Ob - Chapter 2
A nursing instructor is describing trends in maternal and newborn health care and the rise in community-based care for childbearing women. The instructor addresses the length of stay for vaginal births during the past decade, citing that which of the following denotes the average stay?
A) 24-48 hours or less B) 72-96 hours or less C) 48-72 hours or less D) 96-120 hours or less Ans: A Feedback: Hospital stays for vaginal births have averaged 24-48 hours or less during the past decade, and 72-96 hours or less for cesarean births.
The nurse would recommend the use of which supplement as a primary prevention strategy to prevent neural tube defects in pregnant women?
A) Calcium B) Folic acid C) Vitamin C D) Iron Ans: B Feedback: Prevention of neural tube defects in the offspring of pregnant women via the use of folic acid is an example of a primary prevention strategy. Calcium, vitamin C, and iron have no effect on the prevention of neural tube defects.
A nurse is preparing a teaching plan for a woman who is pregnant for the first time. Which of the following would the nurse incorporate into the teaching plan to foster the client's learning? Select all that apply.
A) Teach "survival skills" first. B) Use simple, nonmedical language. C) Refrain from using a hands-on approach. D) Avoid repeating information. E) Use visual materials such as photos and videos. Ans: A, B, E Feedback: To foster learning, the nurse should slow down and repeat information often; speak in a conversational style using plain, nonmedical language; prioritize information, teaching "survival skills" first; use visuals; and use an interactive, "hands-on" approach.
Ans: A Feedback: 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 nurse is caring for a 2-week-old girl with a metabolic disorder. Which of the following activities would deviate from the characteristics of family-centered care? A) Softening unpleasant information or prognoses B) Evaluating and changing the nursing plan of care C) Collaborating with the child and family as equals D) Showing respect for the family's beliefs and wishes
Ans: A Feedback: The tertiary level of prevention involves restorative, rehabilitative, or quality-of-life care, such as arranging for a physical therapy session. Teaching the parents to administer albuterol and reminding them to give the full course of antibiotics as prescribed are part of the secondary level of prevention, which focuses on diagnosis and treatment of illness. Giving a DTaP vaccination at proper intervals is an example of the primary level of prevention, which centers on health promotion and illness prevention.
The nurse is providing home care for a 6-year-old girl with multiple medical challenges. Which of the following activities would be considered the tertiary level of prevention? A) Arranging for a physical therapy session B) Teaching the parents to administer albuterol C) Reminding the parents to give the full course of antibiotics D) Giving the DTaP vaccination at proper intervals
A nurse is educating a client about a care plan. Which of the following would the nurse use to assess the client's learning ability?
A) "Did you graduate from high school; how many years of schooling did you have?" B) "Do you have someone in your family who would understand this information?" C) "Many people have trouble remembering information; is this a problem for you?" D) "Would you prefer that the doctor give you more detailed medical information?" Ans: C Feedback: It's appropriate to ask the client if he or she will have trouble remembering the information. Many clients have this problem. It removes any judgment or stereotypes regarding one's education level, understanding, or learning skills. Avoid giving information that uses a lot of medical language or jargon and use a simple, conversational style.
A pregnant client tells her nurse that she is interested in arranging a home birth. After educating the client on the advantages and disadvantages, which statement would indicate that the client understood the information?
A) "I like having the privacy, but it might be too expensive for me to set up in my home." B) "I want to have more control, but I am concerned if an emergency would arise." C) "It is the safest method for giving birth because there are no interferences." D) "The midwife is trained to resolve any emergency, and she can bring any pain meds." Ans: B Feedback: Home births have many advantages, such as having more control over the birth, being the least expensive option, creating a good relationship with a midwife, minimizing interferences, and having more flexibility in the comfort of your home. However, the limited availability of pain medication and danger to the mother and baby if an emergency arises are two of the main disadvantages. Thus, it is not considered the safest method for delivery
During class, a nursing student asks, "I read an article that was talking about integrative medicine. What is that?" Which response by the instructor would be most appropriate?
