Lowdermilk: Maternity Nursing, 8th Edition

Chapter 01: 21st Century Maternity Nursing: Culturally Competent, Family and Community Focused

Test Bank 

MULTIPLE CHOICE

1.	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

	Feedback	
A	Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation.	
B	The woman may need assistance from a social worker at some time during her pregnancy, but this is not the most important aspect the nurse should address at this time.	
C	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, this 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.	
D	Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality.	

DIF:	Cognitive Level: Comprehension	REF:	8	
OBJ:	Client Needs: Health Promotion and Maintenance	TOP:	Nursing Process: Planning

2.	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

	Feedback	
A	Although adolescent pregnant patients statistically receive less prenatal care, this factor is not the most significant barrier.	
B	Significant disparities in morbidity and mortality rates exist for minority women; however, this is not the most significant barrier to access to care.	
C	Disparities in educational level are associated with morbidity and mortality rates; the educational level is not the most significant barrier to access to care.	
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.	

DIF:	Cognitive Level: Knowledge	REF:	5	
OBJ:	Client Needs: Safe and Effective Care Environment	TOP:	Nursing Process: Assessment

3.	What is the primary role of practicing nurses in the research process?
a.	Designing research studies	
b.	Collecting data for other researchers	
c.	Identifying researchable problems	
d.	Seeking funding to support research studies	

ANS:	C

	Feedback	
A	Designing research studies is only one factor of the research process.	
B	Data collection is one factor of research.	
C	When problems are identified, research can be conducted properly. Research of health care issues leads to evidence-based practice guidelines.	
D	Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.	

DIF:	Cognitive Level: Comprehension	REF:	12	
OBJ:	Client Needs: Safe and Effective Care Environment	
TOP:	Nursing Process: Diagnosis, Evaluation	

4.	The nurse caring for the pregnant woman 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 beginning to decline.	
c.	Cigarette smoking among pregnant women continues to increase.	
d.	The rates of pregnancy and abortion among teens are lower in the United States than in any other industrialized country.	

ANS:	A
	Feedback	
A	Low-birth-weight infants and preterm births are more likely because of the large number of teenagers in the unmarried group.	
B	Birth rates for women in their early forties continue to increase.	
C	Fewer pregnant women smoke.	
D	Teen pregnancy and abortion rates are higher in the United States than in any other industrialized country.	

DIF:	Cognitive Level: Comprehension	REF:	6	
OBJ:	Client Needs: Psychosocial Integrity			TOP:	Nursing Process: Assessment

5.	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 procedure manual and follow the guidelines for the procedure.	

ANS:	D

	Feedback	
A	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.	
B	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.	
C	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.	
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.	

DIF:	Cognitive Level: Comprehension	REF:	11	
OBJ:	Client Needs: Physiologic Integrity			
TOP:	Nursing Process: Implementation

6.	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

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

DIF:	Cognitive Level: Comprehension	REF:	4	
OBJ:	Client Needs: Physiologic Integrity			
TOP:	Nursing Process: Planning

7.	Contemporary maternity nursing is exemplified by:
a.	The use of midwives for all vaginal deliveries.	
b.	Family-centered care.	
c.	Free-standing birth clinics.	
d.	Physician-driven care.	

ANS:	B

	Feedback	
A	Midwives and physicians both perform vaginal deliveries.	
B	Contemporary maternity nursing focuses on the family’s needs and desires.	
C	Free-standing clinics are an example of alternative birth options.	
D	Contemporary maternity nursing is driven by the relationship between nurses and their patients.	

DIF:	Cognitive Level: Comprehension	REF:	8	
OBJ:	Client Needs: Health Promotion and Maintenance	
TOP:	Nursing Process: Planning

8.	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 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

	Feedback	
A	The woman’s race is not a factor for a case of negligence.	
B	The infant’s gender is not a factor for a case of negligence.	
C	Not meeting the standards of care is a legitimate factor for a case of negligence.	
D	Although fetal monitoring is the standard of care, the woman has the right to refuse treatment. This refusal is not a case for negligence, but informed consent should be properly obtained, and the woman should sign an against medical advice form for refusal of any treatment that is within the standard of care.	

DIF:	Cognitive Level: Analysis	REF:	10	
OBJ:	Client Needs: Safe and Effective Care Environment	
TOP:	Nursing Process: Implementation

9.	All of the following conditions have contributed to the increase in maternity-related health care costs except:
a.	Early postpartum discharges.	
b.	Liability costs.	
c.	The use of high-tech equipment.	
d.	The cost of care for low-birth-weight (LBW) infants.	

