OB-Chapter 1

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." Rational: 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 nurse is reviewing the medical records of several infants. Which infant is at highest risk for death according to the infant mortality rate in the United States?

An infant born at a low birth weight Rational: Infant mortality in the United States is associated with low birth weight, prematurity, and congenital abnormalities, among other concerns. An infant born to young or older parents, or at 38 weeks' gestation, would not be considered low birth weight or premature nor considered to be at higher risk for congenital abnormalities.

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 Rational: 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.

The nursery nurse is preparing a consent form for the circumcision of a newborn. The mother of the child is 16 years of age. The baby's father is not participating in the care. When planning to complete the surgical consent, which action by the nurse is most appropriate?

Ask the baby's mother to sign the surgical consent. Rational: The consent of a parent or guardian is required for completion of a surgical procedure such as a circumcision. The parent in this case is underage. She may, however, consent for health care treatment of her child.

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 Rational: 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.

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

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

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. Rational: 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 young mother with an ill child tells the visiting nurse that she belongs to the Christian Scientist religious group and will not seek medical attention for the child. Which statement best reflects the mother's religion's beliefs about health?

Healing will come through prayer and spiritual regeneration only.

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 Rational: 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. Rational: 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.

A client who has recently given birth arrives in a health care facility wanting to know ways to prevent sudden infant death syndrome (SIDS) in her infant. Which instructions should the nurse provide to address the concern?

Place the infant on his or her back to sleep. Rational: The nurse should instruct the client to place the infant on his or her back to sleep to prevent SIDS. Wrapping the infant in warm clothes, providing very soft bedding, or feeding only breast milk will not prevent SIDS in the infant and may increase the risk.

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. Rational: 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 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. Rational: The nurse should provide information to the client regardless of his or her own personal views.

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. Rational: 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.

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. Rational: 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.

Consent for urgent treatment is needed for a minor. The parents are unable to be at the hospital. What action by the nurse constitutes informed consent?

Telephone consent with two witnesses listening simultaneously. Rational: Telephone consent documented with two witness signatures is appropriate. None of the other options constitutes informed consent.

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 Rational: Motor-vehicle accidents are a leading cause of death in this age group.

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. Rational: During the 18th century (1700s), female midwives attended the majority of births and these births occurred in the home setting. 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 opioids were used during labor, occurred during the early 20th century (1900s). Books on childbirth education also became readily available during the 20th century.

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. Rational: 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.

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 Rational: 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).

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. Rational: 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.

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

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

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

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 Rational: 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.

An expectant mother states that she read that more black mothers die in childbirth than do white mothers. When responding to her questions about the reasons for this, the nurse accurately states that which is the major reason for the high maternal mortality rate?

lack of prenatal care. Rational: Research shows that maternal mortality rate is directly related to lack of prenatal care secondary to lack of access to services or insurance. Income as well as educational level may play a role in the availability of health care, but they are not directly responsible. Being unmarried has no bearing on infant mortality.

The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained?

learning the mother is not the custodial parent Rational: It would not be legal for this mother to give consent. A mother younger than 18 years of age or never married may not be a problem in most states because she would be considered autonomous. The physician or nurse could read the consent form to a mother who cannot read plus carefully explain the medical information in terms she understood.

An infant at 33 weeks' gestation dies after 1 week of life in the neonatal intensive care unit. This infant's death rate would be classified under which statistical category?

neonatal death Rational: The neonatal death rate is the number of deaths of an infant in the first 28 days of life. Gestational age is not a consideration when reporting deaths of infants. The other categories are not classifications for reporting infant deaths.

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

observing the mother/child interaction Rational: 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.

