Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment

The maternal-child health nurse provides care to which client populations working within an appropriate scope of practice? Select all that apply.

a 52-year-old posthysterectomy client a 14-year-old primigravida client a 2-week-old preterm infant The nurse would provide care to women from preconception to menopause and infants during the first 4 weeks of life. Therefore, care would include the posthysterectomy client, the young primigravida client, and the 2-week-old preterm infant. The orchiectomy client and post hip replacement client do not fall within the specialty of maternal-child health.

The student nurse is teaching breast-feeding to a group of clients on the postpartum unit. The student recognizes that this action represents which component of the nursing process?

Implementation Implementation represents the part of the nursing process in which the nurse puts the plan of care into action.

A nurse is conducting an in-service program for a group of nurses on the health of women and their families, incorporating information from Healthy People 2030. The nurse determines that additional discussion and clarification is needed when the group makes which statement?

"Immunizations may be the cause of some illnesses being seen currently." Obesity, drug use, and smoking are major concerns. Physical activity and environmental quality are also on the list of leading health indicators in Healthy People 2030. The students who have determined that immunizations are the causes of diseases need clarification since maintenance of immunizations is one of the health indicators listed in the report.

A nurse is conducting a monthly chart audit in the newborn nursery. Which finding could indicate an ethical consideration of practice?

200% increase in IV cath attempts With such a significant increase in the number of IV catheter attempts versus the number of clients, this warrants a further investigation as to why such a large change. This could be an ethical consideration in weighing the amount of pain the infant experiences during the procedure.

The pediatric nurse is performing research on the development of pediatric care. Which health care provider does the nurse identify as the father of pediatrics?

Abraham Jacobi Many view Ambraham Jacobi as the father of pediatrics. Under his direction, several New York hospitals opened pediatric units. He helped found the American Pediatric Society in 1888. The remaining health care providers have had an impact on maternal-child nursing; however, none are referred to as the father of pediatrics.

Which actions should the nurse perform when supporting the goals of maternal and child health care? Select all that apply.

Advocates protecting the rights of the mother and fetus Teaches family members interventions to improve health Assesses family members for strengths and specific needs or challenges Actions that the nurse should perform when supporting the goals of maternal and child health care include advocating the rights for the mother and fetus, teaching health promotion interventions, and assessing the family for strengths and specific needs or challenges. Adhering to principles that focus on the needs of the mother and encouraging maternal hospitalization to regain strength and stamina are not actions that support the goals of maternal and child health care.

A nurse who specializes in maternal and child health care performs many varied functions in diverse settings over the course of a year. Which action would be outside the nurse's scope of practice?

Assist in the treatment and recovery of a woman with ovarian cancer. The primary goal of both maternal and child health nursing can be stated simply as the promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing. Assisting in the treatment and recovery of a woman with ovarian cancer is the least likely function of a nurse specializing in this type of nursing. Preconceptual care, care of a woman during her first trimester, and reading journal articles regarding breastfeeding are all within the scope of practice of maternal and child health nursing.

A nurse is preparing to teach a class to high school students on the risks of teenage birth and the various methods of contraception. The nurse recognizes that enhanced provisions of sex education to adolescents have had a positive influence on which measurement in the past 10 years in the United States?

Birth rate The birth rate in the United States has decreased gradually over the past 10 years due to additional counseling and publicity concerning the risks of teenage birth. Such counseling does not impact the other measures listed.

When integrating the principles of family-centered care into the birthing process, the nurse would base care upon which belief?

Birth results in changes in relationships. Family-centered care is based on the following principles: Birth affects the entire family, and relationships will change; birth 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.

The community health nurse is working with a group of clients receiving prenatal care. The nurse recognizes that there is racial disparity in the maternal mortality rate for which racial group?

Black Racial disparity in the United States occurs predominately among Black women with regard to mortality rate and pregnancy complications. While there may be racial disparity with access to health care for other ethnic groups, the maternal morality rate is higher among Black women.

A nurse is providing cardiopulmonary resuscitation (CPR) to an infant with chronic health problems when the mother of the child tells the nurse to discontinue CPR. Which is the most appropriate action by the nurse?

Discontinue all resuscitation efforts. The parents of the child can determine if they wish for resuscitation efforts to continue. The nurse should stop CPR when told so by the parents.

