maternal newborn trends and issues

19. A nurse is caring for a single teen mother who has just given birth to her first child. The patient notes that the child's father "wants no relationship with his son." The patient goes on to express concerns about the short- and long-term impact of her teen pregnancy on herself and on her child. Which statements made by the nurse are accurate? Select all that apply. 1. "You are more likely than others to have additional children before you turn 20." 2. "You may have difficulty completing high school or college." 3. "Your child is less likely to experience behavioral problems." 4. "Your child is at increased risk of abusing alcohol when he is a teenager." 5. "You may not earn enough money to independently support yourself and your child."

ANS: 1, 2, 4 1 This is correct. Teen mothers are more likely to have additional children than their peers. Roughly 17% of all teen mothers will have at least one more birth before the age of 20. 2 This is correct. Only half of teen mothers earn their high school diploma by age 22. Less than 2% of teen mothers finish college by age 30. 3 This is incorrect. Children of teen mothers are more likely to experience behavioral problems. 4 This is correct. Teenage males without an involved father have a higher risk of abusing alcohol or drugs. 5 This is correct. Around one-fourth of teen mothers begin receiving welfare within 3 years of the birth of their first child. 66% of teen mothers are poor.

17. An infant was recently born weighing 1,498 grams. The nurse understands that the birth weight of this infant is an important indicator of what? Select all that apply. 1. Morbidity rate 2. Prenatal care 3. Mortality rate 4. Infant health outcome 5. Postpartum care

ANS: 1, 3, 4 1 This is correct. Morbidity rate is an outcome of low birth weight. 2 This is incorrect. Prenatal care is not an outcome of low birth weight. 3 This is correct. Mortality rate is an outcome of low birth weight. 4 This is correct. Infant health is an outcome of low birth weight. 5 This is incorrect. Postpartum care is not an outcome of low birth weight.

6. The nurse is caring for a 23-year-old patient who arrives at the clinic for a pregnancy test. The test confirms the patient is pregnant. The patient states, "I do not need to stop smoking my electronic cigarette because it will not harm my baby." Which is the best response by the nurse? 1. "You are correct. Electronic cigarettes are not harmful during pregnancy." 2. "Tobacco products, including electronic cigarettes, should not be used during pregnancy due to risking nicotine toxicity." 3. "According to the FDA, although electronic cigarettes are safe for you, they can cause harm to the fetus during pregnancy." 4. "Electronic cigarettes are considered harmful only in the first trimester."

ANS: 2 1 This is incorrect. Electronic cigarettes can be harmful during pregnancy. 2 This is correct. Pregnant women should not use tobacco products or electronic cigarettes during pregnancy. 3 This is incorrect. Electronic cigarettes are not controlled by the FDA and may be harmful to both mother and fetus. 4 This is incorrect. Electronic cigarettes are considered harmful during pregnancy.

4. The nurse is caring for a 14-year-old patient who is 32 weeks pregnant. After complaining of genital sores and discomfort, the patient tests positive for syphilis. The fetus is at increased risk of which condition? 1. Diabetes 2. Blindness 3. Pneumonia 4. Hypertension

ANS: 2 1 This is incorrect. Maternal obesity increases a child's risk of developing childhood obesity and diabetes. 2 This is correct. Neonatal blindness, maternal death, and neonatal death are all associated with a patient who contracts syphilis during pregnancy. 3 This is incorrect. Chlamydial pneumonia is associated with maternal chlamydia. 4 This is incorrect. Teen mothers may have a higher risk of contracting sexually transmitted illnesses and hypertension during pregnancy; however, maternal syphilis is not associated with fetal hypertension.

15. A nursing student is asked to set goals that will decrease the fetal death outcomes during delivery. What guidelines will the nursing student use to assist in setting her goals? 1. WHO Maternal care guidelines 2. Healthy People 2020 3. AWHONN white papers 4. State Practice Act

ANS: 2 1 This is incorrect. The WHO guidelines are too broad for this purpose and the nurse will need to use national goals. 2 This is correct. The national goals for improving maternal and infant health are found in Healthy People 2020. 3 This is incorrect. AWHONN white papers will present positions but not necessarily detail health promotion goals. 4 This is incorrect. State practice acts specify legal requirements rather than health promotion goals.

