NUR 328 Exam 1
A nurse informs a 19-year-old client that she is pregnant. The client immediately states that she plans to have an abortion. What would be the most appropriate response from the nurse to this client? "Are you sure you want to do that?" "I'll put together the information that you will need." "I don't know of any health care providers who will perform them." "Have you notified the father?"
"I'll put together the information that you will need." Rationale: 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.
A preterm newborn is to be discharged home on oxygen therapy and tube feedings. Which statement by the parents would indicate that they need additional teaching and preparation for this transition? "We'll make sure that we have enough feeding solution to get through the weekend." "Our parents are going to take turns helping out at night so that we can get some sleep." "Our insurance company will pay for all the equipment that we need for the treatments." "We know how to check to make sure the feeding tube isn't clogged."
"Our insurance company will pay for all the equipment that we need for the treatments." Rationale: High-risk newborn home care involves all family members working together to provide 24-hour care. Managing supplies, trouble-shooting potential problems, and ensuring support are crucial to providing home care. Parents or caregivers must investigate and then negotiate with insurers for reimbursement of medical equipment and supplies. Insurers do not always cover all items necessary for care.
Infant mortality continues to be a concern. What factor has done the most to reduce infant mortality? Parental education Breastfeeding Hospital births Improved prenatal care
Breastfeeding
A nurse at a prenatal class discusses the evolution of obstetrical care. Which statements would best describe birth in America presently? Select all that apply. Certified nurse midwives (CNMs) assist with births safely in many settings. The United States ranks 15th in the world for infant mortality rates. One in three women in the United States undergoes a surgical birth (cesarean). The infant mortality rate in the United States is approximately 6.17 in 1,000 live births. Primary care providers remain the safest birth attendants for most women.
Certified nurse midwives (CNMs) assist with births safely in many settings., One in three women in the United States undergoes a surgical birth (cesarean)., The infant mortality rate in the United States is approximately 6.17 in 1,000 live births.
When preparing a teaching plan for a group of women during their first pregnancy, the nurse reviews how maternity care has changed over the years. Which information would the nurse include when discussing events occurring in the 20th century? Performance of the first cesarean birth Development of free-standing birthing centers (LDRPs) X-ray developed to assess pelvic size Epidemics of puerperal fever
Development of free-standing birthing centers (LDRPs)
A young mother with an ill child tells the visiting nurse that she belongs to the Christian Scientist religious group and will not seek medical attention for the child. Which statement best reflects the mother's religion's beliefs about health? Healing will come through prayer and spiritual regeneration only. Illness comes from violating dietary restrictions, and no treatment will be sought. Illness is an opportunity to develop the soul with no treatment sought. Fasting will establish health back to normal.
Healing will come through prayer and spiritual regeneration only.
A client, 6 hours post-birth, has a severe postpartum hemorrhage that the health care providers are unable to control. She succumbed to the hemorrhage in the intensive care unit. The client's death would become part of the: maternal mortality rate. neonatal mortality rate. neonatal morbidity rate. maternal morbidity rate.
Maternal mortality rate.
Childhood morbidity produces a large amount of disability in children. What factor has the highest impact on childhood disability? Living below the poverty level Attending day care Foreign born adoptions Missed days of school
Missed days of school
What nursing intervention by the maternity nurse is the most important in providing family-centered care? Providing early discharge Allowing doulas to attend the woman in labor Promoting uninterrupted infant bonding Allowing siblings in the delivery room
Promoting uninterrupted infant bonding Rationale: Since World War II many changes and innovations have occurred in maternity care and how nurses provide this care. The evolution has gone from task-oriented nursing services, to providing education and promoting breastfeeding, to family-centered care. Promoting uninterrupted infant bonding has been identified as a priority in the development of the family unit. Allowing doulas in the delivery room, having siblings at the bedside and providing early discharge are all parts of family-centered care, but establishing bonding between the infant and the family unit is the priority.