The utilization review nurse working in pediatrics uses the prospective payment system, as utilized by the health care facility. Which example best describes an example of the prospective payment system?

Ensuring efficient use of client supplies and tests A prospective payment system is where a predetermined rate is paid to the health care provider for a certain diagnosis. This encourages efficient use of client supplies and tests. The remaining actions reflect methods of cost containment in nursing; however, these do not best reflect an example of the prospective payment system.

During an initial assessment, a mother reports several problems she has been having coming to the local clinic. Which reported problem should the nurse give highest priority to in assisting this client?

Family finances Financial barriers are one of the most important factors that limit care, with a substantial 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 workers' attitudes, and transportation are also barriers to health care but are not as fundamentally important as finances.

What aspects of care play an essential role in the health of a woman and fetus during pregnancy? Select all that apply.

Financial support Prenatal care Emotional support Maternal nutrition The outcomes of pregnancy and for the maternity client are multifactorial and require support, both financial and emotional, as well as health care. Maternal nutrition also is an important part of a successful pregnancy. Having a high level of income does not directly correlate to a positive pregnancy outcome.

The nurse notes that statistics on maternal mortality had improved but are again becoming elevated. What does the nurse realize as a reason for this change in maternal mortality rates?

Gestational hypertension This increasing rate in maternal mortality is associated with more cesarean births, more gestational hypertension related to preexisting hypertensive disorders, and lack of health insurance for many Americans. This increase is not because of earlier prenatal care, increased vaginal deliveries, or treatment for chronic diseases.

Cost containment in the health care field has become a sought-after necessity because of rising costs and the influence of managed care. Nurses are instrumental in assisting with cost containment of health care by prioritizing which strategy?

Health promotion Specific cost-containment strategies that nurses have been instrumental in implementing include health promotion, case management, and critical care paths. Health promotion is accomplished by methods such as using alternative birth systems, providing client teaching, and quality improvement.

A nurse statistician is examining the rates of maternal morbidity and mortality in the United States. Which factor does the nurse identify as a reason why maternal death rates are difficult to trend in pregnancy?

Increased chronic conditions among pregnant women Increased chronic conditions among pregnant women make it difficult to trend death rates in pregnancy within the United States. The remaining factors may contribute to morbidity and mortality; however, these are not the reason why maternal death rates are difficult to trend.

A nurse is instructing students about trends in maternal health in developed and developing countries. Which indicator provides the most information about the global adequacy of maternal and perinatal health?

Maternal mortality rate Maternal mortality rate is the number of deaths of women during pregnancy, childbirth, and the postpartum period. This statistic best reflects the adequacy of maternal health in a nation. The risk of a woman in a developing country dying from a pregnancy-related cause during her lifetime is 25 times higher than for women in developed countries. Maternal mortality is a health indicator that shows very wide gaps between rich and poor, both between and within countries. Infant mortality rate and rate of low birth weight infants are more indicative of poor health of a country. Access to sexual and reproductive care is a potential subset of the maternal mortality rate but may or may not contribute to poor maternal health outcomes.

The nurse works in a maternal and child care area that supports health promotion. Which activities will the nurse perform to support this philosophy of health care? Select all that apply.

Patient teaching Family counseling New mother advocacy Extensive changes in the scope of maternal and child health nursing have occurred as health promotion has become a greater priority in care. The nursing activities for health promotion include teaching, counseling, and advocacy. Planning care and identifying nursing diagnoses are a part of the nursing process and not specific to health promotion.

When integrating the principles of family-centered care, the nurse would include which concept?

People have taken increased responsibility for their own health. Due to the influence of managed care, the focus on prevention, better education, and technological advances, people have taken increased responsibility for their own health. Parents now want information about their child's illness, to participate in making decisions about treatment, and to accompany their children to all health care situations.

A nursing instructor is teaching a session investigating infant mortality as a standard measurement of the quality of health care in the country. The instructor determines the session is successful when the students correctly choose which factors as contributing to the high numbers of deaths in the United States? Select all that apply.

Preterm births Maternal complications Congenital deformities and chromosomal abnormalities Many factors contribute to the high infant mortality rates in the United States. Some of the most common factors are low gestational age and prematurity, congenital deformities and chromosomal abnormalities, and maternal complications such as cervical insufficiency, multiple births, and premature rupture of membranes. Female infants have lower mortality rates than males, and the best outcomes are in mothers who give birth between 30 and 34 years of age.

