OB Exam 1

What led to a decline in home births and an increase in physician-assisted hospital births in the late 19th century?

- Semmelweis: discovered that puerperal infection could be prevented by hygienic practices - forceps - chloroform to control pain - drugs to initiate labor or increase contractions - advances in operative procedures (c-section)

What are the basic principles of family-centered maternity care?

- childbirth is usually a normal, healthy event in the life of a family - childbirth affects the entire family, and restructuring of family relationships is required - families are capable of making decisions about care, provided that they are given adequate information and professional support

What requirements must be met before consent can be considered informed?

- competence - full disclosure - understanding information

What are some factors that contribute to homelessness?

- decreasing wages among the employed - lack of affordable housing - domestic violence - substance abuse - mental illness

How does nursing accountability relate to the law?

Must have knowledge of current laws Must be accountable to the family as well as to the child

What are the three categories of safeguards that determine how the law views nursing practice?

1 - state nurse practice acts 2 - standards of care set by professional organizations 3 - rules and policies set by the institution

A semen analysis shows a sperm concentration of 2 million/mL. In explaining this result to a couple, the nurse can base her answer on the knowledge that 1) Normal sperm concentration is 20 million/mL or greater 2) Normal sperm concentration is greater than 1 million/mL 3) There is no "normal" sperm analysis; each is individual 4) The pH of the semen is more important that the sperm concentration

1) Normal sperm concentration is 20 million/mL or greater

What is the AAP's screen time recommendation?

1 - 2 hours per day

Do established standards and health agency policies have the force of law?

No, but courts have generally held that nurses must practice according to these.

A woman has been diagnosed with a severe sinus infection. The physician prescribed amoxicillin (Amoxil) 500 mg every 8 hours as an antibiotic. As the woman is preparing to leave the office, the nurse notices that the woman is also taking oral contraceptives. What patient teaching is important at this time? 1) Some antibiotics will decrease the effectiveness of oral contraceptives and the woman should use another method of contraceptives. 2) Oral contraceptives will increase the occurrence of nausea during an infective episode. 3) Antibiotics combined with oral contraceptives will increase the risk of side effects of both medications. 4) Oral contraceptives will decrease the effectiveness of antibiotics and the woman will need a stronger dosage.

1) Some antibiotics will decrease the effectiveness of oral contraceptives and the woman should use another method of contraceptives.

What are four of the most important ethical principles in nursing?

1. Beneficence: one is required to do or promote good for others 2. Nonmaleficence: one must avoid risking or causing harm to others 3. Autonomy: people have the right to self-determination. This includes the right to respect, privacy, and the information necessary to make decisions 4. Justice: all people should be treated equally and fairly regardless of disease or social or economic status. Rendering to others what is due them

The average man is taller than the average woman at maturity because of A. A longer period of skeletal growth. B. Earlier development of secondary sexual characteristics. C. Earlier onset of the growth spurt. D. Starting puberty at an earlier age.

A. A longer period of skeletal growth * A male's greater height at maturity is the combined result of beginning the growth spurt at a later age and continuing it for a longer period of time

What are the stipulations of Roe v. Wade?

1. a woman can obtain an abortion at any time during the first trimester 2. the state can regulate abortions during the second trimester only to protect the woman's health 3. the state can regulate or prohibit abortion during the third trimester, except when the mother's life may be jeopardized by continuing the pregnancy

What are health behaviors among youth in the US that contribute to increased mortality, morbidity, and social problems?

1. behaviors that contribute to unintentional violence and injuries 2. tobacco use 3. alcohol and other drug use 4. sexual behaviors related to unintended pregnancy and STIs 5. unhealthy dietary behaviors 6. physical inactivity

What are the five leading causes of infant mortality?

1. congenital malformations, deformations, and chromosomal abnormalities 2. disorders related to low birthweight 3. newborn problems related to material complications 4. SIDs 5. unintentional injury

What is the current percentage of babies born prematurely (less than 37 weeks)?

10%

What percentage of children ages 2 - 5 are obese?

10%

What percentage of homeless are families?

15%

What was the percentage of total government expenditures for healthcare in 2013?

17.4%

Which is a secondary sexual characteristic? A. Female breast development B. Production of sperm C. Maturation of ova D. Secretion of gonadotropin-releasing hormone

A. Female breast development * A secondary sexual characteristic is one not directly related to reproduction, such as development of the characteristic female body form

The role of the nurse in family planning is to 1) Advise couples on which contraceptive to use 2) Educate couples on the various methods of contraception 3) Decide on the best method for the couple 4) Refer the couple to a reliable physician

2) Educate couples on the various methods of contraception

What percentage of children in the US live in poverty?

22%

What percentage of children have no usual place of healthcare?

4%

What is much of the racial disparity in infant mortality attributable to?

premature and low-birth-weight infants

What percentage of children under 18 were covered by publicly sponsored health insurance in 2013?

43%

What is a prospective form of payment?

A fixed amount of money is agreed upon in advance to cover necessary services for specifically diagnosed conditions

Which populations have the highest rate of premature births?

Black and Native American

Which populations are more likely to die from pregnancy-related causes?

Black or African-American women are three times more likely to die than white women

What is a granny midwife?

Common before the 20th century; childbirth usually occurred at home with a granny midwife. Their training usually came through an apprenticeship with a more experienced midwife.

What is the Association for the Care of Children's Health (ACCH)?

Founded in 1965 to focus on child healthcare in the hospital, community, and home

Which act set the stage for allocation of federal funds toward maternity healthcare?

The 1921 Sheppard-Towner Act, although ruled unconstitutional in 1922.

What is a root cause analysis?

The analysis of medical error from a systems perspective; used as a tool to prevent future errors or near misses

Are minors allowed to give consent?

no

Why was the decline in infant mortality slow?

preventable problems, such as poor nutrition, infectious diseases, and inadequate prenatal care Typically because of inequalities in healthcare deliver (poverty)

What is risk management?

prevention of claims, also called quality assurance

What is Medicaid's Early and Periodic Screening, Diagnosis, and Treatment program (EPSDT)?

provides comprehensive healthcare to Medicaid recipients from birth to 21. Pays for well-child exams, and for the treatment of any medical problems diagnosed during such checkups.

What is WIC?

provides supplemental food supplies to low-income women who are pregnant or breastfeeding and to their children up to age 5

What are nurse-sensitive indicators?

patient outcomes that are particularly dependent on the quality and quantity of nursing care provided outcomes that improve with optimal nursing care

What are disadvantages of LDRs?

routine, rather than selective, use of technology such as EFM and administration of IV fluids

What are standards of care?

set by professional organizations, describe the level of care that can be expected by practitioners

What are four elements that must be present to prove negligence?

- duty - breech of duty - damage - proximate cause

What are some changes in the focus of nursing care for children?

- even acutely ill children only have brief hospital stays - nursing care for children has become more specialized - much nursing care is provided in community settings such as schools or outpatient clinics

What are health issues of increasing concern in children?

- food allergies - ADHD - child and adolescent depression

What is the major disadvantage of birth centers?

- most are not equipped for obstetric emergencies - the very short stay after birth (often less than 12 hours) may not allow time to detect early complications

What were common causes of maternal death with lay midwives before the 20th century?

- postpartum hemorrhage - postpartum infection (puerperal sepsis) - hypertensive disorders of pregnancy

What were common causes of infant death with lay midwives before the 20th century?

- prematurity - dehydration from diarrhea - contagious diseases

What are services offered in a school-based health center?

- primary preventative care (health assessments, anticipatory guidance, vision and hearing screenings, immunizations) - acute care - prescription services - mental health and counseling services

What are qualities of nurses providing home care?

- proficient at interviewing, counseling, and teaching - assume a leadership role in coordinating all the services - frequently supervise the work of other care providers

What are some focuses of Healthy People 2020 that involve nurses?

- reduce infant mortality - reduce low birth weight - ensure that 77.9% of women receive prenatal care in the first trimester - vaccinations - reduce vaccine-preventable diseases - increase those with health insurance to 100%

What are possible causes for increased violence in schools?

- socioeconomic disparity - language barriers - diverse cultural upbringing - lack of supervision and behavioral feedback - domestic violence - changes within the family - exposure to violent acts via the media

A woman calls the nurse at the clinic stating, "I forgot to take my birth control pill this morning before I left for work. What should I do?" The nurse's answer should be based on the knowledge that 1) The woman should use another form of birth control until she completes a new cycle of pills 2) The woman should take the one missed pill as soon as possible and the next pill at the regular scheduled time. She will not need back-up contraception 3) The woman should take two pills as soon as possible and then continue on with the regular schedule. She will also need to use a back-up contraceptive method 4) The woman should wait until withdrawal bleeding and then start on her next cycle of pills; she will need to use a backup contraceptive method

2) The woman should take the one missed pill as soon as possible and the next pill at the regular scheduled time. She will not need back-up contraception

During a postpartum teaching session concerning contraception, the woman states she will continue to use her diaphragm she has had for 2 years. The best response by the nurse should be based on the fact that 1) Diaphragms are a good contraceptive choice during the early postpartum period 2) Diaphragms should not be used during the late postpartum period 3) Diaphragms should be refitted after the birth of a baby 4) Diaphragms are not effective if the mother is breastfeeding

3) Diaphragms should be refitted after the birth of a baby

The situation that best describes secondary infertility is a couple who has 1) Never conceived 2) Had repeated spontaneous abortions 3) One child but has not been able to conceive a second time 4) Not conceived after 1 year of unprotected intercourse

3) One child but has not been able to conceive a second time

A woman is seeing the nurse practitioner for her yearly Pap smear. She tells the nurse that she has heard of a nonsurgical sterilization method and that she is interested in more information. The nurse's teaching should be based on the knowledge that 1) There is no such procedure available at this time 2) The procedure can be preformed in the physician's office, but it is not permanent and will need to be repeated every 5 years 3) The procedure will permanently block the fallopian tubes, but another method of birth control must be used until a hysterosalpingogram proves blockage 4) The procedure has a low success rate and should be used only in women who cannot tolerate other methods of birth control

3) The procedure will permanently block the fallopian tubes, but another method of birth control must be used until a hysterosalpingogram proves blockage

When are new mothers discharged?