A) "It refers to the use of complementary and alternative medicine in place of traditional therapies for a condition." B) "It means that complementary and alternative medicine is used together with conventional therapies to reduce pain or discomfort." C) "It means that mainstream medical therapies and complementary and alternative therapies are combined based on scientific evidence for being effective." D) "It refers to situations in which a client and his or her family prefer to use an unproven method of treatment over a proven one." Ans: C Feedback: Integrative medicine combines mainstream medical therapies and CAM therapies for which there is some scientific evidence of safety and effectiveness (NCCAM, 2011). These include acupuncture, reflexology, therapeutic touch, meditation, yoga, herbal therapies, nutritional supplements, homeopathy, naturopathic medicine, and many more used for the promotion of health and well-being. Complementary medicine is used together with conventional medicine, such as using aromatherapy to reduce discomfort after surgery or to reduce pain during a procedure or during early labor. Alternative medicine is used in place of conventional medicine, such as eating a special natural diet to control nausea and vomiting or to treat cancer instead of undergoing surgery, chemotherapy, or radiation that has been recommended by a conventional doctor.
When caring for childbearing families from cultures different from one's own, which of the following must the nurse accomplish first?
A) Adapting to the practices of the family's culture B) Determining similarities between both cultures C) Assessing personal feelings about that culture D) Learning as much as possible about that culture Ans: C Feedback: The first step is to develop cultural awareness, engaging in self-exploration beyond one's own culture, seeing patients from different cultures, and examining personal biases and prejudices toward other cultures. Once this occurs, the nurse can learn as much about the culture as possible and become familiar with similarities and differences between his or her own culture and the family's culture. The nurse would adapt nursing care to address the practices of the family's culture to provide culturally competent care.
A pregnant woman asks the nurse about giving birth in a birthing center. She says, "I'm thinking about using one but I'm not sure." Which of the following would the nurse need to integrate into the explanation about this birth setting? Select all that apply.
A) An alternative for women who are uncomfortable with a home birth B) The longer length of stay needed when compared to hospital births C) Focus on supporting women through labor instead of managing labor D) View of labor and birth as a normal process requiring no intervention E) Care provided primarily by obstetricians with midwives as backup care Ans: A, C, D Feedback: Birthing centers are an alternative for women who are uncomfortable with a home birth but do not want a hospital birth. A birthing center offers a home-like setting but with close proximity to a hospital in case of complications. Typically the normal discharge time in birthing centers ranges from 4 to 24 hours, shorter than that for a hospital birth. Labor and birth are viewed as a normal process and midwives, not obstetricians, support the woman through labor rather than manage labor. Most centers use a noninterventional view of labor and birth.
A 3-year-old boy with encephalitis is scheduled for a lumbar puncture. Which of the following actions by the nurse would demonstrate atraumatic care?
A) Applying an anesthetic cream before the lumbar puncture B) Having his anxious mother stay in the waiting room C) Explaining, using medical terms, what will happen D) Starting the child's intravenous infusion in his room Ans: A Feedback: Using an anesthetic cream prior to the lumbar puncture reduces the pain associated with the procedure and is an example of atraumatic care. The presence of a parent during procedures is supportive for the child and should be encouraged because it can reduce stress. The explanation of what will happen should be given on the child's level. The IV should not be started in the child's hospital room, which should remain a "safe" area.
When integrating the principles of family-centered care for a pregnant woman and her family, the nurse would integrate understanding of which of the following?
A) Childbirth is viewed as a medical event. B) Families are unable to make informed choices. C) Childbirth results in changes in relationships. D) Families require little information to make appropriate decisions. Ans: C Feedback: Family-centered care is based on the following principles. Childbirth affects the entire family and relationships will change. Childbirth is viewed as a normal, healthy event in the life of the family. Families are capable of making decisions about their own care if given adequate information and professional support.
The nurse is providing care to an ill child and his family. Which of the following activities would deviate from the basic principles of case management?
A) Collaborating with the family throughout the care path B) Focusing on both the client's and the family's needs C) Coordinating care provided by the interdisciplinary team D) Ensuring quality care regardless of the cost Ans: D Feedback: Ensuring quality care regardless of the cost is not part of case management, but providing cost-effective, high-quality care is. Collaborating with the family throughout the care path, coordinating care provided by the interdisciplinary team, and focusing on client and family needs are key components of case management that increase family satisfaction.
A nursing instructor is presenting a class for a group of students about community-based nursing interventions. The instructor determines that additional teaching is needed when the students identify which of the following as a role of the community-based nurse?
A) Conducting childbirth education classes B) Counseling a pregnant teen with anemia C) Consulting with a parent of a child who is vomiting D) Performing epidemiologic investigations Ans: D Feedback: Community health nurses, not community-based nurses, perform epidemiologic investigations to help analyze and develop health policy and community health initiatives. Community-based nurses are involved in teaching, such as childbirth education classes; counseling, such as with a pregnant teenager; and consulting with clients.
When assuming the role of discharge planner for a child requiring ventilator support at home, the nurse would do which of the following?
A) Confer with the school nurse or teacher. B) Teach new self-care skills to the child. C) Determine if there is a need for backup power. D) Discuss coverage with the family's insurance company. Ans: C Feedback: Discharge planning involves the development and implementation of a comprehensive plan for the safe discharge of a client from a health care facility and for continuing safe and effective care in the community and at home. Thus as a discharge planner, the nurse should establish if there is a need for backup power to ensure the safety of the child. Conferring with a school nurse or teacher and dealing with insurance companies are case management activities. Teaching self-care skills is an activity associated with the nurse's role as an educator.
The nurse who is scheduled to work in a clinic in a Hispanic neighborhood takes time to research Hispanic cultural norms to better provide culturally competent care to people at work. This behavior is an example of which of the following cultural components?
A) Cultural awareness B) Cultural knowledge C) Cultural skills D) Cultural encounter Ans: B Feedback: Cultural knowledge is the acquisition of information about other cultures from a variety of sources. Cultural awareness is an exploration of one's own culture and how values, beliefs, and behaviors have influenced personal life. Cultural skills and practices provide for the incorporation of knowledge of cultural background, including specific practices for health, and a cultural encounter is participation in and interaction with persons of diverse cultural backgrounds.
A group of nurses is engaged in developing cultural competence. The students demonstrate achievement of this goal after developing which of the following?
A) Cultural knowledge B) Cultural skills C) Cultural encounter D) Cultural awareness Ans: C Feedback: The steps to developing cultural competence are cultural awareness, cultural knowledge, cultural skills, and, last, cultural encounter.
The parents of an 8-year-old with cancer are telling the nurse their problems and successes when caring for their child. In response, the nurse arranges for social services to meet with the parents to help them obtain financial assistance for the equipment and supplies. The nurse is acting in which role?
A) Educator B) Advocate C) Case manager D) Direct care provider Ans: B Feedback: The nurse is acting as an advocate, representing the client and family to a third party, by ensuring that the family has the resources and services to provide care for their child. The nurse acts as a direct care provider through assessment, observation of physical care, and the actual provision of physical care. The role of educator would require the nurse to give rather than receive information. Case management involves coordinating elements of a nursing plan of care.
A nurse is developing cultural competence. Which of the following indicates that the nurse is in the process of developing cultural knowledge? Select all that apply.
A) Examining personal sociocultural heritage B) Reviewing personal biases and prejudices C) Seeking resources to further understanding of other cultures D) Becoming familiar with other culturally diverse lifestyles E) Performing a competent cultural assessment F) Advocating for social justice to eliminate disparities Ans: C, D Feedback: When developing cultural knowledge, the nurse would seek resources to increase understanding of different sociocultural groups and become familiar with culturally/ethnically diverse groups, worldviews, beliefs, practices, lifestyles, and problem-solving styles. Examining one's personal sociocultural heritage and personal biases and prejudices are components involved with developing cultural awareness. Performing a competent cultural assessment and advocating for social justice are components involved with developing cultural skills.
The nurse is caring for a 14-year-old girl with multiple health problems. Which of the following activities would best reflect evidence-based practice by the nurse?