A client learns she is 6 weeks' pregnant and asks the nurse for the name of the local abortion clinic. What is the most appropriate response by the nurse?

Provide the client with the requested information. The nurse should provide information to the client regardless of his or her own personal views.

The nurse is caring for a 14-year-old boy with a growth hormone deficiency. Which action best reflects using the nursing process to provide quality care to children and their families?

Reviewing the effectiveness of interventions The nursing process is used to care for the child and family during health promotion, maintenance, restoration, and rehabilitation. It is a problem-solving method based on the scientific method that allows nursing care to be planned and implemented in a thorough, organized manner to ensure quality and consistency of care. The nursing process is applicable to all health care settings and consists of five steps: assessment, nursing diagnosis, outcome identification and planning, implementation, and outcome evaluation. Reviewing the effectiveness of interventions is related to outcome evaluation in the nursing process. Even though the three remaining answer options are valuable in ensuring quality of care in health care facilities, they do not involve the direct care of the child and family using the nursing process.

A nurse is conducting a teaching session on sudden infant death syndrome (SIDS) for expectant parents. Which information should the nurse include? Select all that apply.

Sharing a room allows for monitoring of the infant. Place the infant on his or her back to sleep. Maintain neutral temperatures and avoid overheating. Sharing of a room allows for monitoring and bonding of the infant as well as ease of feeding. Placing the infant on his or her back to sleep is the recommended sleeping position for all infants until 12 months of age, or until they can change their own position during sleep. Infants are not able to regulate their temperature; therefore, overheating can increase their risk for SIDS. Co-bedding increases the risk for accidental suffocation, and allowing an infant to sleep with a bottle increases risk for aspiration and infection.

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. 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.

The nurse completes a focused assessment on a client complaining of migraine headaches. Which items identified during the assessment would the nurse recommend the client change in an attempt to decrease the incidence of migraine headaches?

Uses an oral contraceptive pill (OCP) Drinks 3-4 glasses of wine in the evening Consumes large quantities of aged cheeses and salty foods Triggers of migraine headaches include using a combined oral contraceptive pill, consuming large quantities of aged cheeses and salty foods, drinking alcohol, strenuous exercise, and unpredictable sleep patterns.

A nurse is assisting a pregnant client in signing up for Medicaid to help with the cost of her medical care. The nurse explains that Medicaid is a federally funded program mandated by which act of Congress?

Title XIX of the Social Security Act Medicaid was founded in 1965 under Title XIX of the Social Security Act.

A 15-year-old client has just given birth and states that she does not want her infant to receive any newborn vaccines. What is the appropriate action for the nurse to take?

Withhold the vaccines. The client would frequently be considered emancipated and therefore legally able to make legal decisions regarding the health care of the infant. The nurse should withhold the vaccines but inquire as to the reason for no vaccination.

After hearing of a lawsuit being filed by a client against another nurse, a nurse becomes concerned about the 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 limit liability in the event of litigation?

carefully documenting every intervention with a client Documentation is essential for justifying actions and for providing evidence of proper care in the event of a lawsuit. Although staying current in the research of one's field is advisable, it does not protect a nurse in the event of a lawsuit. Having parents sign waiver forms and having a heath care provider confirm the nurse's every decision are not feasible.

The nurse works at the local public health office. Which is a major but often overlooked problem in this setting?

fetal mortality Fetal mortality is a major, but often overlooked, public health problem. This refers to the spontaneous intrauterine death at any time during pregnancy, commonly referred to as a miscarriage. The fetal mortality rate in the United States is 6.2 per 1,000 live births. The impact of fetal mortality on families is considerable and provides a picture of the quality of maternal health and prenatal care.

A nurse is speaking with a client who has just learned that she is pregnant with her first child. The nurse reads in the client's chart that she does not drink alcohol on a regular basis. However, the nurse decides to go ahead and warn the client about the dangers of drinking alcohol while pregnant. Which phase of health care would this action be classified as?

health promotion This action is an example of health promotion, which may be defined as educating parents and children to follow sound health practices through teaching and role modeling. Health maintenance is intervening to maintain health when risk for illness is present. Health restoration is using conscientious assessment to be certain symptoms of illness are identified and interventions are begun to return the client to wellness most rapidly. Health rehabilitation is helping prevent complications from illness, helping a client with residual effects achieve an optimal state of wellness and independence, and helping a client to accept inevitable death.