48 hours after vaginal birth 96 hours after C section

How has the Back to Sleep campaign affected SIDs deaths?

50% decrease

What is the percentage of children under 17 who lack health insurance?

6.6% 3.4% uninsured for more than one year

Women should start emergency contraceptives within __________ of unprotected intercourse.

72 hours

What percentage of children in the US have asthma?

8%

What percentage of children reported having seen a dentist within the previous year?

88%

In 1960, what percentage of births in the US occurred in hospitals?

90%

What is case management?

A practice model that uses a systematic approach to identify specific patients, determine eligibility for care, arrange access to appropriate resources and services, and provide continuity of care through a collaborative model

What is outcomes management?

A systematic method to identify outcomes and to focus care on interventions that will accomplish the state outcomes for children with specific issues (ie asthma)

Families are sometimes categorized into three types: Select all that apply. A. Traditional B. Nontraditional C. Low risk D. High risk

A, B, D Traditional families (also called nuclear families) are headed by two parents. The growing number of nontraditional families includes single-parent families, blended families, adoptive families, unmarried couples with children, multigenerational families, and homosexual parent families. Examples of high-risk families are those experiencing marital conflict and divorce, those with adolescent parents, those affected by violence against one or more of the family members, those involved with substance abuse, and those with a chronically ill child.

The nurse is providing discharge information for a family who recently moved from China and who say they understand English quite well. Which approaches would be best for the nurse to use for effective teaching? Select all that apply. A. Address the oldest family member first before beginning any teaching. B. Use "yes" and "no" questions for easiest feedback from the family. C. Have the family members explain what has been said. D. Have the family members demonstrate a skill if one will need to be done in the home. E. Avoid staring at the family members directly in the eye. F. Speak clearly, but a little louder, so they can understand the language better.

A, C, D, E The elders of the family are highly respected and should be addressed initially. Other family members should be encouraged to learn and participate. Even people who have been in the United States for many years often do not feel competent in English. People from Southeast Asia avoid prolonged eye contact, which they consider rude. It is better to glance at their face and eyes periodically. The nurse should avoid "yes" or "no" questions and have the family explain or demonstrate understanding of the teaching provided. Speaking louder does not help someone understand the language better.

The nurse is assessing a 3-year-old African-American child in the clinic for the first time. The child's height and weight are at the 25th percentile on the commonly used growth chart from the National Center for Health Statistics. How should the nurse interpret these data? A. The child's growth is within normal limits. B. The child's growth is not within normal limits. C. The chart is not accurate for African-American children. D. The chart is not useful until several measurements are plotted over time.

A. The child's growth is within normal limits. The 25th percentile is within the normal range. Children from different ethnic and racial groups are included in the statistics, making the growth chart representative. The chart is useful both for screening and for assessment over time.

When comparing the endometrial cycle with the ovarian cycle on day 22,: A. The progesterone level is at its peak, but the LH level is low B. The progesterone level is low, but the FSH level is at its peak C. The estrogen level is low, but the LH level is at its peak D. Both the estrogen level and the LH level are at the peak

A. The progesterone is at its peak, but the LH level is low *Progesterone level will start to decrease in 1 to 2 days in the endometrial cycle. In the ovarian cycle, the LH levels will remain low until day 10 on the next cycle

1. The standard of care for women who are dependent on heroin or other narcotics is ___________ maintenance treatment (MMT).

ANS: methadone Methadone maintenance treatment should be offered as part of a comprehensive care program that includes behavior therapy and support services. MMT has been shown to decrease opioid and other drug abuse, decrease criminal activity, improve individual functioning, and decrease the HIV rate.

5. In counseling a patient who has decided to relinquish her baby for adoption, the nurse should a. Affirm her decision while acknowledging her maturity in making it. b. Question her about her feelings regarding adoption. c. Tell her she can always change her mind about adoption. d. Ask her if anyone is coercing her into the decision to relinquish her baby.

ANS: A Feedback A A supportive, affirming approach by the nurse will strengthen the patient's resolve and help her to appreciate the significance of the event. The teen needs help in coping with her feelings about this decision. B It is important for the nurse to support and affirm the decision the patient has made. This will strengthen the patient's resolve to follow through. Later the patient should be given an opportunity to express her feelings. C This should not be an option after the baby is born and placed with the adoptive parents. D It is important that the teenager is treated as an adult, with the assumption that she is capable of making an important decision on her own.

18. A common effect of both smoking and cocaine use on the pregnant woman is a. Vasoconstriction b. Increased appetite c. Changes in insulin metabolism d. Increased metabolism

ANS: A Feedback A Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. B Both smoking and cocaine use decrease the appetite. C Smoking and cocaine use do not change insulin metabolism. D Smoking can increase metabolism.

11. The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by a. Contact between maternal blood and fetal capillaries within the chorionic villi b. Interaction of maternal and fetal pH levels within the endometrial vessels c. A mixture of maternal and fetal blood within the intervillous spaces d. Passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries

ANS: A Feedback A Fetal capillaries within the chorionic villi are bathed with oxygen- and nutrient-rich maternal blood within the intervillous spaces. B The endometrial vessels are part of the uterus. There is no interaction with the fetal blood at this point. C Maternal and fetal blood do not normally mix. D Maternal carbon dioxide does not enter into the fetal circulation.

17. In helping bereaved parents cope and move on, nurses should keep in mind that a. A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group. b. When pictures of the infant are taken for keepsakes, no close-ups should be taken of any congenital anomalies. c. No significant differences exist in grieving individuals from various cultures, ethnic groups, and religions. d. In emergency situations, nurses who are so disposed must resist the temptation to baptize the infant in the absence of a priest or minister.

ANS: A Feedback A For example, a religious-based group may not work for nonreligious parents. B Close-up pictures of the baby must be taken as the infant was, congenital anomalies and all. C Although death and grieving are events shared by all people, mourning rituals, traditions, and taboos vary by culture, ethnicity, and religion. Differences must be respected. D Baptism for some religious groups can be performed by a layperson, such as a nurse, in an emergency situation when a priest is not available.

9. A new mother asks the nurse about the "white substance" covering her infant. The nurse explains that the purpose of vernix caseosa is to a. Protect the fetal skin from amniotic fluid. b. Promote normal peripheral nervous system development. c. Allow transport of oxygen and nutrients across the amnion. d. Regulate fetal temperature.

ANS: A Feedback A Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. B Normal peripheral nervous system development is dependent on nutritional intake of the mother. C The amnion is the inner membrane that surrounds the fetus. It is not involved in the oxygen and nutrient exchange. D The amniotic fluid aids in maintaining fetal temperature.

15. Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. A diagnosis of Fetal Alcohol Syndrome is made when there are visible markers in each of three categories. Which is not a recognized category for diagnosis of FAS? a. Respiratory conditions b. Impaired growth c. CNS abnormality d. Craniofacial dysmorphologies

ANS: A Feedback A Respiratory difficulties are not a category of conditions that are related to FAS. Other abnormalities related to FAS include: organ deformities, genital malformations and kidney and urinary defects. B Impaired growth is a visible marker for FAS. C A CNS abnormality with neurologic and intellectual impairments is a category used to assist in the diagnosis of FAS. D An infant with FAS manifests at least two craniofacial abnormalities such as microcephaly, short palpebral fissures, poorly developed philtrum, thin upper lip or flattening of the maxillary.

1. Which part of the mature sperm contains the male chromosomes? a. The head of the sperm b. The middle portion of the sperm c. X-bearing sperm d. The tail of the sperm

ANS: A Feedback A The head of the sperm contains the male chromosomes that will join the chromosomes of the ovum. B The middle portion of the sperm supplies energy for the tail's whip-like action. C If an X-bearing sperm fertilizes the ovum, the baby will be female. D The tail of the sperm helps propel the sperm toward the ovum.

20. The various systems and organs develop at different stages. Which statement is accurate? a. The cardiovascular system is the first organ system to function in the developing human. b. Hematopoiesis originating in the yolk sac begins in the liver at 10 weeks. c. The body changes from straight to C-shaped at 8 weeks. d. The gastrointestinal system is mature at 32 weeks.

ANS: A Feedback A The heart is developmentally complete by the end of the embryonic stage. B Hematopoiesis begins in the liver during the 6th week. C The body becomes C-shaped at 21 weeks. D The gastrointestinal system is complete at 36 weeks.

16. When the nurse is alone with a battered patient, the patient seems extremely anxious and says, "It was all my fault. The house was so messy when he got home and I know he hates that." The best response by the nurse is a. "No one deserves to be hurt. It's not your fault. How can I help you?" b. "What else do you do that makes him angry enough to hurt you?" c. "He will never find out what we talk about. Don't worry. We're here to help you." d. "You have to remember that he is frustrated and angry so he takes it out on you."

ANS: A Feedback A The nurse should stress that the patient is not at fault. B This is placing the blame on the woman. C This is false reassurance. In order to assist the woman, many times the batterer will find out about the conversation. D This is placing the blame on the woman and finding excuses for the batterer.

2. One of the assessments performed in the delivery room is checking the umbilical cord for blood vessels. Which finding is considered within normal limits? a. Two arteries and one vein b. Two arteries and two veins c. Two veins and one artery d. One artery and one vein

ANS: A Feedback A The umbilical cord contains two arteries and one vein to transport blood between the fetus and the placenta. B This option is abnormal and may indicate other anomalies. C Any option other than two arteries and one vein is considered abnormal and requires further assessment. D The presence of one umbilical artery is considered an abnormal finding. This infant would require further assessment for other anomalies.

