TEST BANK
Maternity and Women's Health Care
Deitra L. Lowdermilk, Kitty Cashion, Kathryn R. Alden, Ellen Olshansky, and Shannon E. Perry
13th Edition Table of Contents
Chapter 01 21st Century Maternity and Women’s Health Nursing 1
Chapter 02 Community Care-The Family and Culture 8
Chapter 03 Nursing and Genomics 14
Chapter 04 Assessment and Health Promotion 19
Chapter 05 Violence Against Women 28
Chapter 06 Reproductive System Concerns 34
Chapter 07 Sexually Transmitted and Other Infections 41
Chapter 08 Contraception and Abortion 48
Chapter 09 Infertility 57
Chapter 10 Problems of the Breast 62
Chapter 11 Structural Disorders and Neoplasms of the Reproductive System 70
Chapter 12 Conception and Fetal Development 77
Chapter 13 Anatomy and Physiology of Pregnancy 85
Chapter 14 Nursing Care of the Family During Pregnancy 96
Chapter 15 Maternal Nutrition 110
Chapter 16 Labor and Birth Processes 121
Chapter 17 Maximizing Comfort for the Laboring Woman 131
Chapter 18 Fetal Assessment During Labor 142
Chapter 19 Nursing Care of the Family During Labor and Birth 154
Chapter 20 Postpartum Physiologic Changes 169
Chapter 21 Nursing Care of the Family During the Postpartum Period 178
Chapter 22 Transition to Parenthood 185
Chapter 23 Physiologic and Behavioral Adaptations of the Newborn 194
Chapter 24 Nursing Care of the Newborn and Family 206
Chapter 25 Newborn Nutrition and Feeding 216
Chapter 26 Assessment of High Risk Pregnancy 226
Chapter 27 Hypertensive Disorders 235
Chapter 28 Hemorrhagic Disorders 242
Chapter 29 Endocrine and Metabolic Disorders 251
Chapter 30 Medical-Surgical Disorders 255
Chapter 31 Mental Health Disorders and Substance Abuse 261
Chapter 32 Labor and Birth Complications 267
Chapter 33 Postpartum Complications 276
Chapter 34 Nursing Care of the High-Risk Newborn 283
Chapter 35 Acquired Problems of the Newborn 292
Chapter 36 Hemolytic Disorders and Congenital Anomalies 298
Chapter 37 Perinatal Loss, Bereavement, and Grief 304 Chapter 01: 21st Century Maternity and Women’s Heal th Nursing Lowdermilk: Maternity and 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 The rise in the overall LBW rates was due to increa ses in LBW births to non-Hispanic black women (13.35%) and Hispanic women (7.21%); non-Hisp anic black infants are almost twice as likely as non-Hispanic white infants to be of LB W and to die in the first year of life. Race is a nonmodifiable risk factor. Cigarette smoking i s 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 po tential infant mortality rates, but it is not the most important. Additionally, nutritional status is a modifiable risk factor. Maternal education is an important factor in potential infant mortalit y rates, but it is not the most important. Additionally, maternal education is a modifiable ri sk factor. DIF: Cognitive Level: Understanding TOP: Assessment MSC: Client Needs: Health Promotion and Maintenance , Antepartum Care 2. A 23-year-old African-American woman is pregnant wi th her first child. Based on current statistics for infant mortality, which intervention is most important for the nurse to include in the client’s plan of care? a. Perform a nutrition assessment. b. Refe r the woman to a social worker. c. Advise the woman to see an obstetrician, not a midw ife. d. Explain to the woman the importance of keeping her prenatal care appointments. ANS: D Consistent prenatal care is the best method of prev enting or controlling risk factors associated with infant mortality. Nutritional status is an imp ortant modifiable risk factor, but it is not the most important action a nurse should take in this s ituation. The client may need assistance from a social worker at some time during her pregna ncy, but a referral to a social worker is not the most important aspect the nurse should addr ess at this time. If the woman has identifiable high-risk problems, then her health ca re may need to be provided by a physician. However, it cannot be assumed that all African-Amer ican women have high-risk issues. In addition, advising the woman to see an obstetrician is not the most important aspect on which the 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: Understanding TOP: Planning MSC: Client Needs: Health Promotion and Maintenance ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Maternity and Women’s Health Care, 13th Edition (Lowdermilk, 2024)
