Chapter 1: Perspectives on Maternal, Newborn, and Women's Health Care

The nursing student correctly identifies which statement to be the contributing factor that made hospitals more attractive for births in the early 1900s? a) Giving birth in a hospital suggested affluence, and the hospital provided pain management. b) Hospitals had nurse midwives in attendance for births. c) Hospitals allowed for the father to be involved in the birthing process. d) Mothers who planned hospital births were provided with birth classes.

a) Giving birth in a hospital suggested affluence, and the hospital provided pain management. In the early 1900s many women were attracted to hospitals because this showed affluence and hospitals provided pain management. Nurse midwives were not located in hospitals at this time and birth classes did not evolve until the late 1950s when "natural birth" became popular again. The father was prohibited in the birth room until much later. Pg. 4

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

b) health promotion This action is an example of health promotion, which may be defined as educating parents and children to follow sound health practices through teaching and role modeling. Health maintenance is intervening to maintain health when risk for illness is present. Health restoration is using conscientious assessment to be certain symptoms of illness are identified and interventions are begun to return the client to wellness most rapidly. Health rehabilitation is helping prevent complications from illness, helping a client with residual effects achieve an optimal state of wellness and independence, and helping a client to accept inevitable death. Pg. 8

A group of students are reviewing the historical aspects of birth. The students demonstrate understanding of the information when they identify the use of twilight sleep as a key event during which time frame? a) 1800s b) 1700s c) 1900s d) 2000s

c) 1900s Twilight sleep, or the use of a heavy dose of opioids and amnesiacs, was used on women during birth in the United States during the 1900s. Female midwives attended the majority of births during the 1700s. Care shifted to doctors among middle-class women during the 1800s. Certified nurse midwives and birth classes characterize the 2000s. Pg. 5

A nurse is reviewing the statistical outcomes related to fetal deaths nationwide and notes that the numbers have changed over the last several decades. The best explanation would be: a) increases are noted because of the growing number of pregnancies to teen mothers. b) expectant mothers are seeking prenatal care later, resulting in decreases in the number. c) improved prenatal care has reduced the numbers of fetal deaths. d) increases are noted due the increasing number of older mothers becoming pregnant.

c) improved prenatal care has reduced the numbers of fetal deaths. The number of fetal deaths in the United States has fallen. This has been attributed to the improvement in the delivery of prenatal care. Pg. 10, 11

A nurse informs a 19-year-old client that she is pregnant. The client immediately states that she plans to have an abortion (elective termination of pregnancy). What would be the most appropriate response from the nurse to this client? a) "I don't know of any health care providers who will perform them." b) "Have you notified the father?" c) "Are you sure you want to do that?" d) "I'll put together the information that you will need."

d) "I'll put together the information that you will need." The nurse should not respond to this client with any judgment or biased information. The client does not have to notify the father, and the other responses show the nurse's personal bias. If a nurse has an ethical issue with this procedure, she should address it with her managers, not the client. Pg. 26-27

The nursing instructor is discussing the infant mortality rate with a group of students. The instructor determines the discussion is successful when the students correctly choose which action as a priority to help decrease infant mortality in the United States? a) Spending more money on health care for infants and mothers b) Improving accessibility to postnatal health care for infants c) Mothering classes for all primiparous mothers d) Improving maternal nutrition during pregnancy

b) Improving accessibility to postnatal health care for infants Infant deaths are due to many factors, including congenital malformations, deformations, and chromosomal abnormalities; disorders related to short gestation and low birth weight; and newborns affected by maternal complications of pregnancy. The mother's nutritional status would affect a limited number of infants. Making postnatal health care available and affordable would have the greatest impact on improving infant health and reducing the number of infant deaths. Spending more money on health care has proven to not improve infant survival rates postnatally. Although providing for mothering classes and improving maternal nutrition would be a good idea, these measures will not positively impact infant survival rates. Pg. 11

A nurse is working in an ambulatory health care clinic located in a poor neighborhood. Which nursing intervention would provide the greatest benefit for the women and their children seen at this clinic? a) cautioning the parents about home safety issues b) educating the parents about preventive care c) promoting healthy sleep and rest habits d) screening for diabetes and malnutrition

b) educating the parents about preventive care Preventative care is consistent with a health promotion approach that aims to prevent illnesses and health disorders before they develop. Home safety is one example of health promotion and preventative care but there are many others. Screening for disease and promoting sleep are likely to be beneficial, but a general focus on preventative care is likely to have the greatest benefit. Pg. 19

A client presents for her routine prenatal visit, but on examination the nurse notices multiple bruises in various stages of healing. The nurse's most appropriate action would be to: a) call the authorities. b) report her findings to the primary care provider. c) document findings. d) send the client to the women's shelter.

c) document findings. Nurses serve their clients best not by trying to rescue them but by helping them build on their strengths and providing support. The first step is to document the findings and then alert others. Using a screening tool like "RADAR" can prove beneficial in assessing potential violence. (R: routinely screen every client for abuse; A: affirm feelings and assess abuse; D: document findings; A: assess the client's safety; R: review options and make referrals). Pg. 19

The nurse is organizing health information to teach a client basic principles that will help maintain wellness in the family. Which actions should the nurse prioritize in this teaching? a) assisting in understanding a treatment b) teaching insulin injection techniques c) encouraging yearly checkups for all clients. d) medication administration

c) encouraging yearly checkups for all clients. The current movement in health care is to focus on health promotion and thereby prevent future illness and diseases. Encouraging yearly checkups would assist with finding problems before they become serious. Prevention, treatment, and rehabilitation are all processes of care. Teaching a client how to give injections, administer medication, or understand a treatment would occur after a specific health issue but not prevent these issues from occurring. Pg. 8

The nursing faculty is teaching students about maternal mortality and morbidity rates for black women in the United States, noting that they are often three to four times higher than for white women. This fact can most accurately be contributed to which reason? a) weight gain of 25 lb (11.4 kg) or less b) poor nutrition during the pregnancy c) lack of access to adequate prenatal care d) low socioeconomic status

c) lack of access to adequate prenatal care The maternal mortality and morbidity rates for black women in the United States have been three to four times higher than for non-Hispanic white women. Researchers do not entirely understand what accounts for this disparity but recognize that there are a number of factors that increase the incidence such as lack of prenatal care, obesity, and hypertension during pregnancy. Pg. 10

The nurse working in a free health clinic is providing care to a 1-year-old girl and her single teenage mother. Which action would be most important initially? a) assessing the child's cognitive level b) discussing family health history c) observing the mother/child interaction d) obtaining food stamps for the family

c) observing the mother/child interaction The nurse's initial interactions with the parent and child can provide valuable insights into maternal-child attachment. This information can be used to inform other aspects of the health assessment. This observation is likely to precede formal assessments, such as cognitive assessment and family health history. At this point, it is not known if food stamps are needed. Assessment is the priority. Pg. 15

A group of women are attending a community presentation regarding the leading health concerns of women. Which interventions should the nurse recommend to have the greatest impact on the leading cause of death? a) prompt attention to respiratory tract infections b) regular neurologic exams to note any cognitive or behavioral changes early c) weight control and being knowledgeable about family history of cardiovascular disease d) yearly gynecological exams

c) weight control and being knowledgeable about family history of cardiovascular disease Cardiovascular disease is the leading cause of death of women in the United States. Interventions that address reduction of this risk would be a priority. Elevations in death rates are in part attributed to the difficulty recognizing cardiovascular concerns in women. The second leading cause of death in women is cancer, specifically lung and cervical. Lower respiratory tract infections have increased over recent years as a cause of death in women, but they are not the number one cause. Alzheimer disease, although impacting the mortality rates of women, is not the greatest cause of death. Pg. 12

The pediatric nurse knows that the children being treated are considered minors. Which statement accurately describes the regulations related to consent for medical treatment? a) Children older than age 16 can provide their own consent for, or refusal of, medical procedures. b) When divorce occurs, the parent with whom the child is living on a daily basis will be granted custody of the child. c) A guardian ad litem may be appointed by the parents to serve to protect the child's best interests. d) Parents ultimately are the decision makers regarding medical treatment for their children younger than the age of 18.

d) Parents ultimately are the decision makers regarding medical treatment for their children younger than the age of 18. Parents ultimately are the decision makers for their children. Generally, only persons over the age of majority (18 years of age) can legally provide consent for health care. Minors (children younger than 18 years of age) generally require adult guardians to act on their behalf. Biological or adoptive parents are usually considered to be the child's legal guardian. When divorce occurs, one or both parents may be granted custody of the child. In certain cases (such as child violence or neglect, or during foster care), a guardian ad litem may be appointed by the courts. This person generally serves to protect the child's best interests. Pg. 30

