Maternity and women s health care 13th edition lowdermilk test bank.pdf file:///C:/Users/EliteBook%20840/Downloads/Maternity%20and%2
TEST BANK
Maternity and Women's Health Care 13th Edition
by Lowdermilk; Cashion; Perry; Alden; Chapters 1 - 37
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Chapter 01: 21st Century Maternity and Women’s Health Nursing
Lowdermilk: Maternity & Women’s Health Care, 13th Edition
MULTIPLE CHOICE
1. In evaluating the level of a pregnant woman’s risk of having a low-birth-weight (LBW) infant,
which factor is the most important for the nurse to consider?
a. African-American race
b. Cigarette smoking
c. Poor nutritional status
d. Limited maternal education
ANS: A
For African-American births, the incidence of LBW infants is twice that of Caucasian births.
Race is a nonmodifiable risk factor. Cigarette smoking is an important factor in potential infant
mortality rates, but it is not the most important. Additionally, smoking is a modifiable risk factor.
Poor nutrition is an important factor in potential infant mortality rates, but it is notthe most
important. Additionally, nutritional status is a modifiable risk factor. Maternal education is an
important factor in potential infant mortality rates, but it is not the most important. Additionally,
maternal education is a modifiable risk factor.
DIF: Cognitive Level: Understand REF: p. 6
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance, Antepartum Care
2. A 23-year-old African-American woman is pregnant with her first child. Based on the
statistics for infant mortality, which plan is most important for the nurse to implement?
a. Perform a nutrition assessment.
b. Refer the woman to a social worker.
c. Advise the woman to see an obstetrician, not a midwife.
d. Explain to the woman the importance of keeping her prenatal care appointments.
ANS: D
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Consistent prenatal care is the best method of preventing or controlling risk factors associated
with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the
most important action a nurse should take in this situation. The client may need assistance from
a social worker at some time during her pregnancy, but a referral to a social worker is not the
most important aspect the nurse should address at this time. If the woman has identifiable high-
risk problems, then her health care may need to be provided by a physician. However, it cannot
be assumed that all African-American women have high-risk issues. In addition, advising the
woman to see an obstetrician is not the most important aspect on whichthe nurse should focus
at this time, and it is not appropriate for a nurse to advise or manage the type of care a client is
to receive.
DIF: Cognitive Level: Understand REF: p. 6 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
3. During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment
of a 21-year-old Hispanic client with limited English proficiency. Which action isthe most
important for the nurse to perform?
a. Use maternity jargon to enable the client to become familiar with these terms.
b. Speak quickly and efficiently to expedite the visit.
c. Provide the client with handouts.
d. Assess whether the client understands the discussion.
ANS: D
Nurses contribute to health literacy by using simple, common words, avoiding jargon, and
evaluating whether the client understands the discussion. Speaking slowly and clearly and
focusing on what is important will increase understanding. Most client education materials are
written at a level too high for the averag e adult and may not be useful for a client with limited
N R I G B. C M
English proficiency. USNT O
DIF: Cognitive Level: Apply REF: p. 5 TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
4. The nurses working at a newly established birthing center have begun to compare their
performance in providing maternal-newborn care against clinical standards. This comparison
process is most commonly known as what?
a. Best practices network
b. Clinical benchmarking
c. Outcomes-oriented practice
d. Evidence-based practice
ANS: C
Outcomes-oriented practice measures the effectiveness of the interventions and quality of care
against benchmarks or standards. The term best practice refers to a program or service that has
been recognized for its excellence. Clinical benchmarking is a process used to compare one’s
own performance against the performance of the best in an area of service. The term evidence-based
practice refers to the provision of care based on evidence gained through research and clinical
trials.
DIF: Cognitive Level: Understand REF: p. 11 TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment
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5. Which statement best exemplifies contemporary maternity nursing?
a. Use of midwives for all vaginal deliveries
b. Family-centered care
c. Free-standing birth clinics
d. Physician-driven care
ANS: B
Contemporary maternity nursing focuses on the family’s needs and desires. Fathers, partners,
grandparents, and siblings may be present for the birth and participate in activities such as
cutting the baby’s umbilical cord. Both midwives and physicians perform vaginal deliveries.
Free-standing clinics are an example of alternative birth options. Contemporary maternity
nursing is driven by the relationship between nurses and their clients.
DIF: Cognitive Level: Understand REF: pp. 8-9 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
6. A 38-year-old Hispanic woman vaginally delivered a 9-pound, 6-ounce baby girl after beingin
labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the woman
have a legitimate legal case for negligence?
a. Inexperienced maternity nurse was assigned to care for the client.
b. Client was past her due date by 3 days.
c. Standard of care was not met.
d. Client refused electronic fetal monitoring.
