REVISED OB EXAM TEST BANK, Exams of Nursing

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REVISED OB EXAM TEST BANK

When providing care for a pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is:

a. diabetes mellitus.

b. mitral valve prolapse (MVP).

c. chronic hypertension.

d. anemia. - CORRECT ANSWER -ANS: A

The most frequently reported maternal medical risk factors are diabetes and hypertension associated with pregnancy. Both of these conditions are associated with maternal obesity. There are no studies that indicate MVP is among the most frequently reported maternal risk factors. Hypertension associated with pregnancy, not chronic hypertension, is one of the most frequently reported maternal medical risk factors. Although anemia is a concern in pregnancy, it is not one of the most frequently reported maternal medical risk factors in pregnancy

To ensure optimal outcomes for the patient, the contemporary maternity nurse must incorporate both teamwork and communication with clinicians into her care delivery. The SBAR technique of communication is an easy-to-remember mechanism for communication. Which of the following correctly defines this acronym?

a. Situation, baseline assessment, response

b. Situation, background, assessment, recommendation

c. Subjective background, assessment, recommendation

d. Situation, background, anticipated recommendation - CORRECT ANSWER -ANS: B

The situation, background, assessment, recommendation (SBAR) technique provides a specific framework for communication among health care providers. Failure to communicate is one of the major reasons for errors in health care. The SBAR technique has the potential to serve as a means to reduce errors.

The role of the professional nurse caring for childbearing families has evolved to emphasize:

a. providing care to patients directly at the bedside.

b. primarily hospital care of maternity patients.

c. practice using an evidence-based approach.

d. planning patient care to cover longer hospital stays. - CORRECT ANSWER -ANS: C

Professional nurses are part of the team of health care providers who collaboratively care for patients throughout the childbearing cycle. Providing care to patients directly at the bedside is one of the nurse's tasks; however, it does not encompass the concept of the evolved professional nurse. Throughout the prenatal period, nurses care for women in clinics and physician's offices and teach classes to help families prepare for childbirth. Nurses also care for childbearing families in birthing centers and in the home. Nurses have been critically important in developing strategies to improve the well-being of women and their infants and have led the efforts to implement clinical practice guidelines using an evidence-based approach. Maternity patients have experienced a decreased, rather than an increased, length of stay over the past two decades.

d. assess whether the patient understands the discussion. - CORRECT ANSWER -ANS: D

Nurses contribute to health literacy by using simple, common words; avoiding jargon; and evaluating whether the patient understands the discussion. Speaking slowly and clearly and focusing on what is important increase understanding. Most patient education materials are written at too high a level for the average adult and may not be useful for a patient with limited English proficiency.

When managing health care for pregnant women at a prenatal clinic, the nurse should recognize that the most significant barrier to access to care is the pregnant woman's:

a. age.

b. minority status.

c. educational level.

d. inability to pay. - CORRECT ANSWER -ANS: D

The most significant barrier to health care access is the inability to pay for services; this is compounded by the fact that many physicians refuse to care for women who cannot pay. Although adolescent pregnant patients statistically receive less prenatal care, age is not the most significant barrier. Significant disparities in morbidity and mortality rates exist for minority women; however, minority status is not the most significant barrier to access of care. Disparities in educational level are associated with morbidity and mortality rates; however, educational level is not the most significant barrier to access of care.

When the nurse is unsure about how to perform a patient care procedure, the best action would be to:

a. ask another nurse.

b. discuss the procedure with the patient's physician.

c. look up the procedure in a nursing textbook.

d. consult the agency's procedure manual and follow the guidelines for the procedure. - CORRECT ANSWER -ANS: D

It is always best to follow the agency's policies and procedures manual when seeking information on correct patient procedures. These policies should reflect the current standards of care and state guidelines. Each nurse is responsible for her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe patient care delivery. Physicians are responsible for their own patient care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or individual state or hospital policies.

From the nurse's perspective, what measure should be the focus of the health care system to reduce the rate of infant mortality further?

a. Implementing programs to ensure women's early participation in ongoing prenatal care.

b. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days.

c. Expanding the number of neonatal intensive care units (NICUs).

d. Mandating that all pregnant women receive care from an obstetrician. - CORRECT ANSWER -ANS: A

a. She is Hispanic.

b. She delivered a girl.

c. The standards of care were not met.

d. She refused fetal monitoring. - CORRECT ANSWER -ANS: C

Not meeting the standards of care is a legitimate factor for a case of negligence. The patient's race is not a factor for a case of negligence. The infant's gender is not a factor for a case of negligence. Although fetal monitoring is the standard of care, the patient has the right to refuse treatment. This refusal is not a case for negligence; however, informed consent should be properly obtained, and the patient should sign an against medical advice form for refusal of any treatment that is within the standard of care.