7. What is most likely to be a concern for the older mother? a. The importance of having enough rest and sleep b. Information about effective contraceptive methods c. Nutrition and diet planning d. Information about exercise and fitness

ANS: A Feedback A The woman who delays childbearing may have unique concerns, one of which is having less energy than younger mothers. B The older mother usually has more financial means to search out effective contraceptive methods. C The older mother is better off financially and can afford better nutrition. D Information about exercise and fitness is readily available.

What part of the nursing process includes the collection of data on vital signs, allergies, sleep patterns, and feeding behaviors? a. Assessment b. Planning c. Intervention d. Evaluation

ANS: A A Assessment is the gathering of baseline data. B Planning is based on baseline data and physical assessment. C Implementation is the initiation and completion of nursing interventions. D Evaluation is the last step in the nursing process and involves determining whether the goals were met.

A nurse determines that a child consistently displays predictable behavior and is regular in performing daily habits. Which temperament is the child displaying? a. Easy b. Slow-to-warm-up c. Difficult d. Shy

ANS: A A Children with an easy temperament are even tempered, predictable, and regular in their habits. They react positively to new stimuli. B The slow-to-warm-up temperament type prefers to be inactive and moody. C A high activity level and adapting slowly to new stimuli are characteristics of a difficult temperament. D Shyness is a personality type and not a characteristic of temperament.

Which response by the nurse to the woman's statement, "I'm afraid to have a cesarean birth," would be the most therapeutic? a. "What concerns you most about a cesarean birth?" b. "Everything will be OK." c. "Don't worry about it. It will be over soon." d. "The doctor will be in later, and you can talk to him."

ANS: A A Focusing on what the woman is saying and asking for clarification is the most therapeutic response. B This response belittles the woman's feelings. C This response will indicate that the woman's feelings are not important. D This response does not allow the woman to verbalize her feelings when she desires.

The formula used to guide time-out as a disciplinary method is a. 1 minute per each year of the child's age b. To relate the length of the time-out to the severity of the behavior c. Never to use time-out for a child younger than 4 years d. To follow the time-out with a treat

ANS: A A It is important to structure time-out in a time frame that allows the child to understand why he or she has been removed from the environment. B Relating time to a behavior is subjective and is inappropriate when the child is very young. C Time-out can be used with the toddler. D Negative behavior should not be reinforced with a positive action.

Which principle of teaching should the nurse use to ensure learning in a family situation? a. Motivate the family with praise and positive reinforcement. b. Present complex subject material first, while the family is alert and ready to learn. c. Families should be taught by using medical jargon so they will be able to understand the technical language used by physicians. d. Learning is best accomplished using the lecture format.

ANS: A A Praise and positive reinforcement are particularly important when a family is trying to master a frustrating task, such as breastfeeding. B Learning is enhanced when the teaching is structured to present the simple tasks before the complex material. C Even though a family may understand English fairly well, they may not understand the medical terminology or slang terms. D A lively discussion stimulates more learning than a straight lecture, which tends to inhibit questions.

1. Congenital disorders refer to those conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, she should be knowledgeable regarding known human teratogens, which include (select all that apply) a. Infections b. Radiation c. Maternal conditions d. Drugs e. Chemicals

ANS: A, B, C, D Feedback Correct Exposure to radiation and a number of infections may result in profound congenital deformities. These include varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and PKU may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics, as well as chemicals including lead, mercury, tobacco, and alcohol, also may result in structural and functional abnormalities. Incorrect Coffee is not considered a teratogen.

Today's nurse often assumes the role of teacher or educator. Patient teaching begins early in the childbirth process and continues throughout the postpartum period. Which strategies would be best to use for a nurse working with a teen mother? Select all that apply. a. Computer-based learning b. Videos c. Printed material d. Group discussion e. Models

ANS: A, B, C, D, E A number of factors influence learning at any age. One of the most significant considerations is developmental level. Teenage parents often have very different concerns and learn in a different way than older parents. Often grandparents are also involved in the rearing of these children and must be able to review and understand the material. There is a wealth of new information that may not have been available when they became parents.

1. Many teens wait until the second or even third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include (select all that apply) a. Lack of realization that they are pregnant b. Uncertainty as to where to go for care c. Continuing to deny the pregnancy d. A desire to gain control over their situation e. Wanting to hide the pregnancy as long as possible

ANS: A, B, C, E Feedback Correct These are all valid reasons for the teen to delay seeking prenatal care. An adolescent often has little to no understanding of the increased physiologic needs that a pregnancy places on her body. Once care is sought, it is often sporadic and many appointments are missed. The nurse should formulate a diagnosis that assists the pregnant teen to receive adequate prenatal care. Incorrect The opposite is true. Planning for her pregnancy and impending birth actually provides some sense of control for the teen and increases feelings of competency. Receiving praise from the nurse when she attends her prenatal appointments will reinforce the young woman's positive self-image.

The nurse is caring for a child from a Middle Eastern family. Which interventions should the nurse include in planning care? Select all that apply. a. Include the father in the decision making. b. Ask for a dietary consult to maintain religious dietary practices. c. Plan for a male nurse to care for a female patient. d. Ask the housekeeping staff to interpret if needed. e. Allow time for prayer.

ANS: A, B, E The man is typically the head of the household in Muslim families. So the father should be included in all decision making. Muslims do not eat pork and do not use alcohol. Many are vegetarians. The dietitian should be consulted for dietary preferences. Compulsory prayer is practiced several times throughout the day. The family should not be interrupted during prayer, and treatments should not be scheduled during this time. Muslim women often prefer a female health care provider because of laws of modesty; therefore, the female patient should not be assigned a male nurse. A housekeeping staff member should not be asked to interpret. When interpreters are used, they should be of the same country and religion, if possible, because of regional differences and hostilities.

2. Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy. These include (select all that apply) a. Human chorionic gonadotropin (hCG) b. Insulin c. Estrogen d. Progesterone e. Testosterone

ANS: A, C, D Feedback Correct hCG causes the corpus luteum to persist and produce the necessary estrogens and progesterone for the first 6 to 8 weeks. Estrogens cause enlargement of the woman's uterus and breasts; cause growth of the ductal system in the breasts; and, as term approaches, play a role in the initiation of labor. Progesterone causes the endometrium to change, providing early nourishment. Progesterone also protects against spontaneous abortion by suppressing maternal reactions to fetal antigens and reduces unnecessary uterine contractions. Other hormones produced by the placenta include hCT, hCA, and a number of growth factors. Incorrect Human placental lactogen promotes normal nutrition and growth of the fetus and maternal breast development for lactation. This hormone decreases maternal insulin sensitivity and utilization of glucose, making more glucose available for fetal growth. If a Y chromosome is present in the male fetus, hCG causes the fetal testes to secrete testosterone necessary for the normal development of male reproductive structures.

7. A woman is 16 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is a. "You should have felt the baby move by now." b. "Within the next month, you should start to feel fluttering sensations." c. "The baby is moving, but you can't feel it yet." d. "Some babies are quiet, and you don't feel them move."

ANS: B Feedback A Because this is her first pregnancy, movement is felt toward the later part of the 17 to 20 weeks. This statement may be alarming to the woman. B Maternal perception of fetal movement usually begins 17 to 20 weeks after conception. C This is a true statement. The fetus's movements are not strong enough to be felt until 17 to 20 weeks; however, this statement does not answer the concern of the woman. D Fetal movement should be felt by 17 to 20 weeks. If movement is not felt by the end of that time, further assessment will be necessary.

2. During which phase of the cycle of violence does the batterer become contrite and remorseful? a. Battering phase b. Honeymoon phase c. Tension-building phase d. Increased drug-taking phase

ANS: B Feedback A During the battering phase violence actually occurs, and the victim feels powerless. B During the honeymoon phase, the battered person wants to believe that the battering will never happen again, and the batterer will promise anything to get back into the home. C During the tension-building phase, the batterer becomes increasingly hostile, swears, threatens, throws things, and pushes the battered. D Often the batterer increases the use of drugs during the tension-building phase.

5. The upper uterus is the best place for the fertilized ovum to implant because it is here that the a. Placenta attaches most firmly b. Developing baby is best nourished c. Uterine endometrium is softer d. Maternal blood flow is lower

ANS: B Feedback A If the placenta attaches too deeply, it does not easily detach after birth. B The uterine fundus is richly supplied with blood and has the thickest endometrium, both of which promote optimal nourishment of the fetus. C Softness is not a concern with implantation; attachment and nourishment are the major concerns. D The blood supply is rich in the fundus, which allows for optimal nourishment of the fetus.

12. A patient is sent from the physician's office for assessment because of too little amniotic fluid. The nurse is aware that oligohydramnios can result in a. Excessive fetal urine secretion b. Newborn respiratory distress c. Central nervous system abnormality d. Gastrointestinal blockage

ANS: B Feedback A Oligohydramnios may be caused by a decreased in urine secretion. B Because an abnormally small amount of amniotic fluid restricts normal lung development, the infant may have inadequate respiratory function after birth, when the placenta no longer performs respiratory function. C Excessive amniotic fluid production may occur when the fetus has a central nervous system abnormality. D Excessive amniotic fluid production may occur when the gastrointestinal tract prevents normal ingestion of amniotic fluid.

14. Oogenesis, the process of egg formation, begins during fetal life in the female. Which statement related to ovum formation is correct? a. Two million primary oocytes will mature. b. At birth, all ova are contained in the female's ovaries. c. The oocytes complete their division during fetal life. d. Monthly, at least two oocytes mature.

