Chapter 1
In 2007 the World Factbook published statistics that showed the United States still lagged behind other industrialized nations in the incidence of infant mortality. What is one reason that the United States has a higher infant mortality rate than other countries?
Low birth weight
A pregnant client comes to the local health clinic for her scheduled prenatal visit. On her chart, the nurse notices that the client indicated that she resides in an extended family situation. Which arrangement would validate this information?
She lives with her grandmother, her uncle, her mother and her younger sister.
To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups?
Teach injury prevention and proper safety practices.
Consent for urgent treatment is needed for a minor. The parents are unable to be at the hospital. What action by the nurse constitutes informed consent?
Telephone consent with two witnesses listening simultaneously
What major developments greatly influenced the way maternity care is practiced in the United States over the last century?
Development of anesthesia and acceptance of the germ theory
In an effort to improve the health status of women and their children several national campaigns have been implemented. The campaign that reduced the incidence of Sudden Infant Death (SIDS) by 50% was called what?
Back to Sleep Campaign
A nurse counsels a 14-year-old girl on the risks of teenage birth and on methods of contraception. The nurse recognizes that provision of sex education to adolescents have had a positive influence on which measurememt in the past 10 years in the United States?
Birth rate
After hearing of a lawsuit being filed by a patient against another nurse, a nurse becomes concerned about her own potential liability in working with premature infants at high risk for morbidity and mortality. Which action is most essential for the nurse to take to protect herself in the event of litigation?
Carefully documenting every intervention she makes with a patient
You are discussing health care provider options with a patient. She indicates she felt her doctor was too busy for her during her last pregnancy and wants to know what her options are for receiving care during her current pregnancy and for labor and delivery. Which option could the nurse suggest to this patient?
Certified nurse midwife
Morbidity data indicate that support is needed from pediatric nursing groups to establish improved and additional services for children with what health issues?
Mental health and behavioral disorders
An important change in maternal and child health care that nurses must often explain is the new emphasis on ambulatory care. The goal of this change in emphasis is meant to achieve which outcome?
Minimize the separation of children from their parents
A 33-week gestation infant dies after 1 week of life in the Neonatal Intensive Care Unit. This infant's death rate would be classified under which statistical category?
Neonatal death
A new single mother is sharing her concerns about the cost of daycare with her nurse. She is new to the area. The nurse recognizes that which trends are likely contributing to this patient's concerns? (Select all that apply.)
• Fewer extended family members to help care for a child • Ninety percent of women working outside the home • The increase in the number of single parent families • The increased tendency for families to move from one part of the country to another
A nursing group is examining their hospital's maternal outcomes for the previous 5 years. Which identified factors have contributed to the decline in the maternal mortality rate? Select all that apply.
• Increased participation of women in prenatal care • Use of ultrasound to detect disorders • Better management of hemorrhage and infection • Closer monitoring for complications associated with hypertension of pregnancy
Which of the following are areas of leading health indicators in the Healthy People initiative? Select all that apply.
• Obesity and overweight • Physical activity • Injury and violence • Immunization
The development of what medical treatment was most influential in moving birth from the home into the hospital?
Anesthesia and analgesic therapy
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?
"I'll put together the information that you will need."
A nurse is determining whether or not informed consent has been obtained from the family of a child who is going to have abdominal surgery. Which statement by the family would lead the nurse to suspect that informed consent is lacking?
"We had to sign the form right away so the surgery could get scheduled."
The physician most likely to provide care to a pregnant woman during her prenatal period and her labor/delivery is what type of physician?
Obstetrician
A client tells the nurse that she is getting divorced and wants to be sure that her soon-to-be ex-husband cannot have access to her medical information. Which response would be the most accurate for the nurse to give the client?
"You have the right to say who can access your health records and who cannot."
A client who has just given birth is concerned about the high rate of infant mortality in the United States. She is anxious about the health of her child and wants to know ways to keep her baby healthy. Which recommendation would best meet this goal?
Breastfeed the infant
The nurse is caring for a 5-year-old Hispanic boy and his family. Which action best demonstrates cultural competence?
Coordinating care through the mother
The school nurse is caring for several children who witnessed an accident in which an 8-year-old girl was struck by a car on the way to school. Which is the most important first step in developing the nursing care plan for these children?
Determining whether the children were traumatized by the accident
Morbidity rates among children are most highly associated with which cause?
Environmental factors
The nurse is caring for a client with end-stage breast cancer. When the nurse takes chemotherapy medication into the client's room, the client states, "I'm too tired to fight any more. I don't want any more medication that may prolong my life." The client's husband is at the bedside and states, "No! You have to give my wife her medication. I can't let her go." What action by the nurse is most appropriate?
Explain to the husband that his wife has the right to refuse medication and care
In an attempt to control Medicare costs, the government developed a system that predetermines rates to be paid to the health care provider. The rates are paid regardless of the costs that the health care provider actually incurs. What is this system called?
Prospective payment system
A nurse is caring for a 31-year-old pregnant client who is subjected to abuse by her partner. 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?
Provide emotional support to empower the client to help herself
The pediatric nurse knows that the state of children's health in the United States is evaluated by specific determinants and measures of health status. These determinants include:
Race and ethnicity
The nurse is talking with the mother of a 2-year-old girl during a scheduled visit. Which teaching subject best supports the emphasis on preventive care?
