Chapter 01: Contemporary Perinatal and Pediatric Nursing in Canada
Keenan-Lindsay: Perry’s Maternal Child Nursing Care in Canada, 3rd Edition

MULTIPLE CHOICE

	1.	Which is true regarding perinatal nurses?
a.	They provide care for only childbearing persons and babies.	
b.	They require advanced practice education beyond an entry to practice degree.	
c.	They work with patients and families from preconception throughout the child-bearing year.	
d.	They provide care for families with children up to age 18 years.	

ANS:	C
Perinatal nurses are those nurses who work collaboratively with patients and families from the preconception period throughout the child-bearing year. Pediatric nurses care for children from birth up to age 18 years. Perinatal or pediatric nurses also provide care for the family. Perinatal nurses often do have advanced education, but this is not a requirement.

DIF:	Cognitive Level: Knowledge	OBJ:	1	KEY:	Nursing Process: N/A

	2.	Which is true regarding pediatric nurses?
a.	They provide care for children up to and including 13 years of age.	
b.	They require advanced practice education beyond an entry to practice degree.	
c.	They work with patients and families throughout the child-bearing year.	
d.	They provide care for children and families up to age 18 years.	

ANS:	D
Pediatric nurses care for children from birth up to age 18 years. Perinatal nurses are those nurses who work collaboratively with patients and families from the preconception period throughout the child-bearing year. Perinatal and pediatric nurses also provide care for the family. Pediatric nurses often do have advanced education, but this is not a requirement.

DIF:	Cognitive Level: Knowledge	OBJ:	1	KEY:	Nursing Process: N/A

	3.	Which of the following would not be included in a discussion of the social determinants of health (SDOH)?
a.	Racism	
b.	Daily exercise	
c.	Chronic illness	
d.	Presence of playgrounds	

ANS:	C
Chronic illness is not considered a SDOH. Racism, healthy behaviours (exercise) and healthy outdoor spaces (playgrounds) can all impact a person’s health.

DIF:	Cognitive Level: Application	OBJ:	3	
KEY:	Nursing Process: Assessment

	4.	An Indigenous patient is pregnant with their first child. Which evidence-informed intervention is most important for the nurse to implement?
a.	Perform a nutrition assessment.	
b.	Refer the patient to a social worker.	
c.	Advise the patient to see an obstetrician, not a midwife.	
d.	Explain to the patient the importance of keeping their prenatal care appointments.	

ANS:	D
Consistent prenatal care is associated with healthier infants. Nutritional status is an important modifiable risk factor, but it 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 the pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the patient has identifiable high-risk problems, their health care may need to be provided by a physician. However, it cannot be assumed that all Indigenous patients have high-risk issues. In addition, advising the patient to see an obstetrician is not the most important aspect on which the nurse should focus at this time.

DIF:	Cognitive Level: Application	OBJ:	1	KEY:	Nursing Process: Planning

	5.	Which social determinant of health has the greatest influence on health status and behaviours?
a.	Education and literacy	
b.	Income and social status	
c.	Employment and working conditions	
d.	Biology and genetic endowment	

ANS:	B
Income and social status has the greatest influence on health status and behaviours and use of health care services. Lower-income Canadians have poorer health, with more chronic illness and earlier death, than that of higher-income Canadians, regardless of age, gender, culture, race, or residence.

DIF:	Cognitive Level: Application	OBJ:	3	
KEY:	Nursing Process: Assessment

	6.	Which is an example of invisible poverty?
a.	Insufficient clothing	
b.	Limited employment opportunities	
c.	Poor sanitation	
d.	Deteriorating housing	

ANS:	B
Invisible poverty refers to social and cultural deprivation, such as limited employment opportunities, inferior educational opportunities, lack of or inferior medical services and health care facilities, and an absence of public services. Visible poverty refers to lack of money or material resources, which includes insufficient clothing, poor sanitation, and deteriorating housing.

DIF:	Cognitive Level: Knowledge	OBJ:	3	
KEY:	Nursing Process: Assessment

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

ANS:	C
The primary role of the practicing nurse is to identify areas for further research in the health and health care of women, children, and families. When problems are identified, research can be conducted properly. Research of health care issues leads to evidence-informed practice guidelines. Designing research studies is only one factor of the research process. Data collection is one factor of research. 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	OBJ:	6	
KEY:	Nursing Process: Implementation

	8.	Which event shifted the focus of the Public Health Agency of Canada (PHAC) away from a population health and health promotion focus?
a.	Shift to home births	
b.	Emergence of avian influenza	
c.	United Nations Sustainable Goals	
d.	Increase in the maternal mortality rate	

ANS:	B
The emergence of the avian influenza shifted the focus of the PHAC from population health and a health promotion focus to a focus on planning for a pandemic. There has been no shift to home births from hospital births in Canada. The United Nations Millennium Goals did not cause a focal shift for the PHAC. There has not been an increase in the maternal mortality rate.

