Chapter 1 :Perspective on Maternal , Newborn , and womens health
4.After teaching a group of students about pregnancy-related mortality, the instructor determines that additional teaching is needed when the students identify which condition as a leading cause? A)Hemorrhage B)Embolism C)Obstructed labor D)Infection
Ans: B)Embolism Feedback: Most pregnancy-related complications are preventable. The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor, and unsafe abortion. Embolism is not a leading cause.
9.After teaching nursing students about the basic concepts of family-centered care, the instructor determines that the teaching was successful when the students state which of the following? A)"Childbirth affects the entire family, and relationships will change." B)"Families are not capable of making health care decisions for themselves." C)"Mothers are the family members affected by childbirth." D)"Childbirth is a medical procedure."
Ans: A)"Childbirth affects the entire family, and relationships will change." Feedback: Childbirth affects the entire family, and relationships will change. Childbirth is viewed as a normal life event, not a medical procedure. Families are capable of making health care decisions about their own care with information and support.
14.After teaching a group of students about the concept of maternal mortality, the instructor determines that additional teaching is needed when the student's state which of the following? A)"The rate includes accidental causes for deaths." B)"It addresses pregnancy-related causes." C)"The duration of the pregnancy is not a concern." D)"The time frame is typically for a specified year."
Ans: A)"The rate includes accidental causes for deaths." Feedback: The maternal mortality ratio is the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 live births, for a specified year.
13.A nursing instructor is preparing a class discussion on case management in maternal and newborn health care. Which of the following would the instructor include as a key component? Select all that apply. A)Advocacy B)Coordination C)Communication D)Resource management E)Event managed care
Ans: A)Advocacy B)Coordination C)Communication D)Resource management Feedback: Case management is a continuous process that requires critical thinking about how care is delivered and its effect on the entire care progression of a client. It has at its core the values of care coordination, utilization management and client advocacy across the continuum of care (Smith, 2011). It involves the following components: advocacy, communication, and resource management; client-focused comprehensive care across a continuum; and coordinated care with an interdisciplinary approach.
8.The nurse is trying to get consent to care for an 11-year-old boy with diabetic ketoacidosis. His parents are out of town on vacation, and the child is staying with a neighbor. Which action would be the priority? A)Getting telephone consent with two people listening to the verbal consent B)Providing emergency care without parental consent C)Contacting the child's aunt or uncle to obtain their consent D)Advocating for termination of parental rights for this situation
Ans: A)Getting telephone consent with two people listening to the verbal consent Feedback: The priority action would be to contact the neighbor for an emergency number to reach the parents and get their verbal consent with two witnesses listening simultaneously. If the nurse cannot reach the parents, and there is no relative or other person with written authorization to act on the parent's behalf, then the physician may initiate emergency care without the parents' consent. Advocating for terminating parental rights would be inappropriate.
7.After teaching a group of nursing students about the issue of informed consent. Which of the following, if identified by the student, would indicate an understanding of a violation of informed consent? A)Performing a procedure on a 15-year-old without consent B)Serving as a witness to the signature process C)Asking whether the client understands what she is signing D)Getting verbal consent over the phone for emergency procedures
Ans: A)Performing a procedure on a 15-year-old without consent Feedback: In most states, only clients over the age of 18 can legally provide consent for health care. Serving as a witness to the signature process, asking whether the client understands what she is signing, and getting verbal consent over the phone for emergency procedures are all key to informed consent and are not violations.
19.A group of students are reviewing an article describing information related to indicators for women's health and the results of a national study. Which of the following would the students identify as being satisfactory for women? Select all that apply. A)Smoking cessation B)Colorectal cancer screening C)Violence against women D)Health insurance coverage E)Mammograms
Ans: B, E Feedback: In the 2010 National Report Card, the nation met three benchmarks since 2007: colorectal cancer screening, annual dental visit, and mammograms. All other areas were considered unsatisfactory.
15.A group of students are reviewing the historical aspects about childbirth. The students demonstrate understanding of the information when they identify the use of twilight sleep as a key event during which time frame? A)1700s B)1800s C)1900s D)2000s
Ans: C)1900s Feedback: Twilight sleep, or the use of a heavy dose of narcotics and amnesiacs, was used on women during childbirth 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 childbirth classes characterize the 2000s.