Showing the mother how to teach hand washing to her child
The line at the well-child walk-in clinic is long, with closing time near. Which child does the nurse assess based on knowledge of morbidity data?
The foreign-born adopted child
The nurse is caring for a pregnant Arab American woman. Which statement most accurately describes the client's potential health care beliefs?
The husband makes all the healthcare decisions for the wife
Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because
increasing numbers of children live with chronic disabilities due to advances in healthcare that allow children with formerly fatal diseases to survive.
A nurse is considering employment in a practice that promotes family-centered care. When considering this position, the nurse recognizes that this philosophy will:
promote the involvement of the child and parents as members of the health care team
A 15-year-old with leukemia tells the nurse that she wants to file for emancipation in order to control her own treatment plan. The nurse explains the process by stating: Select all that apply.
• The process is governed by individual state laws. • The minor must be at least 14 years of age. • The minor must demonstrate the ability to manage financial affairs.
A national campaign to improve the health of the people in the United States has as one of its goals to "eliminate health disparities". What is the name of this national campaign?
Healthy People 2010
When communicating with a client who speaks a different language, the best practice for the nurse is to:
Arrange for an interpreter when communicating with the client.
The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role?
Facilitating return to school by working with the school nurse
In order to advocate for children and families, the nurse must first acknowledge that the basic system in which health behavior and care are organized, secured, and performed is the:
Family
What makes the area of family nursing a difficult arena to provide care at times?
Family members who might not agree on treatments and a plan of care
Which of the following is a trend in child health care today?
Health promotion rather than health restoration is stressed.
Which statement best describes the pattern of maternal mortality since World War II?
It has steadily decreased.
You are going to provide an education program to early grade-school children. Which of the following topics would address the number one cause of death for this age group?
The importance of crossing streets safely
When describing childbirth during the 18th century, which description would be most accurate regarding maternal care during pregnancy and delivery?
The majority of births occurred in the home with female midwives in attendance.
The nurse is caring for a Hispanic client who is in labor. The client appears to closely follow traditional cultural behaviors. Which behavior would most likely to be noted by the nurse?
The woman reports a desire to have her extended family present during the labor and delivery.
In 1965 Medicaid, a federally funded program, was initiated. It supplied block grants to states to provide health care to those who have low income and who meet other state-determined eligibility criteria. What federal mandate was Medicaid created under?
Title XIX of the Social Security Act
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?
Weight control and being knowledgeable about family history of cardiovascular disease
A nurse who specializes in maternal and child health care performs many varied functions in diverse settings over the course of a year. Which of the following would she be least likely to do, as it would be outside her scope of practice?
Assist in the treatment and recovery of a woman with ovarian cancer
A nurse is speaking with a patient who has just learned that she is pregnant with her first child. The nurse reads in the patient's chart that she does not drink alcohol on a regular basis. However, the nurse decides to go ahead and warn the patient about the dangers of drinking alcohol while pregnant. Which phase of health care would this action be classified as?
Health promotion
An expectant mother has arranged for her massage therapist to provide gentle hand, arm, and neck massage for the patient while she is in labor in the hospital. Which trend in today's health care environment is most related to this arrangement?
Increasing use of alternative treatment modalities
A group of nurses are discussing the most recent statistics on death due to prematurity in the United States. Which action, if implemented, would have the greatest impact on improving outcomes?
Improve women's access to receiving prenatal care
A research 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:
Improved prenatal care has reduced the numbers of fetal deaths.
A program designed to decrease the infant mortality rate in the United States would probably make the greatest impact if it focused on which aspect of care?
Increasing the number of women receiving prenatal care
A nurse working in a pediatrician's office has requested that a generic brand of cotton swabs be ordered in place of a more expensive brand name. Which trend in today's health care environment is most related to this nurse's action?
Initiating cost containment
When providing care to a child, which aspect would be most important for the nurse to consider related to informed consent?
Knowing the laws in the state where care is being provided
An expectant mother states that she read that more African-American infants than white infants die before they are 1 year old. In response to her questions about the reasons for this, the nurse accurately responds that the major reason for the high infant mortality rate is:
Lack of prenatal care
The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained?
Learning the mother is not the custodial parent
The nurse is updating the records of a 10-year-old boy who had his appendix removed. Which action could jeopardize the privacy of the child's medical records?
Letting another nurse use the nurse's log-in session
A nurse has just assisted in the delivery of a premature neonate. She recognizes that which factor, when associated with prematurity, is a leading cause of death in neonates?
Low birth weight
A nurse is caring for a critically ill female client who has recently been diagnosed with advanced lung cancer. The family asks the nurse why their mother's cancer is so advanced and was not detected earlier. Which response would be most accurate and appropriate?
Lung cancer has few early symptoms and is often explained away as some other minor illness.
A nurse is caring for a client who wishes to undergo an abortion. The nurse has concerns because abortion is against her personal convictions, and this is interfering with her professional duty. Which action should the nurse take to follow American Nurses Association's (ANA) code of ethics for nurses?
Make arrangements for alternate care providers