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Test Bank for Olds Maternal Newborn Nursing and Womens Health Across the Lifespan 11th Edition by Davidson
Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig) Chapter 1 Contemporary Maternal-Newborn Nursing
1) The nurse is speaking to students about changes in maternal-newborn care. One change is that self-care has gained wide acceptance with clients and the healthcare community due to research findings that suggest that it has which effect? A) Shortens newborn length of stay
B) Decreases use of home health agencies
C) Decreases healthcare costs
D) Decreases the number of emergency department visits
Answer: C
Explanation: A) Length of stay is often determined by third-party payer (insurance company) policies as well as the physiologic stability of the mother and newborn. Home healthcare agencies often are involved in client care to decrease hospital stay time.
B) Home healthcare agencies often are involved in client care to decrease hospital stay time.
C) Research indicates that self-care significantly decreases healthcare costs.
D) Acute emergencies are addressed by emergency departments, and are not delayed by those practicing self-care.
Page Ref: 3
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Self-Care
Standards: QSEN Competencies: I.A.2. Describe strategies to empower patients or families in all aspects of the healthcare process. | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Context and Environment: Health care economic policy; reimbursement structures; accreditation standards; staffing models and productivity; supply chain models | Nursing/Integrated Concepts: Nursing Process: Planning.
Learning Outcome: 1 Discuss the impact of the self-care movement on contemporary childbirth. MNL LO: Recognize contemporary issues related to care of the childbearing family.
2) Care delivered by nurse-midwives can be safe and effective and can represent a positive response to the healthcare provider shortage. Nurse-midwives tend to use less technology, which often results in which of the following? A) There is less trauma to the mother.
B) More childbirth education classes are available.
C) They are instrumental in providing change in the birth environment at work.
D) They advocate for more home healthcare agencies.
Answer: A
Explanation: A) Nurse-midwife models of care can be one way to ensure that mothers receive excellent prenatal and intrapartum care.
B) It is appropriate for nurse-midwives, in conjunction with doctors and hospitals, to provide childbirth classes for expectant families.
C) By working with other staff members and doctors, the nurse-midwife is able to implement changes as needed within the birthing unit.
D) Clients are increasingly going home sooner, so there needs to be more follow-up in the home.
Page Ref: 3
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: III.A. 6. Describe how the strength and relevance of available evidence influences the choice of interventions in provision of patient-centered care. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Planning.
Learning Outcome: 2 Compare the nursing roles available to the maternal-newborn nurse. MNL LO: Recognize contemporary issues related to care of the childbearing family.
e units.
C) Prenatal care is primary care. Community care is often provided at clinics in neighborhoods to facilitate clients' access to primary care, including prenatal care and prevention of illness.
D) Community care decreases costs while improving client outcomes, and is not unnecessarily expensive. Page Ref: 3
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care Standards: QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: VI. 1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education, and licensure requirements). | NLN Competencies: Context and Environment: Environmental health; health promotion/disease prevention (e.g. transmission of disease, disease patterns, epidemiological principles); chronic disease management; health care systems; transcultural approaches to health; family dynamics. | Nursing/Integrated Concepts:
Nursing Process: Implementation.
Learning Outcome: 3 Describe the use of community-based nursing care in meeting the needs of childbearing families.
MNL LO: Recognize contemporary issues related to care of the childbearing family.
11) The nurse at an elementary school is performing TB screenings on all of the students. Permission slips were returned for all but the children of one family. When the nurse phones to obtain permission, the parent states in clearly understandable English that permission cannot be given because the grandmother is out of town for 2 more weeks. Which cultural element is contributing to the dilemma that faces the nurse? A) Permissible physical contact with strangers
B) Beliefs about the concepts of health and illness
C) Religion and social beliefs
D) Presence and influence of the extended family
Answer: D
Explanation: A) The situation the nurse faces is not being caused by permissible contact with strangers.
B) The situation the nurse faces is not caused by beliefs about the concepts of health and illness.
C) The situation the nurse faces is not caused by religion and social beliefs.
D) The presence and influence of the extended family is contributing to the situation the nurse faces. In many cultures, a family elder is the primary decision maker when it comes to health care. In this case, the parent cannot grant permission to the nurse until the parent consults the grandmother.