A newly graduated nurse is attempting to understand the reason for increasing health care spending in the United States. Her research finds that these costs are much higher compared with other developed countries as a result of:

a. a higher rate of obesity among pregnant women.

b. limited access to technology.

c. increased usage of health care services along with lower prices.

d. homogeneity of the population. - CORRECT ANSWER -ANS: A

Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.5% of the gross domestic product is spent on health care. Higher spending in the United States compared with 12 other industrialized countries is related to higher prices and readily accessible technology along with greater obesity rates among women. More than one third of women in the United States are obese. Of the U.S. population, 16% is uninsured and has limited access to health care. Maternal morbidity and mortality are directly related to racial disparities.

The term used to describe legal and professional responsibility for practice for maternity nurses is:

a. collegiality.

b. ethics.

c. evaluation.

d. accountability. - CORRECT ANSWER -ANS: D

Accountability refers to legal and professional responsibility for practice. Collegiality refers to a working relationship with one's colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes.

Through the use of social media technology, nurses can link with other nurses who may share similar interests, insights about practice, and advocate for patients. The most concerning pitfall for nurses using this technology is:

a. violation of patient privacy and confidentiality.

b. institutions and colleagues may be cast in an unfavorable light.

b. Birth rates for women 40 to 44 years old are beginning to decline.

c. Cigarette smoking among pregnant women continues to increase.

d. The rates of maternal death owing to racial disparity are elevated in the United States. - CORRECT ANSWER -ANS: A

Low-birth-weight infants and preterm birth are more likely because of the large number of teenagers in the unmarried group. Birth rates for women in their early 40s continue to increase. Fewer pregnant women smoke. In the United States, there is significant racial disparity in the rates of maternal death.

Maternity nursing care that is based on knowledge gained through research and clinical trials is:

a. derived from the Nursing Intervention Classification.

b.known as evidence-based practice.

c. at odds with the Cochrane School of traditional nursing.

d. an outgrowth of telemedicine. - CORRECT ANSWER -ANS: B

Evidence-based practice is based on knowledge gained from research and clinical trials. The Nursing Intervention Classification is a method of standardizing language and categorizing care. Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice movement. Telemedicine uses communication technologies to support health care.

The level of practice a reasonably prudent nurse provides is called:

a. the standard of care.

b. risk management.

c. a sentinel event.

d. failure to rescue. - CORRECT ANSWER -ANS: A

Guidelines for standards of care are published by various professional nursing organizations. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events are unexpected negative occurrences. They do not establish the standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the standard of care.

While obtaining a detailed history from a woman who has recently emigrated from Somalia, the nurse realizes that the patient has undergone female genital mutilation (FGM). The nurse's best response to this patient is:

a. "this is a very abnormal practice and rarely seen in the United States."

b. "do you know who performed this so that it can be reported to the authorities?"

c. "we will be able to restore your circumcision fully after delivery."

d. "the extent of your circumcision will affect the potential for complications." - CORRECT ANSWER -ANS: D

"The extent of your circumcision will affect the potential for complications" is the most appropriate response. The patient may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. With the growing number of immigrants from countries where FGM is practiced,

b. low birth weight and preterm birth.

c. elimination of health disparities based on race.

d. infant mortality and the prevention of birth defects. - CORRECT ANSWER -ANS: A

Trends in maternal child health indicate that progress has been made in relation to reduced infant and fetal deaths and increased prenatal care. Notable gaps remain in the rates of low birth weight and preterm births. According to the March of Dimes, persistent disparities still exist between African- Americans and non-Hispanic Caucasians. Many of these negative outcomes are preventable through access to prenatal care and the use of preventive health practices. This demonstrates the need for comprehensive community-based care for all mothers, infants, and families.

Which interventions would help alleviate the problems associated with access to health care for maternity patients? (Select all that apply.)

a. Provide transportation to prenatal visits.

b. Provide child care so that a pregnant woman may keep prenatal visits.

c. Mandate that physicians make house calls.

d. Provide low-cost or no-cost health care insurance.

e. Provide job training. - CORRECT ANSWER -ANS: A, B, D

Lack of transportation to visits, lack of child care, and lack of affordable health insurance are prohibitive factors associated with lack of prenatal care. House calls are not a cost-effective approach to health care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote.