ANS: C
Not meeting the standard of care is a legitimate factor for a case of negligence. An
inexperienced maternity nurse would need to display competency before being assigned to
care for clients on his or her NowUnR
.TShIisNcGliT
enB.C
tmayOhM
ave been past her due date; however, a
term pregnancy often goes beyond 40 weeks of gestation. Although fetal monitoring is the
standard of care, the client has the right to refuse treatment. This refusal is not a case for
negligence, but informed consent should be properly obtained, and the client should have signed
an against medical advice form when refusing any treatment that is within the standardof care.
DIF: Cognitive Level: Analyze REF: p. 13
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
7. When the nurse is unsure how to perform a client care procedure that is high risk and low
volume, his or her best action in this situation would be what?
a. Ask another nurse.
b. Discuss the procedure with the client’s physician.
c. Look up the procedure in a nursing textbook.
d. Consult the agency procedure manual, and follow the guidelines for the procedure.
ANS: D
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Following the agency’s policies and procedures manual is always best when seeking information
on correct client procedures. These policies should reflect the current standards ofcare and the
individual state’s guidelines. Each nurse is responsible for his or her own practice. Relying on
another nurse may not always be a safe practice. Each nurse is obligated to follow the standards
of care for safe client care delivery. Physicians are responsible for theirown client 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 the individual state or hospital policies.
DIF: Cognitive Level: Understand REF: p. 13
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
8. The National Quality Forum has issued a list of “never events” specifically pertaining to
maternal and child health. These include all of the following except:
a. infant discharged to the wrong person.
b. kernicterus associated with the failure to identify and treat hyperbilirubinemia.
c. artificial insemination with the wrong donor sperm or egg.
d. foreign object retained after surgery.
ANS: D
Although a foreign object retained after surgery is a never event, it does not specifically pertain
to obstetric clients. A client undergoing any type of surgery may be at risk for this event. An
infant discharged to the wrong person specifically pertains to postpartum care. Death or serious
disability as a result of kernicterus pertains to newborn assessment and care.Artificial
insemination affect s families s eeking care for infertility.
N R I G B. C M
USNT O
DIF: Cognitive Level: Remember REF: p. 4
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
9. A nurse caring for a pregnant client should be aware that the U.S. birth rate shows what trend?
a. Births to unmarried women are more likely to have less favorable outcomes.
b. Birth rates for women 40 to 44 years of age are declining.
c. Cigarette smoking among pregnant women continues to increase.
d. Rates of pregnancy and abortion among teenagers are lower in the United States
than in any other industrialized country.
ANS: A
LBW infants and preterm births are more likely because of the large number of teenagers inthe
unmarried group. Birth rates for women in their early 40s continue to increase. Fewer
pregnant women smoke. Teen pregnancy and abortion rates are higher in the United States
than in any other industrial country.
DIF: Cognitive Level: Understand REF: p. 6
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
10. A recently graduated nurse is attempting to understand the reason for increasing health care
spending in the United States. Which information gathered from her research best explains the
rationale for these higher costs compared with other developed countries?
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a. Higher rate of obesity among pregnant women
b. Limited access to technology
c. Increased use of health care services along with lower prices
d. Homogeneity of the population
ANS: A
Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.4% of the
gross domestic product is spent on health care. Higher spending in the United States, as
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. In the population in the United States, 16% are uninsured and have
limited access to health care. Maternal morbidity and mortality are directly related to racial
disparities.
DIF: Cognitive Level: Understand REF: p. 5 TOP: Nursing Process: N/A
MSC: Client Needs: Safe and Effective Care Environment
11. Which statement best describes maternity nursing care that is based on knowledge gained
through research and clinical trials?
a. Maternity nursing care is derived from the Nursing Intervention Classification.
b. Maternity nursing care is known as evidence-based practice.
c. Maternity nursing care is at odds with the Cochrane School of traditional nursing.
d. Maternity nursing care is an outgrowth of telemedicine.
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 systematiNcaUllRreIviN
yS GeTdBre.seCaO
ew rcM
h trials and is part of the evidence-based
practice movement. Telemedicine uses communication technologies to support health care.
DIF: Cognitive Level: Understand REF: pp. 10-11 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Safe and Effective Care Environment
12. What is the minimum level of practice that a reasonably prudent nurse is expected to provide?
a. Standard of care
b. Risk management
c. Sentinel event
d. Failure to rescue
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 doesnot define the
standard of care.