Which statements about the maternal mortality and morbidity rates for black women in the Unites States indicate understanding of the issue? Select all that apply. Black women have a genetic link to high-risk pregnancies. Quality obstetrical health care may not be available in the community. Many black women have low socioeconomic status. Many black women are unmarried when pregnant. Black women often have limited or no health care insurance coverage. Bias among health care providers toward the black population fosters distrust.
Quality obstetrical health care may not be available in the community., Many black women have low socioeconomic status., Black women often have limited or no health care insurance coverage., Bias among health care providers toward the black population fosters distrust.
A nurse is teaching a parenting class about key issues that threaten children's health today. Which statements by the participants would indicate comprehension of those key issues? (Select all that apply.) Unintentional injuries are a leading cause of injury after 1 year of age. Mental health issues for children are not a concern until young adulthood. Childhood obesity is a continuing threat to children's health. The environmental toxin threat to children's health is improving. Allergies are a serious threat to childhood health.
Unintentional injuries are a leading cause of injury after 1 year of age., Childhood obesity is a continuing threat to children's health., Allergies are a serious threat to childhood health. Rationale: Unintentional injuries continue to be the leading cause of death in children greater than 1 year. Obesity, environmental toxins, allergies, and mental health problems are some of the key issues that endanger children's health today.
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. Postpartum hemorrhages were handled proficiently. Infections were not common. Preeclampsia is a concern of 20th century. Women giving birth often died from dehydration. Exhaustion during labor occurred, resulting in death.
Women giving birth often died from dehydration., Exhaustion during labor occurred, resulting in death.
The nurse researcher investigates the morbidity rate in the United States. Which statement accurately reflects this concept? Morbidity measures the prevalence of a specific illness in a population at a particular time. In general, 76% of children in the United States enjoyed excellent health and 27% had very good health in a 2007 report. Morbidity statistics are revised more frequently because of the ease in defining or obtaining the information. Morbidity is presented in rates per 100,000 population.
Morbidity measures the prevalence of a specific illness in a population at a particular time. Rationale: Morbidity is the measure of prevalence of a specific illness in a population at a particular time. It is presented in rates per 1,000 population. Morbidity is often difficult to define and record because the definitions used vary widely. For example, morbidity may be defined as visits to the physician or diagnosis for hospital admission. Also, data may be difficult to obtain. Morbidity statistics are revised less frequently because of the difficulty in defining or obtaining the information. In general, 56% of children in the United States enjoyed excellent health and 27% had very good health as reported in a summary of health statistics for children in 2007.
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. The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor, and unsafe abortion. The United States ranks below more than 45 countries in rates of maternal deaths. Most pregnancy-related complications women experience are not preventable. Each year 100 to 200 women die as a result of birth complications. Most of pregnancy-related complications respond well to proper care.
The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor, and unsafe abortion., The United States ranks below more than 45 countries in rates of maternal deaths., Most of pregnancy-related complications respond well to proper care.
When describing birth during the 18th century, which description would be most accurate regarding maternal care during pregnancy and birth? The majority of births occurred in the home with female midwives in attendance. Heavy doses of narcotics were used during labor. Books on birth education became readily available. Streptococci were identified as the major cause of puerperal fever.
The majority of births occurred in the home with female midwives in attendance. Rationale: During the 18th century (1700s), female midwives attended the majority of births and these births occurred in the home setting. Louis Pasteur demonstrated that streptococci were the major cause of puerperal fever during the 19th century (1800s). The use of twilight sleep, in which heavy doses of narcotics were used during labor, occurred during the early 20th century (1900s). Books on childbirth education also became readily available during the 20th century.
A parent brings a foster child to the clinic for immunizations. What is the first responsibility of the nurse? Obtain authorization to treat Have case worker present Confirm identity with foster agency Verify legal documentation
Verify legal documentation
A chronically ill child attends school regularly. The parents have signed a do not resuscitate (DNR) order for the child and presented it to the school nurse. What action should the school nurse take first? Consult the school's legal team Determine the parents wishes if death should occur at school Involve the school principal Share the information with the child's teacher
Determine the parents wishes if death should occur at school
A nurse is developing a health promotion presentation for a parent group on childhood mortality and morbidity. Which information should the nurse incorporate into the presentation? Select all that apply. Unintentional injury prevention Safe suburban living Single parenting Parenting styles Female gender risks
Unintentional injury prevention, Single parenting, Parenting styles Rationale: Unintentional injury remains a leading cause of mortality and morbidity in children. Risk factors associated with childhood injuries include young age, male gender, low socioeconomic status, parents who are unmarried or single, low maternal education level, poor housing, and low support within the family (i.e., parenting styles).