Page Ref: 4
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance: Health Screening
Standards: QSEN Competencies: I. A. 2. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Context and Environment: Analyze ethical challenges presented by ambiguous and uncertain clinical situations; self-assess one's own tolerance for ambiguity and uncertainty; accept the possibility of multiple "right" answers (rather
than one right answer thinking) in patient care and other professional situations. | Nursing/Integrated Concepts: Nursing Process: Planning.
Learning Outcome: 4 Identify specific factors that contribute to a family's value system. MNL LO: Recognize contemporary issues related to care of the childbearing family.
12) A maternity client is in need of surgery. Which healthcare member is legally responsible for obtaining informed consent for an invasive procedure?
A) The nurse
B) The physician
C) The unit secretary
D) The social worker
Answer: B
Explanation: A) It is not the nurse's legal responsibility to obtain informed consent.
B) Informed consent is a legal concept designed to allow clients to make intelligent decisions regarding their own health care. Informed consent means that a client, or a legally designated decision maker, has granted permission for a specific treatment or procedure based on full information about that specific treatment or procedure as it relates to that client under the specific circumstances of the permission. The individual who is ultimately responsible for the treatment or procedure should provide the information necessary to obtain informed consent. In most instances, this is a physician.
C) Unit secretaries are not responsible for obtaining informed consent.
D) It is not within a social worker's scope of practice to obtain informed consent.
Page Ref: 7—8
Cognitive Level: Remembering
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I. B. 12. Facilitate informed patient consent for care. | AACN Essentials Competencies: VIII. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Context and Environment: Code of ethics (e.g. American Nurses Association 2005; International Council of Nurses, 2006); regulatory and professional standards (ANA Social Policy Statement [ANA, 2003]; HIPAA [Health Insurance Portability and Accountability Act]); ethical decision making modes; scope of practice considerations; principles of informed consent, confidentiality, patient self-determination. | Nursing/Integrated Concepts: Nursing Process: Planning.
Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.
MNL LO: Recognize contemporary issues related to care of the childbearing family.
13) A nurse who tells family members the sex of a newborn baby without first consulting the parents would have committed which of the following?
A) A breach of privacy
B) Negligence
C) Malpractice
D) A breach of ethics
Answer: A
Explanation: A) A breach of privacy would have been committed in this situation, because informing other family members of the child's sex without the parents' consent violates the parents' right to privacy. The right to privacy is the right of a person to keep his person and property free from public scrutiny (or even from other family members). B) Negligence is a punishable legal offense, and is more serious.
C) Malpractice is a punishable legal offense, and is more serious.
D) No breach of ethics has been committed in this situation.
Page Ref: 8
Cognitive Level: Understanding
Client Need/Sub: Safe and Effective Care Environment: Ethical Practice
Standards: QSEN Competencies: I. B. 13. Assess own level of communication skill in encounters with patient and families. | AACN Essentials Competencies: IV. 8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy. | NLN Competencies: Context and Environment: Code of ethics (e.g. American Nurses Association 2005; International Council of Nurses, 2006); regulatory and professional standards
(ANA Social Policy Statement [ANA, 2003]; HIPAA [Health Insurance Portability and
Accountability Act]); ethical decision making modes; scope of practice considerations; principles of informed consent, confidentiality, patient self-determination. | Nursing/Integrated Concepts:
Nursing Process: Implementation.
Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.
MNL LO: Recognize contemporary issues related to care of the childbearing family.
14) The nursing instructor explains to the class that according to the 1973 Supreme Court decision in Roe v. Wade, abortion is legal if induced: A) Before the 30th week of pregnancy.
B) Before the period of viability.
C) To provide tissue for therapeutic research.
D) Can be done any time if mother, doctor, and hospital all agree.
Answer: B
Explanation: A) This statement is not true, because the fetus is viable many weeks before the 30th week.
B) Abortion can be performed legally until the period of viability.
C) Abortion cannot be used for the sole purpose of providing tissue for therapeutic research.
D) This is not true. Legal abortion can be done only up until the time of viability. Page Ref: 9
Cognitive Level: Remembering
Client Need/Sub: Safe and Effective Care Environment: Ethical Practice
Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IV. 8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and client's right to privacy. | NLN Competencies: Context and Environment: Code of ethics (e.g. American Nurses Association 2005; International Council of Nurses, 2006); regulatory and professional standards (ANA Social Policy Statement [ANA, 2003]; HIPAA [Health Insurance Portability and Accountability Act]); ethical decision making modes; scope of practice considerations; principles of informed consent, confidentiality, patient self-determination. | Nursing/Integrated Concepts: Nursing Process: Planning.
Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.
MNL LO: Recognize contemporary issues related to care of the childbearing family.
15) The nurse reviewing charts for quality improvement notes that a client experienced a complication during labor. The nurse is uncertain whether the labor nurse took the appropriate action during the situation. What is the best way for the nurse to determine what the appropriate action should have been?
A) Call the nurse manager of the labor and delivery unit and ask what the nurse should have done.
B) Ask the departmental chair of the obstetrical physicians what the best nursing action would have been.
C) Examine other charts to find cases of the same complication, and determine how it was handled in those situations.
D) Look in the policy and procedure book, and examine the practice guidelines published by a professional nursing organization.
Answer: D
Explanation: A) The nurse should find the standards, and not rely on another person to determine appropriateness of care.
B) Physician care and nursing care are very different; physicians might not be up to date on nursing standards of care or nursing policies and procedures.
C) What nursing action was undertaken in a different situation might not be based on the policies and procedures or other standards of care. The quality improvement nurse will obtain the most accurate information by examining the policies, procedures, and standards of care.
D) Agency policies, procedures, and protocols contain guidelines for nursing action in specific situations. Professional organizations such as the Association of Women's Health, Obstetrical, and Neonatal Nurses (AWHONN) also publish standards of practice that should guide nursing care.
Page Ref: 7
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV. A. 4. Explain the importance of variation and measurement in assessing quality of care. | AACN Essentials Competencies: V. 1. Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments; including local, state, national, and global healthcare trends. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strength of evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Evaluation.
Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.
MNL LO: Recognize contemporary issues related to care of the childbearing family.
16) The nurse is reviewing care of clients on a mother-baby unit. Which situation should be reported to the supervisor?
A) A 2-day-old infant has breastfed every 2-3 hours and voided four times.
B) An infant was placed in the wrong crib after examination by the physician.
C) The client who delivered by cesarean birth yesterday received oral narcotics.
D) A primiparous client who delivered today is requesting discharge within 24 hours. Answer: B
Explanation: A) Breastfeeding every 2 hours and voiding four times is within normal limits for a 2-day-old infant. There is no negligence in this situation.
B) Placing an infant in the wrong crib is malpractice. Malpractice is negligent action by a professional person.
C) Receiving oral narcotics at this point in the client's stay is within normal limits. There is no negligence in this situation.
D) If the client is feeling well and able to care for her infant, it is normal to be discharged at this time. The mother and baby both must be within normal limits to be discharged.
Page Ref: 7
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control
Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: VIII. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Quality and Safety: Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Evaluation.
Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.
MNL LO: Recognize contemporary issues related to care of the childbearing family.
17) The nurse manager is planning a presentation on ethical issues in caring for childbearing families. Which example should the nurse manager include to illustrate maternal-fetal conflict? A) A client chooses an abortion after her fetus is diagnosed with a genetic anomaly.
B) A 39-year-old nulliparous client undergoes therapeutic insemination.
C) A family of a child with leukemia requests cord-blood banking at a sibling's birth.
D) A cesarean delivery of a breech fetus is court ordered after the client refuses.
Answer: D
Explanation: A) Abortion is a different type of ethical situation.
B) Achieving pregnancy through the use of therapeutic insemination is a form of reproductive assistance, and is not considered a maternal-fetal conflict. C) Cord-blood banking is a different type of ethical situation.
D) Maternal-fetal conflict is a special ethical situation where the rights of the fetus and the rights of the mother are considered separately. Forced cesarean birth, coercion of mothers who practice high-risk behaviors, and, perhaps most controversial, mandating experimental in utero therapy or surgery in an attempt to correct a specific birth defect are interventions that infringe on the mother's autonomy.
Page Ref: 9
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I. B. 9. Assess level of patient's decisional conflict and provide access to resources. | AACN Essentials Competencies: VIII. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Context and Environment: Show respect for others' values; appreciate diversity; be civil during relationships and work; value community empowerment and social justice; work to improve social conditions affecting health; adopt inclusive language. | Nursing/Integrated Concepts: Nursing Process: Planning. Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.
MNL LO: Recognize contemporary issues related to care of the childbearing family.
18) Client safety goals, which are evaluated and updated regularly, are requirements for what? A) Clinical practice guidelines
B) Scope of practice
C) Accreditation
D) Standards of care
Answer: C
Explanation: A) Clinical practice guidelines are adopted within a healthcare setting to reduce variation in care management, to limit costs of care, and to evaluate the effectiveness of care. B) State nurse practice acts protect the public by broadly defining the legal scope of practice within which every nurse must function and by excluding untrained or unlicensed individuals from practicing nursing.
C) The Joint Commission has identified client safety as an important responsibility of healthcare providers.
D) Standards of care establish minimum criteria for competent, proficient delivery of nursing care.
Explanation: Several elements must be addressed to ensure that the patient has given informed consent. The information must be clearly and concisely presented in a manner understandable to the patient and must include risks and benefits, the probability of success, and significant treatment alternatives. The patient also needs to be told the consequences of receiving no treatment or procedure. Finally, the patient must be told of the right to refuse a specific treatment or procedure. Each patient should be told that refusing the specified treatment or procedure does not result in the withdrawal of all support or care.
Page Ref: 7
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I.B. 12. Facilitate informed patient consent for care. | AACN
Essentials Competencies: II. 7. Promote factors that create a culture of safety and caring. | NLN Competencies: Context and Environment; Knowledge; principles of informed consent, confidentiality, patient self-determination. | Nursing/Integrated Concepts: Evaluation; Nursing Process.
Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.
MNL LO: Recognize contemporary issues related to care of the childbearing family.
30) The nurse is preparing a presentation for new labor and delivery nurses. Which cultural group should the nurse identify as having the lowest birth rate for the 20 to 24 age range?
Table 1-2 Birth Rate by Age and Race of Mother, 2011
|
Age |
All Races |
White |
Black |
American Indian or Alaska Native |
Asian or Pacific Islander |
|
10-14 |
0.4 |
0.3 |
0.9 |
0.5 |
0.1 |
|
15-19 |
31.3 |
29.1 |
47.3 |
36.1 |
10.2 |
|
15-17 |
15.4 |
14.1 |
24.7 |
18.2 |
4.6 |
|
18-19 |
54.1 |
50.8 |
78.8 |
61.6 |
18.1 |
|
20-24 |
85.3 |
83 |
111.9 |
86.6 |
41.9 |
|
25-29 |
107.2 |
110 |
101.7 |
75.4 |
93.7 |
|
30-34 |
96.5 |
100.1 |
74.1 |
47.3 |
114.9 |
|
35-39 |
47.2 |
47.6 |
38.0 |
23.1 |
64.1 |
|
40-44 |
10.3 |
10.1 |
9.4 |
5.5 |
15.2 |
|
45-49 |
0.7 |
0.6 |
0.7 |
0.2 |
1.2 |
Source: Martin, J.A., Hamilton, B.E., Ventura, S.J., Osterman, M.J.K., & Matthews, T.J. (2013). Births: Final data 2011. National Vital Statistics Reports, 62(1), 1-70.
A) Asian
B) White
C) Black
D) American Indian
Answer: A
Explanation: A) For the 20 to 24 age group, the lowest birth rate is within the Asian or Pacific Islander cultural group. The birth rate for Whites for this age range is the next lowest. The birth rate for American Indians within this age group is the third highest and the highest birth rate for this age group is within the Black cultural group.
Page Ref: 11-12
Cognitive Level: Analyzing
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: V. 6. Explore the impact of sociocultural, economic, legal and political factors influencing healthcare delivery and practice. | NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a person's development. | Nursing/Integrated Concepts: Implementation; Teaching/Learning.
Learning Outcome: 6 Evaluate the potential impact of some of the special situations in contemporary maternity care.
MNL LO: Recognize contemporary issues related to care of the childbearing family.
31) The manager of a maternal-child care area is preparing information to share with nursing staff regarding the leading causes of infant death in the United States. In which order, from most to least frequent, should the manager provide this information?
1. SIDS
2. Low birth weight
3. Unintentional injuries
4. Maternal complications
5. Congenital malformation Answer: 5, 2, 1, 4, 3
Explanation: The five leading causes of deaths of infants in the United States, from highest to lowest in frequency, are congenital malformations, low birth weight, SIDS, maternal complications, and unintentional injuries.
Page Ref: 13
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment: Management of Care
Standards: QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: V. 6. Explore the impact of sociocultural, economic, legal and political factors influencing healthcare delivery and practice. | NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a person's development. | Nursing/Integrated Concepts: Implementation; Teaching/Learning.
Learning Outcome: 6 Evaluate the potential impact of some of the special situations in contemporary maternity care.
MNL LO: Recognize contemporary issues related to care of the childbearing family.
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