DIF: Cognitive Level: Remember REF: p. 13
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
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13. Through the use of social media technology, nurses can link with other nurses who may share
similar interests, insights about practice, and advocate for clients. Which factor is the most
concerning pitfall for nurses using this technology?
a. Violation of client privacy and confidentiality
b. Institutions and colleagues who may be cast in an unfavorable light
c. Unintended negative consequences for using social media
d. Lack of institutional policy governing online contact
ANS: A
The most significant pitfall for nurses using this technology is the violation of client privacy and
confidentiality. Furthermore, institutions and colleagues can be cast in an unfavorable light with
negative consequences for those posting information. Nursing students have been expelled from
school and nurses have been fired or reprimanded by their Board of Nursing forinjudicious
posts. The American Nurses Association has published six principles for social networking and
the nurse. All institutions should have policies guiding the use of social media, and the nurse
should be familiar with these guidelines.
DIF: Cognitive Level: Analyze REF: p. 8
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
14. During a prenatal intake interview, the client informs the nurse that she would prefer a midwife
to provide both her care during pregnancy and deliver her infant. Which informationis most
appropriate for the nurse to share with this client?
a. Midwifery care is only available to clients who are uninsured because their
services are less expensive than an obstetrician.
b. She will receive fewer interventions during the birth process.
c. She should be aware that m NUidwRSiveI
N GTnot
s are B.CceO M
rtified.
d. Her delivery can take place only at home or in a birth center.
ANS: B
This client will be able to participate actively in all decisions related to the birth process and is
likely to receive fewer interventions during the birth process. Midwifery services are availableto all
low-risk pregnant women, regardless of the type of insurance they have. Midwifery carein all
developed countries is strictly regulated by a governing body to ensure that core competencies are
met. In the United States, this body is the American College of
Nurse-Midwives (ACNM). Midwives can provide care and delivery at home, in freestanding
birth centers, and in community and teaching hospitals.
DIF: Cognitive Level: Understand REF: p. 8 TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
15. While obtaining a detailed history from a woman who has recently immigrated from Somalia,the
nurse realizes that the client has undergone female genital mutilation. What is the nurse’s most
appropriate response in this situation?
a. “This is a very abnormal practice and rarely seen in the United States.”
b. “Are you aware of who performed this mutilation so that it can be reported to the
authorities?”
c. “We will be able to restore fully your circumcision after delivery.”
d. “The extent of your circumcision will affect the potential for complications.”
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ANS: D
The extent of the circumcision is important. The client may experience pain, bleeding, scarring,
or infection and may require surgery before childbirth. Although this practice is not prevalent in
the United States, it is very common in many African and Middle Eastern countries for religious
reasons. Mentioning that the practice is abnormal and rarely seen in theUnited States is culturally
insensitive. The infibulation may have occurred during infancy or childhood; consequently, the
client will have little to no recollection of the event. She would have considered this to be a
normal milestone during her growth and development. The International Council of Nurses has
spoken out against this procedure as harmful to a woman’s health.
DIF: Cognitive Level: Analyze REF: p. 9
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
16. To ensure client safety, the practicing nurse must have knowledge of The Joint Commission’s
current “Do Not Use” list of abbreviations. Which term is acceptable for use regarding
medication administration?
a. q.o.d. or Q.O.D.
b. MSO4 or MgSO4
c. International Unit
d. Lack of a leading zero
ANS: C
“I.U.” and “i.u.” are no longer acceptable because they could be misread as “I.V.” or the number
“10.” “Q.O.D.” should be written out as “every other day.” The period after the “Q” could be
mistaken for an “I” and the “o” could also be mistaken for an “i.” Confusing one medication for
another is too easy. Medications are used for very different purposes and could
place a client at risk for an advN
UerseR
SoutINcom
GTe.B.C
For O M these medications should be
example,
written as morphine sulfate and magnesium sulfate. The decimal point should never be missedbefore a
number (e.g., 0.4 rather than .4). A leading zero is the preferred form.
DIF: Cognitive Level: Remember REF: p. 13
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
17. Maternity nurses can enhance communication among health care providers by using the
SBAR technique. The acronym SBAR stands for what?
a. Situation, background, assessment, recommendation
b. Situation, baseline, assessment, recommendation
c. Subjective, background, analysis, recommendation
d. Subjective, background, analysis, review
ANS: A
SBAR is an easy-to-remember, useful, and concrete mechanism for communicating important
information that requires a clinician’s immediate attention. Baseline is not discussed as part of
SBAR. Subjective and analysis are not specific to the SBAR acronym. Subjective, analysis, and review
are not specific to the SBAR acronym.
DIF: Cognitive Level: Apply REF: p. 14
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
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