The nurse is teaching a birthing class to expectant fathers. A father wants to know how he can directly help his partner. How should the nurse respond? Select all that apply. "Be aware that hormonal changes may make your partner have some behavior changes temporarily." "You can be supportive by encouraging your partner during labor." "Learning about the labor process is important for supporting your partner." "Involving yourself in infant care provides for better family bonding." "Providing a back rub helps with pain and provides relaxation."
"Be aware that hormonal changes may make your partner have some behavior changes temporarily.", "You can be supportive by encouraging your partner during labor.", "Involving yourself in infant care provides for better family bonding.", "Providing a back rub helps with pain and provides relaxation." Rationale: Fathers began to be part of the birthing process and postpartum care in the 1970s. It was also during this time that education began to play a larger role in maternity care. Maternity nurses involved themselves in teaching fathers how to be birthing partners, how to be supportive of their partners during labor and during the postpartum period, and how to be more involved in their infant's care to promote bonding. Teaching the father to do simple things like giving back rubs, being positive and supportive during labor and understanding their partners mental health due to the hormonal changes of pregnancy and the postpartum period became important parts of the education. A father could learn about the birthing process to be more educated, but this knowledge only helped the partner indirectly.
A nurse is teaching an 18-year-old client about circumcision care for her second baby. Which statement made by the nurse would be most appropriate to assess the client's learning ability? "Is it difficult having two babies to care for with you being a teenager?" "I note you're having problems with reading the information. Will you tell me about this?" "Since leaving high school, have you been able to find employment?" "Can I help fill out the forms for government financial assistance for your family?"
"I note you're having problems with reading the information. Will you tell me about this?" Rationale: The American Medical Association reports that poor health literacy skills are a stronger predictor of health status than age, income, employment status, education level, or racial or ethnic group. Poor health literacy leads to increased complications and increased mortality. The fact that the client is 18 years old in a low socioeconomic situation are predictors for poor health, but finding out about her literacy level is a priority. The other questions will not get at her literacy ability.
A female client comes to the emergency room with pain in her jaw and neck, being dizzy and feeling so tired she just wants to sit or lie down. What priority nursing intervention(s) should the nurse include in this client's plan of care? Select all that apply. Assess the blood pressure Obtain cardiac enzymes Assess the level of pain Perform an electrocardiogram Insert a peripheral IV
Assess the blood pressure, Obtain cardiac enzymes, Perform an electrocardiogram, Insert a peripheral IV Rationale: Women experience cardiovascular events different from men. Most women never experience the "crushing" chest pain that is associated in a myocardial infarct in men. Women report pain in the jaw, arms or neck. They report unusual fatigue, being dizzy, having indigestion, being anxious, being short of breath and having sleep problems. When women present with these symptoms the priority is to have a cardiac workup to determine if a myocardial infarction (MI) is occurring or has occurred. An electrocardiogram and cardiac enzymes would provide the most accurate information. The vital signs and blood pressure would need to be taken to assess any irregularities, and an IV needs to be established for safety and emergent needs. Pain should be assessed but it is not a priority intervention. Nurses need to explore the risk factors of the female client when a diagnosis is being made. These include menopause, having diabetes, having an increased cholesterol and known left ventricular hypertrophy.
After teaching nursing students about the child health practices in the 1700s and 1800s that led to a high mortality rate, the instructor determines that the teaching was successful when the students make which statements? Select all that apply. It was thought that the main role of a child was to share in the work. The court system viewed children as having many rights. During this period, it was thought that children were easily replaced. Public schools were well established to assist in child health. Childhood epidemics of contagious diseases were a major cause of death. Food sources for children were extremely unsanitary.