A married couple lives in a single-family house with their newborn son and the husband's daughter from a previous marriage. On the basis of the information given, what family form best describes this family?

a. Married-blended family

b. Extended family

c. Nuclear family

d. Same-sex family - CORRECT ANSWER -ANS: A

Married-blended families are formed as the result of divorce and remarriage. Unrelated family members join together to create a new household. Members of an extended family are kin, or family members related by blood, such as grandparents, aunts, and uncles. A nuclear family is a traditional family with male and female partners and the children resulting from that union. A same-sex family is a family with homosexual partners who cohabit with or without children.

In what form do families tend to be most socially vulnerable?

a. Married-blended family

b. Extended family

c. Nuclear family

d. Single-parent family - CORRECT ANSWER -ANS: D

d. The prevailing cultural beliefs of society. - CORRECT ANSWER -ANS: C

The family stress theory is concerned with the family's reaction to stressful events; internal context factors include elements that a family can control such as psychologic defenses. It is not concerned with biologic and genetic makeup, maturation of family members, or the prevailing cultural beliefs of society.

While working in the prenatal clinic, you care for a very diverse group of patients. When planning interventions for these families, you realize that acceptance of the interventions will be most influenced by:

a. educational achievement.

b. income level.

c. subcultural group.

d. individual beliefs. - CORRECT ANSWER -ANS: D

The patient's beliefs are ultimately the key to acceptance of health care interventions. However, these beliefs may be influenced by factors such as educational level, income level, and ethnic background. Educational achievement, income level, and subcultural group all are important factors. However, the nurse must understand that a woman's concerns from her own point of view will have the most influence on her compliance.

The nurse's care of a Hispanic family includes teaching about infant care. When developing a plan of care, the nurse bases interventions on the knowledge that in traditional Hispanic families:

a. breastfeeding is encouraged immediately after birth.

b. male infants typically are circumcised.

c. the maternal grandmother participates in the care of the mother and her infant.

d. special herbs mixed in water are used to stimulate the passage of meconium. - CORRECT ANSWER - ANS: C

In Hispanic families, the expectant mother is influenced strongly by her mother or mother-in-law. Breastfeeding often is delayed until the third postpartum day. Hispanic male infants usually are not circumcised. Olive or castor oil may be given to stimulate the passage of meconium.

The woman's family members are present when the home care maternal-child nurse arrives for a after birth and newborn visit. What should the nurse do?

a. Observe the family members' interactions with the newborn and one another.

b. Ask the woman to meet with her and the baby alone.

c. Do a brief assessment on all family members present.

d. Reschedule the visit for another time so that the mother and infant can be assessed privately. - CORRECT ANSWER -ANS: A

The nurse should introduce herself to the patient and the other family members present. Family members in the home may be providing care and assistance to the mother and infant. However, this care may not be based on sound health practices. Nurses should take the opportunity to dispel myths while family members are present. The responsibility of the home care maternal-child nurse is to provide care to the new after birth mother and her infant, not to all family members. The nurse can politely ask about the other people in the home and their relationships with the woman. Unless an indication is given that the woman would prefer privacy, the visit may continue.

The nurse should be aware that during the childbearing experience an African-American woman is most likely to:

The patient's family is important to the maternity nurse because:

a. they pay the bills.

b. the nurse will know which family member to avoid.

c. the nurse will know which mothers will really care for their children.

d. the family culture and structure will influence nursing care decisions. - CORRECT ANSWER -ANS: D

Family structure and culture influence the health decisions of mothers.

A mother's household consists of her husband, his mother, and another child. She is living in a(n):

a. extended family.

b. single-parent family.

c. married-blended family.

d. nuclear family. - CORRECT ANSWER -ANS: A

An extended family includes blood relatives living with the nuclear family. Both parents and a grandparent are living in this extended family. Single-parent families comprise an unmarried biologic or adoptive parent who may or may not be living with other adults. Married-blended refers to families reconstructed after divorce. A nuclear family is where male and female partners and their children live as an independent unit.

A traditional family structure in which male and female partners and their children live as an independent unit is known as a(n):

a. extended family.

b. binuclear family.

c. nuclear family.

d. blended family. - CORRECT ANSWER -ANS: C

About two thirds of U.S. households meet the definition of a nuclear family. Extended families include additional blood relatives other than the parents. A binuclear family involves two households. A blended family is reconstructed after divorce and involves the merger of two families.

Which statement about family systems theory is inaccurate?

a. A family system is part of a larger suprasystem.

b. A family as a whole is equal to the sum of the individual members.

c. A change in one family member affects all family members.

d. The family is able to create a balance between change and stability. - CORRECT ANSWER -ANS: B

A family as a whole is greater than the sum of its parts. The other statements are characteristics of a system that states that a family is greater than the sum of its parts.

A pictorial tool that can assist the nurse in assessing aspects of family life related to health care is the: