Davis Edge Trends, Issues, and Ethics

he nurse is caring for a client who is deliberating over terminating a severely abnormally developed fetus. Which factors may have influence on the client's decision? Select all that apply. 1. Ideas of morality 2. Spiritual beliefs 3. Cultural practices 4. Societal values 5. Legislative mandates

1, 2, 3

A nurse is attending the birth of a 22-week neonate. At delivery, there are no signs of life. Which are reasons for the healthcare team's decision to withhold treatment? Select all that apply. 1. Parental wishes 2. Ethical standards 3. Neonate prognosis 4. Hospital policy 5. Personal morals

1, 2, 3, 4

A client at 20 weeks gestation presents to the unit reporting contractions every five minutes for two hours. Which intervention would the nurse perform first? 1. Assess for imminence of birth. 2. Assess contraction pattern. 3. Evaluate medical history. 4. Evaluate for pregnancy complications.

1

A client at 38 weeks gestation reports drinking alcohol throughout her pregnancy. Which issue, in addition to fetal alcohol spectrum disorders (FASDs), should the nurse explain that the fetus is at increased risk for? 1. Low birth weight 2. Increased birth weight 3. Poorly developed lungs 4. Spina Bifida

1

A client decision based on the right to self-determination could result in decisions that are not in the best interest of the fetus. Which ethical principle addresses the nurse's support of client decisions? 1. Autonomy 2. Fidelity 3. Justice 4. Beneficence

1

A nurse receives an order to prepare a client who is pregnant with quadruplets for fetal reduction in order to promote a better outcome for the mother and babies. This is this an example of which? 1. Utilitarianism 2. Libertarianism 3. Beneficence 4. Non-Maleficence

1

A past trend of maternal newborn nursing is a hospital post-partum stay of 10 days. Which issue did this put the client at risk for? 1. Deep vein thrombosis (DVT) 2. Pulmonary hypertension 3. Impaired skin integrity 4. Post-partum infection

1

A student nurse asks the nurse to explain the purpose of risk management. How would the nurse respond? 1. To avoid preventable adverse outcomes 2. To guide Evidence-Based Practice 3. To generate plans of care 4. To manage court-ordered treatment

1

The U.S. has a higher rate of premature births compared to other high-income countries. How could this be explained? 1. Increase in induction of labor 2. Increased cesarean rates 3. Increase in obesity of mothers 4. Improved outcomes of premature neonates

1

The nurse in teaching a group of pregnant women. A client asks why cesarean section (C-section) rates in the U.S. have increased since 1996. How would the nurse respond? 1. Increased fetal monitoring 2. Increase in birthrates 3. Increase in home births 4. Improved birthing rooms

1

The nurse is caring for a post-partum client who delivered at 33 weeks. Which classification of preterm birth would the neonate fit into? 1. Moderately premature 2. Very premature 3. Late premature 4. Nonviable

1

The nurse is evaluating declining birthrates of women ages 15 to 19 over the last 4 decades. Which is determined as a cause of this occurrence? 1. An increase in the availability of highly effective contraceptives 2. An increase in obesity in this age group causing infertility 3. An increase incidence of sexually transmitted infections (STI) causing infertility 4. An increase in schools teaching abstinence for pregnancy prevention

1

A client complains to the nurse manager about the incompetent care she received from a nurse and threatens to sue the hospital. The nurse manager will anticipate which defensible nursing action against litigation? 1. Focus on Evidence-Based Practice care 2. Focus on competent care practices 3. Focus on routine facility protocols 4. Focus on the well-being of the patient

4

Upon which is the status of maternal health, community health, and quality healthcare dependent? 1. Maternal mortality 2. Birth rates 3. Infant mortality 4. Total fertility rates

1

Maternity nursing is the most litigious of all practice areas. Which interventions would a nurse utilize to minimize the risks of litigation. Select all that apply. 1. Maintain current knowledge and skills through life-long learning 2. Adhere to facility standards and policies 3. Ensure comprehensive and objective documentation 4. Make patient's well-being the focus of care 5. Utilize applicable evidence-based standards and guidelines

1, 2, 3, 4, 5

A neonatal nurse caring for a newborn suspects fetal alcohol syndrome (FAS). Which assessment findings would the nurse report to the health care provider for early diagnosis and interventions of fetal alcohol syndrome? Select all that apply. 1. Lack of focus 2. Small head 3. Poor coordination 4. Hypoactivity 5. Facial deformity

1, 2, 3, 5

A nurse educator is presenting declining birthrate trends in several countries including the United States at a perinatal class. Which factors selected by the participants indicate that the teaching was successful? Select all that apply. 1. More women choosing to remain child-free 2. Legalization and availability of elective abortions 3. Decreased stigma to single motherhood 4. Rising cost of raising children 5. More teenagers are having children

1, 2, 4

Maternity nurses advocate for both mother and baby. A dilemma the nurse may face is advocating for maternal rights versus fetal rights. Which of the following would this include? Select all that apply. 1. Alcohol use during pregnancy 2. Refusing fetal surgery 3. Induction of anencephalic fetus 4. Drug testing in pregnancy 5. Pre-conception gender selection