20. The nurse is caring for a woman who is pregnant. The patient reports that she has also smoked less than five cigarettes per day and that she has continued to smoke during her pregnancy. Routine prenatal examination and diagnostics have indicated she tested negative for sexually transmitted infections and has a BMI of 25. Based on statistics, which is likely true about the patient and the developing fetus? Select all that apply. 1. She will breastfeed her infant. 2. She is probably aged 20-24. 3. She likely has earned a college degree. 4. Her child may have impaired brain development. 5. Her child is more likely to be born prematurely.

ANS: 2, 4, 5 1 This is incorrect. Mother who smoke during pregnancy are less likely to breastfeed their infants. 2 This is correct. Only 4.5% of mothers over 35 smoke during pregnancy, which is the lowest smoking prevalence rate of age ranges listed. Mothers aged 20-24 have the highest prevalence of smoking during pregnancy (13%). 3 This is incorrect. Statistics indicate that mothers with less than a high school diploma have the highest prevalence of smoking during pregnancy (14.1%). Patients with a bachelor's degree or higher have the lowest prevalence of smoking during pregnancy (0.9%). 4 This is correct. Fetal brain development may be impaired when the mother continues to smoke throughout pregnancy. 5 This is correct. Tobacco exposure during development is toxic to developing fetuses. It may contribute to a variety adverse effects, including abruptio placenta and premature birth.

13. A pregnant patient with a BMI of 35 is concerned about health effects she and her baby may face during pregnancy. During routine testing, the patient tested negative for sexually transmitted illnesses (STIs) and indicated that she is in a committed, long-term relationship with the child's father. Which of the following is accurate? 1. The patient's infant is at increased risk of neonatal blindness. 2. The patient's infant has a decreased risk of birth injury. 3. The patient will have increased risk of wound infection. 4. The patient will have a decreased risk of preeclampsia.

ANS: 3 1 This is incorrect. Infants born to mothers with certain sexually transmitted illnesses (STIs) are at increased risk of neonatal blindness. 2 This is incorrect. Infants born to obese pregnant women have increased risk of birth injury related to macrosomia. 3 This is correct. Obese pregnant patients are at increased risk for wound infections. 4 This is incorrect. Obese pregnant patients have an increased risk of developing certain conditions, including gestational diabetes, gestational hypertension, and preeclampsia.

7. The nurse is caring for a 16-year-old patient who is 32 weeks pregnant with her first child, who is male. The patient's mother has accompanied her to today's visit. During the nursing assessment, the patient mentions that she is no longer in a relationship with the baby's father but her mother plans to help her. However, the patient's mother asks whether this will have any impact on the child. Which should the nurse indicate the child is at increased risk of during his adolescence? 1. Hypertension 2. Diabetes 3. Alcohol abuse 4. Intraventricular bleeding

ANS: 3 1 This is incorrect. Teen mothers, rather than their children, are at increased risked of hypertension during pregnancy. 2 This is incorrect. Children born to mothers who are obese have an increased risk of developing childhood obesity and childhood diabetes. 3 This is correct. Statistics have shown that adolescent boys without an involved father may be at higher risk of incarceration, dropping out of school, and abusing drugs or alcohol. 4 This is incorrect. Children born to teen mothers are at increased risk for health problems associated with low birth weight, including intraventricular bleeding

12. The nurse is taking a history of a mother who admits to cocaine drug use. Which action should the nurse take first? 1. Refer the patient to a drug abuse program. 2. Screen the infant for side effects associated with cocaine use. 3. Educate the patient of the risks associated with cocaine use during pregnancy. 4. Advise the patient that her baby will be okay even with the history of cocaine use.

ANS: 3 1 This is incorrect. This is appropriate, but not the first action the nurse should take. 2 This is incorrect. The infant is not screened for side effects of maternal drug use until delivery. 3 This is correct. The patient should be educated on possible risks associated with drug use. 4 This is incorrect. It is not appropriate to tell a patient "your baby will be okay" in any circumstance.