A 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. The number of fetal deaths in the United States has fallen. This has been attributed to the improvement in the delivery of prenatal care.

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 Receiving prenatal care has proven to be a major strategy for reducing infant mortality. The other interventions will not directly impact infant mortality rates to the degree that prenatal care will.

A nurse is working in a community designated as having low fertility rates. Which would be an appropriate first-level investigation by the nurse?

local dietary habits Fertility rates are affected by poor nutrition, which can make conceiving difficult. The nurse should assess the local dietary habits of the community to understand if there is a lack of nutritional resources available to the community.

Which of the 2020 National Health Goals should a maternal child health nurse working in a developed nation focus on for the betterment of clients? Select all that apply.

reduction of child mortality improvement of primary education environmental sustainability gender equality Goals that focus on disease, poverty, and gender equality impact the health of women and children in all countries. A nurse working in a developed country will encounter individuals from various socioeconomic, ethnic, and cultural backgrounds. Therefore, it is important to understand how to help in meeting these goals of reducing child mortality, improving primary or elementary education, increasing environmental sustainability, and promoting gender equality and empowering women.

A nurse is providing teaching to a parenting class on childhood mortality prevention. Which topic would be the priority for the nurse to include?

seat belt safety The leading cause of death in children is unintentional injuries and is often preventable. Seatbelt safety would be a priority topic for the nurse to discuss as that is the one that could result in an injury.

A school nurse is working with a group of adolescents. Which assessment findings might prompt the nurse to screen for eating disorders? Select all that apply.

weight fluctuation erosion of teeth menstrual irregularity Screening for eating disorders may be routine for a particular client population in some clinical settings or may be cued by clinical manifestations, such as weight fluctuation, teeth erosion, disruption of menstruation, chronic constipation, dehydration, gastric reflux, syncope, and others. Frequent nurse visits do not necessarily mean there is an eating disorder. Those with eating disorders still experience hunger but ignore it as well as signs of physical weakness and fatigue.

A public health nurse is reviewing the statistics of infant and maternal mortality in the United States. Which factor does the nurse identify as the leading cause of maternal mortality?

Hemorrhage Hemorrhage is the leading cause of maternal mortality in the U.S. The remaining factors contribute to maternal mortality in the U.S.; however, these are not leading causes.

Which statement correctly defines the term "perinatal death rate"?

Number of deaths per 1000 live births beginning when the fetus reaches 500 g and ending 28 days after birth The term "perinatal" refers to the time of birth and that closely following it or the time "around birth."

The nurse case manager working in maternal-child nursing is involved in identifying clients who will most benefit case management services. Which pregnant client will the nurse identify as the best for case management services?

A teenage client with gestational diabetes Case management involves monitoring and coordinating care for individuals who need high-cost or extensive health care services. An at-risk pregnant woman with diabetes is a good candidate for case management because she requires frequent monitoring of her blood sugar and the coordination of several health care providers. The remaining clients require quality maternity care; however, these are not the best candidates for case management because they are not as complex as the cases that require case management.

While providing care to a child, the nurse informs the parents about the treatment plans and helps the parents make decisions about the child's care needs. What do this nurse's actions support?

Empowerment Nurses promote empowerment of parents and children by respecting their views and concerns, regarding parents as important participants in their own or their child's health, keeping them informed, and helping/supporting them to make decisions about care. The nurse's actions are not being done to support autonomy, accountability, or informed consent.

A nurse is trying to reduce a mother's anxiety about her child being in the hospital. What would be the best way to accomplish this?

Include the mother in the medical decision-making. The family-centered care approach is a researched-based philosophy that promotes family coping with a child needing medical attention. The nurse should collaborate with the family to address the family's needs, as well as the medical care of the child. Including the mother in the medical decision-making is an example of how to accomplish this.

The nurse is reviewing a copy of the U.S. Surgeon General's Report, Healthy People 2030. Which nursing action reflects the nurse fostering this health care agenda?