ANS:	A

	Feedback	
A	Early postpartum discharges have reduced costs.	
B	The liability costs of a litigious society contribute to higher health costs.	
C	High-tech equipment increases health costs.	
D	LBW or high risk infants increase health costs.	

DIF:	Cognitive Level: Evaluation	REF:	5	
OBJ:	Client Needs: Health Promotion and Maintenance	
TOP:	Nursing Process: Evaluation

10.	Maternity nurses can work to dispel the health disparities among women through:
a.	Increased education for mothers.	
b.	Late prenatal care.	
c.	Increased number of cesarean sections.	
d.	Making all women take more vitamins.	

ANS:	A

	Feedback	
A	Educating mothers enables them to recognize problems they should report to their health care provider and teaches them ways to take better care of themselves.	
B	Late prenatal care is one factor that contributes to health disparities.	
C	Cesarean sections are performed for various reasons, although they may be the result of health concerns related to the mother.	
D	Taking vitamins may improve overall health, but it does not necessarily ensure health or dispel health disparities.	

DIF:	Cognitive Level: Application	REF:	8	
OBJ:	Client Needs: Health Promotion and Maintenance	
TOP:	Nursing Process: Implementation

11.	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

	Feedback	
A	Collegiality refers to a working relationship with one’s colleagues.	
B	Ethics refers to a code to guide practice.	
C	Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes.	
D	Accountability refers to legal and professional responsibility for practice.	

DIF:	Cognitive Level: Knowledge	REF:	10	
OBJ:	Client Needs: Safe and Effective Care Environment	
TOP:	Nursing Process: Implementation

12.	Recent trends in childbirth practices in the United States indicate that:
a.	Only 15% of mothers receive prenatal care in the first trimester.	
b.	The percentage of Hispanics, non-Hispanic African-Americans, and Caucasians who received prenatal care was essentially the same.	
c.	Ninety-nine percent of births occurred in the hospital.	
d.	Cesarean births have been declining as a percentage of live births.	

ANS:	C

	Feedback	
A	Approximately 84% of women receive prenatal care in the first trimester.	
B	Minority women are twice as likely to receive late prenatal care.	
C	Almost no births occur outside the hospital.	
D	The percentage of cesarean births is increasing.	

DIF:	Cognitive Level: Knowledge	REF:	8	
OBJ:	Client Needs: Safe and Effective Care Environment	
TOP:	Nursing Process: Planning
13.	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

	Feedback	
A	The Nursing Intervention Classification is a method of standardizing language and categorizing care.	
B	Evidence-based practice is based on knowledge gained from research and clinical trials.	
C	Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice movement.	
D	Telemedicine uses communication technologies to support health care.	

DIF:	Cognitive Level: Comprehension	REF:	9	
OBJ:	Client Needs: Safe and Effective Care Environment	
TOP:	Nursing Process: Diagnosis

14.	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 abbreviations 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

	Feedback	
A	This abbreviation 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.”	
B	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 if the wrong medication was administered. They should be written as morphine sulfate and magnesium sulfate.	
C	“i.u.” and “I.U.” are no longer acceptable because they could be misread as “I.V.” or the number “10.”	
D	To avoid the decimal point before a fractional number being overlooked and causing confusion, a leading zero should always be included in such cases; e.g., 0.4 rather than .4.	

DIF:	Cognitive Level: Knowledge	REF:	11	
OBJ:	Client Needs: Safe and Effective Care Environment	
TOP:	Nursing Process: Implementation

15.	The nurse should be aware that a statistic widely used to compare the health status of different populations would be the:
a.	Incidence of specific infections such as acquired immunodeficiency syndrome (AIDS) and tuberculosis.	
b.	Infant mortality rate.	
c.	Maternal morbidity rate.	
d.	Incidence of low-birth-weight infants.	

ANS:	B

	Feedback	
A	These factors may be the target of research studies, but maternal and infant mortality rates are particularly important.	
B	City, county, and state health departments provide annual reports of births and deaths. Maternal and infant death rates are particularly important because they reflect health outcomes that may be preventable.	
C	These factors may be the target of research studies, but maternal and infant mortality rates are particularly important.	
D	These factors may be the target of research studies, but maternal and infant mortality rates are particularly important.	

DIF:	Cognitive Level: Knowledge	REF:	19	
OBJ:	Client Needs: Health Promotion and Maintenance	
TOP:	Nursing Process: Assessment

16.	A married couple lives in a single-family house with their newborn son and the husband’s daughter from a previous marriage. On the basis of the information given, what family form best describes this family?
a.	Married-blended family	
b.	Extended family	
c.	Nuclear family	
d.	Same-sex family	

ANS:	A

	Feedback	
A	Married-blended families are formed as the result of divorce and remarriage. Unrelated family members join together to create a new household.	
B	Members of an extended family are kin, or family members related by blood, such as grandparents, aunts, and uncles.	
C	A nuclear family is a traditional family with male and female partners along with the children resulting from that union.	
D	A same-sex family is a family with homosexual partners who cohabit with or without children.	