ANS: B Feedback A Only 400 to 500 ova will mature during the approximately 35 years of a woman's reproductive life. B All of the cells that may undergo meiosis in a woman's lifetime are contained in the ovaries at birth. C The primary oocytes begin their first meiotic division during fetal life but remain suspended until puberty. D Every month, one primary oocyte matures and completes meiotic division yielding two unequal cells.

19. With regard to the structure and function of the placenta, the maternity nurse should be aware that a. As the placenta widens, it gradually thins to allow easier passage of air and nutrients. b. As one of its early functions, the placenta acts as an endocrine gland. c. The placenta is able to keep out most potentially toxic substances, such as cigarette smoke, to which the mother is exposed. d. Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

ANS: B Feedback A The placenta widens until week 20 and continues to grow thicker. B The placenta produces four hormones necessary to maintain the pregnancy. C Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. D Optimal circulation occurs when the woman is lying on her side.

10. A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" The best answer is a. "A baby's sex is determined as soon as conception occurs." b. "The baby has developed enough that we can determine the sex by examining the genitals through ultrasound." c. "Boys and girls look alike until approximately 20 weeks after conception, and then they begin to look different." d. "It might be possible to determine your baby's sex, but the external organs look very similar right now."

ANS: B Feedback A This is a true statement, but the external genitalia are similar in appearance until approximately the 12th week. B Although gender is determined at conception, the external genitalia of males and females look similar through the 9th week. By the 12th week, the external genitalia are distinguishable as male or female. C The external genitalia are similar in appearance until approximately 12 weeks, not 20 weeks. D The external genitalia are different at approximately week 12.

14. A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been battered? a. The woman and her partner are having an argument that is loud and hostile. b. The woman has injuries on various parts of her body that are in different stages of healing. c. Examination reveals a fractured arm and fresh bruises. Her husband asks her about her pain. d. She avoids making eye contact and is hesitant to answer questions.

ANS: B Feedback A This is not always an indication of battering. Many times the batterer will be attentive and refuse to leave the woman's bedside. B The battered woman often has multiple injuries in various stages of healing. C With battering there are injuries in various stages of healing. D It is more normal for the woman to have a flat affect.

A pictorial tool that can assist the nurse in assessing aspects of family life related to health care is the a. Genogram b. Ecomap c. Life cycle model d. Human development wheel

ANS: B A A genogram (also known as a pedigree) is a diagram that depicts the relationships of family members over generations. B An ecomap is a pictorial representation of the family structures and their relationships with the external environment. C The life cycle model in no way illustrates a family genogram. This model focuses on stages that a person reaches throughout his or her life. D The human development wheel describes various stages of growth and development rather than a family's relationships to each other.

A nurse observes that parents discuss rules with their children when the children do not agree with the rules. Which style of parenting is being displayed? a. Authoritarian b. Authoritative c. Permissive d. Disciplinarian

ANS: B A A parent who expects children to follow rules without questioning is using an authoritarian parenting style. B A parent who discusses the rules with which children do not agree is using an authoritative parenting style. C A parent who does not consistently enforce rules and allows the child to decide whether he or she wishes to follow rules is using a permissive parenting style. D A disciplinarian style would be similar to the authoritarian style.

Which nursing intervention is an independent function of the nurse? a. Administering oral analgesics b. Teaching the woman perineal care c. Requesting diagnostic studies d. Providing wound care to a surgical incision

ANS: B A Administering oral analgesics is a dependent function; it is initiated by a physician and carried out by the nurse. B Nurses are now responsible for various independent functions, including teaching, counseling, and intervening in nonmedical problems. Interventions initiated by the physician and carried out by the nurse are called dependent functions. C Requesting diagnostic studies is a dependent function. D Providing wound care is a dependent function; it is usually initiated by the physician through direct orders or protocol.

Which family will most likely have the most difficulty coping with an ill child? a. A single-parent mother who has the support of her parents and siblings b. Parents who have just moved to the area and are living in an apartment while they look for a house c. The family of a child who has had multiple hospitalizations related to asthma and has adequate relationships with the nursing staff d. A family in which there is a young child and four older married children who live in the area

ANS: B A Although only one parent is available, she has the support of her extended family, which will assist her in adjusting to the crisis. B Parents in a new environment will have increased stress related to their lack of a support system. They have no previous experiences in the setting from which to draw confidence. C Because this family has had positive experiences in the past, family members can draw from those experiences and feel confident about the setting. D This family has an extensive support system that will assist the parents in adjusting to the crisis.

What characteristic would most likely be found in a Mexican-American family? a. Stoicism b. Close extended family c. Considering docile children weak d. Very interested in health-promoting lifestyles

ANS: B A Although stoicism may be present in any family, Mexican-American families tend to be more expressive. B Most Mexican-American families are very close, and it is not unusual for children to be surrounded by parents, siblings, grandparents, and godparents. It is important to respect this cultural characteristic and to see it as a strength, not a weakness. C Considering docile children weak is a characteristic of Native Americans. D Although everyone tends now to embrace more health-promoting lifestyles, they are more prominent in Anglo-Americans.

The step of the nursing process in which the nurse determines the appropriate interventions for the identified nursing diagnosis is called: a. Assessment b. Planning c. Intervention d. Evaluation

ANS: B A During the assessment phase, data are collected. B The third step in the nursing process involves planning care for problems that were identified during assessment. C The intervention phase is when the plan of care is carried out. D The evaluation phase is determining whether the goals have been met.

The nurse who coordinates and manages a patient's care with other members of the health care team is functioning in the role of: a. Teacher b. Collaborator c. Researcher d. Advocate

ANS: B A Education is an essential role of today's nurse. The nurse functions as a teacher during prenatal care, during maternity care, and when teaching parents of children regarding normal growth and development. B The nurse collaborates with other members of the health care team, often coordinating and managing the patient's care. Care is improved by this interdisciplinary approach as nurses work together with dietitians, social workers, physicians, and others. C Nurses contribute to their profession's knowledge base by systematically investigating theoretic for practice issues and nursing. D A nursing advocate is one who speaks on behalf of another. As the health professional who is closest to the patient, the nurse is in an ideal position to humanize care and to intercede on the patient's behalf.

More than 100 different ethno-cultural groups reside within the United States, and numerous traditional health beliefs are observed among these groups. Traditional beliefs related to the maintenance of health are likely to include a. Avoidance of natural events such as a solar eclipse b. Practicing silence, meditation, and prayer c. Protection of the soul by avoiding envy or jealousy d. Understanding that a hex, spell, or the evil eye may cause illness or injury

ANS: B A Illness can be prevented by avoiding natural events such as a solar eclipse along with environmental factors such as bad air. B Mental and spiritual health is maintained by activities such as silence, meditation, and prayer. Many people view illness as punishment for breaking their religious code and adhere strictly to morals and religious practices to maintain health. C Phenomena such as accidental provocation of envy, jealousy, or hate of a friend or acquaintance may cause illness. D Agent such as hexes, spells, and the evil eye may strike a person (often a child) and causes injury, illness, or misfortunate.

The consequences technique will assist children to learn the direct result of their behavior. This technique can be used with children from toddler age to adolescence. If children learn to understand consequences, they are less likely to repeat the offending behavior. Consequences fall into which categories? Select all that apply. a. Corporal b. Natural c. Logical d. Unrelated e. Behavioral

ANS: B, C, D Natural consequences are those that occur spontaneously. For example, a child leaves a toy outside and it is lost. Logical consequences are those that are directly related to the misbehavior. If two children are fighting over a toy, the toy is removed and neither child has it. Unrelated consequences are purposely imposed; for example, the child is late for dinner so he or she is not allowed to watch television. Corporal punishment is not part of this behavioral approach and usually takes the approach of spanking the child. Corporal punishment is highly controversial and is strongly discouraged by the American Academy of Pediatrics. Behavior modification is another disciplinary technique that rewards positive behavior and ignores negative behavior.

2. Approximately 82% of teen pregnancies are unintended. Seventy percent of teens have had sex by their 19th birthday. Factors that contribute to an increased risk for teen pregnancy include (select all that apply) a. High self-esteem b. Peer pressure c. Limited access to contraception d. Planning sexual activity e. Lack of role models

ANS: B, C, E Feedback Correct Peer pressure to begin sexual activity is a contributing factor towards teenage pregnancy. Limited access to contraceptive devices and lack of accurate information about how to use these devices are also factors. Lack of appropriate role models, desire to alleviate or escape the present situation at home, along with feelings of invincibility, also contribute to teenage pregnancy. Incorrect Low self-esteem and the consequent inability to set limits on sexual activity places the adolescent at risk for teen pregnancy. Ambivalence towards sexuality, and not planning intercourse, are more likely to result in teen pregnancy.

Optimal patient care relies on the nurse's expertise and clinical judgment; however, critical thinking (a component of nursing judgment) underlies the nursing process. The nurse who uses critical thinking understands that the steps of critical thinking include (select all that apply) a. Therapeutic communication b. Examining biases c. Setting priorities d. Managing data e. Evaluating other factors

ANS: B, D, E Correct The 5 steps of critical thinking include: recognizing assumptions, examining biases, analyzing the need for closure, managing data, and evaluating other factors. Incorrect Therapeutic communication is a skill that nurses must have to carry out the many roles expected with in the profession; however, it is not one of the steps of critical thinking. Setting priorities is part of the planning phase of the nursing process.

8. During a centering pregnancy group meeting, the nurse teaches patients that the fetal period is best described as one of a. Development of basic organ systems b. Resistance of organs to damage from external agents c. Maturation of organ systems d. Development of placental oxygen-carbon dioxide exchange

ANS: C Feedback A Basic organ systems are developed during the embryonic period. B The organs are always at risk for damage from external sources; however, the older the fetus, the more resistant the organs will be. The greatest risk is when the organs are developing. C During the fetal period, the body systems grow in size and mature in function to allow independent existence after birth. D The placental system is complete by week 12, but that is not the best description of the fetal period.