1, 2, 4

he nurse is teaching an obese pregnant client about the risks associated with obesity during pregnancy. Which teachings would the nurse include? Select all that apply. 1. Gestational diabetes 2. Preeclampsia 3. Abruptio placenta 4. Sleep apnea 5. Precipitous delivery

1, 2, 4

A nursing student asks about the AWHONN standards of care. The nurse explains the standards of care guide optimal practice. Which responses are included in the standards of care. Select all that apply. 1. Assessment 2. Evaluation 3. Risk management 4. Diversity 5. Implementation

1, 2, 5

Maternity nurses are more likely to face litigation than other areas of nursing. Which scenarios listed below exemplify errors in clinical judgement? Select all that apply. 1. Failure to recognize deteriorating fetal status 2. Failure to check for imminence of delivery 3. Failure to have client sign admission paperwork 4. Failure to therapeutically communicate with client 5. Failure to communicate status of client to provider

1, 2, 5

A nurse caring for a laboring client strives to decrease the risk of exposure to liability. Which common malpractice allegations would the nurse guard against? Select all that apply. 1. Failure to accurately assess maternal and fetal status 2. Failure to heed the medical suggestions of the doula 3. Failure to treat an abnormal or indeterminate fetal heart rate (FHR) 4. Failure to correctly communicate maternal/fetal status to the family 5. Failure to institute the chain of command when there is a clinical disagreement

1, 3, 5

A teen mom is in the clinic for her prenatal intake assessment. Which assessment data would indicate that the client is at increased risk for complications during and following this pregnancy? Select all that apply. 1. Age: 16 2. Housing: lives with parents 3. Father: also 16 4. Weight: 240 lbs 5. Occupation: unemployed

1, 4

A nurse is assessing a newborn of a client who smoked during pregnancy to determine the Apgar score. Which assessment findings would the nurse associate with maternal smoking during pregnancy? Select all that apply. 1. Premature birth 2. Still birth or miscarriage 3. Sudden infant death syndrome 4. Low birth weight 5. Respiratory problems

1, 4, 5

A client in active labor has progressed to the second stage of labor. Allowing the mother to initiate spontaneous pushing is one of the quality measures set by the: 1. ANA 2. AWHONN 3. EBP 4. AHRQ

2

A nurse is developing a prenatal course and reviews articles of Randomizing Control Trials (RCT) to prepare. RCT are an example of which level of evidence? 1. Lowest 2. Highest 3. Moderate 4. Minimal

2

A nurse is explaining Body Mass Index (BMI) to clients at a preconception class. Which BMI selected by a client as normal for optimal conception indicates that learning has occurred? 1. Less than 18.5 2. 18.5 to 24.9 3. 25 to 29.9 4. More than 30

2

A nurse was presenting problems of health disparity at a conference. Which population experiences the greatest health disparity? 1. Hispanic 2. Black 3. Asian 4. White

2

A teen mother gives birth to a premature low birth weight (LBW) neonate. She asks the nurse why her baby is so small. Which risk factor contributed the most to the low birth weight? 1. Teen pregnancy 2. Smoking tobacco 3. Using illicit drugs 4. Obesity

2

The fetal heart rate (FHR) tracing records 90 beats per minute without absent baseline variability. Which FHR classification will the nurse interpret for this tracing? 1. Category I (normal) 2. Category II (indeterminate) 3. Category III (abnormal) 4. Category IV (subnormal)

2

The husband of a laboring client is insisting on a cesarean birth. The primary advocacy role of the nurse will be for which client? 1. Father 2. Mother 3. Fetus 4. Family

2

The nurse caring for a laboring client reassures the client that her pain will be effectively managed. Which ethical principle would the nurse utilize to accomplish the pain management intervention? 1. Autonomy 2. Fidelity 3. Veracity 4. Beneficence

2

The nurse is assessing a neonate born before term. Which is the correct classification of preterm birth? 1. Neonate born at less than 20 weeks of gestation 2. Neonate born at less than 32 weeks of gestation 3. Neonate born at 38 weeks of gestation 4. Neonate born at 41 weeks of gestation

2

The nurse is mentoring a nursing student. The student asks about the leading cause of infant death. How would the nurse respond? 1. Disorders related to short gestation and low birth weight 2. Congenital malformations and chromosomal abnormalities 3. Newborn affected by maternal complications of pregnancy 4. Newborns affected by complications of placenta, cord, and membranes

2

A nurse is providing health teaching to a group of teenagers about the long-term effects teen pregnancies and births may have on the mothers and the family. Which effects will the nurse include as an effect on the children of teen mothers? Select all that apply. 1. Health problems related to high birth weight 2. High mortality rates 3. Behavioral problems 4. Placement in group homes 5. Lower school achievement

2, 3, 5

The Jonsen Model is a systematic approach to analyzing clinical ethics to help healthcare providers reach an ethical decision. Place the four topics of Jonsen's model in the correct order. 1 Contextual features 2 Medical indications 3 Quality of life 4 Patient preferences

2, 4, 3, 1

A nurse is caring for an obese, 12-week-pregnant client with a history of hypertension. Which priority childhood problem would the nurse associate with adverse effects of the client's obesity? 1. Childhood diabetes 2. Childhood hypertension 3. Childhood obesity 4. Childhood hyperthyroidism

3

A nurse is discussing infant morbidity and mortality with a student nurse. Which statement by the student nurse would indicate understanding of infant mortality? 1. "Infant mortality is death at birth." 2. "Infant mortality is death before birth." 3. "Infant mortality is death before the first birthday." 4. "Infant mortality is death before the first month."

