consider how their actions will impact others, and one member cannot fulfill all roles within the family.

A nursing student is preparing a presentation illustrating the Human Genome Project. Which function will the student point out as being the primary focus?

Identification of human genes and functions Explanation: The Human Genome Project was founded in 1990 and its primary purpose was to identify and label all human genes and their functions. Information from the HGP may eventually be used in genetic testing, the detection of mutations or variations in children, and gene therapy.

A group of nurses are discussing the most recent statistics on death due to prematurity in the United States. Which action, if implemented, would have the greatest impact on improving outcomes?

Improve women's access to receiving prenatal care. Explanation: The best way to have a positive impact on perinatal outcomes and reduce prematurity is to improve women's access to prenatal care. Tracking the incidence of violent crime does not give information on how to improve outcomes, nor does examining health disparities between ethnic groups or identifying specific national goals related to maternal and infant care without acting on the information. None of these address the true problem.

After describing the procedure and medical necessity, the nurse asks a 14-yearold child to assent to a skin graft. Which statement accurately describes the requirements for this type of assent?

In some cases, such as cases of significant morbidity or mortality, dissent may need to be overridden. Rationale: Assent means agreeing to something. In pediatric health care, the term assent refers to the child's participation in the decision-making process about health care (McCullough & Stein, 2009). In some cases, such as cases of significant morbidity or mortality, dissent may need to be overridden. The age of assent depends on the child's developmental level, maturity, and psychological state. The converse of assent, dissent (disagreeing with the treatment plan), when given by an adolescent 13 to 17 years of age, is considered binding in some states.

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

It has steadily decreased. Explanation: Improved prenatal care and early ambulation after birth are factors that have decreased maternal death rates following birth over the past 70 years.

A client asks the nurse about her potential risk factors for breast cancer. Which risks would be important for the nurse to include in the response? Select all that apply.

Oral contraceptive use Irregularities in menstruation Obesity Rationale: A positive family history of breast cancer, aging, and irregularities in the menstrual cycle at an early age are major risk factors for breast cancer. Other risk factors include excess weight or obesity, not having children, oral contraceptive use, excessive alcohol consumption, a high-fat diet, sedentary lifestyle, and longterm use of hormones. Smoking is not a major risk factor for breast cancer, although it is considered. The age of the mother when children are born is not a risk factor.

The pediatric nurse knows that the children being treated are considered minors. Which statement accurately describes the regulations related to consent for medical treatment?

Parents ultimately are the decision makers regarding medical treatment for their children younger than the age of 18. Rationale: Parents ultimately are the decision makers for their children. Generally, only persons over the age of majority (18 years of age) can legally provide consent for health care. Minors (children younger than 18 years of age) generally require adult guardians to act on their behalf. Biological or adoptive parents are usually considered to be the child's legal guardian. When divorce occurs, one or both parents may be granted custody of the child. In certain cases (such as child violence or neglect, or during foster care), a guardian ad litem may be appointed by the courts. This person generally serves to protect the child's best interests.

When integrating the principles of family-centered care, the nurse would include which concept?

People have taken increased responsibility for their own health. Rationale: Due to the influence of managed care, the focus on prevention, better education, and technological advances, people have taken increased responsibility for their own health. Parents now want information about their child's illness, to participate in making decisions about treatment, and to accompany their children to all health care situations.

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 that the teaching was effective when the group identifies which situation as a violation of informed consent?

Performing a procedure on a 15-year-old without parental consent Rationale: In most states, only clients over the age of 18 can legally provide consent for health care. Serving as a witness to the signature process, asking whether the client understands what she is signing, and getting verbal consent over the phone for emergency procedures are all key to informed consent and are not violations.

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. Explanation: Few women die giving birth in a developed countries, but it still happens. Health care providers can have the greatest impact on reducing these numbers by implementing good infection control measures, appropriate use of antibiotics during labor and postpartum periods, and use of oxytocics for maternal bleeding to prevent hemorrhage. Diabetes and cardiac arrhythmias are not considered direct causes (i.e., they are known and predictable).

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 Explanation: 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 cervical insufficiency, multiple births, and premature rupture of membranes. Female infants have lower mortality rates than males, and the best outcomes are in mothers who give birth between 30 and 34 years of age.

The nurse is caring for a 14-year-old boy with a growth hormone deficiency. Which action best reflects using the nursing process to provide quality care to children and their families?

Reviewing the effectiveness of interventions Rationale: The nursing process is used to care for the child and family during health promotion, maintenance, restoration, and rehabilitation. It is a problem-solving method based on the scientific method that allows nursing care to be planned and implemented in a thorough, organized manner to ensure quality and consistency of care. The nursing process is applicable to all health care settings and consists of five steps: assessment, nursing diagnosis, outcome identification and planning, implementation, and outcome evaluation. Reviewing the effectiveness of interventions is related to outcome evaluation in the nursing process. Even though the three remaining answer options are valuable in ensuring quality of care in health care facilities, they do not involve the direct care of the child and family using the nursing process.