1. A pregnant woman who abuses cocaine admits to exchanging sex for her drug habit. This behavior puts her at a greater risk for a. Depression of the central nervous system b. Hypotension and vasodilation c. Sexually transmitted diseases d. Postmature birth

ANS: C Feedback A Cocaine is a central nervous system stimulant. B Cocaine causes hypertension and vasoconstriction. C Sex acts exchanged for drugs place the woman at increased risk for sexually transmitted diseases because of multiple partners and lack of protection. D Premature delivery of the infant is one of the most common problems associated with cocaine use during pregnancy.

3. What is a major barrier to health care for teen mothers? a. The hospital/clinic is within walking distance of the girl's home. b. The institution is open days, evenings, and Saturday by special arrangement. c. The teen must be prepared to see a different nurse or doctor or both at every visit. d. The health care workers have a positive attitude.

ANS: C Feedback A If the hospital/clinic were within walking distance of the girl's home, it would prevent the teen from missing appointments because of transportation problems. B If the institution were open days, evenings, and Saturday by special arrangement, this availability would be helpful for teens who work, go to school, or have other time-of-day restrictions. Scheduling conflicts are a major barrier to health care. C Whenever possible, the teen should be scheduled to see the same nurses and practitioners for continuity of care. D A negative attitude is unfortunate, because it discourages families that would benefit most from consistent prenatal care.

11. When helping the mother, father, and other family members actualize the loss of the infant, nurses should a. Use the words lost or gone rather than dead or died. b. Make sure the family understands that it is important to name the baby. c. If the parents choose to visit with the baby, apply lotion to the baby and wrap the infant in a pretty blanket. d. Set a firm time for ending the visit with the baby so that the parents know when to let go.

ANS: C Feedback A Nurses must use dead and died to assist the bereaved in accepting reality. B Although naming the baby can be helpful, it is important not to create the sense that parents have to name the baby. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died. C Presenting the baby in a nice way stimulates the parents' senses and provides pleasant memories of their baby. D Parents need different time periods with their baby to say goodbye. Nurses need to be careful not to rush the process.

3. The purpose of the ovum's zona pellucida is to a. Make a pathway for more than one sperm to reach the ovum. b. Allow the 46 chromosomes from each gamete to merge. c. Prevent multiple sperm from fertilizing the ovum. d. Stimulate the ovum to begin mitotic cell division.

ANS: C Feedback A Once one sperm has entered the ovum, the zona pellucida changes to prevent other sperm from entering. B Each gamete (sperm and ovum) has only 23 chromosomes. There will be 46 chromosomes when they merge. C Fertilization causes the zona pellucida to change its chemical composition so that multiple sperm cannot fertilize the ovum. D Mitotic cell division begins when the nuclei of the sperm and ovum unite.

17. Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), "How does my baby get air inside my uterus?" The correct response is a. "The baby's lungs work in utero to exchange oxygen and carbon dioxide." b. "The baby absorbs oxygen from your blood system." c. "The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream." d. "The placenta delivers oxygen-rich blood through the umbilical artery to the baby's abdomen."

ANS: C Feedback A The fetal lungs do not function for respiratory gas exchange in utero. B The baby does not simply absorb oxygen from a woman's blood system. Blood and gas transport occur through the placenta. C The placenta functions by supplying oxygen and excreting carbon dioxide to the maternal bloodstream. D The placenta delivers oxygen-rich blood through the umbilical vein, not artery.

6. A woman who is older than 35 years may have difficulty achieving pregnancy, because a. Personal risk behaviors influence fertility. b. She has used contraceptives for an extended time. c. Her ovaries may be affected by the aging process. d. Prepregnancy medical attention is lacking.

ANS: C Feedback A The older adult participates in fewer risk behaviors than the younger adult. B The problem is the age of the ovaries, not the past use of contraceptives. C Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. D Prepregnancy medical care is available and encouraged.

16. At approximately _____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. a. 20 b. 24 c. 28 d. 30

ANS: C Feedback A These milestones would not be completed by 20 weeks of gestation. B These milestones in human development will not be completed at 24 weeks of gestation. C These are all milestones that occur at 28 weeks. D These specific milestones will be reached as early as 28 weeks, not 30 weeks of gestation.

9. A patient at 24 weeks of gestation says she has a glass of wine with dinner every evening. The nurse will counsel her to eliminate all alcohol intake, because a. A daily consumption of alcohol indicates a risk for alcoholism. b. She will be at risk for abusing other substances as well. c. The fetus is placed at risk for altered brain growth. d. The fetus is at risk for multiple organ anomalies.

ANS: C Feedback A This is not the major risk for the infant. B This has not been proven. C The brain grows most rapidly in the third trimester and is most vulnerable to alcohol exposure during this time. D The major concerns are mental retardation, learning disabilities, high activity level, and short attention span.

4. Of adolescents who become pregnant, what percentage have had a previous birth? a. 10% b. 15% c. 19% d. 35%

ANS: C Feedback A This percentage rate is too low; it is actually 19%. B The percentage of teens who have had a previous birth is 19%. C 19% of pregnant adolescents have had one or more previous births. D This percentage rate is too high when measuring previous adolescent births.

Alternative and complementary therapies: a. Replace conventional Western modalities of treatment b. Are used by only a small number of American adults c. Allow for more patient autonomy d. Focus primarily on the disease an individual is experiencing

ANS: C A Alternative and complementary therapies are part of an integrative approach to health care. B An increasing number of American adults are seeking alternative and complementary health care options. C Many popular alternative healing modalities offer human-centered care based on philosophies that recognize the value of the patient's input and honor the individual's beliefs, values, and desires. D Alternative healing modalities offer a holistic approach to health, focusing on the whole person and not just the disease.

In general, healthy families are able to adapt to changes within the family unit; however, some factors add to the usual stress experienced by any family. The nurse is in a unique position to assess the child for symptoms of neglect. Which high-risk family situation places the child at the greatest risk for being neglected? a. Marital conflict and divorce b. Adolescent parenting c. Substance abuse d. A child with special needs

ANS: C A Although divorce is traumatic to children, research has shown that living in a home filled with conflict is also detrimental. In this situation conflict may arise and young children may be unable to verbalize their distress; however, the child is not likely to be neglected. B Teenage parenting often has a negative effect on the health and social outcomes of the entire family. Adolescent girls are at risk for a number of pregnancy complications, are unlikely to attain a high level of education, and are more likely to be poor. C Parents who abuse drugs or alcohol may neglect their children because obtaining and using the substance(s) may have a stronger pull on the parents than the care of their children. D When a child is born with a birth defect or has an illness that requires special care, the family is under additional stress. These families often suffer financial hardship as health insurance benefits quickly reach their maximum.

While reviewing the dietary-intake documentation of a 7-year-old Asian boy with a fractured femur, the nurse notes that he consistently refuses to eat the food on his tray. What assumption is most likely accurate? a. He is a picky eater. b. He needs less food because he is on bed rest. c. He may have culturally related food preferences. d. He is probably eating between meals and spoiling his appetite.

ANS: C A Although the child may be a picky eater, the key point is that he is from a different culture. The foods he is being served may seem strange to him. B Nutrition plays an important role in healing. Although the energy the child expends has decreased while on bed rest, he has increased needs for good nutrition. C When cultural differences are noted, food preferences should always be obtained. A child will often refuse to eat unfamiliar foods. D Although the nurse should determine whether the child is eating food the family has brought from home, the more important point is to determine whether he has food preferences.

The parent of a child who has had numerous hospitalizations asks the nurse for advice because her child has been having behavior problems at home and in school. In discussing effective discipline, what is an essential component? a. All children display some degree of acting out and this behavior is normal. b. The child is manipulative and should have firmer limits set on her behavior. c. Positive reinforcement and encouragement should be used to promote cooperation and the desired behaviors. d. Underlying reasons for rules should be given and the child should be allowed to decide which rules should be followed.

ANS: C A Behavior problems should not be disregarded as normal. B It would be incorrect to assume the child is being manipulative and should have firmer limits set on her behaviors. C Using positive reinforcement and encouragement to promote cooperation and desired behaviors is one of the three essential components of effective discipline. D Providing the underlying reasons for rules and giving the child a choice concerning which rules to follow constitute a component of permissive parenting and are not considered an essential component of effective discipline.

A nurse is caring for a child with the religion of Christian Science. What intervention should the nurse include in the care plan for this child? a. Offer iced tea to the child who is experiencing deficient fluid volume. b. Inform the spiritual care department that the child has been admitted to the hospital. c. Allow parents to sign a form opting out of routine immunizations. d. Ask parents whether the child has been baptized.

ANS: C A Coffee and tea are declined as a drink. B When a Christian Science believer is hospitalized, a parent or patient may request that a Christian Science practitioner be notified as opposed to the hospital-assigned clergy. C Christian Science believers seek exemption from immunizations but obey legal requirements. D Baptism is not a ceremony for the Christian Science religion.

To evaluate the woman's learning about performing infant care, the nurse should: a. Demonstrate infant care procedures. b. Allow the woman to verbalize the procedure. c. Observe the woman as she performs the procedure. d. Routinely assess the infant for cleanliness.

ANS: C A Demonstration is an excellent teaching method, but not an evaluation method. B During verbalization of the procedure, the nurse may not pick up on techniques that are incorrect. It is not the best tool for evaluation. C The woman's ability to perform the procedure correctly under the nurse's supervision is the best method of evaluation. D This will not ensure that the proper procedure is carried out. The nurse may miss seeing unsafe techniques being used.