It was thought that the main role of a child was to share in the work., During this period, it was thought that children were easily replaced., Childhood epidemics of contagious diseases were a major cause of death., Food sources for children were extremely unsanitary.
The nurse is discharging a 30-week gestation antepartum client with gestational hypertension home for bed rest. Which activities can be managed at home? Select all that apply. Correctoptionfetal ultrasound monitoring Correctoptionblood pressure monitoring Unansweredoptionamniocentesis assessments Unansweredoptionstress test monitoring Correctoptionuterine monitoring
fetal ultrasound monitoring, blood pressure monitoring, uterine monitoring Rationale: The intent is to reduce health care costs and to monitor women with complications of pregnancy in the home rather than in the hospital. Examples of services offered in the home setting might include infusion therapy to treat infections or combat dehydration; hypertension monitoring for women with gestational hypertension; uterine monitoring for mothers who are at high risk for preterm labor; fetal monitoring to evaluate fetal well-being; and portable ultrasound to perform a biophysical profile to assess fetal well-being. Amniocentesis would not be done in the home. Stress test monitoring would be high risk and done on specialty units.
Which are potential capabilities of umbilical cord blood? Select all that apply. It can be used for bone marrow transplants if needed later in the child's life. It can be used to treat inborn errors of metabolism. Transfusion therapies use umbilical cord blood in various treatments. Umbilical cord blood is used for admission laboratory studies in newborns. If a family member develops a disease, umbilical cord blood can be used in treatment.
It can be used for bone marrow transplants if needed later in the child's life., Transfusion therapies use umbilical cord blood in various treatments., Umbilical cord blood is used for admission laboratory studies in newborns., If a family member develops a disease, umbilical cord blood can be used in treatment. Rationale: Umbilical cord blood can be a source of stem cells for an individual in need of a bone marrow transplant later in life. It can also be used for admission laboratory studies in neonates, and also for a transfusions if needed. Stem cells from cord blood cannot currently be used to treat inborn errors of metabolism. Cord blood can be used as an alternative source for bone marrow transplantation.
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? the client's marital status the client's level of formal education the ethnicity of the client the client's socioeconomic status
the ethnicity of the client Rationale: 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.
A prenatal nurse is preparing a presentation for clients on the various roles of a midwife in the management of their maternity care. Which information would the nurse include in the presentation to describe their role? Select all that apply. Midwives do not perform any clinical or medical tasks in their scope of practice. Midwives have a certified designation from accredited bodies identifying their scope of practice. According to their scope of practice, midwives are the primary obstetrical care providers. Midwives have postgraduate training in the care of normal pregnancy and birth. Midwives' scope of practice allows them to assist only in the labor process.
Midwives have a certified designation from accredited bodies identifying their scope of practice., According to their scope of practice, midwives are the primary obstetrical care providers., Midwives have postgraduate training in the care of normal pregnancy and birth. Rationale: A certified nurse midwife has postgraduate training in the care of normal pregnancy and birth and is certified by the American College of Nurse Midwives. Midwives are primary care providers for women with a special emphasis on pregnancy, birth, and reproductive health. They are committed to providing ethical, individualized, evidence-based care for all women throughout their life cycle. A doula is a nonmedical birth companion who provides continuous emotional, physical, and educational support to the woman and family during birth and the postpartum period. Doulas do not perform clinical or medical tasks; they are there to comfort and support the mother and to enhance communication between the mother and medical professionals (DONA International, n. d.).
When utilizing a doula during labor, the client would expect which services to be included? Select all that apply. The doula will provide emotional, physical, and educational support. The doula provides support in the antepartum period only. The doula will act as a nonmedical companion. The doula performs necessary medical tasks. The doula will provide emotional support only.
The doula will provide emotional, physical, and educational support., The doula will act as a nonmedical companion. Rationale: A doula is a nonmedical birth companion who provides continuous emotional, physical, and educational support to the woman and family during childbirth and the postpartum period. Doulas do not perform clinical or medical tasks; they are there to comfort and support the mother and to enhance communication between the mother and medical professionals.