A nurse is conducting a teaching session on sudden infant death syndrome (SIDS) for expectant parents. Which information should the nurse include? Select all that apply.

Sharing a room allows for monitoring of the infant. Place the infant on his or her back to sleep. Maintain neutral temperatures and avoid overheating. Explanation: Sharing of a room allows for monitoring and bonding of the infant as well as ease of feeding. Placing the infant on his or her back to sleep is the recommended sleeping position for all infants until 12 months of age, or until they can change their own position during sleep. Infants are not able to regulate their temperature; therefore, overheating can increase their risk for SIDS. Co-bedding increases the risk for accidental suffocation, and allowing an infant to sleep with a bottle increases risk for aspiration and infection.

The nurse is caring for a 2-week-old girl with a metabolic disorder. Which activity would deviate from the characteristics of family-centered care?

Softening unpleasant information or prognoses Rationale: Family-centered care requires that the nurse provide open and honest information to the child and family. It is inappropriate to soften unpleasant information or prognoses. Evaluating and changing the nursing plan of care to fit the needs of the child and family, collaborating with them as equals, and showing respect for their beliefs and wishes are guidelines for family-centered care.

The nurse working in a free health clinic is providing care to a 1-year-old girl and her single teenage mother. Which action would be most important initially?

observing the mother/child interaction Explanation: The nurse's initial interactions with the parent and child can provide valuable insights into maternal-child attachment. This information can be used to inform other aspects of the health assessment. This observation is likely to precede formal assessments, such as cognitive assessment and family health history. At this point, it is not known if food stamps are needed. Assessment is the priority.

The nurse is caring for a 12-year-old child hospitalized for internal injuries following a motor vehicle accident. For which medical treatment would the nurse ensure that an informed consent is completed beyond the one signed at admission?

Spinal tap Rationale: Most care given in a health care setting is covered by the initial consent for treatment signed when the child becomes a client at that office or clinic or by the consent to treatment signed upon admission to the hospital or other inpatient facility. Certain procedures, however, require a specific process of informed consent, including major and minor surgery; invasive procedures such as lumbar puncture or bone marrow aspiration; treatments placing the child at higher risk, such as chemotherapy or radiation therapy; procedures or treatments involving research; photography involving children; and applying restraints to children.

An older couple approaches the nurse's station seeking information about their hospitalized grandchild. What should be the nurse's response?

Tell the couple to seek information directly from the child's parents. Explanation: To protect the child's privacy, information can be shared only with legal guardians, parents, or those identified in writing. "Looking busy" only temporarily avoids confronting the privacy rights.

A preschool child is scheduled to undergo a diagnostic test. Which action by the nurse would violate a child's bill of health care rights?

Telling the child the test will not hurt Rationale: Telling the child the test will not hurt lacks veracity. It is not a lie, but it does not honor the child's right to be educated honestly about his or her health care. Arranging for the mother to be with the child, assuring the child that the test will be done quickly, and introducing the child to the lab technicians are actions that honor the child's bill of health care rights.

A nurse is preparing a presentation for a local prenatal group about the White House initiative called the Prevention of Infant Mortality Association. Which information would the nurse expect to address when discussing this initiative? Select all that apply.

The association was formed to address the poor working and living conditions of American children. The initiative's primary goal was to increase the quality of life for children. The association assisted in creating a registration procedure for all births and deaths. Explanation: Prevention of Infant Mortality Association was formed in 1909 and addressed the poor working and living conditions of many children in the United States. It aimed at improving the lives of children. The association played a major role in creating a new registration procedure for all infant births and deaths nationally. It was established by President Theodore Roosevelt in 1909. The Head Start program was established in 1964.

A nurse is preparing for a presentation on parenting at a local school. Which information would the nurse include when describing the results of an authoritarian parent? Select all that apply.

The child will have lower self-esteem. An increase in aggression may be a result. Rationale: This parenting style is associated with negative effects on self-esteem, happiness and social skills, increased aggression, and defiance. The child will not feel more secure as the parent is always in control. It will not result in higher achievements or an increase in social skills.

The nurse notes that an older adult client receives only one visitor and asks the client if family members could be called. The client states, "I consider her to be all of my family." What would the nurse consider in responding to the client?

The client defines who is and who is not part of the family without undue influence. Rationale: It is important for nurses to remain neutral to all they hear and see in order to enhance trust and maintain open communication lines with all family members. Nurses need to remember that clients are experts of their own health and can define their own family.

A child needs a consent form signed for a minor surgical procedure. Which statement accurately describes the responsibilities of the health care providers when obtaining the consent?

The nurse is responsible for determining that the parents or legal guardians understand what they are signing by asking them pertinent questions. Rationale: The nurse's responsibility related to informed consent includes the following: determining that the parents or legal guardians understand what they are signing by asking them pertinent questions, ensuring that the consent form is completed with signatures from the parents or legal guardians, and serving as a witness to the signature process. The physician or advanced practitioner providing or performing the treatment and/or procedure is responsible for informing the child and family about the procedure and obtaining consent by providing a detailed description of the procedure or treatment, the potential risks and benefits, and alternative methods available.