The nurse volunteers at a local health care clinic providing free vaccinations for low-income populations. Healthy People 2030 is a comprehensive health promotion and disease prevention agenda that is working toward improving the quantity and quality of life for all Americans. Overarching goals are to eliminate preventable disease, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; create physical and social environments that promote good health; and promote healthy development and behaviors across every stage of life. Volunteering at a local health care clinic directly reflects the goal of improving the health of all groups of people. Signing up for classes, performing in-services on equipment, and compiling nursing articles on evidence-based practices in nursing are all worthwhile activities that foster health care delivery, but are not as directly linked to the agenda of promoting health in the community.

The public health nurse is performing a nutritional assessment on a pregnant client who wishes to qualify for services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Which questions might the nurse use to determine medically based risk factors? Select all that apply.

"Do you have any pregnancy complications?" "What is your date of birth?" "Can you tell me your height and weight?" The WIC program is a federally funded program who's goal is to enhance the nutritional status of women and children. Women and children must first meet income eligibility, and a trained health professional screens applicants for nutritional risk factors based on federal guidelines. These risk factors may be either medically based or diet based. Individuals with pregnancy complications, young maternal age, and those who are underweight represent medically based risk factors. The remaining questions represent diet based risk factors.

After teaching a group of students about the concept of maternal mortality, the instructor determines that additional teaching is needed when a student makes which statement?

"The rate includes accidental causes for deaths." 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.

The nurse is caring for a child who says, "I'm tired of being in the hospital and I miss my own home." Which response by the nurse is most appropriate?

"What can we do to make your room seem more like home?" It is important to promote the involvement of the child in the plan of care and involve the child in decision-making to foster his empowerment. The hospitalized child is away from home and should be encouraged to participate in the care and the development of the room's environment. Asking what can be done to promote improved feelings makes the child a part of the team. Telling the child that he will go home when he is better does not address the concerns. Offering sympathy does not attempt to address the concerns. Asking about feelings in this manner is a closed question and does not solicit information from the child.

A nursing student asks an experienced nurse to explain the role of evidence-based practice on the maternal child unit. Which statement by the experienced nurse is most appropriate?

"Women have been able to be successful at having a natural birth after a cesarean birth." Evidence-based practice brings together research, clinical expertise, and client preference to increase nursing outcomes. The research has increasingly indicated that it is safe for women to give birth vaginally following a cesarean birth (VBAC).

The nursing instructor is explaining the utilization of regionalized or centralized care to a group of maternal infant students. Which example should the instructor point out best demonstrates regionalized or centralized care?

An at-risk mother is sent to a specialized facility to deliver. Regionalized or centralized care was designed to prevent duplication of services in communities. To accomplish this goal, a regional or central facility may be created that contains the most highly specialized care in one central location even though it may not be the closest facility to the client's home. Regionalized or centralized care may require that a sick infant be sent to a facility that is actually farther away from the community in order to receive specialized care.

The nurse is reviewing the medical records of several infants. Which infant is at highest risk for death according to the infant mortality rate in the United States?

An infant born at a low birth weight Infant mortality in the United States is associated with low birth weight, prematurity, and congenital abnormalities, among other concerns. An infant born to young or older parents, or at 38 weeks' gestation, would not be considered low birth weight or premature nor considered to be at higher risk for congenital abnormalities.

Which aspect of client wellness has not been a focus of health during the 21st century ?

Analysis of morbidity and mortality 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.

The nurse is planning goals for a client admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). Which factors will the nurse consider when developing the client's outcomes? Select all that apply.

Client-focused Attainable Measurable Realistic Outcomes (goals) should be client-focused, attainable, measurable, and realistic. Although cost efficiency is important in health care, it is not a consideration when developing the client's outcomes or goals.

A nursing instructor has completed a discussion about the importance of critical thinking with a group of students. The instructor emphasized which aspect of critical thinking as most important?

Clinical judgment In all nursing roles in maternal-child health care, it is important to use clinical judgment and purposeful thought and reasoning to make decisions; doing so leads to positive outcomes for the client. This process is critical thinking. Collecting data through reading evidence-based practice helps provide information that can be used to make those critical judgments. The care plan should be flexible and changed as the client's situation changes.

A nurse is analyzing a journal article presenting statistics concerning newborn and infant health. Which condition has been determined to be the most likely cause of infant mortality in the United States?

Congenital abnormalities Congenital abnormalities remain the leading cause of infant mortality in the United States. Low birth weight and prematurity are significant predictors of infant mortality. Respiratory distress syndrome is not the leading cause of infant mortality.

