OB? (Week 1: Ch 1+2)

14. The nurse has made it a goal to increase the rate at which women begin prenatal care in the first trimester. The nurse relates this decision to national goals for better maternal and infant outcomes. What guidelines will the nurse use to guide her maternal health goals? 1. WHO Maternal care guidelines 2. State Practice Acts 3. AWHONN white papers 4. Healthy People 2020

4

9. In the last 10 years in pediatric nursing, there has been an increase in: 1. Obesity. 2. Diabetes. 3. Hypertension. 4. All of the above.

ANS: 4

Infant mortality is defined as a death before _________. A. 28 days of age B. 6 months of age C. 1 year of age D. 18 months of age

C

Moderately premature neonates are neonates born: A. At less than 28 weeks of gestation B. Between 28 weeks and 30 weeks of gestation C. Between 30 and 32 weeks of gestation D. Between 32 and 34 weeks of gestation

D

10. The nurse is educating the pregnant patient with a body mass index (BMI) of 33. The nurse knows that teaching has been effective when the patient states which of the following? 1."My child may be at increased risk for birth injury." 2."My child may have a decreased risk of developing childhood diabetes." 3."I will probably give birth vaginally." 4."I have a lower risk of developing gestational hypertension."

1

Which factors will facilitate the integration of evidence-based practice (EBP) in the maternitynewborn clinical setting? Select all that apply. 1. Frame clinical questions in PICOT format. 2. Collect the best and most relevant evidence. 3. Cultivate a spirit of inquiry in the workplace. 4. Encourage the use of trial and error methods. 5. Base practical decisions on nursing consensus.

1. Frame clinical questions in PICOT format. 2. Collect the best and most relevant evidence. 3. Cultivate a spirit of inquiry in the workplace.

The nurse is experiencing an ethical dilemma when confronted with a situation in which either the mother or fetus is predicted to die. The nurse feels bound by the ANA Code of Ethics to protect both patients. Which aspect of care during an ethical dilemma will guide the nurse? 1. Maternity nurses are bound to advocate first and foremost for the well-being of the mother. 2. The nurse is ethically bound to provide the best care for both the mother and fetus. 3. If the fetus is viable and healthy, its survival is the priority of the maternity nurse. 4. Survival of the mother is solely based on both patient and family decision making.

1. Maternity nurses are bound to advocate first and foremost for the well-being of the mother.

A patient at 33 weeks gestation with a first pregnancy arrives at the labor and delivery unit with contractions. After monitoring the patient, the nurse determines the woman is in active labor and calls the health care provider (HCP), who prescribes a sleeping medication and sends the patient home. Which action does the nurse take? 1. Questions the HCP's prescribed treatment 2. Administers the medication and keeps the patient 3. Calls another HCP for a different prescription 4. Follows the HCP's instructions as prescribed

1. Questions the HCP's prescribed treatment

The nurse is providing care for a patient in active labor. The patient continuously asks the nurse for medication to "stop the pain." Which ethical principle does the nurse use when replying, "We need to protect the baby from being overmedicated. Let me help you with some breathing and relaxation techniques"? 1. Veracity 2. Beneficence 3. Nonmaleficence 4. Fidelity

1. Veracity

The nurse is assisting a patient in the use of an ethical decision-making model related to quality of life. Which question is inappropriate when using this model? 1. What are the prospects for a normal life? 2. Are arrangements made for prolonging life? 3. Which type of deficits for the patient are likely? 4. Does a present or future condition make life undesirable?

2. Are arrangements made for prolonging life?

13. A pregnant patient with a BMI of 35 is concerned about health effects she and her baby may face during pregnancy. During routine testing, the patient tested negative for sexually transmitted illnesses (STIs) and indicated that she is in a committed, long-term relationship with the child's father. Which of the following is accurate? 1. The patient's infant is at increased risk of neonatal blindness. 2. The patient's infant has a decreased risk of birth injury. 3. The patient will have increased risk of wound infection. 4. The patient will have a decreased risk of preeclampsia.

3

2. A patient with a history of hypertension is giving birth. During delivery, the staff was not able to stabilize the patient's blood pressure. As a result, the patient died shortly after delivery. This is an example of what type of death? 1.Early maternal death 2.Late maternal death 3.Direct obstetric death 4.Indirect obstetric death

4. Indirect obstetric death

11. A pregnant woman weighs 90.9 kg. The nurse is educating the patient on complications that the patient may be at risk for during pregnancy. Which response by the patient indicates that she understands? 1. "Due to my weight, there is a possibility that I may develop gestational diabetes." 2. "I am not overweight, but I am still at risk for gestational diabetes." 3. "My mother had preeclampsia during one of her pregnancies." 4. "I will need to do a glucose tolerance test in my second trimester."