The nurse is caring for a child brought to the emergency department by a babysitter. The child needs an emergency appendectomy and the parents cannot be contacted. What would be the nurse's best response to this situation? a) Document failed attempts to obtain consent to allow emergency care. b) Have the babysitter sign the consent form even if she does not have signed papers to do so. c) Delay medical care until the child's next of kin can be contacted. d) Have the primary care physician for the child sign the consent form.

a) Document failed attempts to obtain consent to allow emergency care. Health care providers can provide emergency treatment to a child without consent if they have made reasonable attempts to contact the child's parent or legal guardian (American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, 2007). If the parent is not available, then the person in charge may give consent for emergency treatment if that person has a signed form from the parent or legal guardian allowing him or her to do so. During an emergency situation, a verbal consent via the telephone may be obtained. In urgent or emergent situations, appropriate medical care never should be delayed or withheld due to an inability to obtain consent. Pg. 30

A nurse is caring for a 31-year-old pregnant client who is subjected to intimate partner violence. The client has developed a feeling of hopelessness and does not feel confident in dealing with the situation at home, which makes her feel suicidal. Which nursing intervention should the nurse offer to help the client deal with her situation? a) Provide emotional support to empower the client to help herself. b) Help the client understand the legal impact of her situation to help protect her. c) Introduce the client to a women's rights group. d) Counsel the client's partner to refrain from subjecting his partner to violence.

a) Provide emotional support to empower the client to help herself. In cases of intimate partner violence, nurses can serve their clients best by not trying to rescue them but by helping them build on their strengths, providing support, and empowering them to help themselves. Counseling the client's partner against violence, helping the client know the legal impact of her situation, and introducing the client to a women's rights group to garner support are not the best ways of serving the client. Pg. 19

A prenatal nurse is developing a plan of care for a Black woman who is at 34 weeks' gestation and visiting the community health clinic for the first time. Which factor would be a priority for the nurse to incorporate into the plan of care? a) the client's socioeconomic status b) the ethnicity of the client c) the client's marital status d) the client's level of formal education

b) the ethnicity of the client In the United States, Black women suffer maternal mortality ratios far higher than any other ethnic group. The risk of maternal mortality has remained about three to four times higher among Black women when compared to white women during the past six decades. Black women had higher degrees of hypertension and lower hemoglobin levels on admission and had presented for prenatal care much later than white women or not at all. The marital status of a client is not as important as her ethnicity. The socioeconomic status is a factor, but the client's ethnicity will give the nurse more background on the potential complications that the ethnicity might bring. Her education is important, but that is not the priority for the nurse at this time. Pg. 19

A nurse has started working at a new clinic that treats local immigrants. Which factor about the clients would be most important for the nurse to acknowledge when caring for them? a) level of enculturation b) language c) differences in culture d) ethnic background

c) differences in culture Although an understanding of the groups ethnicity, language, and level of enculturation may be helpful, it is important for nurses to recognize the various cultural differences among the clients. It is important to recognize their traditions and practices as a point of congruence rather than a potential source of conflict. With today's changing demographic patterns, nurses must be able to assimilate cultural knowledge into their interventions so they can care for culturally diverse women, children, and families. Nurses must be aware of the wide range of cultural traditions, values, and ethics. Cultural competence is the ability to apply knowledge about a client's culture so that the health care provided can be adapted to meet his or her needs. Pg. 19-20

The nurse is reviewing the medical records of several infants. Which infant is at highest risk for death according to the infant mortality rate in the United States? a) An infant born at 38 weeks' gestation b) An infant born to adolescent parents c) An infant born to a 43-year-old mother d) An infant born at a low birth weight

d) An infant born at a low birth weight Infant mortality in the United States is associated with low birth weight, prematurity, and congenital abnormalities, among other concerns. An infant born to young or older parents, or at 38 weeks' gestation, would not be considered low birth weight or premature nor considered to be at higher risk for congenital abnormalities. Pg. 11