DIF:	Cognitive Level: Comprehension	OBJ:	2	KEY:	Nursing Process: N/A

	9.	The World Health Organization has identified which period as the most important for overall development throughout a person’s lifetime?
a.	Preconception	
b.	Early childhood	
c.	Young adult	
d.	Adolescence	

ANS:	B
The period from prenatal development to eight years of age is critical for cognitive, social, emotional and physical development of the child. It is important to identify where children are most at risk for adversity and to intervene accordingly.

DIF:	Cognitive Level: Knowledge	OBJ:	N/A	
KEY:	Nursing Process: Assessment

	10.	Which is a characteristic of integrative healing?
a.	It replaces conventional Western modalities of treatment.	
b.	It is used by only a small number of Canadian adults.	
c.	It recognizes the value of patients’ input into their health care.	
d.	It focuses primarily on the disease an individual is experiencing.	

ANS:	C
Integrative healing encompasses complementary and alternative therapies and healing modalities that offer human-centred care based on philosophies that recognize the value of the patient’s input and honour the individual’s beliefs, values, and desires. Alternative and complementary therapies are part of an integrative approach to health care.

DIF:	Cognitive Level: Comprehension	OBJ:	1	KEY:	Nursing Process: Planning

	11.	Which of the following was highlighted in the Truth and Reconciliation Report (2015)?
a.	Increased transportation for Indigenous people to travel to tertiary care centres for health care.	
b.	Recognize the value of Indigenous healing practices and their use in the health care system.	
c.	Treat health concerns of Indigenous people with Western ways of healing.	
d.	Educate health care providers about Indigenous healing practices to eliminate the role of the Elder.	

ANS:	B
The TRC (2015) final report calls on health care providers to recognize the value of Indigenous healing practices and to use them in the treatment of Indigenous patients in collaboration with Indigenous healers and Elders where requested by Indigenous patients. It is imperative that health care providers become knowledgeable in Indigenous healing practices, not to eliminate the role of the Elder but to work collaboratively with Elders. Health care services need to be available where Indigenous people work and live and not require increased transportation to tertiary care centres for health care.

DIF:	Cognitive Level: Comprehension	OBJ:	5	KEY:	Nursing Process: Planning

	12.	Which has directly increased the life expectancy of children experiencing a chronic disease?
a.	Early postpartum discharges	
b.	Enhanced technology	
c.	The reduction in acceptable genetic screening options	
d.	Rural health services delivered via telehealth	

ANS:	B
Enhanced technology has increased the life expectancy of many children with chronic diseases. Early postpartum discharges and genetic screening options have not increased the life expectancy of children with chronic disease. Rural health services delivered via telehealth are altering how services are delivered and may indirectly increase life expectancy, but it is not a direct contributing factor.

DIF:	Cognitive Level: Analysis	OBJ:	1	
KEY:	Nursing Process: Implementation

	13.	Which is the focus of the Code of Ethics for Registered Nurses?
a.	Collegiality	
b.	Dependent role	
c.	Evaluation	
d.	Accountability	

ANS:	D
The Code of Ethics for Registered Nurses, by the Canadian Nurses Association (CNA), provides the framework and core responsibilities for nursing practice. The Code of Ethics focuses on the nurse's accountability and responsibility to the patient (CNA, 2017) and emphasizes the nursing role as an independent professional, one that upholds its own legal liability. Collegiality refers to a working relationship with one’s colleagues. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes.

DIF:	Cognitive Level: Evaluation	OBJ:	9	KEY:	Nursing Process: N/A

	14.	Which reflects a future goal for perinatal and pediatric nursing?
a.	Limiting interprofessional teams	
b.	Maintaining existing power structures	
c.	Advocating for an increased number of Caesarean births	
d.	Addressing health inequities by engaging in policy analysis and advocacy	

ANS:	D
Addressing health inequities by creating health policy and services that focus on both resources needed for health and access to health services is a future goal of perinatal nurses. Nurses should be expanding interprofessional teams rather than limiting their existence. Existing power structures and practices need to be disrupted rather than maintained. Advocating for an increased number of Caesarean births is not a future goal for perinatal nursing.

