OB: Chapter 1: Perspectives on Maternal, Newborn, and Women's Health Care

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 2020 Healthy People 2020 outlines two basic goals for health promotion and disease prevention (Healthy People 2020, 2015): 1. Increase quality and years of healthy life 2. Eliminate health disparities

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. The best way to have a positive impact on perinatal outcomes and reduce prematurity is to improve women's access to prenatal care. Tracking the incidence of violent crime does not give information on how to improve outcomes, nor does examining health disparities between ethnic groups or identifying specific national goals related to maternal and infant care without acting on the information. None of these address the true problem. Page 15

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." 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. Page 28

After teaching a prenatal class about maternal mortality rates, the nurse determines that the teaching has been effective when the participants identify which ethnic group as having the highest ratio of maternal mortality?

African American mothers In the United States, the maternal mortality ratio is mixed depending on ethnic background. African American 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. White women have a rate of 12.5, and Hispanics have a rate of 8.9. Asian mothers are lower than Black mothers. Page 11

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 the nurse be least likely to do, as it 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. Page 8

A prenatal nurse is preparing a presentation on the trends in childhood mortality rates in order to strategize for program funding. Which statements would the nurse likely include in the presentation? Select all that apply.

Disparities exist by gender, age, race, and ethnicity. Leading causes of childhood mortality include suicide. Unintentional injury remains a leading cause of mortality in children. The childhood mortality rate in the United States has decreased significantly since 1980, but disparities by gender, age, race, and ethnicity persist. The leading cause of death is unintentional injuries followed by congenital malformations. For children ages 5 to 14 years the leading cause is unintentional injuries followed by cancer, suicide, homicide, diseases of the heart, influenza, and pneumonia. There is no evidence to suggest that having community services would decrease childhood mortality.

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. Page 11

The nurse is providing care to a pregnant client from the Middle East. The client tells the nurse that she will not make a decision without her husband's approval. The nurse interprets this statement as reflecting:

cultural difference. Different social groups have a specific view of the world and set of traditions that guide their actions, beliefs, and interactions with others. It is important that the nurse recognize these cultural differences and work with them when providing care. The client's statement reflects the specific cultural view, not a religious idea, family preference, or traditional value. Page 21

A nurse is conducting a class about breast cancer for a group of young adult women. Which statements by the class indicates to the nurse that the teaching was successful? Select all that apply.

"My risk is increased if I had an irregular menstrual cycle starting at an early age." "A diet high in fat can be a risk factor for developing breast cancer." "If someone in the family has breast cancer, my risk would be increased." A positive family history of breast cancer, aging, and irregularities in the menstrual cycle at an early age are major risk factors. Other risk factors include excess weight, not having children, oral contraceptive use, excessive alcohol consumption, a high-fat diet, and long-term use of hormone replacement therapy. page 15

A nurse is preparing a breast cancer presentation for a health forum. Which fact would the nurse expect to address in this presentation?

Breast cancer is more advanced in African American women when found. White women get breast cancer at a higher rate than African American women; however, African American women are more likely to die as they get breast cancer before 40 years of age, cancer is more advanced when found, and survival at every cancer stage is worse among African American women. African American women are not at greater risk due to the BRCA 1 and BRCA 2 gene that causes breast cancer. There is no evidence that Hispanic women smoke more, placing them at risk. White women do not respond better to cancer treatment. Page 15

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?

Breast-feed the infant Breast-feeding reduces the rates of infection in infants and helps to improve long-term maternal health. Placing the infant on his or her back to sleep prevents SIDS but does not prevent infections in the infant. Feeding solids early is not recommended and has no affect on prevention of infections. Vitamins will not prevent infections by themselves and only help meet daily nutritional requirements and may not be necessary. Page 12

The nursing student correctly identifies which statement to be the contributing factor that made hospitals more attractive for births in the early 1900s?