After teaching a group of nursing students about major threats to children's health, the instructor determines that the teaching was successful when the students state that:

the prevalence of chronic disease is increasing. Rational: Many childhood infectious diseases, such as mumps and measles, have all but disappeared in North America because of the emphasis placed on immunization against certain preventable diseases. However, the prevalence of chronic diseases is increasing. The incidence of overweight and obesity in young children and teens is increasing rapidly. The birth rate for teen moms has seen a significant downward trend. Infant mortality rates have increased due to the numbers of infants born weighing less than 750 grams (1 lb, 10 oz).

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 Rational: Cardiovascular disease is the leading cause of death of women in the United States. Interventions that address reduction of this risk would be a priority. Elevations in death rates are in part attributed to the difficulty recognizing cardiovascular concerns in women. The second leading cause of death in women is cancer, specifically lung and cervical. Lower respiratory tract infections have increased over recent years as a cause of death in women, but they are not the number one cause. Alzheimer disease, although impacting the mortality rates of women, is not the greatest cause of death.

A recently licensed nurse is orienting to a pediatric unit in an acute care facility. The nurse is discussing causes of infant mortality with the preceptor. Which statement by the preceptor most accurately addresses this problem?

"The most common cause of infant deaths is chromosomal abnormalities and congenital anomalies, which we have no control over." Rational: Congenital anomalies and chromosomal abnormalities are the leading cause of infant mortality in the United States. Violence and neglect can be contributory to infant deaths but are not major predictors of infant mortality. SIDS is a cause of infant mortality, but it is not the greatest cause. Infant mortality statistics go from age one month to one year of age, not starting at birth.

The client is a 1-year-old girl from a low-income family presenting with a vitamin D deficiency and anemia. What assistance program would you recommend to the child's young mother?

WIC Rational: The special supplemental nutrition program for women, infants, and children (WIC) provides services to supply nutritional food to low-income women and their children. SCHIP or CHIP provides health insurance to newborns and children in low-income families who do not otherwise qualify for Medicaid and are uninsured. The Early Childhood Intervention (ECI) program, sponsored by Easter Seals, is available for the child with disabilities or developmental delays.

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. Rational: 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 nurse is assisting a pregnant client in signing up for Medicaid to help with the cost of her medical care. The nurse explains that Medicaid is a federally funded program mandated by which act of Congress?

Title XIX of the Social Security Act Rational: Medicaid was founded in 1965 under Title XIX of the Social Security Act.

A group of nurses are working to provide quality care for their clients within the current health care environment of cost containment. Which strategy(ies) would be appropriate for the nurses to use? Select all that apply.

educating clients about seeking help for problems early on urging clients to participate in screening programs creating easy access programs for clients to receive immunizations Rational: Nurses can be leaders in providing quality care within a limited-resource environment by emphasizing the importance of making healthy lifestyle and food choices, seeking early interventions for minor problems before they become major ones, and learning about health-related issues that affect clients. Mammograms, cervical cancer screenings, prenatal care, smoking cessation programs, and immunizations are a few examples of preventive care that yield positive outcomes and reduce overall health care costs. Prevention services and health education are the cornerstones of delivering quality maternal, newborn, and women's health care. Although organic foods may be considered healthy choices, they can be more costly. If encouraged, clients may opt to spend more for the organic foods, thereby limiting their choices for selecting other healthy foods. Using the emergency department for routine care would not be cost-effective.

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

parents Rational: 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.

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 2030. The nurse determines that additional discussion and clarification is needed when the group makes which statement?

"Immunizations may be the cause of some illnesses being seen currently." Rational: Obesity, drug use, and smoking are major concerns. Physical activity and environmental quality are also on the list of leading health indicators in Healthy People 2030. The students who have determined that immunizations are the causes of diseases need clarification since maintenance of immunizations is one of the health indicators listed in the report.

After teaching nursing students about the child health practices in the 1700s and 1800s 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.