What is the primary role of practicing nurses in the research process? a. Designing research studies b. Collecting data for other researchers c. Identifying researchable problems d. Seeking funding to support research studies

ANS: C A Designing research studies is only one factor of the research process. B Data collection is one factor of research. C Nursing generates and answers its own questions based on evidence within its unique subject area. D Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.

A traditional family structure in which male and female partners and their children live as an independent unit is known as a(n) _____ family. a. Extended b. Binuclear c. Nuclear d. Blended

ANS: C A Extended families include other blood relatives in addition to the parents. B A binuclear family involves two households. C Approximately two thirds of U.S. households meet the definition of a nuclear family. This is also known as the traditional family. D A blended family is reconstructed after divorce and involves the merger of two families.

Families who deal effectively with stress exhibit which behavior pattern? a. Focus on family problems b. Feel weakened by stress c. Expect that some stress is normal d. Feel guilty when stress exists

ANS: C A Healthy families focus on family strengths rather than on the problems and know that stress is temporary and may be positive. B If families are dealing effectively with stress, then weakening of the family unit should not occur. C Healthy families recognize that some stress is normal in all families. D Because some stress is normal in all families, feeling guilty is not reasonable. Guilt only immobilizes the family and does not lead to resolution of the stress.

Which step in the nursing process identifies the basis or cause of the patient's problem? a. Intervention b. Expected outcome c. Nursing diagnosis d. Evaluation

ANS: C A Interventions are actions taken to meet the problem. B Expected outcome is a statement of the goal. C A nursing diagnosis states the problem and its cause ("related to"). D Evaluation determines whether the goal has been met.

When addressing the questions of a newly pregnant woman, the nurse can explain that the certified nurse-midwife is qualified to perform: a. Regional anesthesia b. Cesarean deliveries c. Vaginal deliveries d. Internal versions

ANS: C A Regional anesthesia must be performed by a physician. B Cesarean deliveries must be performed by a physician. C The nurse-midwife is qualified to deliver infants vaginally in uncomplicated pregnancies. D Internal versions must be performed by a physician.

To resolve family conflict, it is necessary to have open communication, accurate perception of the problem, and a(n) a. Intact family structure b. Arbitrator c. Willingness to consider the view of others d. Balance in personality types

ANS: C A The structure of a family may affect family dynamics, but it is still possible to resolve conflict without an intact family structure if all of the ingredients of conflict resolution are present. B Conflicts can be resolved without the assistance of an arbitrator. C Without the willingness of the members of a group to consider the views of others, conflict resolution cannot take place. D Most families have diverse personality types among their members. This diversity may make conflict resolution more difficult but should not impede it as long as the ingredients of conflict resolution are present.

Which nursing intervention is correctly written? a. Encourage turning, coughing, and deep breathing. b. Force fluids as necessary. c. Assist to ambulate for 10 minutes at 8 AM, 2 PM, and 6 PM. d. Observe interaction with infant.

ANS: C A This intervention does not state how often this procedure should be done. B "Force fluids" is not specific; it does not state how much. C Interventions may not be carried out unless they are detailed and specific. D This intervention is not detailed and specific.

13. When explaining twin conception, the nurse points out that dizygotic twins develop from a. A single fertilized ovum and are always of the same sex b. A single fertilized ovum and may be the same sex or different sexes c. Two fertilized ova and are the same sex d. Two fertilized ova and may be the same sex or different sexes

ANS: D Feedback A A single fertilized ovum that produces twins is called monozygotic. B Monozygotic twins are always the same sex. C Dizygotic twins are from two fertilized ova and may or may not be the same sex. D Dizygotic twins are two different zygotes, each conceived from a single ovum and a single sperm. They may be both male, both female, or one male and one female.

8. The most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant is a. Genetic changes and anomalies b. Extensive central nervous system damage c. Fetal addiction to the substance inhaled d. Intrauterine growth restriction

ANS: D Feedback A Cigarettes normally will not cause genetic changes. B Cigarettes normally will not cause extensive central nervous system damage. C Addiction is not a normal concern with the neonate. D The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss.

10. As a powerful central nervous system stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth? a. Heroin b. Alcohol c. PCP d. Cocaine

ANS: D Feedback A Heroin is an opiate. Its use in pregnancy is associated with preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. B The most serious effect of alcohol use in pregnancy is FAS. C The major concerns regarding PCP use in pregnant women are its association with polydrug abuse and the neurobehavioral effects on the neonate. D Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth.

18. The most basic information a maternity nurse should have concerning conception is a. Ova are considered fertile 48 to 72 hours after ovulation. b. Sperm remain viable in the woman's reproductive system for an average of 12 to 24 hours. c. Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. d. Implantation in the endometrium occurs 6 to 10 days after conception.

ANS: D Feedback A Ova are considered fertile for approximately 24 hours after ovulation. B Sperm remain viable in the woman's reproductive system for an average of 2 to 3 days. C Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed. D After implantation, the endometrium is called the decidua.

15. Between 6 and 10 days after conception, the trophoblast secretes enzymes that enable it to burrow into the endometrium until the entire blastocyst is covered. This is termed implantation. Tiny projections then develop out of the trophoblast and extend into the endometrium. These projections are referred to as a. Decidua basalis b. Decidua capsularis c. Decidua vera d. Chorionic villi

ANS: D Feedback A The deciduas basalis is the portion of the endometrium where the chorionic villi tap into the maternal blood vessels. B The deciduas capsularis is the portion of the endometrium that covers the blastocyst. C The portion of the endometrium that lines the rest of the uterus is called deciduas vera. D These villi are vascular processes that obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood.

4. While teaching an early pregnancy class, the nurse explains that the morula is a a. Fertilized ovum before mitosis begins b. Flattened disc-shaped layer of cells within a fluid-filled sphere c. Double layer of cells that becomes the placenta d. Solid ball composed of the first cells formed after fertilization

ANS: D Feedback A The fertilized ovum is called the zygote. B This is the embryonic disc. It will develop into the baby. C The placenta is formed from two layers of cells: the trophoblast, which is the other portion of the fertilized ovum, and the deciduas, which is the portion of the uterus where implantation occurs. D The morula is so named because it resembles a mulberry. It is a solid ball of 12 to 16 cells that develops after fertilization.

6. Some of the embryo's intestines remain within the umbilical cord during the embryonic period because the a. Umbilical cord is much larger at this time than it will be at the end of pregnancy. b. Intestines begin their development within the umbilical cord. c. Nutrient content of the blood is higher in this location. d. Abdomen is too small to contain all the organs while they are developing.

ANS: D Feedback A The intestines remain within the umbilical cord only until approximately week 10. B Intestines begin their development within the umbilical cord, but only because the liver and kidneys occupy most of the abdominal cavity. All the intestines are within the abdominal cavity around week 10. C Blood supply is adequate in all areas. Intestines stay in the umbilical cord for approximately 10 weeks because they are growing faster than the abdomen. D The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks, the abdomen is large enough to contain them.

13. An appropriate nursing measure when a baby has an unexpected anomaly is to a. Remove the baby from the delivery area immediately. b. Tell the parents that the baby has to go to the nursery immediately. c. Inform the parents immediately that something is wrong. d. Explain the defect and show the baby to the parents as soon as possible.

ANS: D Feedback A The parents should be able to touch and hold the baby as soon as possible. B This would raise anxiety levels of the parents; they should be told about the defect and allowed to see the baby. C They should be told immediately, but they should be told about the defect and be allowed to see the infant. D Parents experience less anxiety when they are told about the defect as early as possible and are allowed to touch and hold the baby.

12. A woman has delivered twins. The first twin was stillborn, and the second is in the intensive care nursery and is recovering quickly from respiratory distress. The woman is crying softly and says, "I wish my baby could have lived." What is the most therapeutic response? a. "Don't be sad. At least you have one healthy baby." b. "How soon do you plan to have another baby?" c. "I have a friend who lost a twin and she's doing just fine now." d. "I am so sorry about your loss. Would you like to talk about it?"

ANS: D Feedback A This is denying the loss of the other infant. B This is denying the loss of the infant and her grief and belittling her feelings. C This is belittling her feelings. D The nurse should recognize the woman's grief and its significance.

The nurse observes that when an 8-year-old boy enters the playroom, he often causes disruption by taking toys from other children. The nurse's best approach for this behavior is to a. Ban the child from the playroom. b. Explain to the children in the playroom that he is very ill and should be allowed to have the toys. c. Approach the child in his room and ask, "Would you like it if the other children took your toys from you?" d. Approach the child in his room and state, "I am concerned that you are taking the other children's toys. It upsets them and me."

ANS: D A Banning the child from the playroom will not solve the problem. The problem is his behavior, not the place where he exhibits it. B Illness is not a reason for a child to be undisciplined. When the child recovers, the parents will have to deal with a child who is undisciplined and unruly. C Children should not be made to feel guilty and to have their self-esteem attacked. D By the nurse's using "I" rather than the "you" message, the child can focus on the behavior. The child and the nurse can begin to explore why the behavior occurs.

What should the nurse expect to be problematic for a family whose religious affiliation is Jehovah's Witness? a. Immunizations b. Autopsy c. Organ donation d. Blood transfusion

ANS: D A Christian Science believers may seek exemption from immunizations. B Believers in Islam are opposed to organ donation. C Jehovah's Witness believers can make individual decisions about autopsy. D Jehovah's Witness believers are opposed to blood transfusions. They may accept alternatives to transfusions, such as non-blood plasma expanders.

Which statement is true about the characteristics of a healthy family? a. The parents and children have rigid assignments for all the family tasks. b. Young families assume the total responsibility for the parenting tasks, refusing any assistance. c. The family is overwhelmed by the significant changes that occur as a result of childbirth. d. Adults agree on the majority of basic parenting principles.