1

A nursing student is asked to set goals that will decrease the fetal death outcomes during delivery. What guidelines will the nursing student use to assist in setting her goals? 1. WHO Maternal care guidelines 2. Healthy People 2020 3. AWHONN white papers 4. State Practice Act

2

6. The leading infant mortality risk in the United States is: 1. Birth defects. 2. Prematurity/low birth weight. 3. Sudden Infant Death Syndrome (SIDS). 4. Unintentional injury.

ANS: 1

The nurse is taking the history of a gravida 2 para 1 patient. Which findings in the patient's history warrant further action? Select all that apply. 1. Anemia 2. Severe hemorrhage 3. Infections 4. Malnutrition 5. Eclampsia

1 2 3 5

two most important predictors of an infant's health and survival after birth are: A. Gestational age and birth weight B. Gestational age and early prenatal care C. Gestational age and complication during labor and birth D. Gestational age and Apgar score

A

The population with the lowest birthrate but highest premature birthrate is: A. Non-Hispanic white B. Non-Hispanic black C. American Indian or Alaska Native D. Asian or Pacific Islanders E. Hispanic

C

What maternal health conditions are associated with maternal obesity? A. Gestational diabetes B. Pre-eclampsia C. Caesarean section D. All of the above

D. All of the above

A woman has recently given birth to an infant born at 35 weeks and 5 days gestation. What long-term effects should the nurse be concerned about with the infant being born at this gestation? Select all that apply. 1. Cerebral palsy 2. Respiratory disorders 3. Developmental delays 4. Visual impairments 5. Hearing impairments

1 2 3 4 5

An infant was recently born weighing 1,498 grams. The nurse understands that the birth weight of this infant is an important indicator of what? Select all that apply. 1. Morbidity rate 2. Prenatal care 3. Mortality rate 4. Infant health outcome 5. Postpartum care

1 3 4

Parents of a neonate are grieving over their child's life-threatening disabilities. The neonate's course of treatment has changed three times in the last 24 hours due to irrational parenteral decisions. Which interventions will the NICU nurse implement in order to fulfill nursing responsibility to both the parents and the neonate? Select all that apply. 1. Inform the parents as to realistic expectations. 2. Use neonate's status with parenteral counseling. 3. Elicit parenteral input regarding medical care. 4. Advocate for medical support of the neonate. 5. Inform parents they are the final decision makers.

1. Inform the parents as to realistic expectations. 2. Use neonate's status with parenteral counseling. 4. Advocate for medical support of the neonate.

5. The nurse is caring for a 15-year-old female who is pregnant with her first child. In her previous prenatal visit, the patient tested negative for chlamydia, syphilis, gonorrhea, and HIV. Based on the information provided, which condition is the patient's baby at higher risk for? 1. Intestinal problems 2. Neonatal conjunctivitis 3. Blindness 4. Pneumonia

1. Intestinal problems

The nurse on a maternity unit is an Orthodox Jew whose rabbi teaches that pregnancy terminations are permitted only to save the life of the mother. Which situation becomes possible if the nurse puts aside personal values and assists with elective terminations? 1. Moral distress 2. Legal actions 3. Loss of spirituality 4. Professional dilemma

1. Moral distress

A nurse is suspended for refusal to participate in the performance of an elective termination of a pregnancy. Which specific group's standards does the nurse use for job reinstatement? 1. American Nurses Association (ANA) 2. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) 3. State board of nursing 4. Facility ethics committee

2. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)

The labor and delivery nurse is providing care to a patient in active labor. The nurse notes EFM changes that suggest fetal distress and monitors the fetus for an additional 20 minutes before calling the health care provider. The health care provide determines that an emergency cesarean delivery is required. During transport, EFM is interrupted and not resumed due to expectations of an emergent procedure. A stillborn fetus is delivered. For which actions can the nurse be held legally responsible? Select all that apply. 1. Inappropriate use of oxytocin, causing fetal distress. 2. Lack of appropriate response to fetal compromise. 3. Inability to initiate resuscitation to a compromised fetus. 4. Delayed communication resulting in a delay of cesarean. 5. Performance of a technical error related to monitoring.

2. Lack of appropriate response to fetal compromise. 4. Delayed communication resulting in a delay of cesarean. 5. Performance of a technical error related to monitoring.

The nurse is caring for a patient at 7 weeks gestation. The nurse suspects that a pregnant patient may have been using marijuana. With consent, the nurse confirms via urine drug screen. Which statement by the nurse is most appropriate? 1."Did you smoke marijuana when pregnant with your other child?" 2."To avoid negative effects on your baby, you'll need to stop using marijuana during your last trimester." 3."Using marijuana while pregnant can have a negative effect on the neurological development of your baby." 4."Marijuana use while pregnant greatly increases your risk of miscarriage."

3. "Using marijuana while pregnant can have a negative effect on the neurological development of your baby."

The nurse is providing care for a patient in labor. The unborn fetus was diagnosed with severe microcephaly at 20 weeks' gestation. The patient tells the nurse, "We want everything done to save our baby who has as much right to a good life as anyone else." Which ethical approach does this represent? 1. Autonomy 2. Libertarianism 3. Egalitarianism 4. Utilitarianism

3. Egalitarianism

The nurse manager in the labor and delivery unit decides that all unit nurses are to take a course in electronic fetal monitoring (EFM) as recommended by AWHONN. Which is the most important issue related to EFM the nurse manager is expecting to address? 1. Eliminate the amount of litigation related to fetal injury. 2. Strengthen the staff's level of confidence with monitoring. 3. Reduce failure to accurately assess maternal and fetal status. 4. Improve the lack of communication with health care providers.

3. Reduce failure to accurately assess maternal and fetal status.

A nurse is assisting a patient in the birth center who happens to be a friend. The patient is still in the very early stage of labor and requires no immediate assistance of the nurse. However, the patient says that she enjoys the nurse's company, as it helps to pass the time. The nurse, however, tells the friend that the nurse must attend to another patient. Which of the following ethical principles is the nurse observing by not staying and chatting with the friend? 1. Fidelity 2. Veracity 3. Utility 4. Justice

4 (1. Fidelity is faithfulness or obligation to keep promises. 2. Veracity is the obligation to tell the truth. 3. Utility is the principle that the nurse should perform the action that will bring the greatest good for the individual or that is the most valuable. 4. Justice is the principle of equal treatment of others or that others be treated fairly. Because the nurse is acting to ensure that the other patient is treated fairly and that the nurse is not favoring the friend, the ethical principle of justice is being observed here.)

The nurse works in the labor and delivery department. Which action by the nurse indicates a breach in the nursing care principles outlined by AWHONN? 1. Assists with an emergency delivery of a woman in a homeless shelter 2. Informs employer of religious beliefs against pregnancy termination 3. Suggests a nurse care for a patient who speaks the same native language 4. Declines a patient assignment because of a history of illegal drug use

4. Declines a patient assignment because of a history of illegal drug use

1. The nurse is caring for a patient who is in labor with her first child. The patient's mother is present for support and notes that things have changed in the delivery room since she last gave birth in the early 1980s. Which current trend or intervention may the patient's mother find most different? 1. Fetal monitoring throughout labor 2. Postpartum stay of 10 days 3. Expectant partner and family in operating room for cesarean birth 4. Hospital support for breastfeeding

4. Hospital support for breastfeeding

The nurse in an OB's office is evaluating a patient who exhibits vaginal bleeding at 30 weeks gestation. The patient is prescribed bedrest at home and instructed to avoid lifting. The patient states, "I cannot go to bed, I have an 18-month-old at home." On which topic of the Jonsen model for ethical decision making will the nurse focus? 1. Contextual features 2. Quality of life 3. Patient preferences 4. Medical indications

4. Medical indications

The nurse works in the maternal-newborn unit dedicated to management of high-risk pregnancy and delivery. A patient has delivered two children who died from a genetic disorder. The current pregnancy tests positive for the same disorder. Which ethical decision-making model will the nurse use with this patient? 1. The model that focuses on medical treatment 2. The model that focuses on patient preference 3. The model that focuses on religion and culture 4. The model that focuses on the quality of life

4. The model that focuses on the quality of life

3. The nurse is providing education to a patient who has given birth to her first child and is being discharged home. The patient expressed concern regarding infant mortality and sudden infant death syndrome (SIDS). The patient had an uncomplicated pregnancy, labor, and vaginal delivery. She has a body mass index of 25 and has no other health conditions. The infant is healthy and was delivered full-term. What will be most helpful thing to explain to the patient? 1.Uses of extracorporeal membrane oxygenation therapy (ECMO) 2.Uses of exogenous pulmonary surfactant 3.The Baby-Friendly Hospital Initiative 4.The Safe to Sleep campaign

4. the safe to sleep campaign

4. A neonate born at 36 weeks gestation is classified as which of the following? a. Very premature b. Moderately premature c. Late premature d. Term

ANS: c Feedback a. Very premature is less than 32 weeks' gestation. b. Moderately premature is 32 to 33 completed weeks' gestation. c. Correct. Late premature is 34 to 36 completed weeks' gestation. d. Term is 37 to 42 weeks' gestation. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy

A maternal and infant goal stated in Healthy People Rank Order—Infant 2020 is: A. Increase abstinence from smoking during pregnancy to 100%. B. Reduce cesarean birth for first-time mothers to 23.9%. C. Increase the proportion of infants who are breastfed at 6 months to 50%. D. Reduce the rate of maternal mortality to 5%.

B

Very low birth weight (VLBW) is defined as a birth weight less than __________. A. 500 grams B. 1,000 grams C. 1,500 grams D. 2,000 grams

C