An infant at 33 weeks' gestation dies after 1 week of life in the neonatal intensive care unit. This infant's death rate would be classified under which statistical category? a) preterm gestational death b) postneonatal death c) infant death under one month d) neonatal death

d) neonatal death The neonatal death rate is the number of deaths of an infant in the first 28 days of life. Gestational age is not a consideration when reporting deaths of infants. The other categories are not classifications for reporting infant deaths. Pg. 11

A nurse is conducting research in preparation for developing programs to improve maternal and newborn health. The nurse is reviewing statistics revealing the number of infant deaths occurring in the first 28 days of life. The nurse is researching which rate? a) infant mortality rate b) perinatal mortality rate c) fetal mortality rate d) neonatal mortality rate

d) neonatal mortality rate The neonatal mortality rate is the number of infant deaths occurring in the first 28 days of life per 1,000 live births. Fetal mortality rate refers to the spontaneous intrauterine death of a fetus at any time during pregnancy per 1000 live births. Infant mortality rate is the number of deaths occurring in the first 12 months of life. The perinatal mortality rate is the total of the fetal and neonatal mortality rates. Pg. 11

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

d) nuclear The way that families are defined has changed. In years past, the nuclear family was once considered the traditional family structure. However, this structure is now less common due to increased divorce rates and child-rearing by unmarried persons. Pg. 15

The nursing instructor is introducing students to Healthy People 2030, which highlights the major health indicators that need to be addressed. The nurse informs the students that this includes national health goals for maternal, infant, and child health. Which goal(s) would be included? Select all that apply. a) Reduce the rate of fetal deaths at 20 or more weeks of gestation. b) Reduce infant death rates. c) Reduce preterm births. d) Increase the number of scheduled cesarean births. e) Increase infant birth weights. f) Reduce maternal weight gain.

a) Reduce the rate of fetal deaths at 20 or more weeks of gestation. b) Reduce infant death rates. c) Reduce preterm births. e) Increase infant birth weights. The National Health Goals identified by Healthy People 2030 for maternal, infant, and child health are numerous. Some of these include reducing the number of fetal and infant deaths, reducing the incidence of low birth weight, reducing preterm labor, and decreasing the number of cesarean births. Pg. 8

A nurse who specializes in maternal and child health care performs many varied functions in diverse settings over the course of a year. Which action would be outside the nurse's scope of practice? a) Provide preconceptual health care to a client. b) Read a recent journal article on breastfeeding and its benefits for new mothers. c) Assist in the treatment and recovery of a woman with ovarian cancer. d) Discuss methods of alleviating morning sickness with a client in her first trimester.

c) Assist in the treatment and recovery of a woman with ovarian cancer. The primary goal of both maternal and child health nursing can be stated simply as the promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing. Assisting in the treatment and recovery of a woman with ovarian cancer is the least likely function of a nurse specializing in this type of nursing. Preconceptual care, care of a woman during her first trimester, and reading journal articles regarding breastfeeding are all within the scope of practice of maternal and child health nursing. Pg. 13

A healthy client without a primary care provider is exploring the options available for a health care provider to assist with her pregnancy. Which health care provider can the nurse point out as a best option? a) Lay midwife b) Clinical nurse specialist (CNS) c) Certified nurse midwife d) Women's health nurse practitioner (NP)

c) Certified nurse midwife A certified nurse midwife is a nurse with advanced practice training in the care of women, specific to pregnancy and birth. A women's health NP would not be able to deliver the infant. A CNS is an advanced practice role but not specific to the care of pregnancy women. The lay midwife has no formal education. Pg. 6

A nurse is conducting a presentation for a group of pregnant women about appropriate health promotion strategies to address issues related to infant mortality. Which strategy would the nurse encourage to reduce the infant's risk for infection after birth? a) newborn development support groups b) folic acid supplementation c) breastfeeding d) sleeping on the back

c) breastfeeding After birth, other health promotion strategies can significantly improve an infant's health and chances of survival. Breastfeeding has been shown to reduce rates of infection in infants and to improve long-term health. Emphasizing the importance of placing an infant on his or her back to sleep will reduce the incidence of SIDS. Newborn development support groups will help provide education about normal child development and child rearing. Folic acid supplementation is used during pregnancy to prevent neural tube defects. Pg. 11-12