8. The nurse is caring for a patient at 7 weeks gestation. The nurse suspects that a pregnant patient may have been using marijuana. With consent, the nurse confirms via urine drug screen. Which statement by the nurse is most appropriate? 1. "Did you smoke marijuana when pregnant with your other child?" 2. "To avoid negative effects on your baby, you'll need to stop using marijuana during your last trimester." 3. "Using marijuana while pregnant can have a negative effect on the neurological development of your baby." 4. "Marijuana use while pregnant greatly increases your risk of miscarriage."

ANS: 3 1 This is incorrect. Whether or not the woman used marijuana during her previous pregnancy is not relevant to her current care. 2 This is incorrect. Marijuana should not be used at any point during pregnancy. 3 This is correct. Marijuana use during pregnancy may have a negative effect on the neurological development of the fetus. 4 This is incorrect. There currently is no research linking marijuana use to increased risk of miscarriage.

2. A patient with a history of hypertension is giving birth. During delivery, the staff was not able to stabilize the patient's blood pressure. As a result, the patient died shortly after delivery. This is an example of what type of death? 1. Early maternal death 2. Late maternal death 3. Direct obstetric death 4. Indirect obstetric death

ANS: 4 1 This is incorrect. Early maternal death is not an example of maternal death. Examples of maternal death include late maternal death, indirect obstetric death, direct obstetric death, and pregnancy-related death. 2 This is incorrect. Late maternal death occurs 42 days after termination of pregnancy from a direct or indirect obstetric cause. 3 This is incorrect. Direct obstetric death results from complications during pregnancy, labor, birth, and/or postpartum period. 4 This is correct. Indirect obstetric death is caused by a preexisting disease, or a disease that develops during pregnancy.

14. The nurse has made it a goal to increase the rate at which women begin prenatal care in the first trimester. The nurse relates this decision to national goals for better maternal and infant outcomes. What guidelines will the nurse use to guide her maternal health goals? 1. WHO Maternal care guidelines 2. State Practice Acts 3. AWHONN white papers 4. Healthy People 2020

ANS: 4 1 This is incorrect. The WHO guidelines are too broad for this purpose, and the nurse will need to use national goals. 2 This is incorrect. State practice acts specify legal requirements rather than health promotion goals. 3 This is incorrect. AWHONN white papers will present positions but not necessarily detail health promotion goals. 4 This is correct. The national goals for improving maternal and infant health are found in Healthy People 2020.

The nurse is caring for a patient who is in labor with her first child. The patient's mother is present for support and notes that things have changed in the delivery room since she last gave birth in the early 1980s. Which current trend or intervention may the patient's mother find most different? 1. Fetal monitoring throughout labor 2. Postpartum stay of 10 days 3. Expectant partner and family in operating room for cesarean birth 4. Hospital support for breastfeeding

ANS: 4 This is correct. Hospital support for breastfeeding, including a lactation consultant and employment of the Baby-Friendly Hospital Initiative, were both enacted during the early 1990s.

9. The nurse is counseling a female patient about alcohol use during pregnancy. Which statement by the patient demonstrates successful patient teaching? 1. "I will limit my drinking to just one alcoholic beverage per day." 2. "It's best for my baby if I avoid drinking during pregnancy." 3. "An occasional drink on special occasions is okay." 4. "Drinking alcohol is only acceptable in the first trimester."

ANS: 2 1 This is incorrect. Alcohol should not be consumed while pregnant. 2 This is correct. Drinking alcohol while pregnant can cause low birth weight, fetal alcohol syndrome, mental retardation, and intrauterine growth restriction. 3 This is incorrect. Alcohol should not be consumed while pregnant. 4 This is incorrect. Alcohol should not be consumed while pregnant.