12.A nurse is developing a plan of care for a woman to ensure continuity of care during pregnancy, labor, and childbirth. Which of the following would be most important for the nurse to incorporate into that plan? A)Adhering to strict, specific routines B)Involving a pediatric physician C)Educating the client about the importance of a support person D)Assigning several nurses as a support team
Ans: C)Educating the client about the importance of a support person Feedback: Educating the client about the importance of a support person during labor and delivery has been shown to improve and enhance the birthing experience.
16.A nurse is providing care to a woman who has just delivered a healthy newborn. Which action would least likely demonstrate application of the concept of family-centered care? A)Focusing on the birth as a normal healthy event for the family B)Creating opportunities for the family to make informed decisions C)Encouraging the woman to keep her other children at home D)Fostering a sense of respect for the mother and the family
Ans: C)Encouraging the woman to keep her other children at home Feedback: 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 teach the family appropriate health care interventions. Families are kept together after childbirth, not separated as in years past.
18.A nurse is preparing a presentation for a local community group about health status and children's health. Which of the following would the nurse include as one of the most significant measures? A)Fetal mortality rate B)Neonatal mortality rate C)Infant mortality rate D)Maternal mortality rate
Ans: C)Infant mortality rate Feedback: The infant mortality rate is used as an index of the general health of a country. Generally, this statistic is one of the most significant measures of children's health.
20.A nurse is preparing a presentation for a local women's group about heart disease and women. Which of the following would the nurse expect to address when discussing measures to promote health. A)Women have similar symptoms as men for a heart attack. B)Heart disease is no longer viewed as a "man's disease." C)Women experiencing a heart attack are at greater risk for dying. D)Heart attacks in women are more easily diagnosed.
Ans: C)Women experiencing a heart attack are at greater risk for dying. Feedback: Women who have a heart attack are more likely than men to die. Heart attacks in women are often more difficult to diagnose than in men because of their vague and varied symptoms. Heart disease is still thought of as a "man's disease," and thus a heart attack may not be considered in the differential diagnosis when a woman presents to the emergency room. Nurses need to look beyond the obvious "crushing chest pain" textbook symptom that heralds a heart attack in men. Manifestations of heart disease differ between men and women.
10.A nursing instructor is preparing a class discussion on the trends in health care and health care delivery over the past several centuries. When discussing the changes during the past century, which of the following would the instructor be least likely to include? A)Disease prevention B)Health promotion C)Wellness D)Analysis of morbidity and mortality
Ans: D)Analysis of morbidity and mortality Feedback: The focus on health has shifted to disease prevention, health promotion, and wellness. In the last century, much of the focus was on analyzing morbidity and mortality rates.
11.A nurse is assigned to care for an Asian American client. The nurse develops a plan of care with the understanding that based on this client's cultural background, the client most likely views illness as which of the following? A)Caused by supernatural forces. B)A punishment for sins. C)Due to spirits or demons. D)From an imbalance of yin and yang
Ans: D)From an imbalance of yin and yang Feedback: Asian Americans believe that illness is caused by an imbalance of yin and yang. Native Americans believe that illness is caused by supernatural forces, and African Americans may believe that illness is caused by spirits or demons.
22. A group of nursing students is reviewing information about factors affecting maternal, newborn, and women's health. The students demonstrate an understanding of the information when they identify which of the following deficiencies as being associated with poverty? Select all that apply. A)Literacy B) Employment opportunities C) Mobility D) Political representation E) Skills
Ans: A)Literacy B) Employment opportunities C) Mobility D) Political representation E) Skills Feedback: Poverty, particularly for women, is more than monetary deficiency. Women continue to lag behind men in control of cash, credit, and collateral. Other forms of impoverishment may include deficiencies in literacy, education, skills, employment opportunities, mobility, and political representation, as well as pressures on time and energy linked to their responsibilities.
21.A nurse is working to develop a health education program for a local community to address breast cancer awareness. Which of the following would the nurse expect to include when describing this problem to the group? Select all that apply. A)White women have higher rates of breast cancer than African American women. B)African American women are more likely to die from breast cancer at any age. C)Survival at any stage is worse among white women. D)Women living in South America have the highest rates of breast cancer. E)Breast cancer is the leading cause of cancer mortality in women.