1 | P a g e 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 li mited English proficiency. Which intervention is the most important for the nurse to implement? 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 discussio n. ANS: D Nurses contribute to health literacy by using simpl e, common words, avoiding jargon, and evaluating whether the client understands the discu ssion. Speaking slowly and clearly and focusing on what is important will increase underst anding. Most client education materials are written at a level too high for the average adult a nd may not be useful for a client with limited English proficiency. DIF: Cognitive Level: Applying TOP: Implementation 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 agai nst 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: D Outcomes-oriented practice measures the effectivene ss 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 be nchmarking is a process used to compare one’s own performance against the performance of th e 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: Understanding TOP: Evaluation MSC: Client Needs: Safe and Effective Care Environm ent 5. Which statement best exemplifies contemporary mater nity 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 famil y’s needs and desires. Fathers, partners, grandparents, and siblings may be present for the b irth and participate in activities such as cutting the baby’s umbilical cord. Both midwives an d physicians perform vaginal deliveries. Free-standing clinics are an example of alternative birth options. Contemporary maternity nursing is driven by the relationship between nurse s and their clients. DIF: Cognitive Level: Understanding TOP: Planning ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Maternity and Women’s Health Care, 13th Edition (Lowdermilk, 2024)
2 | P a g e MSC: Client Needs: Health Promotion and Maintenance 6. A 38-year-old woman vaginally delivered a 9-pound, 6-ounce baby girl after being in labor for 43 hours. The baby died 3 days later from sepsi s. 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 fa ctor 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 own. This client may have been past her due date; however, a term pregnancy often goes beyond 40 weeks of gestat ion. Although fetal monitoring is the standard of care, the client has the right to refus e 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 th e standard of care. DIF: Cognitive Level: Analyzing TOP: Implementation MSC: Client Needs: Safe and Effective Care Environm ent 7. When the nurse is unsure how to perform a client ca re procedure that is high risk and low volume, his or her best action in this situation wo uld 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. First consult the agency procedure manual. ANS: D Following the agency’s policies and procedures manu al is always best when seeking information on correct client procedures. These pol icies should reflect the current standards of care and the individual state’s guidelines. Each nu rse is responsible for his or her own practice. Relying on another nurse may not always b e a safe practice. Each nurse is obligated to follow the standards of care for safe client car e delivery. Physicians are responsible for their own client care activity. Nurses may follow safe or ders 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 k nowledge. Furthermore, the information in a textbook may not reflect the current standard of care or the individual state or hospital policies. DIF: Cognitive Level: Understanding TOP: Implementa tion MSC: Client Needs: Physiological Integrity 8. A nurse caring for a pregnant client should be awar e that the U.S. birth rate shows what trend? a. Births to unmarried women are more likely to have l ess favorable outcomes. b. Birth rates for women 40 –44 years of age are declining. c. Cigarette sm oking 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. ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Maternity and Women’s Health Care, 13th Edition (Lowdermilk, 2024)
3 | P a g e ANS: A LBW infants and preterm births are more likely beca use 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. Teen pregnancy and abortion r ates are higher in the United States than in any other industrial country. DIF: Cognitive Level: Understanding TOP: Assessment MSC: Client Needs: Psychosocial Integrity 9. A recently graduated nurse is attempting to underst and the reason for increasing health care spending in the United States. Which information ga thered from research best explains the rationale for these higher costs compared with othe r developed countries? a. Higher rate of obesity among pregnant women b. Limited access to technology c. Increased use of health care services along with lo wer prices d. Homogeneity of the population ANS: A Health care is one of the fastest growing sectors o f the U.S. economy. Currently, 19.7% of the gross domestic product is spent on health care. Hig her 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 ra tes among women. Approximately 31% of women ages 20–39 are obese. In the population in th e United States, 8.5% are uninsured and have limited access to health care. Maternal morbid ity and mortality are directly related to racial disparities. DIF: Cognitive Level: Understanding TOP: Teaching/L earning MSC: Client Needs: Safe and Effective Care Environm ent 10. Which statement best describes maternity nursing ca re 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 car e is an outgrowth of telehealth. ANS: B Evidence-based practice is based on knowledge gaine d from research and clinical trials. The Cochrane Collaboration oversees up-to-date systemat ic reviews of randomized controlled trials and disseminates these reviews. Telehealth u ses communication technologies to support health care. DIF: Cognitive Level: Understanding TOP: Analysis MSC: Client Needs: Safe and Effective Care Environm ent 11. What is the minimum level of practice that a reason ably prudent nurse is expected to provide? a. Standard of care b. Risk management c. Sentinel event d. Failure to rescue ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Maternity and Women’s Health Care, 13th Edition (Lowdermilk, 2024)