3

A nurse manager is planning shift assignments with inadequate staffing. Based on the nurse's level of competence, which ethical approach principle will guide the manager's efforts? 1. Libertarianism 2. Egalitarianism 3. Utilitarianism 4. Patrialianism

3

A perinatal nurse educator is presenting information on infant death prevention strategies at a prenatal class. Which prevention strategy from the participants indicates the class session met the learning outcome? 1. More normal birth weight infants 2. Increased breastfeeding trend 3. Back to sleep campaign 4. More babies born at full term

3

A pregnant client is about to undergo an elective abortion. She has consented to the harvesting of fetal tissue. The nurse notifies the manager that she finds the harvesting morally wrong. Which is the manager's best response? 1. "I'm sorry you feel that way, you still have to assist." 2. "This is about the client, not your judgement." 3. "I will have another nurse assist with the procedure." 4. "I agree with you, harvesting fetal tissue is wrong."

3

A pregnant teen is being treated for a sexually transmitted infection. Which STI can cause neonatal blindness and death? 1. Chlamydia 2. Gonorrhea 3. Syphilis 4. HIV

3

An outcome of Healthy People 2020 is to "increase abstinence from alcohol among pregnant women." Which pregnant client would be at the highest risk for alcohol use? 1. A 19-year-old African American 2. A 24-year-old Hispanic 3. A 30-year-old Caucasian 4. A 17-year-old Pacific Islander

3

During a prenatal intake a client admits to smoking marijuana daily. The nurse's only option, while functioning as an advocate, is to: 1. Report her substance abuse to the police department 2. Have the patient committed to a substance abuse center 3. Encourage the client to stop and provide information for recovery 4. Report the client to the public health department

3

The nurse educator is planning education for the nursing staff on the application of evidence- based practice into patient care. Which level of evidence will the nurse educator consider as the gold standard? 1. Unsystematic clinical observations 2. Expert opinions 3. Randomized controlled trial (RCT) 4. Controlled cohort studies

3

The nurse is caring for a 19-year-old primigravida who has no health insurance or support system. Which ethical principle guides the nurse to provide the same care to this client as other clients on the unit? 1. Autonomy 2. Fidelity 3. Justice 4. Beneficence

3

The nurse is caring for a pregnant teenage client who is abusing drugs. Which ethical principle will the nurse consider when planning the client's educational activity on the consequences of drug abuse during pregnancy? 1. Autonomy 2. Justice 3. Nonmaleficence 4. Veracity

3

The nurse educator is assessing nurses' integration of best research evidences in practice. Which assessment findings would the nurses associate with barriers to implementation of EBP in nursing practice? 1. Difficulty in judging the quality of research reports 2. Insufficient time at work place to implement changes in practice 3. Inadequate mentoring by nurses who have adequate EBP experience 4. Inadequate support from nurse managers who embrace EBP 5. Insufficient time to conduct EBP

3, 4

A nurse overhears a primigravida telling her friend that her newborn is underweight. Which does the nurse recall as normal birth weight? 1. 4000 grams and above 2. 1,000 to 1,499 grams 3. 1,500 to 2,499 grams 4. 2,500 to 3,999 grams

4

Providing encouragement to stop drinking alcohol to a prenatal client is an example of which ethical dilemma? 1. Non-maleficence 2. Fidelity 3. Veracity 4. Autonomy

4

The ANA code of ethics applies to all nurses. Which is a function of the code of ethics? 1. To establish a moral standard for the profession 2. To hold nurses accountable for responsibilities 3. To distribute resources according to need 4. To be a resource for nurses facing ethical dilemma

4

The nurse asks for clarification regarding malpractice insurance at a conference. Which concept will the facilitator most likely address regarding malpractice litigation? 1. Scope of practice 2. Qualified licensure 3. Rapport with patient 4. Evidence-Based Practice

4

The nurse is caring for a client who has been laboring for several hours. The client asks the nurse about the possibility and risks of cesarean delivery. Which ethical principle guides the nurse's response? 1. Beneficence 2. Nonmaleficence 3. Fidelity 4. Veracity

4

The nurse is caring for two clients in their 40s who are pregnant for the first time. Which is the anticipated assessment finding for the trend in birthrate related to the client's age and time of first delivery? 1. Birthrate has increased for women over 40, due to the availability of contraceptives. 2. Birthrate has decreased for women over 40 years, due to delayed childbirth over career. 3. Birthrate has decreased for women over 40 years, due to availability of contraceptives. 4. Birthrate has increased for women over 40 years, due to delayed childbirth over career.

4