Food sources for children were extremely unsanitary. Childhood epidemics of contagious diseases were a major cause of death. During this period, it was thought that children were easily replaced. It was thought that the main role of a child was to share in the work. Rational: Infectious diseases in children were rampant, and unsanitary food sources contributed to illness in children. Devastating epidemics of smallpox, diphtheria, scarlet fever, and measles hit children the hardest. During this period, the prevalent view was that children were a commodity; their role was to share in the work to be done. Public schools were established after this period, and the court system began viewing children as minors. The health of children began to receive more and more attention later on.

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

gently holdlng the child's hand while the glass is being removed from it Rational: Restraining the child only as much as is needed in order to provide needed care is practicing ethically while being sensitive to the sanctity and quality of human life. It is practicing nonmaleficence (avoiding causing harm, intentionally or unintentionally). Removing the parent is not just. The child needs support. Discussing sutures and staples while the child listens harms through fear. Developmentally, the child will misinterpret and not understand. Telling the child not to scream and promoting guilt ("scare others") does not benefit the child. At 5 years of age, he does not have emotional control when hurt. Promoting guilt is inappropriate for the developmental stage (initiative vs. guilt).

A nurse educator is conducting a class on intimate partner violence for a group of new graduate nurses during orientation. Which statement by the educator best reflects current practice regarding these problems in women's health?

"The nurse should screen for these problems at every client encounter." Rational: Both child and intimate partner violence is increasing in incidence. Families are more mobile than in the past. Screening for child abuse (child maltreatment) or intimate partner violence should be included in all family contacts. Nurses must be aware of the legal responsibilities for reporting violence.

The nurse is caring for a child who says, "I'm tired of 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?" Rational: It is important to promote the involvement of the child in the plan of care and involve the child in decision-making to foster his empowerment. The hospitalized child is away from home and should be encouraged to participate in the care and the development of the room's environment. Asking what can be done to promote improved feelings makes the child a part of the team. Telling the child that he will go home when he is better does not address the concerns. Offering sympathy does not attempt to address the concerns. Asking about feelings in this manner is a closed question and does not solicit information from the child.

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 Rational: Many factors may be associated with high infant mortality rates and poor health. Low birth weight and late or nonexistent prenatal care are the main factors in the poor rankings in infant mortality.

A pregnant client comes to the local health clinic for her scheduled prenatal visit. On her chart, the nurse notices that the client indicated that she resides in an extended family situation. Which arrangement would validate this information?

She lives with her grandmother, her uncle, her mother, and her younger sister. Rational: She lives with her grandmother, her uncle, her mother, and her younger sister.

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. Rational: 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 parent brings a foster child to the clinic for immunizations. What is the first responsibility of the nurse?

verify legal documentation Rational: When a child is placed in foster care the foster parents are given legal documentation of this placement and of their ability to seek and consent to treatment. This documentation should be confirmed before any treatment is rendered. A child placed with a foster parent is not required to have a case manager present at medical visits. The foster parent can take the child for care whenever needed. The authorization to treat is part of the legal documentation provided to the foster parent, so it is not necessary to obtain a new consent at every clinic visit.

A nurse is caring for a critically ill female client who has recently been diagnosed with advanced lung cancer. The family asks the nurse why their mother's cancer is so advanced and was not detected earlier. Which response would be most accurate and appropriate?

Lung cancer has few early symptoms and is often explained away as some other minor Rational: Lung cancer has minimal early symptoms, making its early detection almost impossible. Lung cancer is equally fatal for both men and women; it is not more deadly in men. Women do not have a stronger resistance to lung cancer. It is the most common cancer in women due to the increasing frequency of smoking. Although the early detection of lung cancer is very difficult, its diagnosis is not more challenging in women than in men.

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 Rational: 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 considering employment in a practice that promotes family-centered care. When considering this position, the nurse recognizes that this philosophy will:

promote the involvement of the child and parents as members of the health care team. Rational: Family-centered care involves a mutually beneficial partnership between the child, the family, and health care professionals. It applies to the planning, delivery, and evaluation of health care for children of all ages in any setting.