Giving birth in a hospital suggested affluence, and the hospital provided pain management. In the early 1900s many women were attracted to hospitals because this showed affluence and hospitals provided pain management. Nurse midwives were not located in hospitals at this time and birth classes did not evolve until the late 1950s when "natural birth" became popular again. The father was prohibited in the birth room until much later. pg 6

The nursing instructor is introducing students to Healthy People 2020, which highlights the major health indicators of the 21st century that need to be addressed. The nurse informs the students that this includes national health goals for maternal, infant, and child health. Which goals would be included? Select all that apply.

Reduce fetal and infant death rates. Reduce maternal deaths. Increase infant birth weights. Reduce preterm births. Chapter 1: Perspectives on Maternal, Newborn, and Women's Health Care: p. 11.

A pregnant woman comes to the clinic for a visit. The nurse screens the client for possible abuse using the RADAR tool. Place the components below in the order in which the nurse would complete them. All options must be used.

Routinely screen every client for abuse. Affirm feelings and assess abuse. Document findings. Assess for client's safety. Page 21

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 health care decisions for the wife. In the Arab American culture, women often are subordinate to men. The nurse would deal directly and exclusively with the husband. Arab women are not comfortable in mixed gender birthing classes either. If they were to attend a birthing class, they would be accompanied by a female relative. Inquiring about folk remedies used may be appropriate with African American families but not Arab cultures. Use of birth control to limit the number of children in an Arab family is looked down upon because children are valued. Page 23

Before World War II women moved from home to hospital births. What was the primary reason for that shift in maternity care?

They were convinced that setting would improve birth outcomes. Prior to World War II, American women moved from home to the hospital for birth in part because they were convinced that setting would improve birth outcomes. Women who labored and gave birth at home were traditionally attended to by relatives and midwives. Many women were attracted to hospitals because this showed affluence and hospitals provided pain management, which was not available in home births. Page 6

A nurse is providing care to a pregnant client who is to undergo an amniocentesis. Which action would be most appropriate for the nurse to perform related to the client's informed consent?

determining the client's understanding of the procedure The primary care provider or advanced practice nurse or midwife is responsible for informing the client about the procedure and obtaining consent by providing a detailed description of the procedure or treatment, its potential risks and benefits, and alternative methods available. The nurse's responsibilities related to informed consent include the following: ensuring that the consent form is completed with signatures from the client; serving as a witness to the signature process; and determining whether the client understands what he or she is signing by asking the client pertinent questions. page 31

The nursing faculty is teaching students about maternal mortality and morbidity rates for African American women, noting that they are often three to four times higher than for white women. This fact can most accurately be contributed to which reason?

lack of access to adequate prenatal care The maternal mortality and morbidity rates for African American women have been three to four times higher than for non-Hispanic white women. Researchers do not entirely understand what accounts for this disparity but recognize that there are a number of factors that increase the incidence such as lack of prenatal care, obesity, and hypertension during pregnancy Chapter 1: Perspectives on Maternal, Newborn, and Women's Health Care: p. 11.

The nurse is updating the records of a woman who recently gave birth to a healthy 7-lb (3,175-g) newborn. Which action could jeopardize the privacy of the woman's medical records?

letting another nurse use the nurse's login session It is important to log off whenever leaving the computer. The person who shares the nurse's login session may get called away from the computer, leaving the nurse responsible for any breach in security. Keeping IDs and passwords confidential is basic computer security. Page 32

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 The neonatal death rate is the number of deaths of an infant in the first 28 days of life. Gestational age is not a consideration when reporting deaths of infants. The other categories are not classifications for reporting infant deaths. Page 12

A nurse is conducting research in preparation for developing programs to improve maternal and newborn health. The nurse is reviewing statistics revealing the number of infant deaths occurring in the first 28 days of life. The nurse is researching which rate?

neonatal mortality rate The neonatal mortality rate is the number of infant deaths occurring in the first 28 days of life per 1,000 live births. Fetal mortality rate refers to the spontaneous intrauterine death of a fetus at any time during pregnancy per 1000 live births. Infant mortality rate is the number of deaths occurring in the first 12 months of life. The perinatal mortality rate is the total of the fetal and neonatal mortality rates. Page 12