The nurse is in the process of administering medications to clients on the unit and notices one new mother is in the process of attempting to breastfeed her newborn infant. The nurse makes several suggestions to assist this mother. Which action should the nurse prioritize related to this interaction?

Document the care given Document nursing actions such as medication administration as soon as possible after the intervention to ensure the action is communicated, especially in the care of childbearing women and children. The other actions are important but not the priority. It's important to remember that "if it isn't recorded, it didn't happen."

A nurse compares the average length of stay of postpartum women of today with the past and notes the stay is shorter. Which factor has most influenced this trend of shorter hospital stays?

Efforts to contain health care costs Providing comprehensive prenatal care can help reduce potential problems, which helps reduce the high cost of specialized care in situations which can be avoided. There has been a factor of wellness focus within the health care system but that is not the main factor in this case.

The family is the basic unit of society. Which statement correctly illustrates the importance of this concept related to how society functions?

Healthy, well-functioning families provide members of all ages with fulfilling, supporting relationships. The family is the basic unit of society. In order for this to work well, members of the family must work together. Families make a central contribution to enhance the quality of our society. Families must consider how their actions will impact others, and one member cannot fulfill all roles within the family.

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 Closer monitoring for complications associated with hypertension of pregnancy Better management of hemorrhage and infection The following factors have contributed to the decline in the maternal mortality rate: increased participation of women in prenatal care; greater detection of disorders such as ectopic pregnancy or placenta previa; prevention of related complications through the use of ultrasound; increased control of complications associated with hypertension of pregnancy; and decreased use of anesthesia with birth.

After World War I, infant mortality continued to rise despite acceptance of the germ theory and strict asepsis for the neonate. Which theory resulted?

Infants suffered from lack of stimulation Despite the acceptance of the germ theory and strict asepsis for the neonate, infant mortality after World War I continued to rise. Joseph Brennaman was one of the first people to theorize that infants suffered from lack of stimulation. The remaining statements do not reflect theories that developed as a result of rising infant mortality despite strict asepsis.

A maternal nurse reviews the development of maternity care prior to the acceptance of the germ theory. Which statement(s) does the nurse identify as true? Select all that apply.

Infection and mortality rates were much higher in hospitals than at home. Infection after birth was marked by high fever. Prior to the acceptance of the germ theory, infection and mortality rates were much higher in hospitals than at home. Before scientists knew the principles of infection transmission, it was common for a woman to develop puerperal fever, an illness marked by high fever caused by infection of the reproductive tract after the birth of a child. The remaining statements do not represent true statements regarding the development of maternity care prior to the acceptance of the germ theory.

Which statement best describes the pattern of maternal mortality since World War II?

It has steadily decreased. Improved prenatal care and early ambulation after birth are factors that have decreased maternal death rates following birth over the past 70 years.

What was the impact of "twilight sleep" during birth, which occurred in the 1920s and 1930s? Select all that apply.

It increased the number of women who chose to deliver in hospitals. It gave the health care provider more control over the birth process. It allowed women to experience painless birth. The public viewed the hospital as the most humane place in which to give birth. In the 1920s and 1930s, a method called "twilight sleep" greatly increased the number of women who chose to give birth in hospitals. This development allowed women to experience painless birth and gave the health care provider more control over the birth process. As a result, the public viewed the hospital as the most humane place in which to give birth. This practice was reserved for the wealthiest of women, as those of lower socioeconomic level could not afford the procedure.

A nurse needs to ensure an informed consent has been obtained to provide care to a young client. Which aspect would be the most important for the nurse to consider related to the informed consent?

Knowing the laws in the state where care is being provided Knowing the laws in the state where care is being given is the most important consideration because laws vary from state to state. Emancipation is a legal consideration that is viewed differently by laws of different states. Establishment of parental competency is a legal consideration that may be judged differently by laws of different states. Contacting the parents prior to giving emergency care is a legal consideration that may be judged differently by laws of different states.

Which factor contributes to the United States' increased infant mortality rate when compared to other industrialized nations?

Large number of preterm births Two factors contributes to the United States' increased infant mortality rate when compared to other industrialized nations—a large number of preterm births and variances in the reporting of live births in other nations. The remaining answer choices are not correct.