The nurse is reviewing a copy of the U.S. Surgeon General's Report, Healthy People 2020. Which nursing action best reflects the nurse fostering this health care agenda?

The nurse volunteers at a local health care clinic providing free vaccinations for low-income populations. Rationale: Healthy People 2020 is a comprehensive health promotion and disease prevention agenda that is working toward improving the quantity and quality of life for all Americans. Overarching goals are to eliminate preventable disease, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; create physical and social environments that promote good health; and promote healthy development and behaviors across every stage of life. Volunteering at a local health care clinic directly reflects the goal of improving the health of all groups of people. Signing up for classes, performing in-services on equipment, and compiling nursing articles on evidence-based practices in nursing are all worthwhile activities that foster health care delivery, but are not as directly linked to the agenda of promoting health in the community.

The nurse is administering a number of therapeutic interventions for neonates, infants, and children on the pediatric unit. Which intervention contributes to an increase in chronic illness seen in early childhood?

Using mechanical ventilation for premature infants Rationale: Using mechanical ventilation and medications to foster lung development in premature infants increases their survival rate. Yet the infants who survive are often faced with myriad chronic illnesses. Administering antibiotics to prevent lethal infections, vaccinating children to prevent childhood diseases, and using corticosteroids as a treatment for asthma may cause side effects, but do not contribute to chronic illness in children.

Before World War II women moved from home to hospital births. What was the primary reason for that shift in maternity care?

They were convinced that setting would improve birth outcomes. Explanation: Prior to World War II, American women moved from home to the hospital for birth in part because they were convinced that setting would improve birth outcomes. Women who labored and gave birth at home were traditionally attended to by relatives and midwives. Many women were attracted to hospitals because this showed affluence and hospitals provided pain management, which was not available in home births.

A public health nurse is developing programs to educate parents on infant mortality. Which complications would the nurse include in the education? Select all that apply.

Tricuspid atresia Anencephalus Spina bifida Rationale: The main causes of early infant death in this country include problems occurring at birth or shortly thereafter. These include prematurity, low birth weight, congenital anomalies, sudden infant death syndrome (SIDS), and respiratory distress syndrome. A pregnancy at 39 weeks would be considered a term pregnancy. A birth weight of 3.6 kg would be considered appropriate.

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 Explanation: Ultrasound is a visual method for assessing the fetus in the uterus and will provide information about the gender. Amniocentesis and chorionic villus sampling provide the entire genetic code of the fetus. HGP refers to the Human Genome Project, which can provide information regarding gene mutations and variations.

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

family members who might not agree on treatments and a plan of care Explanation: The family may not agree of the plan of care or treatment plans with each other or for their children. This is a difficult situation as the children do not have their rights to make their own decisions and the family needs to agree.

A nurse is working as part of a larger community group to develop programs to address current barriers to health care being experienced by women. The community is in the city with a large population of low-income families. On which factor should the group focus their efforts to address a main barrier to access to care?

health insurance Explanation: Although transportation, language and culture, and low health literacy are barriers to health care, health insurance is a major factor affecting access to health care. The existence of financial barriers is one of the most important factors that limits access to care. Many families do not have health insurance so they cannot afford to see health care providers for maintenance and prevention services. Many do not have enough health insurance to cover services they need or cannot pay for services.

A nurse is 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 Explanation: 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 for 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.

A nurse is reviewing the statistical outcomes related to fetal deaths nationwide and notes that the numbers have changed over the last several decades. The best explanation would be:

improved prenatal care has reduced the numbers of fetal deaths. Explanation: The number of fetal deaths in the United States has fallen. This has been attributed to the improvement in the delivery of prenatal care.

Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because:

increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. Explanation: Advances in health care have led to more children living with chronic illness or disability. The statements about genetic disease and older women may contain some truth but have only added a few people to the chronic illness total. Acute care pediatric nursing positions are decreasing in community hospitals but are more available in medical centers. Uninsured families may or may not be able to access nonhospital care.

Which factors are causes of the high infant mortality rate? Select all that apply.

low birth weight sudden infant death syndrome necrotizing enterocolitis Rationale: The main causes of early infant death in the United States include problems occurring at birth or shortly thereafter, such as prematurity, low birth weight, congenital and chromosomal anomalies, sudden infant death syndrome, respiratory distress syndrome, unintentional injuries, bacterial sepsis, and necrotizing enterocolitis.

A nurse is caring for a child. Which individual would the nurse identify as being primarily responsible for initiating and coordinating health care?

parents Explanation: Parents and guardians have the primary responsibility for initiating and coordinating services rendered by health professionals. A social worker or case manager may be involved but are not primarily responsible for the child's care. The community provides programs to promote and support children's health.