DIF:	Cognitive Level: Knowledge	OBJ:	1	KEY:	Nursing Process: N/A

	15.	What is the most important aspect of trauma-informed care?
a.	Providing counselling to patients who have be traumatized	
b.	Minimize the potential for harm and re-traumatization	
c.	Asking all patients about previous trauma in their life	
d.	To provide a controlling environment for the patient	

ANS:	B
The focus of trauma and violence-informed approaches are to minimize the potential for harm and re-traumatization, and to enhance safety, control and resilience for all clients. While patients should be asked about trauma in their life this is not the most important point as not all patients will disclose the trauma. It is also important to enhance their own control over the situation and not for health care providers to control the situation. Providing counselling may be appropriate for some patients but it is not the focus of trauma-informed care.

DIF:	Cognitive Level: Application	OBJ:	4	
KEY:	Nursing Process: Implementation

	16.	Which is an accurate statistic related to Indigenous people in Canada?
a.	There are approximately half a million Indigenous people in Canada.	
b.	Indigenous people comprise approximately 2% of the total Canadian population.	
c.	The Indigenous population is increasing at a slower rate than non-Indigenous populations.	
d.	Children 14 years and under comprise approximately one-third of the total Indigenous population.	

ANS:	D
Indigenous children aged 14 and under made up one-third of the total Indigenous population. There are approximately 1.7 million Indigenous people in Canada and they comprise 4.9% of the total Canadian population.

DIF:	Cognitive Level: Knowledge	OBJ:	5	
KEY:	Nursing Process: Assessment

	17.	Approximately what percentage of hospitalized patients experience an adverse event?
a.	2.5%	
b.	5%	
c.	7.5%	
d.	10%	

ANS:	C
According to the Canadian Adverse Events Study (Baker et al., 2004), the most quoted study in Canada regarding medical errors, 7.5% of hospitalized patients had an adverse event, and of these, 16% died as a result.

DIF:	Cognitive Level: Knowledge	OBJ:	N/A	KEY:	Nursing Process: N/A

	18.	Which organization offers certification for perinatal, general pediatrics, and pediatric intensive care nurses?
a.	SOGC	
b.	CNA	
c.	RNAO	
d.	CAPWHN	

ANS:	B
The Canadian Nurses Association (CNA) offers specialty certification in many areas of nursing, including perinatal, general pediatrics, pediatric intensive care, and neonatal intensive care. The SOGC, RNAO, and CAPWHN develop guidelines that help guide nurses’ practice.

DIF:	Cognitive Level: Knowledge	OBJ:	1	KEY:	Nursing Process: N/A

	19.	Which is a United Nations Sustainable Development Goal?
a.	Safe, compassionate, and competent care	
b.	Improve family health	
c.	Reduce child morbidity	
d.	Promote good health and well-being	

ANS:	D
One of the 17 United Nations Sustainable Development Goals is to promote good health and well-being. Safe, compassionate care is included in the Code of Ethics for RNs.

DIF:	Cognitive Level: Knowledge	OBJ:	8	KEY:	Nursing Process: N/A

	20.	Which statement is true of nursing care that is based on knowledge gained through various forms and sources of information?
a.	An outgrowth of telemedicine	
b.	Known as evidence-informed practice	
c.	Exclusive to maternity nursing practice	
d.	At odds with the Cochrane Pregnancy and Childbirth Database	

ANS:	B
Evidence-informed practice (EIP) is the collection, interpretation, and integration of valid, important, and applicable patient-reported, nurse-observed, and research-derived information. Evidence-informed practice is practised within all disciplines of nursing and is not exclusive to maternity nursing practice. The Cochrane Pregnancy and Childbirth Database is based on systematically reviewed research trials and is part of the evidence-informed practice movement. Telemedicine uses communication technologies to support health care.

DIF:	Cognitive Level: Comprehension	OBJ:	6	
KEY:	Nursing Process: Assessment

	21.	Which is a principle of the Canada Health Act?
a.	Justice	
b.	Universality	
c.	Health and well-being	
d.	Informed decision making	

ANS:	B
Universality is one of the five principles of the Canada Health Act. Justice is a guiding principle for perinatal and pediatric nursing in Canada. Informed decision making is a guiding principle for perinatal and pediatric nursing in Canada. Health and well-being is a guiding principle for perinatal and pediatric nursing in Canada.