A nurse is explaining to a young couple the advantages of seeking maternal and child health care in an ambulatory setting versus the emergency department in nonemergent situations. Which goal should the nurse emphasize the most?

Minimize the separation of children from their parents. Separation from parents can be traumatic for young children; ambulatory settings minimize this to some degree. Ambulatory care increases responsibility for parents, has no real bearing on the number of needed hospitals (since they treat different types of clients) and the calm environment does not play a role in change in emphasis. Decreasing the number of hospital visits or increasing the number of urgent care centers could possibly result from more emphasis on ambulatory care; however, the main focus would be reducing the trauma a young child may experience receiving medical care.

A new mother asks the nurse if all of the new baby's injections can be given in one visit because the mother is losing income from missing work because of the office visits. What does this new mother's issue indicate to the nurse?

Missing work does not support the baby's health maintenance visits. An area that needs additional research is finding effective stimuli to encourage women to bring children for health maintenance visits. The mother losing income because of missing work for well-baby visits will deter health maintenance visits for the baby going forward. This mother's issue does not indicate that the mother needs to find another job, that the mother's income is more important that the baby's health, or that the federal government needs to do more to support well-baby visits.

A nurse witnesses a peer tell a client, "You are a mother now and you have to do what is best for you baby. You have to breastfeed her!" Which is the best action by the nurse?

Pull the nurse aside and inquire as to the content of the conversation. The nurse overheard just a small portion of the conversation between the client and the peer nurse. The best action would be to inquire as to the content of the conversation and then determine if the peer nurse's comments were appropriate. If the comments were inappropriate, the nurse would then need to fill out an incident report.

The nurse is caring for a 2-week-old girl with a metabolic disorder. Which activity would deviate from the characteristics of family-centered care?

Softening unpleasant information or prognoses. Family-centered care requires that the nurse provide open and honest information to the child and family. It is inappropriate to soften unpleasant information or prognoses. Evaluating and changing the nursing plan of care to fit the needs of the child and family, collaborating with them as equals, and showing respect for their beliefs and wishes are guidelines for family-centered care.

The pediatric nurse is reviewing statistics on the risks of morbidity and mortality among children. What does the nurse identify as the largest risk to all children and adolescents in the United States?

Unintentional injury Unintentional injury, frequently as the result of motor vehicle accidents, is the largest risk to all children and adolescents in the United States. The remaining answer choices are not the greatest risk to all children and adolescents in the United States.

The maternal-child health nurse is providing care to the following clients. Which client would the nurse assess as being in the health restoration phase?

A 29-year-old G1P1L1 is assessed for ongoing complications from eclampsia, one week postpartum. Blood pressure is 128/92 mm Hg, heart rate 78 bpm, respiratory rate 22 breaths/min, temperature 98.8°F (37°C). Client states no headaches, no vision changes, and no seizure activity. The client who is 1 week postpartum recovering from eclampsia is working to return to a state of wellness and therefore is the individual who is in the restoration phase of health.

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. 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.

The nurse is caring for several families enrolled in Medicaid in the prenatal setting. Which statement by an expectant mother would alert the nurse to assess the family further?

"We just moved here from another state and I am still getting used to the new town." Medicaid is a financial assistance program for low income families and varies from state to state in terms of eligibility and application process. When a family has moved from one state to another, there may be delays in getting Medicaid established in the new state. Hospital births are typically covered by Medicaid. Family helping with the newborn is a benefit, and would not affect Medicaid resources. The mother's sister-in-law giving birth in the same month would not be a situation the nurse would need to assess further, especially regarding Medicaid resources.

The nurse is admitting a client to the emergency clinic and notes that the client's gender expression is different than the gender noted in the driver's license and insurance documentation. What is the nurse's best response?

The nurse should communicate with the client based on the client's preferred pronoun. The nurse should take care to refer to the client by the client's preferred pronoun. The gender indicated in a person's insurance coverage documentation and other legal documents may be discordant with the person's gender identity, and many electronic health records do not allow space for gender identity as opposed to natal sex, making correctly addressing the client more challenging. Building a trusting relationship with all clients is a critical step. It is unnecessary to clarify the conflict between the driver's license and appearance at this time, as this will only cause distrust and emotional harm to the client. Avoiding using gender specific pronouns is a form of avoidance and can also cause distrust and emotional harm.

