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NUR 107 CHAP 1, 2, 3, 10 RICCI
MATERNITY AND PEDIATRIC NURSING,
FOURTH EDITION
A nurse educator is conducting a class on intimate partner violence for a group of new graduate nurses during orientation. Which statement by the educator best reflects current practice regarding these problems in women's health? - Correct Answers -"The nurse should screen for these problems at every client encounter." Explanation: Both child and intimate partner violence is increasing in incidence. Families are more mobile than in the past. Screening for child abuse (child maltreatment) or intimate partner violence should be included in all family contacts. Nurses must be aware of the legal responsibilities for reporting violence. A nursing student is preparing a presentation illustrating the Human Genome Project. Which function will the student point out as being the primary focus? - Correct Answers -Identification of human genes and functions Explanation: The Human Genome Project was founded in 1990 and its primary purpose was to identify and label all human genes and their functions. Information from the HGP may eventually be used in genetic testing, the detection of mutations or variations in children, and gene therapy. In 2007 the World Factbook published statistics that showed the United States still lagged behind other industrialized nations in the incidence of infant mortality. What is one reason that the United States has a higher infant mortality rate than other countries? - Correct Answers -Low birth weight Explanation: Many factors may be associated with high infant mortality rates and poor health. Low birth weight and late or nonexistent prenatal care are the main factors in the poor rankings in infant mortality. What nursing intervention by the maternity nurse is the most important in providing family-centered care? - Correct Answers -promoting uninterrupted infant bonding Explanation: Since World War II many changes and innovations have occurred in maternity care and how nurses provide this care. The evolution has gone from task-oriented nursing
services, to providing education and promoting breastfeeding, to family-centered care. Promoting uninterrupted infant bonding has been identified as a priority in the development of the family unit. Allowing doulas in the delivery room, having siblings at the bedside and providing early discharge are all parts of family-centered care, but establishing bonding between the infant and the family unit is the priority. What makes the area of family nursing a difficult arena in which to provide care at times? - Correct Answers -family members who might not agree on treatments and a plan of care Explanation: The family may not agree of the plan of care or treatment plans with each other or for their children. This is a difficult situation as the children do not have their rights to make their own decisions and the family needs to agree. A nurse at a prenatal class discusses the evolution of obstetrical care. Which statements would best describe birth in America presently? Select all that apply. - Correct Answers -One in three women in the United States undergoes a surgical birth (cesarean). Certified nurse midwives (CNMs) assist with births safely in many settings. The infant mortality rate in the United States is approximately 6.17 in 1,000 live births. Explanation: One in three women undergoes a surgical birth (cesarean). CNMs may once again assist couples at home, in hospitals, or in freestanding facilities with natural childbirths. The United States ranks 55th in the world (compared to 224 other countries) in infant mortality rates. The infant mortality rate is approximately 6.17 in 1,000 live births. Research shows that midwives are the safest birth attendants for most women, with lower infant mortality and maternal rates. The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained? - Correct Answers -learning the mother is not the custodial parent Explanation: It would not be legal for this mother to give consent. A mother younger than 18 years of age or never married may not be a problem in most states because she would be considered autonomous. The physician or nurse could read the consent form to a mother who cannot read plus carefully explain the medical information in terms she understood. The nurse is providing care to a woman who has just given birth to a healthy term neonate. The woman's partner arrives and asks about the neonate's status. Which action by the nurse would be appropriate? - Correct Answers -Check the medical record for written client approval with whom to share information. Explanation: In maternal and newborn health care, information is shared only with the client, legal partner, parents, legal guardians, or individuals as established in writing by the client or the child's parents. This law promotes the security and privacy of health care and health
When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct. 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? - Correct Answers -Improve women's access to receiving prenatal care. Explanation: 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. A nurse working in a pediatrician's office has requested that a generic brand of cotton swabs be ordered in place of a more expensive brand name. Which trend in today's health care environment is most related to this nurse's action? - Correct Answers - initiating cost containment Explanation: Cost containment refers to reducing the cost of health care by closely monitoring the costs of personnel, use and brands of supplies, length of hospital stays, number of procedures carried out, and number of referrals requested while still maintaining quality care. The other trends listed are not as directly related or are unrelated to this nurse's action. The nurse works at the local public health office. Which is a major but often overlooked problem in this setting? - Correct Answers -fetal mortality Explanation: 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 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: - Correct Answers -improved prenatal care has reduced the numbers of fetal deaths. Explanation: 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 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. - Correct Answers -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. Explanation: 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. 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? - Correct Answers -An infant born at a low birth weight Explanation: 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. Before World War II women moved from home to hospital births. What was the primary reason for that shift in maternity care? - Correct Answers -They were convinced that setting would improve birth outcomes. Explanation: 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. 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? - Correct Answers -An infant born at a low birth weight Explanation: 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. Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because: - Correct Answers -increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive.