DIF:	Cognitive Level: Knowledge	REF:	13	
OBJ:	Client Needs: Psychosocial Integrity			
TOP:	Nursing Process: Assessment

17.	The nurse should be aware that the criteria used to make decisions and solve problems within families are based primarily on family:
a.	Rituals and customs.	
b.	Values and beliefs.	
c.	Boundaries and channels.	
d.	Socialization processes.	

ANS:	B

	Feedback	
A	Although culture may play a part in the decision-making process of a family, ultimately values and beliefs dictate the course of action taken by family members.	
B	Values and beliefs are the most prevalent factors in the decision-making and problem-solving techniques of families.	
C	Boundaries and channels affect the relationship between the family members and the health care team, not the decisions within the family.	
D	Socialization processes may help families with interactions with the community, but they are not the criteria used for decision making within the family.	

DIF:	Cognitive Level: Comprehension	REF:	14	
OBJ:	Client Needs: Psychosocial Integrity			
TOP:	Nursing Process: Planning

18.	The nurse’s care of a Hispanic family includes teaching about infant care. When developing a plan of care, the nurse bases interventions on the knowledge that in traditional Hispanic families:
a.	Breastfeeding is encouraged immediately after birth.	
b.	Male infants typically are circumcised.	
c.	The maternal grandmother participates in the care of the mother and her infant.	
d.	Special herbs mixed in water are used to stimulate the passage of meconium.	

ANS:	C

	Feedback	
A	Breastfeeding often is delayed until the third postpartum day.	
B	Hispanic male infants usually are not circumcised.	
C	In the Hispanic family, the expectant mother is influenced strongly by her mother or mother-in-law.	
D	Olive or castor oil may be given to stimulate the passage of meconium.	
DIF:	Cognitive Level: Application	REF:	22	
OBJ:	Client Needs: Psychosocial Integrity			
TOP:	Nursing Process: Planning

19.	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

	Feedback	
A	Guidelines for standards of care are published by various professional nursing organizations.	
B	Risk management identifies risks and establishes preventive practices, but it does not define the standard of care.	
C	Sentinel events are unexpected negative occurrences. They do not establish the standard of care.	
D	Failure to rescue is an evaluative process for nursing, but it does not define the standard of care.	

DIF:	Cognitive Level: Knowledge	REF:	10	
OBJ:	Client Needs: Safe and Effective Care Environment	
TOP:	Nursing Process: Implementation

20.	When attempting to communicate with a patient who speaks a different language, the nurse should:
a.	Respond promptly and positively to project authority.	
b.	Never use a family member as an interpreter.	
c.	Talk to the interpreter to avoid confusing the patient.	
d.	Provide as much privacy as possible.	

ANS:	D

	Feedback	
A	The nurse should not rush to judgment and should make sure that she or he understands the patient’s message clearly.	
B	In crisis situations, the nurse may need to use a family member or neighbor as an interpreter.	
C	The nurse should talk directly to the patient to create an atmosphere of respect.	
D	Providing privacy creates an atmosphere of respect and puts the patient at ease.	

DIF:	Cognitive Level: Application	REF:	16	
OBJ:	Client Needs: Psychosocial Integrity			
TOP:	Nursing Process: Implementation
21.	In which culture is the father more likely to be expected to participate in the labor and delivery?
a.	Asian American	
b.	African American	
c.	European American	
d.	Hispanic	

ANS:	C

	Feedback	
A	European Americans expect the father to take a more active role in the labor and delivery than the other cultures.	
B	European Americans expect the father to take a more active role in the labor and delivery than the other cultures.	
C	European Americans expect the father to take a more active role in the labor and delivery than the other cultures.	
D	European Americans expect the father to take a more active role in the labor and delivery than the other cultures.	

DIF:	Cognitive Level: Comprehension	REF:	17	
OBJ:	Client Needs: Psychosocial Integrity			
TOP:	Nursing Process: Implementation

MULTIPLE RESPONSE

1.	Which methods would help alleviate the problems associated with access to health care for the maternity patient? Choose 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

	Feedback	
Correct	Lack of transportation to visits, lack of child care, and lack of affordable health insurance are prohibitive factors associated with lack of prenatal care.	
Incorrect	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 timeframe of the pregnancy is remote.	

DIF:	Cognitive Level: Evaluation	REF:	5	
OBJ:	Client Needs: Health Promotion and Maintenance	
TOP:	Nursing Process: Planning