The nurse is working in an outpatient women's health facility and cares for a client who wants to become pregnant. Which actions should the nurse perform in order to reduce maternal mortality? Select all that apply.

Discuss the client's daily diet Determine the client's health history Encourage the client to consume adequate folic acid Preconception actions to reduce maternal mortality include screening women for health risks and preexisting chronic conditions, which may be determined by the client's health history. Discussion of the client's daily diet allows the opportunity for the nurse to discuss the benefits of good nutrition. Additionally, education should be provided to ensure the client is consuming adequate folic acid in an effort to prevent neural tube defects in neonates. Education about pregnancy-related conditions should occur during pregnancy. Moderate exercise should be encouraged, not vigorous.

A community health nurse is examining the morbidity rates among pediatric clients within the United States. Which factor does the nurse identify as best contributing to morbidity rates among children?

Environment and socioeconomic factors Environment and socioeconomic factors best contribute to the morbidity rates among pediatric clients within the United States. The remaining answer choices do not best describe factors contributing to the morbidity rates among children.

The nurse is reviewing the 2020 National Health Goals and notes that which is a focus of these goals?

Health promotion and disease prevention The 2020 National Health Goals are intended to help citizens more easily understand the importance of health promotion and disease prevention and to encourage wide participation in improving health in the next decade. These goals do not focus on the early diagnosis of chronic problems, use of medications to treat disease, or reduce the cost of health care and medications.

The nurse caring for pregnant clients understands that access to Medicaid services is often lacking in childbearing women. Which action best describes a method to increase access to Medicaid services for this population?

Improve the application process Medicaid is a federal program that provides grants to states to provide health care for individuals of low income or who meet other eligibility. Pregnant women and children who meet income guidelines qualify for the program. However, many women and children who qualify for the program do not benefit from it. The application process is often cumbersome and complicated, making it difficult to apply. Coverage for the program may continue after pregnancy and lowering the income requirements do not describe a method to increase access the program.

Which socioeconomic change(s) have affected concepts in maternal-child health? Select all that apply.

Large suburban populations A change in the structure of families Consumers demanding more for their money Various socioeconomic changes have affected concepts in maternal-child health; including large suburban populations, a change in the structure of families, and consumers who demand more for their money. There has been an increase in the hospital's responsibility for health care and a decrease in the federal fiscal responsibility. Access to care has increased in rural areas, not decreased.

The nurse is caring for a mother who has just given birth to twins of 28 weeks' gestation, each weighing 2 kg. What is the health risk for the mother and the twins?

Neonatal death Neonatal death reflects the quality of care available to women during pregnancy and childbirth and the quality of care available to infants during the first month of life. The leading causes of death during this time are prematurity with associated low birth weight. Child mortality is the number of people who die during childhood years. Infant mortality is the number of infants who die before the age of 1 year. Maternal mortality is the number of women who die from activities related to childbirth.

What makes the area of maternal-child health nursing a more extensive area for consideration of legal issues than other areas of nursing?

Caring for a fetus, an unseen client When providing care for the pregnant client, the fetus is unseen and unable to speak. Care for the maternal-child couplet, therefore, takes on a greater risk for legal and ethical issues as the fetus is not "born" nor of age to give consent for procedures.

The nurse is caring for a client with a hip fracture. Using the critical pathways systems, which action takes priority?

Applying the nursing process The nursing process is at the center of critical pathways, standardized guidelines that have been established to address concerns related to cost containment, quality improvement, and managed care. The remaining actions are important aspects of using critical pathways; however, applying the nursing process takes priority.

The nursing instructor is discussing the infant mortality rate with a group of students. The instructor determines the discussion is successful when the students correctly choose which action as a priority to help decrease infant mortality in the United States?

Improving accessibility to postnatal health care for infants Infant deaths are due to many factors, including congenital malformations, deformations, and chromosomal abnormalities; disorders related to short gestation and low birth weight; and newborns affected by maternal complications of pregnancy. The mother's nutritional status would affect a limited number of infants. Making postnatal health care available and affordable would have the greatest impact on improving infant health and reducing the number of infant deaths. Spending more money on health care has proven to not improve infant survival rates postnatally. Although providing for mothering classes and improving maternal nutrition would be a good idea, these measures will not positively impact infant survival rates.