ANS: D A Healthy families remain flexible in their role assignments. B Members of a healthy family accept assistance without feeling guilty. C Healthy families can tolerate irregular sleep and meal schedules, which are common during the months after childbirth. D Adults in a healthy family communicate with each other so that minimal discord occurs in areas such as discipline and sleep schedules.

Which goal is most appropriate for the collaborative problem of wound infection? a. The patient will have a temperature of 98.6° F within 2 days. b. The patient's fluid intake will be maintained at 1000 mL per 8 hours. c. The patient will not exhibit further signs of infection. d. The patient will be monitored to detect therapeutic response to antibiotic therapy.

ANS: D A Monitoring a patient's temperature is an independent nursing role. B Intake and output is an independent nursing role. C Monitoring for complications is an independent nursing role. D In a collaborative problem, the goal should be nurse oriented and reflect the nursing interventions of monitoring or observing. In collaborative problems, other team members are involved for other duties, such as prescribing antibiotics.

What situation is most conducive to learning? a. A teacher who speaks very little Spanish is teaching a class of Latino students. b. A class is composed of students of various ages and educational backgrounds. c. An auditorium is being used as a classroom for 300 students. d. An Asian nurse provides nutritional information to a group of pregnant Asian women.

ANS: D A The ability to understand the language in which teaching is done determines how much the patient learns. Patients for whom English is not their primary language may not understand idioms, nuances, slang terms, informal usage of words, or medical words. The teacher should be fluent in the language of the student. B Developmental levels and educational levels influence how a person learns best. In order for the teacher to best present information, it is best for the class to be of the same levels. C A large class is not conducive to learning. It does not allow for questions, and the teacher is not able to see the nonverbal cues from the students to ensure understanding. D A patient's culture influences the learning process; thus a situation that is most conducive to learning is one in which the teacher has knowledge and understanding of the patient's cultural beliefs.

According to Friedman's classifications, providing such physical necessities as food, clothing, and shelter is the _____ family function. a. Economic b. Socialization c. Reproductive d. Health care

ANS: D A The economic function provides resources but is not concerned with health care and other basic necessities. B The socialization function teaches the child cultural values. C The reproductive function is concerned with ensuring family continuity. D Physical necessities such as food, clothing, and shelter are considered part of health care.

2. An increasing number of women are now becoming pregnant relatively late in their reproductive lives. The birth rate for women ages 40 to 44 has increased to the highest level in 40 years. Which advances in maternity care these women are at no greater risk for obstetric complications. Is this statement true or false?

ANS: F The older women it is definitely at an increased risk for obstetric complications, including spontaneous abortion, gestational diabetes, cesarean births, stillbirth, preeclampsia, placenta previa, abruption, preterm delivery, and low birth weight infants.

2. The nurse is precepting a student who asks about fetal circulation. The nurse explains that the fetal circulatory shunts are still required after birth. Is this statement true or false?

ANS: False Fetal circulatory shunts are not needed after birth because the infant oxygenates blood in the lungs, metabolizes substances in the liver, and stops circulating blood to the placenta. As the infant breathes, blood flow to the lungs increases, pressure in the right-sided heart falls, and the foramen ovale closes.

2. Very fine hairs, called __________, appear first on the fetus's eyebrows and upper lip at 12 weeks of gestation. By 20 weeks, they cover the entire body. By 28 weeks, the scalp hair is longer than these fine hairs, which thin and may disappear by term gestation.

ANS: Lanugo By 20 weeks of gestation, the eyelashes, eyebrows, and scalp hair also begin to grow.

Parents of children with special needs often require specialized care and experience frequent hospitalizations. When caring for these families, the nurse should be aware that they may experience financial hardship due to their child's condition and require assistance in obtaining referrals to resources. Is this statement true or false?

ANS: T These families often suffer financial hardship, which can lead to issues related to coping and other strains on the family. Health insurance benefits may quickly reach their maximum. Even if the child is on special assistance for health care, one parent may have to remain home with the child rather than work outside of the home. Social work and financial or prescription assistance may all be necessary and appropriate sources of support.

1. Society tends to minimize perinatal loss because of the prevailing belief that there are no barriers to getting pregnant and the expectation that once a woman is pregnant, a healthy, live infant will result. Is this statement true or false?

ANS: T Because of these perceptions, grieving parents often do not receive the support they need, and society often allows much too short a time for mothers to grieve (and even less for fathers).

1. When teaching contraception, the nurse must be able to effectively communicate the nuances of conception. An ovum has the capacity to be fertilized for only 24 hours, whereas a sperm may remain fertile for up to 80 hours. Is this statement true or false?

ANS: True Most sperm survive for no more than 1 or 2 days, although a few will remain fertile in the female reproductive tract for up to 80 hours. Conception requires correct timing for fertilization to occur. This information is important whether the patient is seeking to become pregnant or prevent pregnancy.

1. The ability of the fetus to survive outside the uterus is called ___________.

ANS: Viability In the past, the earliest age at which fetal survival could be expected was 28 weeks after conception. With modern technology and advancements in maternal and neonatal care, viability is now possible at 20 weeks after conception (22 weeks after last menstrual period [LMP], fetal weight of 500 g or more).

How common is suicide in children?

Ages 5 - 14: third leading cause of death Adolescents: second leading cause of death

What is an incident report?

Also called a quality assurance, occurrence, or variance report: completed when something occurs that might result in legal action, such as injury to a patient or a departure from the expectations in the situation

When can patients withdraw their agreement to treatment?

At any time

Members of the Jehovah's Witness faith are opposed to certain aspects of health care: Select all that apply. A. Birth control B. Blood transfusions C. Infant baptism D. Autopsy

B, C Blood transfusions are not allowed. May accept alternatives to transfusions, such as use of non-blood plasma expanders, careful surgical technique to minimize blood loss, and use of autologous transfusions. Jehovah's Witnesses are prepared to die rather than break God's law. Infant baptism is not performed. Adult baptism is done by immersion. Use of birth control is a personal decision. Autopsy will be decided by persons involved.

The nurse is preparing cough medication for several patients of various faiths and realizes that it contains alcohol. For which religious groups is alcohol forbidden, requiring the nurse to check if the patient can consume the medication? Select all that apply. A. Jewish B. Islam C. Catholic D. Christian Science E. Jehovah's Witness

B, D, E The nurse would need to check with the patient prior to administration. Patients of the Islamic, Christian Science, and Jehovah's Witness religions do not use alcohol.

Fertilization of the ovum takes place in which part of the fallopian tube? A. Interstitial portion B. Ampulla C. Isthmus D. Infundibulum

B. Ampulla * The ampulla is the wider middle part of the tube lateral to the isthmus and is where fertilization occurs

The nurse is reviewing the lab reports on a 17-year-old new patient. The gonadotropin-releasing hormone levels are extremely low. The nurse can anticipate that the patient will: A. Look older than her years B. Not have primary or secondary sexual characteristics C. Have primary, but not secondary, sexual characteristics D. Have adequate levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) Incorrect

B. Not have primary or secondary sexual characteristics * Gonadotropin-releasing hormone is responsible for initiating the beginning of puberty

The nurse is caring for a dying boy whose religion is Islam (Muslim/Moslem). What information should the nurse use when considering his religion and impending death? A. There are no special rites related to death. B. There are specific practices to be followed. C. The family is expected to wait away from the dying person. D. Ask the family about organ donation.

B. There are specific practices to be followed.

When teaching a group of mothers of preteen girls, the nurse explains that the earliest outward sign of puberty starting is ____________.

Breast changes *Breast changes such as nipple enlargement and protrusion, are the earliest outward changes of puberty

Which term refers to a shared cultural, social, and linguistic heritage? A. Beliefs B. Culture C. Ethnicity D. Socialization

C. Ethnicity Ethnicity is an affiliation of a set of persons who share a unique cultural, social, religious, and linguistic heritage. Beliefs are attitudes that can be shared, not only within but also across ethnic groups. Culture is a pattern of beliefs and values that are learned and shared from generation to generation and guides the thinking, decisions, and actions of a group of people. Socialization is the process by which individuals learn the roles that are expected of them.

The parents of a young child ask the nurse for suggestions on how to discipline. When discussing the use of "timeouts," what approach should the nurse recommend? A. Send the child to his or her room if the child has one. B. Use 5 minutes per year of age for this discipline. C. Selecting an area that is safe and non-stimulating, such as a hallway. D. Try another approach if the child cries, refuses, or is more disruptive.

C. Selecting an area that is safe and non-stimulating, such as a hallway. The area must be non-stimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The child's room may have toys and other equipment and activities that may negate the effect of being separated from the family activities. In addition, the place where the child sleeps should retain positive association and should not be used as a site of discipline. The general rule is 1 minute per year of age, not 5 minutes per year. When the child engages in such behavior, the child should be reminded that the timeout begins when the child quiets, rather than allowing the child to manipulate his way out of discipline.

A woman who is 6 weeks' pregnant is in for her prenatal appointment and asks the nurse when the sex of the baby can be determined by ultrasound. The nurse bases her answer on the knowledge that: A. The sex cannot be determined by ultrasound; an amniocentesis must be done B. The sex of the baby can be determined now by ultrasound C. The external genitalia look similar in both males and females until about 9 weeks of gestation D. The external genitalia will look different at 6 weeks, so an ultrasound can be done at that time

C. The external genitalia look similar in both males and females until about 9 weeks of gestation

A 36-year-old comes to the clinic requesting contraception. She presents with a history of hypertension (now under control with treatment) and a past history of pelvic inflammatory disease. She smokes one pack of cigarettes a day and admits to having "numerous" sexual partners. Which contraceptive method is appropriate for her? Oral contraceptives Transdermal contraceptive patch Intrauterine device Condoms

Condoms

What change in consumer demand occurred in the early 1950s?