A nurse is conducting an in-service program for a group of maternal-neonatal nurses about factors affecting maternal and newborn health. As part of the presentation the nurse describes how the family has changed over the years. The nurse determines that the teaching was successful when the group identifies which family structure as having been considered the traditional structure?

nuclear The way that families are defined has changed. In years past, the nuclear family was once considered the traditional family structure. However, now, this structure is less common due to increased divorce rates and child rearing by unmarried persons. Page 16

Infant mortality is a standard measurement of the quality of health care in the country. Which factors contribute 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 incompetent cervix, 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. Page 11

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.

the new understanding of disease at cellular, individual, and societal levels The World Health Organization defines health as "a state of complete physical, mental, and social well-being." It is a complex definition, and it is not merely the absence of disease. The other ideas were part of the initial definition—environmental influences and mental health being seen as a state of well-being. The introduction of new cellular, individual, and societal levels of diseases has changed this era of health care. Page 10

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 Cardiovascular disease is the leading cause of death of women in the United States. Interventions that address reduction of this risk would be a priority. Elevations in death rates are in part attributed to the difficulty recognizing cardiovascular concerns in women. The second leading cause of death in women is cancer, specifically lung and cervical. Lower respiratory tract infections have increased over recent years as a cause of death in women, but they are not the number one cause. Alzheimer's disease, although impacting the mortality rates of women, is not the greatest cause of death. Page 14

The nursing instructor is teaching students about the types of anesthesia used historically during labor and birth. She informs the students that in the 1900s, women often were placed in "twilight sleep" during birth. This type of anesthesia would be described as:

a heavy dose of anesthesia and amnesiacs. Twilight sleep (a heavy dose of narcotics and amnesiacs) was used on women during birth in the United States in the 1900s. Hypnosis is a mental state or imaginative role, while light sedation involves the administration of small amounts of medication in order to deal with anxiety or agitation. A hypnotic used in coordination with spinal anesthesia was not used in birth in the 1900s.

A nurse is explaining the concept of family-centered care to a group of pregnant women at the clinic. Which component would the nurse emphasize?

care that is based on mutual trust and collaboration of all involved Family-centered care is the delivery of safe, satisfying, high-quality health care that focuses on and adapts to the physical and psychosocial needs of the family. It is based on mutual trust and collaboration among the woman, her family, and the health care provider. It is a partnership approach of families and their caregivers that recognizes the strength and integrity of the family. With family-centered care, birth is considered a normal, healthy event in the life of a family; families are capable of making decisions about their own care if given adequate information and professional support. Page 8

A nurse has started working at a new clinic that treats local immigrants. Which factor about the clients would be most important for the nurse to acknowledge when caring for them?

differences in culture Although an understanding of the groups ethinicity, language, and and level of enculturation may be helpful, it is important for nurses to recognize the various cultural differences among the clients. It is important to recognize their traditions and practices as a point of congruence rather than a potential source of conflict. With today's changing demographic patterns, nurses must be able to assimilate cultural knowledge into their interventions so they can care for culturally diverse women, children, and families. Nurses must be aware of the wide range of cultural traditions, values, and ethics. Cultural competence is the ability to apply knowledge about a client's culture so that the health care provided can be adapted to meet his or her needs. Page 21

In the United States, the maternal mortality ratio is mixed depending on ethnic background. African American 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. White women have a rate of 12.5, and Hispanics have a rate of 8.9. Asian mothers are lower than Black mothers.

low body weight multiple pregnancies Multiple pregnancies and low body weight are not considered risk factors associated with breast cancer. A positive family history of breast cancer, aging, and irregularities in the menstrual cycle at an early age are major risk factors. Other risk factors include excess weight, not having children, oral contraceptive use, excessive alcohol consumption, a high-fat diet, and long-term use of hormone replacement therapy. page 15

A nurse is conducting a presentation for a group of pregnant women about factors affecting maternal and newborn health. When discussing the family as an influential factor, which information would the nurse need to keep in mind?