statement best reflects the mother's religion's beliefs about health? - Correct Answers - Healing will come through prayer and spiritual regeneration only. Explanation: Christian Scientists view disease as error of the human mind that can be dispelled by spiritual truth. Health is viewed within a spiritual framework; healing will come through prayer and spiritual regeneration with no medical intervention. There is general opposition to human interventions with drugs or other therapies except for legally required immunizations in the Christian Scientist church, and Christian Scientists usually do not use blood or blood components, seek transplants or act as donors, or seek biopsies or physical examination. A public health nurse is developing a plan to implement strategies to assist in lowering maternal and infant mortality rates for Black women in the United States. Which factor should not be included in the plan? - Correct Answers -Black women have adequate obstetrical insurance coverage. Explanation: The maternal mortality and morbidity rates for black women in the Unites States have been three to four times higher than for white women. This difference in the pregnancy- related mortality ratio is the largest disparity in the area of maternal and child health. Researchers do not entirely understand what accounts for this disparity, but some suspected causes of the higher maternal mortality rates for minority women include low socioeconomic status, limited or no insurance coverage, bias among health care providers, and quality of care available in the community. A nurse is conducting a presentation for a group of pregnant women about appropriate health promotion strategies to address issues related to infant mortality. Which strategy would the nurse encourage to reduce the infant's risk for infection after birth? - Correct Answers -breastfeeding Explanation: After birth, other health promotion strategies can significantly improve an infant's health and chances of survival. Breastfeeding has been shown to reduce rates of infection in infants and to improve long-term health. Emphasizing the importance of placing an infant on his or her back to sleep will reduce the incidence of SIDS. Newborn development support groups will help provide education about normal child development and child rearing. Folic acid supplementation is used during pregnancy to prevent neural tube defects. 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? - Correct Answers -weight control and being knowledgeable about family history of cardiovascular disease Explanation: 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 disease, although impacting the mortality rates of women, is not the greatest cause of death. The maternal-child health nurse provides care to which client populations working within an appropriate scope of practice? Select all that apply. - Correct Answers -a 2-week-old preterm infant a 14-year-old primigravida client BOX 1.1 Childbirth in America: A Time Line - Correct Answers -BOX 1.1 Childbirth in America: A Time Line 1700s Men did not attend births because it was considered indecent. Women faced birth not with joy and ecstasy but with fear of death. Female midwives attended the majority of all births at home. 1800s There is a shift from using midwives to doctors among middle-class women. The word obstetrician was formed from the Latin, meaning "to stand before." Puerperal (childbed) fever was occurring in epidemic proportions. Louis Pasteur demonstrated that streptococci were the major cause of puerperal fever that was killing mothers after delivery. The first cesarean section was performed in Boston in
The x-ray was developed in 1895 and was used to assess pelvic size for birthing purposes. 1900s Twilight sleep (a heavy dose of narcotics and amnesiacs) was used on women during childbirth in the United States. The United States was 17th out of 20 nations in infant mortality rates. Of all women, 50% to 75% gave birth in hospitals by 1940. Nurseries were started because mothers could not care for their baby for several days after receiving chloroform gas. Dr. Grantley Dick-Reed (1933) wrote Childbirth Without Fear, which reduced the "fear- tension-pain" cycle women experienced during labor and birth. Dr. Fernand Lamaze (1984) wrote Painless Childbirth: The Lamaze Method, which advocated distraction and relaxation techniques to minimize the perception of pain. Amniocentesis was first performed to assess fetal growth in 1966. In the 1970s the cesarean section rate was about 5%. In 2011 it rose to 32%, where it stands currently.
The nurse is reviewing the nursing care plan on a pediatric client admitted to the hospital with a respiratory illness. Which goal is written correctly? - Correct Answers - The client will have an oxygen saturation of greater than 95% on room air within 8 hours. Explanation: Goals must be specific, measurable, and have a time frame. The goal identified as "The client will have an oxygen saturation of greater than 95% on room air within 8 hours" includes both measurable, objective information (the oxygen saturation on room air and a time frame). It is client-centered and appropriate. The goals of "breathing better" and "better respiratory rate and oxygen saturation" are vague and do not have a measurable outcome. What is considered "better" is subjective and not measurable. Not having a time frame makes the goal inaccurate as well. The goal of the client walking a specific distance on room air would be a good goal if a date/time frame were included in the goal. A parent brings a foster child to the clinic for immunizations. What is the first responsibility of the nurse? - Correct Answers -verify legal documentation Explanation: When a child is placed in foster care the foster parents are given legal documentation of this placement and of their ability to seek and consent to treatment. This documentation should be confirmed before any treatment is rendered. A child placed with a foster parent is not required to have a case manager present at medical visits. The foster parent can take the child for care whenever needed. The authorization to treat is part of the legal documentation provided to the foster parent, so it is not necessary to obtain a new consent at every clinic visit. 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? - Correct Answers -Pull the nurse aside and inquire as to the content of the conversation. Explanation: 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. Before World War II women moved from home to hospital births. What was the primary reason for that shift in maternity care? - Correct Answers -They were convinced that setting would improve birth outcomes. Explanation: 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.
A nurse is conducting a presentation for a group of pregnant women about appropriate health promotion strategies to address issues related to infant mortality. Which strategy would the nurse encourage to reduce the infant's risk for infection after birth? - Correct Answers -breastfeeding Explanation: After birth, other health promotion strategies can significantly improve an infant's health and chances of survival. Breastfeeding has been shown to reduce rates of infection in infants and to improve long-term health. Emphasizing the importance of placing an infant on his or her back to sleep will reduce the incidence of SIDS. Newborn development support groups will help provide education about normal child development and child rearing. Folic acid supplementation is used during pregnancy to prevent neural tube defects. What societal issues greatly influence delivery of maternal and pediatric health care? Select all that apply. - Correct Answers -Cost of health care Low income of families Increased cultural and ethnic diversity of clients Explanation: Demographic trends such as a decreased number children being born, combined with an increase in a multicultural society seeking health care, are affecting the delivery of maternal-child health care. Poverty and the cost of health care also play a major role in influencing health care delivery for both women and children. A nurse is working as part of a larger community group to develop programs to address current barriers to health care being experienced by women. The community is in the city with a large population of low-income families. On which factor should the group focus their efforts to address a main barrier to access to care? - Correct Answers - health insurance Explanation: Although transportation, language and culture, and low health literacy are barriers to health care, health insurance is a major factor affecting access to health care. The existence of financial barriers is one of the most important factors that limits access to care. Many families do not have health insurance so they cannot afford to see health care providers for maintenance and prevention services. Many do not have enough health insurance to cover services they need or cannot pay for services. Consent for urgent treatment is needed for a minor. The parents are unable to be at the hospital. What action by the nurse constitutes informed consent? - Correct Answers - Telephone consent with two witnesses listening simultaneously. Explanation: Telephone consent documented with two witness signatures is appropriate. None of the other options constitutes informed consent.
the health assessment. This observation is likely to precede formal assessments, such as cognitive assessment and family health history. At this point, it is not known if food stamps are needed. Assessment is the priority. In order to advocate for children and families, the nurse must first acknowledge that the basic system in which health behavior and care are organized, secured, and performed is the: - Correct Answers -family. Explanation: The family is the basic system in which health behavior and care are organized, secured, and performed. In most families, the parents or guardians, as advocates for their child, provide health promotion and health prevention care, as well as primary management of care when the child is sick. Parents and guardians have the prime responsibility for initiating and coordinating services rendered by health professionals. When preparing a teaching plan for a group of women during their first pregnancy, the nurse reviews how maternity care has changed over the years. Which information would the nurse include when discussing events occurring in the 20th century? - Correct Answers -development of birthing centers Explanation: In the 20th century (1900s), birth centers were developed. Puerperal fever epidemics, the first cesarean birth, and X-ray to assess pelvic size were events occurring during the 19th century (1800s). A group of nurses are working to provide quality care for their clients within the current health care environment of cost containment. Which strategy(ies) would be appropriate for the nurses to use? Select all that apply. - Correct Answers -educating clients about seeking help for problems early on urging clients to participate in screening programs creating easy access programs for clients to receive immunizations Explanation: Nurses can be leaders in providing quality care within a limited-resource environment by emphasizing the importance of making healthy lifestyle and food choices, seeking early interventions for minor problems before they become major ones, and learning about health-related issues that affect clients. Mammograms, cervical cancer screenings, prenatal care, smoking cessation programs, and immunizations are a few examples of preventive care that yield positive outcomes and reduce overall health care costs. Prevention services and health education are the cornerstones of delivering quality maternal, newborn, and women's health care. Although organic foods may be considered healthy choices, they can be more costly. If encouraged, clients may opt to spend more for the organic foods, thereby limiting their choices for selecting other healthy foods. Using the emergency department for routine care would not be cost- effective.
A nurse writes the following on a child's electronic medical record: "The child will state the signs and symptoms that indicate an exacerbation of asthma." The nurse is involved in which component of the nursing process? - Correct Answers -outcome identification Explanation: The statement reflects an outcome. An outcome (goal) is client-focused (specific), stated in measurable terms, attainable, realistic, and includes a time frame in which the outcome should be accomplished. Writing outcomes is part of the outcome identification component of the nursing process. Assessment involves data collection. Implementation is the process of putting the nursing care plan into action. Evaluation measures if the nursing plan of care was successful or no Which physician is known as the "Father of Pediatrics"? - Correct Answers -Abraham Jacobi Explanation: Many view Abraham Jacobi, a Prussian-born physician, as the father of pediatrics. 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? - Correct Answers -Efforts to contain health care costs Explanation: 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 nurse working in an obstetrician's office demonstrates case management when which action is completed? - Correct Answers -scheduling an appointment with a counselor when a client reports martial concerns Explanation: Case management is the act of monitoring and coordinating care for the client. The nurse is coordinating care by assuring an appointment is made for the client when the client expresses marital concerns. The nurse would provide the client with additional information about cloth and disposable diapers, but this action is not specific to case management. The nurse is acting as an advocate when assisting the client with discussing test results with the partner. The nurse is meeting the client's social needs by permitting and encouraging the client to bring the partner to each appointment.