Consumers began to insist on their right to be involved in their healthcare.

A woman just gave birth to her sixth child. She states to the nurse, "I just can't have another baby, but I don't want surgery to prevent it either. What can I do?" What contraceptive method can the nurse suggest to the woman as being the most effective? Cervical cap Copper IUD Male condoms Diaphragm

Copper IUD

The nurse is planning care for a patient with an ethnic background different from the nurse's. What approach by the nurse is best during the planning? A. Strive to keep ethnic background from influencing health needs. B. Encourage continuation of ethnic practices in the hospital setting. C. Attempt, in a nonjudgmental way, to change ethnic beliefs. D. Adapt the patient's ethnic practices as possible to the patient's health situation.

D. Adapt the patient's ethnic practices as possible to the patient's health situation. Whenever possible, nursing care should facilitate the integration of ethnic practices into caring for the patient and supporting the patient's health needs. The ethnic background is part of the individual; it would be very difficult to eliminate the influence of the ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting. The ethnic background is part of the individual; it would be very difficult to eliminate the influence of the ethnic background.

During a childbirth class a woman asks the nurse, "I'm just weeks pregnant. I know the placenta is not fully developed yet, so what is producing all the hormones I need?" The nurse will development her answer on the knowledge that A. The placenta is big enough at this point to produce the hormones necessary B. Extra hormones are not necessary for this stage of the pregnancy C. The pituitary is working to secrete the extra hormones that are necessary until the placenta develops D. The corpus luteum secretes the extra hormones necessary until the placenta develops

D. The corpus luteum secretes the extra hormones necessary until the placenta develops * LH causes the follicle to persist as a corpus luteum for about 12 days after ovulation. If conception occurs, the fertilized ovum secretes human chorionic gonadotropin that causes the corpus luteum to persist. The corpus luteum produces the extra estrogen and progesterone necessary to support the pregnancy

Factors that may interfere with the family's ability to provide for the needs of its members include A. adequate financial resources. B. adequate family support. C. birth of a healthy infant. D. smoking and abuse of other substances.

D. smoking and abuse of other substances. Unhealthy habits such as smoking and abuse of other substances may interfere with family functioning. Other factors include a lack of financial resources, absence of adequate family support, birth of an infant who needs specialized care, an ill child, and inability to make mature decisions that are necessary to provide care for the children.

___________ refers to the view that one's own culture's way of doing things is always the best.

Ethnocentrism Rationale: Although the United States is a culturally diverse nation, the prevailing practice of health care is based on the beliefs held by members of the dominant culture, primarily Caucasians of European descent. Cultural relativism is the opposite of ethnocentrism. It refers to learning about and applying the standards of another's culture.

Why did family-centered healthcare develop?

From the recognition that the emotional needs of hospitalized children were usually unmet

What are accountable care organizations (ACOs)?

Groups of hospitals, physician's offices, community agencies, and any agency that provides healthcare to patients. They coordinate care, reducing duplication of services, fragmentation of care, and giving more control to patients and families.

What is managed care?

HMOs, POSs, PPOs Includes strategies such as payment arragements and preadmission or pretreatment authorization to control costs

In what ethnic group is the proportion of children with health insurance lowest?

Hispanic

Why were parents historically not allowed to visit their sick children in hospitals?

In order to prevent emotional distress and the spread of infection

The procedure in which ova are removed, mixed with sperm, and the fertilized ova returned to the woman's uterus is called _____________________.

In vitro fertilization

What was Liliian Walds contribution to child and family care?

Initiated public health nursing at Henry Street Settlement House in NYC, where nurses taught mothers in their homes

What are the implications for nurses regarding abortion?

Nurses must: - be informed about induced abortion from a legal and ethical standpoint and know the laws and regulations of their state - realize that abortion is an ethical dilemma that results in confusion, ambivalence, and personal distress for many - recognize that the issue is not a dilemma for many but is a fundamental violation of personal or religious views that give meaning to their lives - acknowledge the sincere convictions and the strong emotions of people on all sides of the issue

A 23-year-old postpartum woman is having trouble breastfeeding. Upon assessment, the nurse discovers that the woman does not have a let-down reflex. One reason for this may be that she is lacking the horomone ___________________.

Oxytocin *One purpose of oxytocin is to stimulate contractions in the breast muscles that will push the breast milk down towards the tipple. This is called the let down reflex.

A 16-year-old is being seen for the first time by the nurse practitioner. The young woman states that she has not had the onset of menstruation yet. Her breasts are developing and her pelvis has widened. The term used to describe this list of signs and symptoms is ___________.

Primary amenorrhea * This is when a girl has not started menstruation by the time she is 16 year old

Although government funding now supports programs to improve the health of mothers, infants, and children, what problem still remains?

The distribution of healthcare remains unequal (ie in rural or inner-city areas)

What is morbidity?

The ratio of sick people to well people in a population: the number of ill people per 1000

What is healthcare rationing?

When part of a population has no access to care and there is not enough money for all people to share equally in the technology available. Healthcare is also rationed when it is more freely given to those who have money to pay for it than to those who do not. Distance from a needed care facility is another factor.

What are diagnosis-related groups (DRGs)?

a method of classifying related medical diagnoses based on the amount of resources, severity of disease, and other patient characteristics

Which women are eligible for perinatal care through Medicaid?

all women at less than 133% of the federal poverty level

What is a nurse licensure compact program?

allows a nurse licensed in one state to practice nursing in another state

A _________ family is one formed when single, divorced, or widowed parents bring children from a previous union into the new relationship.

blended These families must overcome differences in parenting styles and values to form a cohesive blended family. Often they wish to have children with each other in the new relationship. Differing expectations of the children's development and beliefs regarding discipline may lead to conflict. Older children often resent the introduction of a stepmother or stepfather.

Interventions, modalities, professions, theories, applications, or practices that are not currently part of the conventional medical system in North American culture are often referred to as ____________________ and ____________________ medicine.

complementary, alternative For many people such therapies are not considered alternative, because they are mainstream in their culture. Others combine them with traditional medical practices, thereby using an integrative approach. A continued concern is patient safety. Some patients who use these techniques may delay necessary care, and others may take herbal or other remedies that might become toxic when used in combination with prescription drugs or when taken in excess.

What is the best evidence that a standard of care has been maintained?

documentation

What does Healthy People 2020 focus on?

health promotion: addresses determinants of health, or those factors that contribute to keeping people healthy and achieving high quality of life.

What must a nurse do if they are not competent to perform a task?

immediately communicate this fact to the nursing supervisor or physician

What are LDRP rooms?

includes postpartum as well. Disadvantages include a noisy environment and birthing beds that are less comfortable.

What is the Healthy Start program?

major initiative to reduce infant deaths in communities with disproportionately high infant mortality rates.

Why has there been a decrease in the number of midwives providing home births?

malpractice insurance is expensive and difficult to obtain

What do birth centers provide?

maternity care, gynecologic services, and follow-up care during the first 6 weeks

What are standard procedures or protocols?

methods by which nurses may assume certain duties commonly considered part of healthcare practice

Will a nurse be excused from responsibility due to understaffing?

no

What is the area in which most nursing lawsuits occur?

perinatal nursing

What is the AAP Committee on Bioethics' guideline addressing the issue of withholding or ceasing life-sustaining treatments for children?

recommends the use of "best interests" standard-making recommendations for interventions to families based on what will benefit the child (improving the quality of remaining life, prolonging life so that the parent and child can have the best quality of relationship possible until the child's death) vs what might harm the child.

What is the Agency for Healthcare Research and Quality (AHRQ)?

sponsors research in health issues that are faced by mothers and children. The focus is primarily on accessing care for mothers, infants, children, and adolescents.

What are clinical pathways?

standardized, interdisciplinary plans of care that are devised for patients with a particular health problem. They identify patient outcomes, specify time lines to achieve those outcomes, direct appropriate interventions and sequencing of interventions, and involve a comprehensive approach to care.

What are some types of home care services?

telephone calls, home visits, information lines, developmental surveillance, and lactation consultants

What is couplet care?

the assignment of one nurse to the care of both mother and baby - common in today's postpartum units

What is a variance?

the difference between what was expected and what actually happened

What is capitated care?

the employer or government pays a set amount of money each year to a network of primary care providers. Patients lose their freedom of choice regarding who will provide their care

What is negligence?

the failure to perform the way a reasonable, prudent person of similar background would act in a similar situation

What is the LDR (labor, delivery, and recovery) room?

the most common setting for childbirth: everything occurs in one setting. The mother remains for 1 - 2 hours after vaginal birth, and is then transferred to the postpartum unit.

What is malpractice?

the negligence by professionals, such as nurses or physicians, in performing their duties

In a school setting, who decides which responsibilities will be delegated to UAP?

the nurse, not the administrators the delegation must not relieve the nurse from regular assessment of the children's responses to all treatments and medications

What is family-centered care?

the safe, quality care that recognizes and adapts to both the physical and psychosocial needs of the family, including those of the newborn and older children Based on a philosophy that recognizes and respects the pivotal role of the family in the lives of both well and ill children. It strives to support families in their natural caregiving roles and promotes healthy patterns of living at home and in the community. Parents and professionals are viewed as equals in a partnership committed to excellence at all levels of healthcare.

What is the leading cause of death in children ages 1 - 19?

unintentional injury In all groups except ages 1 - 4, motor vehicle crashes; 1- 4 is drowning

When are children competent to understand the ramifications of a treatment?

when they have reached 14 years old

Are hospitals required to inform patients about advance directives?

yes

Is withholding life-sustaining treatment from physically or intellectually disabled infants considered child abuse?

yes the only exception is if the treatment prolonged the dying process in a child not expected to survive or if the child was in an irreversible coma