The uniqueness of families requires specific methods for support. The family greatly influences the development and health of its members. The family's structure, the roles assumed by family members, and social changes that affect the family's life can influence the woman's and newborn's health status. Families are unique, and every family has different views and requires distinct methods for support. The family is considered the basic social unit of our society. The way that families are defined has changed. The United States Bureau of the Census (2015) defines family as a group of two or more people related by birth, marriage, or adoption and living together. Earlier definitions of family emphasized the legal ties or genetic relationships of people living in the same household with specific roles. Page 16

After teaching a group of students about pregnancy-related mortality, the nurse determines that additional teaching is needed when the students identify which condition as a leading cause?

embolism 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. Chapter 1: Perspectives on Maternal, Newborn, and Women's Health Care: p. 11.

An example of nurses' primary focus of health care education for clients would be demonstrated as:

encouraging yearly check-ups for all clients. The current movement in health care is to focus on health promotion and thereby prevent future illness and diseases. Prevention, treatment, and rehabilitation are all processes of care. In health care today, the treatments are based on prevention in order to save time, money, and improve the quality of life. page 10

Infants in the United States are at highest risk for death statistically in comparison to other modernized countries. Which initiative, if implemented, would have the greatest impact on improving these numbers?

improving accessibility to postnatal health care for 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 healthcare has proven to not improve infant survival rates postnatally. Although provision of mothering classes and improving maternal nutrition would be a good idea, these measures will not positively impact infant survival rates.

A nurse is providing care to an African-American woman who has just given birth to a healthy newborn boy. When planning culturally competent care for the woman and her baby, which practice would the nurse anticipate?

liberal use of oil on the baby's scalp and skin In the African American culture, oil is used liberally on the newborn's scalp and skin. Asian American mothers typically do not expose themselves to cold air or bathe themselves for the first month to avoid exposure to illness. Arab American mothers often delay breastfeeding for 2 to 3 days after birth and may be reluctant to bathe after birth because of beliefs that air gets into the mother and causes illness. Page 23

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. The maternal mortality ratio is the annual number of deaths from any cause related to or aggravated by pregnancy or its management. Morbidity refers to diseases. The infant mortality rate is the number of deaths occurring in the first 12 months of life. Neonatal mortality is reflected in the infant mortality rate. Page 11

A nurse is admitting a female client to the cardiac unit diagnosed with a possible myocardial infarction. During the admission assessment, which symptoms would the nurse expect to find? Select all that apply.

nausea unbalanced pain in the right arm The nurse should look beyond the obvious "crushing chest pain" symptom that heralds a heart attack in men. Clinical manifestations of a heart attack observed in women include nausea, dizziness, irregular heartbeat, unusual fatigue, sleep disturbances, indigestion, anxiety, shortness of breath, pain or discomfort in one or both arms. Chest pain is the most common heart attack symptom, but some women may experience it differently than men. Bradycardia is defined as the heart beating fewer than 60 times a minute. page 14

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 of 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. Page 10

A nurse is developing a prenatal education program for the local health clinic. The nurse plans to emphasize the need for maintaining routine prenatal visits based on the understanding that most pregnancy-related complications can be:

prevented. Most pregnancy-related complications are preventable. Adequate prenatal care includes education and assessments aimed at avoiding these complications. The top five leading causes of pregnancy-related mortality are embolism (20%); hemorrhage (17%); preeclampsia and eclampsia (16%); infection (13%); and cardiomyopathy (8%). page 11

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 prospective payment system predetermines rates to be paid to the health care provider for clients with diseases in certain classifications. These rates are paid regardless of the costs that the health care provider actually incurs. Ambulatory payment classifications and DRGs are forms of prospective payments. Cost sharing refers to the costs that the client incurs when using his or her health insurance plan. Page 27