3. The nurse is providing education to a patient who has given birth to her first child and is being discharged home. The patient expressed concern regarding infant mortality and sudden infant death syndrome (SIDS). The patient had an uncomplicated pregnancy, labor, and vaginal delivery. She has a body mass index of 25 and has no other health conditions. The infant is healthy and was delivered full-term. What will be most helpful thing to explain to the patient? 1. Uses of extracorporeal membrane oxygenation therapy (ECMO) 2. Uses of exogenous pulmonary surfactant 3. The Baby-Friendly Hospital Initiative 4. The Safe to Sleep campaign

ANS: 4 1 This is incorrect. EMCO has been cited as one of the factors that has reduced infant mortality among preterm infants. 2 This is incorrect. Although advances in medical treatments have decreased infant mortality, exogenous pulmonary surfactant is primarily used to reduce mortality of preterm infants. 3 This is incorrect. The Baby-Friendly Hospital Initiative was developed to support breastfeeding and is not directly linked to reduced infant mortality or SIDS. 4 This is correct. The Back to Sleep campaign and the Safe to Sleep campaigns were designed to promote healthy infant sleeping habits. The decrease in SIDS from 1995 to 2015 was attributed to the Safe to Sleep campaign.

16. A woman has recently given birth to an infant born at 35 weeks and 5 days gestation. What long-term effects should the nurse be concerned about with the infant being born at this gestation? Select all that apply. 1. Cerebral palsy 2. Respiratory disorders 3. Developmental delays 4. Visual impairments 5. Hearing impairments

16. ANS: 1, 2, 3, 4, 5

5. The nurse is caring for a 15-year-old female who is pregnant with her first child. In her previous prenatal visit, the patient tested negative for chlamydia, syphilis, gonorrhea, and HIV. Based on the information provided, which condition is the patient's baby at higher risk for? 1. Intestinal problems 2. Neonatal conjunctivitis 3. Blindness 4. Pneumonia

ANS: 1 1 This is correct. Infants born to teen mothers are at increased risk for various conditions related to prematurity, including infant death, intestinal problems, and/or respiratory distress syndrome. 2 This is incorrect. Infants born to teen mothers who have gonorrhea are at increased risk of neonatal conjunctivitis and blindness. 3 This is incorrect. Infants born to teen mothers with syphilis and gonorrhea are at increased risk of blindness. 4 This is incorrect. Infants born to teen mothers with chlamydia may be at increased risk of developing chlamydial pneumonia.

10. The nurse is educating the pregnant patient with a body mass index (BMI) of 33. The nurse knows that teaching has been effective when the patient states which of the following? 1. "My child may be at increased risk for birth injury." 2. "My child may have a decreased risk of developing childhood diabetes." 3. "I will probably give birth vaginally." 4. "I have a lower risk of developing gestational hypertension."

ANS: 1 1 This is correct. Shoulder dystocia and other birth injuries are associated with infant macrosomia (large size) due to maternal obesity. 2 This is incorrect. Children born to mothers who are obese are at increased risk of developing childhood obesity and diabetes. 3 This is incorrect. Pregnant patients who are obese are at increased risk of cesarean birth. 4 This is incorrect. Pregnant patients who are obese have an increased risk of developing gestational diabetes and gestational hypertension.

11. A pregnant woman weighs 90.9 kg. The nurse is educating the patient on complications that the patient may be at risk for during pregnancy. Which response by the patient indicates that she understands? 1. "Due to my weight, there is a possibility that I may develop gestational diabetes." 2. "I am not overweight, but I am still at risk for gestational diabetes." 3. "My mother had preeclampsia during one of her pregnancies." 4. "I will need to do a glucose tolerance test in my second trimester."

ANS: 1 1 This is correct. The patient is at risk for gestational diabetes due to being obese during pregnancy. 2 This is incorrect. The patient is overweight. 3 This is incorrect. This response is not related to the question. 4 This is incorrect. The patient will need to get the glucose tolerance test in the second trimester, but this response does not relate to the question.

18. The nurse is taking the history of a gravida 2 para 1 patient. Which findings in the patient's history warrant further action? Select all that apply. 1. Anemia 2. Severe hemorrhage 3. Infections 4. Malnutrition 5. Eclampsia

ANS: 1, 2, 3, 5 1 This is correct. Anemia is a primary cause of maternal death. 2 This is correct. Severe hemorrhage is a primary cause of maternal death. 3 This is correct. Infection is a primary cause of maternal death. 4 This is incorrect. Malnutrition is not a primary cause of maternal death. 5 This is correct. Eclampsia is a primary cause of maternal death.