4 | P a g e ANS: A Guidelines for standards of care are published by v arious professional nursing organizations. Risk management identifies risks and establishes pr eventive practices, but it does not define the standard of care. Sentinel events are unexpecte d negative occurrences. They do not establish the standard of care. Failure to rescue i s an evaluative process for nursing, but it does not define the standard of care. DIF: Cognitive Level: Remembering TOP: Implementati on MSC: Client Needs: Safe and Effective Care Environm ent 12. Using social media technology, nurses can link with other nurses who may share similar interests, insights about practice, and advocate fo r 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 u nfavorable light c. Unintended negative consequences for using social m edia d. Lack of institutional policy governing online conta ct 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 for injudicious posts. The American Nurses Association has published six principles for social networking and the nurse. All institutions should h ave policies guiding the use of social media, and the nurse should be familiar with these guidelines. DIF: Cognitive Level: Analyzing TOP: Implementation MSC: Client Needs: Safe and Effective Care Environm ent 13. During a prenatal intake interview, the client info rms the nurse that she would prefer a midwife to provide both her care during pregnancy a nd deliver her infant. Which information is most appropriate for the nurse to share with thi s client about resulting care? a. Midwifery care is a good option for clients who are uninsured. b. She will receive fewer interventions during the bir th process. c. She should be aware that midwives are not certified . d. Her delivery can take place only at home or in a bi rth 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 bi rth process. Midwifery services are available to all low-risk pregnant women, regardless of the t ype of insurance they have. Midwifery care in all developed countries is strictly regulated by a governing body to ensure that core competencies are met. In the United States, this bo dy is the American College of Nurse-Midwives (ACNM). Midwives can provide care an d delivery at home, in freestanding birth centers, and in community and teaching hospit als. DIF: Cognitive Level: Understanding TOP: Planning MSC: Client Needs: Safe and Effective Care Environm ent ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Maternity and Women’s Health Care, 13th Edition (Lowdermilk, 2024)
5 | P a g e 14. While obtaining a detailed history from a woman who has recently immigrated, the nurse realizes that the client has undergone female genit al mutilation (FGM). What is the nurse’s most appropriate response in this situation? a. “This is a very abnormal practice and rarely seen i n 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 po tential for complications.” ANS: D The extent of the circumcision is important. The cl ient may experience pain, bleeding, scarring, or infection and may require surgery befo re childbirth. Although this practice is not prevalent in the United States, it is very common i n many African and Middle Eastern countries for religious reasons. Mentioning that th e practice is abnormal and rarely seen in the United States is culturally insensitive. The infibu lation may have occurred during infancy or childhood; consequently, the client will have littl e to no recollection of the event. She would have considered this to be a normal milestone durin g her growth and development. The International Council of Nurses has spoken out agai nst this procedure as harmful to a woman’s health. DIF: Cognitive Level: Analyzing TOP: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Greater than one-third of women in the United State s are now obese (body mass index [BMI] of 30 or greater). Less than one quarter of women i n Canada exhibit the same BMI. Obesity in the pregnant woman increases both maternal medical risk factors and negative outcomes for the infant. The nurse is about to perform an assess ment on a client who is 28 weeks pregnant and has a BMI of 35. What are the most frequently r eported complications for which the nurse must be alert while assessing this client? ( Select