Ans: A)White women have higher rates of breast cancer than African American women. B)African American women are more likely to die from breast cancer at any age. Feedback: White women get breast cancer at a higher rate than African American women, but African American women are more likely to get breast cancer before they are 40, and are more likely to die from it at any age. This is likely because the cancer is more advanced when it is found in African American women, and because survival at every cancer stage is worse among African American women. Women living in North America have the highest rate of breast cancer in the world. At this time there are about 2.6 million breast cancer survivors in the United States. It is the most common malignancy in women and second only to lung cancer as a cause of cancer mortality in women.
5.The nurse is working with a group of community health members to develop a plan to address the special health needs of women. Which of the following conditions would the group address as the major problem? A)Smoking B)Heart disease C)Diabetes D)Cancer
Ans: B)Heart disease Feedback: The group needs to address cardiovascular disease, the number one cause of death in women regardless of racial or ethnic group. Smoking is related to heart disease and the development of cancer. However, heart disease and cancer can occur in any woman regardless of her smoking history. Cancer is the second leading cause of death, with women having a one in three lifetime risk of developing cancer. Diabetes is another important health condition that can affect women. However, it is not the major health problem that heart disease is.
17.When discussing fetal mortality with a group of students, a nurse addresses maternal factors. Which of the following would the nurse most likely include? Select all that apply. A)Chromosomal abnormalities B)Malnutrition C)Preterm cervical dilation D)Underlying disease condition E)Poor placental attachment
Ans: B)Malnutrition C)Preterm cervical dilation D)Underlying disease condition Feedback: Fetal mortality may be attributable to maternal factors (e.g., malnutrition, disease, or preterm cervical dilation) or fetal factors (e.g., chromosomal abnormalities or poor placental attachment).
The United States ranks 50th in the world for maternal mortality and 41st among industrialized nations for infant mortality rate. When developing programs to assist in decreasing these rates, which factor would most likely need to be addressed as having the greatest impact? A)Resolving all language and cultural differences B)Assuring early and adequate prenatal care C)Providing more extensive women's shelters D)Encouraging all women to eat a balanced diet
Ans: B. Assuring early and adequate prenatal care Feedback: The lack of prenatal care during pregnancy is a major contributing factor to a poor outcome. Prenatal care is well known to prevent complications of pregnancy and to support the birth of healthy infants. Infant mortality commonly includes problems occurring at birth or shortly thereafter. Thus, assuring early and adequate prenatal care would have the greatest impact on decreasing these rates. Resolving all language and cultural differences would be helpful, but it is unrealistic. Providing more extensive women's shelters would be helpful for those women who are victims of abuse. Encouraging women to eat balanced diets helps, but does not prevent genetic factors that could be detected by ensuring early and adequate prenatal care.
2.When integrating the principles of family-centered care, the nurse would include which of the following? A)Childbirth is viewed as a procedural event B)Families are unable to make informed choices C)Childbirth results in changes in relationships D)Families require little information to make appropriate decisions
Ans: C)Childbirth results in changes in relationships Feedback: Family-centered care is based on the following principles: Childbirth affects the entire family, and relationships will change; childbirth is viewed as a normal, healthy event in the life of the family; and families are capable of making decisions about their own care if given adequate information and professional support.
6.When assessing a family for possible barriers to health care, the nurse would consider which factor to be most important? A)Language B)Health care workers' attitudes C)Transportation D)Finances
Ans: D)Finances Feedback: Financial barriers are one of the most important factors that limit care, with the number of children and families either not having any insurance, not having enough insurance to cover services obtained, or not being able to pay for services. Language, health care worker's attitudes, and transportation are also barriers to health care but are not as fundamentally important as finances.
3.When preparing a teaching plan for a group of first-time pregnant women, the nurse expects to review how maternity care has changed over the years. Which of the following would the nurse include when discussing events of the 20th century? A)Epidemics of puerperal fever B)Performance of the first cesarean birth C)Development of the x-ray to assess pelvic size D)Creation of free-standing birth centers
Ans: D.Creation of free-standing birth centers Feedback: In the 20th century (1900s), free-standing birth centers were developed. Puerperal fever epidemics, the first cesarean birth, and x-ray to assess pelvic size were events occurring during the 19th century (1800s).