A nurse is providing care to a woman who has just given birth to a healthy newborn. Which action would least likely demonstrate application of the concept of family-centered care? a) encouraging the woman to keep her other children at home b) creating opportunities for the family to make informed decisions c) focusing on the birth as a normal healthy event for the family d) fostering a sense of respect for the mother and the family

a) encouraging the woman to keep her other children at home The philosophy of family-centered care recognizes the family as the constant. Birth is viewed as a normal life event rather than a medical procedure. Family-centered care promotes greater family self-determination, decision-making abilities, control, and self-efficacy, thereby enhancing the client's and family's sense of empowerment. When implementing family-centered care, nurses seek caregiver input; these suggestions and advice are incorporated into the client's plan of care as the nurse counsels and teaches the family appropriate health care interventions. Families are kept together after birth, not separated as in years past. Pg. 6

A nursing instructor is teaching a session investigating infant mortality as a standard measurement of the quality of health care in the country. The instructor determines the session is successful when the students correctly choose which factors as contributing to the high numbers of deaths in the United States? Select all that apply. a) Male gender of infant b) Preterm births c) Congenital deformities and chromosomal abnormalities d) Maternal age 30 to 34 years e) Maternal complications

b) Preterm births c) Congenital deformities and chromosomal abnormalities e) Maternal complications Many factors contribute to the high infant mortality rates in the United States. Some of the most common factors are low gestational age and prematurity, congenital deformities and chromosomal abnormalities, and maternal complications such as cervical insufficiency, multiple births, and premature rupture of membranes. Female infants have lower mortality rates than males, and the best outcomes are in mothers who give birth between 30 and 34 years of age. Pg. 11

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

c) Exhaustion during labor occurred, resulting in death. d) Women giving birth often died from dehydration. During the 17th and 18th centuries, women giving birth often died as a result of severe exhaustion from protracted labor, and they would succumb to dehydration during long labor. Infection was a major cause of death as sepsis during labor and birth was common. Hemorrhages during or after birth were not well controlled. Seizures that happened as a result of untreated high blood pressure and preeclampsia would result in death of the mother. Pg. 4

A nurse is preparing a presentation on current American trends in maternal morbidity and mortality in order to lobby for program funding. Which statements would the nurse include? Select all that apply. a) Each year 100 to 200 women die as a result of birth complications. b) The United States ranks below more than 45 countries in rates of maternal deaths. c) Most pregnancy-related complications women experience are not preventable. d) Most of pregnancy-related complications respond well to proper care. e) The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor, and unsafe abortion (elective termination of pregnancy)

c) Most pregnancy-related complications women experience are not preventable. d) Most of pregnancy-related complications respond well to proper care. e) The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor, and unsafe abortion (elective termination of pregnancy) The United States has approximately 700 to 800 women die each year as a result of pregnancy or a childbirth complication. The United States ranks 48th (in other words, below 47 other countries) in rates of maternal deaths (deaths per 100,000 live births). Most pregnancy-related complications are preventable and respond to proper care. The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor, and unsafe abortion (elective termination of pregnancy). Pg. 10

Before World War II women moved from home to hospital births. What was the primary reason for that shift in maternity care? a) They had no other options as many could not afford midwives. b) They were convinced that setting would provide them with natural birth. c) They were convinced that setting would improve birth outcomes. d) They were convinced that setting would lessen the pain of labor.

c) They were convinced that setting would improve birth outcomes. Prior to World War II, American women moved from home to the hospital for birth in part because they were convinced that setting would improve birth outcomes. Women who labored and gave birth at home were traditionally attended to by relatives and midwives. Many women were attracted to hospitals because this showed affluence and hospitals provided pain management, which was not available in home births. Pg. 5

A pregnant client is to undergo a procedure. Prior to the procedure, a nurse determines that informed consent has been obtained from the client, offering protection for the client based on which principle? a) beneficence b) nonmaleficence c) justice d) autonomy

d) autonomy The purpose of informed consent in health care is to ensure that client autonomy is respected in decisions about the client's health care. The doctrine of informed consent protects clients' rights to voluntary consent or refusal of any medical treatment, procedure, or intervention based on information regarding the risks, benefits, and alternatives of care. This includes the provision of sufficient, evidence-based information to make a decision that reflects self-determination, autonomy, and control. Beneficence, nonmaleficence, and justice are unrelated to informed consent. Pg. 30