Chapter 01: 21st Century Maternity Nursing
Perry: Maternal Child Nursing Care, 7th Edition

MULTIPLE CHOICE

	1.	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.	

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.

DIF:	Cognitive Level: Knowledge	OBJ:	Nursing Process: Assessment
MSC:	Client Needs: Physiologic Integrity		

	2.	To ensure optimal outcomes for the patient, the contemporary maternity nurse must incorporate both teamwork and communication with clinicians into 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	

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.

DIF:	Cognitive Level: Comprehension	
OBJ:	Nursing Process: Assessment | Nursing Process: Planning		
MSC:	Client Needs: Safe and Effective Care Environment

	3.	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.	

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.

DIF:	Cognitive Level: Comprehension	OBJ:	Nursing Process: Implementation
MSC:	Client Needs: Safe and Effective Care Environment

	4.	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
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 a nutrition assessment is not the most important action a nurse should take in this situation. The patient 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, 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 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 patient is to receive.

DIF:	Cognitive Level: Application	OBJ:	Nursing Process: Planning
MSC:	Client Needs: Health Promotion and Maintenance

	5.	During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-old Hispanic patient with limited English proficiency. It is important for the nurse to
a.	use maternity jargon in order for the patient to become familiar with these terms.	
b.	speak quickly and efficiently to expedite the visit.	
c.	provide the patient with handouts.	
d.	assess whether the patient understands the discussion.	

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.

DIF:	Cognitive Level: Application	OBJ:	Nursing Process: Evaluation
MSC:	Client Needs: Health Promotion and Maintenance

	6.	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.	

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.

DIF:	Cognitive Level: Knowledge	OBJ:	Nursing Process: Assessment
MSC:	Client Needs: Safe and Effective Care Environment

	7.	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.	

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.

DIF:	Cognitive Level: Application	OBJ:	Nursing Process: Implementation
MSC:	Client Needs: Physiologic Integrity		

	8.	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	

ANS:	A
Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. An increased length of stay has been shown to foster improved self-care and parental education. However, it does not prevent the incidence of leading causes of infant mortality rates, such as low birth weight. 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 this factor is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetric care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have demonstrated reliable, safe care for pregnant women.

DIF:	Cognitive Level: Comprehension	OBJ:	Nursing Process: Implementation
MSC:	Client Needs: Health Promotion and Maintenance

	9.	Alternative and complementary therapies
a.	replace conventional Western modalities of treatment.	
b.	are used by only a small number of American adults.	
c.	recognize the value of patients’ input into their health care.	
d.	focus primarily on the disease an individual is experiencing.	

ANS:	C
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. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of American adults are seeking alternative and complementary health care options. Alternative healing modalities offer a holistic approach to health, focusing on the whole person, not just the disease.

DIF:	Cognitive Level: Comprehension	OBJ:	Nursing Process: Planning
MSC:	Client Needs: Physiologic Integrity		

	10.	A 38-year-old Hispanic woman delivered a 9-pound, 6-ounce girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds would the woman potentially have a legitimate legal case for negligence?
a.	She is Hispanic.	
b.	She delivered a girl.	
c.	The standards of care were not met.	
d.	She refused fetal monitoring.	

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.

DIF:	Cognitive Level: Comprehension	OBJ:	Nursing Process: Planning
MSC:	Client Needs: Health Promotion and Maintenance

	11.	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.	

ANS:	A
Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.7% 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, 8.5% is uninsured and has limited access to health care. Maternal morbidity and mortality are directly related to racial disparities.

DIF:	Cognitive Level: Analysis	OBJ:	Nursing Process: Planning
MSC:	Client Needs: Safe and Effective Care Environment

	12.	The term used to describe legal and professional responsibility for practice for maternity nurses is
a.	collegiality.	
b.	ethics.	
c.	evaluation.	
d.	accountability.	

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.

DIF:	Cognitive Level: Understanding	OBJ:	Nursing Process: Evaluation
MSC:	Client Needs: Health Promotion and Maintenance

	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 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.	
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 patient privacy and confidentiality. Furthermore, institutions and colleagues can be cast in unfavorable lights 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 nurses. All institutions should have policies guiding the use of social media, and nurses should be familiar with these guidelines.

DIF:	Cognitive Level: Analysis	OBJ:	Nursing Process: Implementation
MSC:	Client Needs: Safe and Effective Care Environment

	14.	An important development that affects maternity nursing is integrative health care, which
a.	seeks to provide the same health care for all racial and ethnic groups.	
b.	blends complementary and alternative therapies with conventional Western treatment.	
c.	focuses on the disease or condition rather than the background of the patient.	
d.	has been mandated by Congress.	

