Transcript
Maternal Child Nursing Care
Contemporary Maternity Nursing
1. Many alternative and complementary therapies share which of the following concepts?
1.
The use of herbs is a cornerstone of good health.
2.
Patients are capable of decision making and should be a part of the health care team.
3.
Touch should be used to relieve pain and reduce anxiety.
4.
Patients should place the responsibility for their health and healing in the hands of alternative healers.
ANS: 2
1. Incorrect: Proper nutrition, adequate rest, relaxation, exercise, and emotional health are cornerstones of good health, not herbs.
2. Correct: The emphasis of alternative and complementary therapies is that the patient is viewed as a whole being, capable of decision making, and an integral part of the health care team.
3. Incorrect: The use of touch has many forms and is used for a multitude of purposes including increased circulation, decreasing edema, promoting lymphatic drainage, relieving muscle tension, and improving the functioning of certain body systems.
4. Incorrect: The road to healing is an individual journey; patients are encouraged to take responsibility for their health and healing.
2. Managed care is gaining popularity. This rise in popularity is most often guided by which of the following considerations?
1.
Concern for the quality of care
2.
Means of controlling costs of care
3.
Greater access to physicians
4.
Allowance for early discharge
ANS: 2
1. Incorrect: Although quality control is important, it does not have any bearing on the rise of popularity of managed care.
2. Correct: Health care is one of the fastest growing sectors of the U.S. economy. Managed care was developed as a direct result of escalating health care costs.
3. Incorrect: Managed care tends to have a gatekeeper effect, which actually may limit the access to physicians, especially specialists.
4. Incorrect: Although early discharges were originally part of the managed care plan to reduce hospital expenditures, they have created a need for additional care in the home.
3. The role of the professional nurse has evolved to emphasize:
1.
providing care to patients directly at the bedside.
2.
planning patient care to cover longer hospital stays.
3.
leading the activities of a team of interdisciplinary health care providers.
4.
managing care to cure health problems once they have occurred.
ANS: 3
1. Incorrect: This is one task of the role of a nurse but is not what encompasses the notion of the evolved professional nurse.
2. Incorrect: One goal of managed care is decreased, not increased, length of stays.
3. Correct: Professional nurses are part of the team of health care providers who collaboratively care for patients in the managed care model.
4. Incorrect: Nurses do not cure health problems; they care for patients with health care ailments.
4. To assess for the risk of having a low-birth-weight (LBW) infant, which of the following factors is the most important for the nurse to consider?
1.
African-American race
2.
Cigarette smoking
3.
Poor nutritional status
4.
Limited maternal education
ANS: 1
1. Correct: For African-American births, the incidence of LBW infants is twice that of Caucasian births. Race is a nonmodifiable risk factor.
2. Incorrect: Cigarette smoking is an important factor in potential infant mortality rates but is not the most important. Additionally, smoking is a modifiable risk factor.
3. Incorrect: Poor nutrition is an important factor in potential infant mortality rates but is not the most important. Additionally, nutritional status is a modifiable risk factor.
4. Incorrect: Maternal education is an important factor in potential infant mortality rates but is not the most important. Additionally, maternal education is a modifiable risk factor.
5. A 23-year-old African-American woman is pregnant with her first child. Based on the statistics related to infant mortality, which of the following plans is most important for the nurse to implement?
1.
Perform a nutrition assessment.
2.
Refer the woman to a social worker.
3.
Advise the woman to see an obstetrician and not a midwife.
4.
Explain to the woman the importance of keeping her prenatal care appointments.
ANS: 4
1. Incorrect: Nutritional status is an important modifiable risk factor, but is not the most important action for a nurse to take in this situation.
2. Incorrect: The patient may need assistance from a social worker at some time during her pregnancy but it is not the most important aspect for the nurse to address at this time.
3. Incorrect: If the woman were to have identifiable high risk issues, her health care may be provided by a physician. However, it cannot be assumed that all African-American women have high risk issues. Additionally, it is not the most important aspect for the nurse to focus on at this time, nor is it appropriate for a nurse to advise or manage the type of care a patient is to receive.
4. Correct: Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality.
6. The nurse will know that teaching to increase self-care is effective when the patient makes which of the following comments?
1.
“I’ll do whatever you say; you’re the nurse.”
2.
“I don’t think I can quit smoking.”
3.
“I exercise for 30 minutes 3 days a week.”
4.
“What do you think I should do?”
ANS: 3
1. Incorrect: Doing is different from comprehension. The goal of teaching about self-care is for the patient to understand the factors associated with her care. Generally, an understanding of self-care practices increases the chances of patients practicing healthy behaviors.
2. Incorrect: Smoking is only one behavior associated with self-care in pregnancy. Additionally, the goal is for the patient to seek self-care health behaviors, not discount them.
3. Correct: This statement indicates the patient’s willing participation and understanding of healthy self-care behaviors.
4. Incorrect: The patient’s question indicates that she does not understand what measures she can take to increase her level of self-care.
7. 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:
1.
age.
2.
minority status.
3.
educational level.
4.
inability to pay.
ANS: 4
1. Incorrect: While adolescent pregnant patients statistically receive less prenatal care, this factor is not the most significant barrier.
2. Incorrect: Significant disparities in morbidity and mortality rates exist for minority women. However, this is not the most significant barrier to access of care.
3. Incorrect: Disparities in educational level are associated with morbidity and mortality rates; educational level is not the most significant barrier to access of care.
4. Correct: 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.
8. What is the primary role of practicing nurses in the research process?
1.
Designing research studies
2.
Collecting data for other researchers
3.
Identifying researchable problems
4.
Seeking funding to support research studies
ANS: 3
1. Incorrect: Designing research studies is only one factor of the research process.
2. Incorrect: Data collection is only factor of research.
3. Correct: By identifying problems, research can be properly conducted. Research of health care issues leads to evidence-based practice guidelines.
4. Incorrect: Financial support is necessary to conduct research but it is not the primary role of the nurse in the research process.
9. When the nurse is unsure about how to perform a patient care procedure, the nurse’s best action would be to:
1.
ask another nurse.
2.
discuss the procedure with the patient’s physician.
3.
look up the procedure in a nursing textbook.
4.
consult the agency procedure manual and follow the guidelines for the procedure.
ANS: 4
1. Incorrect: Each nurse is responsible for his/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.
2. Incorrect: Physicians are responsible for their own patient care activity. Nurses may follow safe orders from physicians but are also responsible for the activities that they as nurses are to carry out.
3. Incorrect: 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/hospital policies.
4. Correct: 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.
10. Which of the following measures should be the focus of the health care system in order to further reduce the rate of infant mortality?
1.
Implementing programs to ensure women’s early participation in ongoing prenatal care
2.
Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days
3.
Expanding the number of neonatal intensive care units
4.
Mandating that all pregnant women receive care from an obstetrician
ANS: 1
1. Correct: Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality.
2. Incorrect: An increased length of stay has shown improved self-care and parental education. However, it does not prevent the incidence of leading causes of infant mortality rates such as LBW.
3. Incorrect: Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high risk infants after they are born. Expanding the number of NICUs would offer better access for high risk care, but is not the factor that should be the primary focus for further reduction of infant mortality rates.
4. Incorrect: A mandate that all pregnant women receive obstetric care would be nearly impossible to enforce. Furthermore, CNMs have demonstrated reliable, safe care for pregnant women.
11. Alternative and complementary therapies:
1.
replace conventional Western modalities of treatment.
2.
are used by only a small number of American adults.
3.
recognize the value of patients’ input into their health care.
4.
focus primarily on the disease an individual is experiencing.
ANS: 3
1. Incorrect: Alternative and complementary therapies are part of an integrative approach to health care.
2. Incorrect: An increasing number of American adults are seeking alternative and complementary health care options.
3. Correct: Many popular alternative healing modalities offer human-centered care based on philosophies that recognize the value of the patient’s input and honor the individual’s beliefs, values, and desires.
4. Incorrect: Alternative healing modalities offer a holistic approach to health, focusing on the whole person, not just the disease.
12. When caring for pregnant women, the nurse should be aware that one of the most frequently reported maternal medical risk factors is:
1.
diabetes mellitus.
2.
mitral valve prolapse.
3.
chronic hypertension.
4.
anemia.