all that apply. ) a. Potential miscarriage b. Diabetes c. Fetal death in utero d. Decreased fertility e. Hypertension ANS: B, E The two most frequently reported maternal medical r isk factors associated with obesity are hypertension associated with pregnancy and diabetes . Decreased fertility, miscarriage, fetal death, and congenital anomalies are also associated with obesity. These clients often experience longer hospital stays and increased use of health services. DIF: Cognitive Level: Applying TOP: Assessment MSC: Client Needs: Physiological Integrity 2. Which statements indicate that the nurse is practic ing appropriate family-centered care techniques? ( Select all that apply. ) a. The nurse commands the pregnant woman to do as she is told. b. The nurse allows time for the partner to ask questi ons. ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Maternity and Women’s Health Care, 13th Edition (Lowdermilk, 2024)
6 | P a g e c. The nurse allows the mother and father to make choi ces when possible. d. The nurse informs the family about what is going to happen. e. The nurse tells the client’s sister, who is a nurse , that she cannot be in the room during the delivery. ANS: B, C Including the partner in the care process and allow ing the couple to make choices are important elements of family-centered care. The nur se should never tell the client what to do. Family-centered care involves collaboration between the health care team and the client. Unless an institutional policy limits the number of attendants at a delivery, the client should be allowed to have whomever she wants present (exce pt when the situation is an emergency and guests are asked to leave). DIF: Cognitive Level: Analyzing TOP: Implementation MSC: Client Needs: Psychosocial Integrity 3. Which methods help alleviate the problems associate d with access to health care for the maternity client? ( Select all that apply. ) a. Provide transportation to prenatal visits. b. Provide child care to enable a pregnant woman to ke ep prenatal visits. c. Increase the number of providers that will care for Medicaid clients. d. Provide low -cost or no -cost health care insurance. e. Provide job training. ANS: A, B, C, D Lack of transportation to prenatal visits, child ca re, access to skilled obstetric providers, and affordable health insurance are prohibitive factors associated with the lack of prenatal care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is r emote. DIF: Cognitive Level: Understanding TOP: Planning MSC: Client Needs: Health Promotion and Maintenance ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Maternity and Women’s Health Care, 13th Edition (Lowdermilk, 2024)
7 | P a g e Chapter 02: Community Care: The Family and Culture Lowdermilk: Maternity and Women’s Health Care, 13th Edition MULTIPLE CHOICE 1. A married couple lives in a single-family house wit h their newborn son and the husband’s daughter from a previous marriage. Based on this in formation, what family form best describes this family? a. Married -blended family b. Extended family c. Nuclear family d. Same -sex family ANS: A Married-blended families are formed as the result o f divorce and remarriage. Unrelated family members join to create a new household. Members of an extended family are kin or family members related by blood, such as grandparents, aun ts, and uncles. A nuclear family is a traditional family with male and female partners al ong with the children resulting from that union. A same-sex family is a family with homosexua l partners who cohabit with or without children. DIF: Cognitive Level: Remembering TOP: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which key factors play the most powerful role in th e behaviors of individuals and families? a. Rituals and customs b. Beliefs and values, or culture c. Boundaries and channels d. Socialization processes ANS: B Beliefs and values (culture) are the most prevalent factors in the decision-making and problem-solving behaviors of individuals and famili es. This prevalence is particularly true during times of stress and illness. Boundaries and channels affect the relationship between the family members and the health care team, not the de cisions within the family. Socialization processes may help families with interactions withi n the community, but they are not the criteria used for decision-making within the family . DIF: Cognitive Level: Understanding TOP: Planning MSC: Client Needs: Psychosocial Integrity 3. What is the primary difference between hospital car e and home health care? a. Home care is routinely and continuously delivered b y professional staff. b. Hom e care is delivered on an intermittent basis by pro fessional staff. c. Home care is delivered for emergency conditions. d. Home care is not available 24 hours a day. ANS: B ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Maternity and Women’s Health Care, 13th Edition (Lowdermilk, 2024)
8 | P a g e