DIF:	Cognitive Level: Knowledge	OBJ:	2	
KEY:	Nursing Process: Assessment

	22.	Which is true of the Muskoka Declaration?
a.	It focused on a commitment to increase global health across the lifespan.	
b.	It provided assistance in developing countries to address health inequities with mothers and infants.	
c.	It expressed an international commitment to develop a global partnership for development of future health care goals.	
d.	It was a strategy to promote gender equality and empower women in health care decisions.	

ANS:	B
In 2010, with the signature of the Muskoka Declaration, the Canadian government promised to assist developing countries in addressing health inequities that affect mothers and infants.

DIF:	Cognitive Level: Knowledge	OBJ:	2	
KEY:	Nursing Process: Assessment

	23.	Alternative and complementary therapies
a.	replace conventional Western modalities of treatment.	
b.	are used by only a small number of Canadians.	
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-centred care based on philosophies that recognize the value of the patient’s input and honour the individual’s beliefs, values, and desires. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of Canadian patients 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:	N/A	KEY:	Nursing Process: Planning

	24.	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 unfavourable 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 unfavourable lights with negative consequences for those posting information. Nursing students have been expelled from school and nurses have been fired or reprimanded by their Licensing Board for injudicious posts. All institutions should have policies guiding the use of social media, and nurses should be familiar with these guidelines.

DIF:	Cognitive Level: Analysis	OBJ:	7	KEY:	Nursing Process: N/A

MULTIPLE RESPONSE

	1.	Which of the following social determinants of health (SDOH) are specifically related to Indigenous people? (Select all that apply.)
a.	Colonization	
b.	Food security	
c.	Working conditions	
d.	Residential schools	
e.	Biology and genetic endowment	

ANS:	A, B, D
All of the SDOH are important but the impact of colonization, food security, and residential schools are related specifically to Indigenous people’s health.

DIF:	Cognitive Level: Knowledge	OBJ:	3	
KEY:	Nursing Process: Assessment

	2.	Which are included in the International Nurse Regulator Collaborative 6 P’s for social media use? (Select all that apply.)
a.	Positive	
b.	Pause	
c.	Probability	
d.	Purpose	
e.	Privacy	
f.	Performance	
g.	Professional	

ANS:	A, B, E, G
The 6 P’s of social media use are professional, positive, patient/person-free, protect, privacy, and pause. Probability, purpose, and performance are not part of the 6 P’s as identified by the International Nurse Regulator Collaborative.

DIF:	Cognitive Level: Knowledge	OBJ:	7	KEY:	Nursing Process: N/A

	3.	When performing an assessment on a child, which aspects would be included to assess the impact of the social determinants of health (SDOH)? (Select all that apply.)
a.	History of symptoms	
b.	Child’s age	
c.	Exposure to toxins in environment	
d.	Access to healthy foods	
e.	Availability of community supports	

ANS:	C, D, E
Although the history of the symptoms and age of the child are important to assess they are not related to the SDOH. Access to healthy food, community support and exposure to toxins in environment are all SDOH that impact the health of all people.

DIF:	Cognitive Level: Knowledge	OBJ:	3	
KEY:	Nursing Process: Assessment

	4.	What are some of the reasons that Indigenous people have poorer health outcomes? (Select all that apply.)
a.	Residential schools	
b.	Use of traditional medicines	
c.	Lack of understanding of modern medicine	
d.	Remote geographical locations	
e.	Fragmented healthcare funding	

ANS:	A, D, E
There are many reasons for poorer health outcomes for Indigenous people although their lack of understanding of modern medicine is not one. The use of traditional medicines may enhance the health of Indigenous people. Health care providers often have a lack of Indigenous traditional therapies that are used to enhance health.

DIF:	Cognitive Level: Comprehension	OBJ:	5	
KEY:	Nursing Process Step: Assessment

TRUE/FALSE

	1.	Prescription medications are considered part of Medicare in all provinces and territories in Canada.

ANS:	F
Home care, extended care, pharmaceuticals, and dental care are not currently covered under Medicare provisions although different provinces do cover some of these items.

DIF:	Cognitive Level: Application	OBJ:	2	KEY:	Nursing Process: N/A

	2.	All patients should be cared for using a trauma-informed approach.

ANS:	T
Not all patients will disclose trauma so it is important to treat everyone as if they have had some trauma in their life. The goal is to prevent re-traumatization.

DIF:	Cognitive Level: Application	OBJ:	4	
KEY:	Nursing Process: Implementation