ANS: 1
1. Correct: The two most frequently reported maternal medical risk factors are hypertension associated with pregnancy and diabetes.
2. Incorrect: There are no studies that indicate that MVP is among the most frequently reported maternal risk factors.
3. Incorrect: Hypertension associated with pregnancy is one of the most frequently reported maternal medical risk factors, not chronic hypertension.
4. Incorrect: Although anemia is a concern in pregnancy, it is not one of the most frequently reported maternal medical risk factors in pregnancy.
13. The nurses working at a newly established birthing center have begun to compare their performances in providing maternal–newborn care with the performances of nurses working in similar settings. This comparison process, designed to improve the quality of patient care, is called:
1.
best practices networking.
2.
clinical benchmarking.
3.
outcomes-oriented care.
4.
evidence-based practice.
ANS: 2
1. Incorrect: Best practice refers to a program or service that has been recognized for excellence.
2. Correct: Clinical benchmarking is a process used to compare one’s own performance against the performance of the best in an area of service.
3. Incorrect: Outcomes-oriented care measures effectiveness of interventions and quality of care.
4. Incorrect: Evidence-based practice refers to providing care based on evidence gained through research and clinical trials.
14. Contemporary maternity nursing is exemplified by:
1.
the use of midwives for all vaginal deliveries.
2.
family-centered care.
3.
freestanding birth clinics.
4.
physician driven care.
ANS: 2
1. Incorrect: Midwives and physicians are utilized for vaginal deliveries.
2. Correct: Contemporary maternity nursing focuses on the family’s needs and desires.
3. Incorrect: Free standing clinics are an example of alternative birth options.
4. Incorrect: Contemporary maternity nursing is driven by the relationship of nurses with patients.
15. Sally, a 38-year-old Hispanic woman, delivered a 9-pound, 6-ounce baby girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds would Sally potentially have a legitimate legal case for negligence?
1.
She is Hispanic.
2.
She delivered a girl.
3.
The Standards of Care were not met.
4.
She refused fetal monitoring.
ANS: 3
1. Incorrect: The patient’s race is not a factor for a case of negligence.
2. Incorrect: The infant’s sex is not a factor for a case of negligence.
3. Correct: Not meeting the standards of care is a legitimate factor for a case of negligence.
4. Incorrect: Although fetal monitoring is the standard of care, the patient has the right to refuse treatment. This refusal is not a case for negligence but the patient should give proper consent and sign an AMA form for refusal of any treatment that is within the standard of care.
16. All of the following have contributed to the increase in maternity-related health care costs except:
1.
early postpartum discharges.
2.
maternal medical risk factors such as diabetes.
3.
the use of high-tech equipment.
4.
the cost of care for LBW infants.
ANS: 1
1. Correct: Early postpartum discharges have reduced costs.
2. Incorrect: High risk factors increase health costs.
3. Incorrect: High-tech equipment increases health costs.
4. Incorrect: LBW or high-risk infants increase health costs.
17. One method that maternity nurses can use to dispel the health disparities among women is through:
1.
increased education provided for mothers.
2.
late prenatal care.
3.
increasing the number of cesarean sections.
4.
making all women take more vitamins.
ANS: 1
1. Correct: Education for mothers will enable them to recognize problems to report to their providers and teach them how to take better care of themselves.
2. Incorrect: Late prenatal care is one factor that contributes to health disparities.
3. Incorrect: Cesarean sections occur for various reasons, but may be the result of health concerns related to the mother.
4. Incorrect: Taking vitamins may improve overall health but does not necessarily ensure health or dispel health disparities.
OTHER
1. What methods would help alleviate the problems associated with access to health care?
(Choose all that apply.)
1. Provide transportation to prenatal visits
2. Provide child care so that a pregnant mother may attend prenatal visits.
3. Mandate that physicians make “house calls”
4. Provide low-cost or no-cost health care insurance.
5. Provide job training.
ANS:
1, 2 and 4
1, 2 and 4. Correct: No transportation to visits, lack of child care, and no affordable health insurance are prohibitive factors associated with lack of prenatal care.
3. Incorrect: House calls are not a cost-effective approach to health care.
5. Incorrect: Although job training may result in employment and income, the likelihood of significant changes during the timeframe of the pregnancy is remote.