A) Following blood pressure monitoring recommendations B) Determining how often vital signs are monitored C) Using hospital protocol for ordering diagnostic tests D) Deciding on the medication dose Ans: A Feedback: Using hospital protocol for ordering a diagnostic test, determining how often vital signs are monitored, and deciding on the medication dose would be the physician's responsibility. However, following blood pressure monitoring recommendations would be part of evidence-based practice reflected in the nursing care delivered.
The nurse is making a home visit to a client who had a cesarean birth 3 days ago. Assessment reveals that she is complaining of intermittent pain, rating it as 8 on a scale of 1 to 10. She states, "I'm pretty tired. And with this pain, I haven't been drinking and eating like I should. The medication helps a bit but not much. My mom has been helping with the baby." Her incision is clean, dry, and intact. Which nursing diagnosis would the nurse identify as the priority for this client?
A) Impaired skin integrity related to cesarean birth incision B) Fatigue related to effects of surgery and caretaking activities C) Imbalanced nutrition, less than body requirements, related to poor fluid and food intake D) Acute pain related to incision and cesarean birth Ans: D Feedback: The client reports a pain rating of 8 out of 10 and states that the medication is helping only a bit. She also mentions that the pain is interfering with her ability to eat and drink. Therefore, the priority nursing diagnosis is acute pain related to incision and cesarean birth. Her incision is clean, dry, and intact, so impaired skin integrity is not the problem. She is fatigued, but her complaints of pain supersede her fatigue. Although her nutritional intake is reduced, it is due to the pain.
After teaching a group of students about the changes in health care delivery and funding, which of the following, if identified by the group as a current trend seen in the maternal and child health care settings, would indicate that the teaching was successful?
A) Increase in ambulatory care B) Decrease in family poverty level C) Increase in hospitalization of children D) Decrease in managed care Ans: A Feedback: The health care system has moved from reactive treatment strategies in hospitals to a proactive approach in the community, resulting in an increased emphasis on health promotion and illness prevention in the community through the use of community-based settings such as ambulatory care. Poverty levels have not decreased and the hospitalization of children has not increased. Case management also is a primary focus of care.
When explaining community-based nursing versus nursing in the acute care setting to a group of nursing students, the nurse describes the challenges associated with community-based nursing. Which of the following would the nurse include?
A) Increased time available for education B) Improved access to resources C) Decision making in isolation D) Greater environmental structure Ans: C Feedback: Community-based nurses often have to make decisions in isolation. This is in contrast to the acute care setting, where other health care professionals are readily available. Nursing care and procedures in the community also are becoming more complex and time-consuming, leaving limited time for education. Nurses working in the community have fewer resources available and the environment is less structured and controlled when compared to the acute care setting.
Which action would the nurse include in a primary prevention program in the community to help reduce the incidence of HIV infection?
A) Provide treatment for clients who test positive for HIV. B) Monitor viral load counts periodically. C) Educate clients about how to practice safe sex. D) Offer testing for clients who practice unsafe sex. Ans: C Feedback: Primary prevention involves preventing disease before it occurs. Therefore, educating clients about safe-sex practices would be an example of a primary prevention strategy. Providing treatment for clients who test positive for HIV, monitoring viral loads periodically, and offering testing for clients who practice unprotected sex are examples of secondary preventive strategies, which focus on early detection and treatment of adverse health conditions.
A nursing student is reviewing information about documenting client care and education in the medical record and the purposes that it serves. The student demonstrates a need for additional study when the student identifies which of the following as a reason for documentation?
A) Serves as a communication tool for the interdisciplinary team B) Demonstrates education the family has received if legal matters arise C) Permits others access to allow refusal of medical insurance coverage D) Verifies meeting client education standards set by the Joint Commission Ans: C Feedback: Medical records are not in place for others to view for the sole purpose of denying medical coverage. Documenting client care and education (medical records) serves four main purposes. The client's medical record serves as a communication tool that the entire interdisciplinary team can use to keep track of what the client and family have learned. Next, it serves to testify to the education the family has received if legal matters arise. Third, it verifies standards set by JCAHO and other accrediting bodies that hold health care providers accountable for client education activities. Last, it informs third-party payers of goods and services provided for reimbursement purposes.
After teaching a group of students about the different levels of prevention, the instructor determines a need for additional teaching when the students identify which of the following as an activity at the tertiary prevention level in community-based health care?
A) Teaching women to take folic acid supplements to prevent neural tube defects B) Working with women who are victims of domestic violence C) Working with clients at an HIV clinic to provide nutritional and CAM therapies D) Teaching hypertensive clients to monitor blood pressure Ans: A Feedback: Primary prevention involves preventing a disease or condition before it occurs, such as teaching women about the importance of taking folic acid supplements to prevent neural tube defects. Secondary prevention is the early detection of disease or conditions. Working with women who are victims of domestic violence, clients at an HIV clinic, or hypertensive clients are all examples of tertiary prevention, which is designed to reduce or limit the progression of a permanent, irreversible disease or disability.
A nurse is considering a change in employment from the acute care setting to community-based nursing. The nurse is focusing her job search on ambulatory care settings. Which of the following would the nurse most likely find as a possible setting? Select all that apply.
A) Urgent care center B) Hospice care C) Immunization clinic D) Physician's office E) Day surgery center F) Nursing home Ans: A, D, E Feedback: Ambulatory care settings include physician's offices, day surgery centers, and freestanding urgent care centers. Hospice may be a part of home health care services or long-term care. Immunization clinics are examples of health department services. Nursing homes are examples of long-term care settings.
While a nurse is obtaining a health history, the client tells the nurse that she practices aromatherapy. The nurse interprets this as which of the following?
A) Use of essential oils to stimulate the sense of smell to balance the mind and body B) Application of pressure to specific points to allow self-healing C) Use of deep massage of areas on the foot or hand to rebalance body parts D) Participation in chanting and praying to promote healing Ans: A Feedback: Aromatherapy involves the use of essential oils to stimulate the sense of smell to balance the mind, body, and spirit. Acupressure involves the application of pressure to specific points to restore balance and allow self-healing to take over. Reflexology is the use of deep massage on identified points of the foot or hand to scan and rebalance body parts that correspond to each point. Spiritual healing involves praying, chanting, presence, laying on of hands, rituals, and meditation to assist in healing.
Ans: D Feedback: Describing what it is like to get a CT scan using age-appropriate words is the best example of therapeutic communication. It is goal-directed, focused, and purposeful communication. Using family-familiar words and soft words is a good teaching technique. Telling him how cool he looks in his baseball cap and pajamas is not goal-directed communication. Telling the child he will get a shot when he wakes up could keep him awake all night.
The nurse is caring for a 4-year-old boy with Ewing's sarcoma who is scheduled for a CT scan tomorrow. Which of the following best reflects therapeutic communication? A) Telling him he will get a shot when he wakes up tomorrow morning B) Telling him how cool he looks in his baseball cap and pajamas C) Using family-familiar words and soft words when possible D) Describing what it is like to get a CT scan using words he understands
Ans: D Feedback: Parents, when given a life-altering diagnosis, need time to absorb information and to ask questions. Therefore, giving the parents information in small amounts at a time is best. The child has just been diagnosed with epilepsy, and surgical intervention is not used unless seizures persist despite medication therapy. Therefore, discussing surgery would be inappropriate at this time. Assessing the parents' knowledge of anticonvulsant medications identifies a knowledge gap and need to learn, but it would be unreasonable to think that they would understand the medications because the diagnosis had just been made. Demonstrating proper seizure safety procedures is an effective way to present information later on, once the family begins to understand the condition.
The nurse is educating the parents of a 7-year-old girl who has just been diagnosed with epilepsy. Which of the following teaching techniques would be most appropriate? A) Assessing the parents' knowledge of anticonvulsant medications B) Demonstrating proper seizure safety procedures C) Discussing the surgical procedures for epilepsy D) Giving the parents information in small amounts at a time