ANS:	B
Integrative health care tries to mix the old with the new at the discretion of the patient and health care providers. Integrative health care is a blending of new and traditional practices. Integrative health care focuses on the whole person, not just the disease or condition. U.S. law supports complementary and alternative therapies but does not mandate them.

DIF:	Cognitive Level: Understanding	OBJ:	Nursing Process: Implementation
MSC:	Client Needs: Health Promotion and Maintenance

	15.	The nurse caring for a pregnant patient should be aware that the U.S. birth rate shows which trend?
a.	Births to unmarried women are more likely to have less favorable outcomes.	
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.	

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.

DIF:	Cognitive Level: Comprehension	OBJ:	Nursing Process: Assessment
MSC:	Client Needs: Safe and Effective Care Environment

	16.	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.	

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.

DIF:	Cognitive Level: Comprehension	OBJ:	Nursing Process: Assessment
MSC:	Client Needs: Psychosocial Integrity		

	17.	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.	

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.

DIF:	Cognitive Level: Comprehension	OBJ:	Nursing Process: Diagnosis
MSC:	Client Needs: Safe and Effective Care Environment

	18.	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.”	

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, nurses will increasingly encounter women who have undergone the procedure. Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Responding with, “This is a very abnormal practice and rarely seen in the United States” is culturally insensitive. The infibulation may have occurred during infancy or childhood. The patient 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: Application	OBJ:	Nursing Process: Planning
MSC:	Client Needs: Safe and Effective Care Environment

	19.	To ensure patient safety, the practicing nurse must have knowledge of the current Joint Commission’s “Do Not Use” list of abbreviations. Which of the following is acceptable for use?
a.	q.o.d. or Q.O.D.	
b.	MSO4 or MgSO4	
c.	International Unit	
d.	Lack of a leading zero	

ANS:	C
The abbreviations “i.u.” and “I.U.” are no longer acceptable because they could be misread as “I.V.” or the number “10.” The abbreviation “q.o.d. or Q.O.D.” should be written out as “every other day.” The period after the “Q” could be mistaken for an “I”; the “o” could also be mistaken for an “i.” With MSO4 or MgSO4, it is too easy to confuse one medication for another. These medications are used for very different purposes and could put a patient at risk for an adverse outcome. They should be written as morphine sulfate and magnesium sulfate. The decimal point should never be missed before a number to avoid confusion (i.e., 0.4 rather than .4).

DIF:	Cognitive Level: Application	OBJ:	Nursing Process: Assessment
MSC:	Client Needs: Psychosocial Integrity		

	20.	Healthy People 2030 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and providing care across the perinatal continuum. Therefore, it is important for the nurse to be aware that significant progress has been made in
a.	the reduction of fetal deaths and use of prenatal care.	
b.	low birth weight and preterm birth.	
c.	elimination of health disparities based on race.	
d.	infant mortality and the prevention of birth defects.	

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.

DIF:	Cognitive Level: Knowledge	OBJ:	Nursing Process: Implementation
MSC:	Client Needs: Safe and Effective Care Environment

MULTIPLE RESPONSE

	1.	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.	

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.

DIF:	Cognitive Level: Implementation	OBJ:	Nursing Process: Planning
MSC:	Client Needs: Health Promotion and Maintenance

MATCHING

Medical errors are a leading cause of death in the United States. The National Quality Forum has recommended numerous safe practices that nursing can promote to reduce errors. Match each safe practice with the correct statement.
a.	Ask the patient to “teach back.”	
b.	Comply with CDC guidelines.	
c.	Ensure that information is documented in a timely manner.	
d.	Promote interventions that will reduce patient risk.	
e.	Reduce exposure to radiation.	

	1.	Hand hygiene

	2.	Informed consent

	3.	Culture measurement, feedback, and intervention

	4.	Pediatric imaging

	5.	Patient care information

	1.	ANS:	B	DIF:	Cognitive Level: Application	
OBJ:	Nursing Process: Implementation	
MSC:	Client Needs: Safe and Effective Care Environment	
NOT:	The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines.	

	2.	ANS:	A	DIF:	Cognitive Level: Application	
OBJ:	Nursing Process: Implementation	
MSC:	Client Needs: Safe and Effective Care Environment	
NOT:	The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines.	

	3.	ANS:	D	DIF:	Cognitive Level: Application	
OBJ:	Nursing Process: Implementation	
MSC:	Client Needs: Safe and Effective Care Environment	
NOT:	The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines.	

	4.	ANS:	E	DIF:	Cognitive Level: Application	
OBJ:	Nursing Process: Implementation	
MSC:	Client Needs: Safe and Effective Care Environment	
NOT:	The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines.	

	5.	ANS:	C	DIF:	Cognitive Level: Application	
OBJ:	Nursing Process: Implementation	
MSC:	Client Needs: Safe and Effective Care Environment	
NOT:	The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines.