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Maternity and Women’s Health Care 12th Edition Lowdermilk Test Bank

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Maternity & Women’s Health Care 12th Edition Lowdermilk Test Bank

1.  21st Century Maternity and Women’s Health Nursing
2.  Community Care: The Family and Culture
3.  Nursing and Genomics
4.  Assessment and Health Promotion
5.  Violence Against Women
6.  Reproductive System Concerns
7.  Sexually Transmitted and Other Infections
8.  Contraception and Abortion
9.  Infertility
10.  Problems of the Breast
11. Structural Disorders and Neoplasms of the Reproductive System
12.  Conception and Fetal Development
13.  Anatomy and Physiology of Pregnancy
14.  Nursing Care of the Family During Pregnancy
15.  Maternal and Fetal Nutrition
16. Labor and Birth Processes
17.  Maximizing Comfort For The Laboring Woman
18.  Fetal Assessment During Labor
19. Nursing Care of the Family During Labor and Birth
20. Postpartum Physiologic Changes
21. Nursing Care of the Family During the Postpartum Period
22. Transition to Parenthood
23. Physiologic and Behavioral Adaptations of the Newborn
24. Nursing Care of the Newborn and Family
25. Newborn Nutrition and Feeding
26.  Assessment of High Risk Pregnancy
27. Hypertensive Disorders
28. Hemorrhagic Disorders
29. Endocrine and Metabolic Disorders
30. Medical-Surgical Disorders
31. Mental Health Disorders and Substance Abuse
32. Labor and Birth Complications
33. Postpartum Complications
34. Nursing Care of the High-Risk Newborn
35. Acquired Problems of the Newborn
36. Hemolytic Disorders and Congenital Anomalies
37. Perinatal Loss, Bereavement, and Grief

Chapter 1: 21st Century Maternity and Women’s Health Nursing
MULTIPLE CHOICE
1. In evaluating the level of a pregnant womans 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 not the 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: IM:
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance, Antepartum Care
2. 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
When problems are identified, research can be properly conducted. Research of health care
issues leads to evidence-based practice guidelines. Designing research studies is only one factor
of the research process. Data collection is another 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: Understand REF: im: 14 TOP: Nursing Process: N/A
MSC: Client Needs: Safe and Effective Care Environment
3. 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 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 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: Understand REF: IM: TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
4. 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 is the
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 average adult and may not be useful for a client with limited
English proficiency.
DIF: Cognitive Level: Apply REF: im: 5 TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
5. 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 ones 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: im: 11 TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment
6. 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 familys needs and desires. Fathers, partners,
grandparents, and siblings may be present for the birth and participate in activities such as
cutting the babys 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
7. A 38-year-old Hispanic woman vaginally delivered a 9-pound, 6-ounce baby girl after being in
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 own. This client may have 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 standard of care.
DIF: Cognitive Level: Analyze REF: im: 13
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
8. 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 clients 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
Following the agencys policies and procedures manual is always best when seeking information
on correct client procedures. These policies should reflect the current standards of care and the
individual states 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 their own 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: im: 13
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
9. 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 affects families seeking care for infertility.
DIF: Cognitive Level: Remember REF: im: 4
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
10. 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 in the
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: IM:
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
11. 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?
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: im: 5 TOP: Nursing Process: N/A
MSC: Client Needs: Safe and Effective Care Environment
12. 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 systematically reviewed research 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
13. 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 does not define the
standard of care.
DIF: Cognitive Level: Remember REF: im: 13
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
14. 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 for injudicious
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: im: 8
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
15. 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 information is
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 midwives are not certified.
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 available to
all low-risk pregnant women, regardless of the type 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 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: im: 8 TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
16. 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
nurses 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.
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 the United 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 womans health.
DIF: Cognitive Level: Analyze REF: im: 9
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
17. To ensure client safety, the practicing nurse must have knowledge of The Joint Commissions
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 adverse
outcome. For example, these medications should be written as morphine sulfate and magnesium
sulfate. The decimal point should never be missed before a number (e.g., 0.4 rather than .4). A
leading zero is the preferred form.
DIF: Cognitive Level: Remember REF: im: 13
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
18. 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 clinicians immediate attention. Baseline is not discussed as part of
SBAR. Subjective and analysisare not specific to the SBAR acronym. Subjective, analysis, and
review are not specific to the SBAR acronym.
DIF: Cognitive Level: Apply REF: im: 14
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
19. Healthy People 2020 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
are providing care across the perinatal continuum. Which of these priorities has made the most
significant progress?
a. Reduction of fetal deaths and use of prenatal care
b. LBW infants and preterm births
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 LBW infants
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. These
preventable negative outcomes demonstrate the need for comprehensive community-based care
for all mothers, infants, and families.
DIF: Cognitive Level: Remember REF: pp. 3, 4
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. Greater than one third of women in the United States are now obese (body mass index [BMI]
of 30 or greater). Less than one quarter of women in 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 assessment on a client who is 28 weeks pregnant and has
a BMI of 35. What are the most frequently reported 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 risk 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: Apply REF: im: 7
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
2. The Patient Protection and Affordable Care Act (ACA) was signed into law by President
Obama in early 2010. The Act provides some immediate benefits, and other provisions will take
place over the next several years. The practicing nurse should have a thorough understanding of
how these changes will benefit his or her clients. Which outcomes are goals of the ACA? (Select
all that apply.)
a. Insurance affordability
b. Improve public health
c. Treatment of illness
d. Elimination of Medicare and Medicaid
e. Cost containment
ANS: A, B, E
The ACA goals are to make insurance more affordable, contain costs, and strengthen Medicare
and Medicaid. The Act contains provisions that promote the prevention of illness and improve
access to public health. The ultimate goal of the Act is to improve the quality of care for all
Americans while reducing waste, fraud, and abuse of the current system.
DIF: Cognitive Level: Comprehend REF: im: 5 TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
3. Which statements indicate that the nurse is practicing 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 questions.
c. The nurse allows the mother and father to make choices when possible.
d. The nurse informs the family about what is going to happen.
e. The nurse tells the clients 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 allowing the couple to make choices are important
elements of family-centered care. The nurse should never tell the client what to do. Familycentered 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 (except when the situation is an emergency and guests are
asked to leave).
DIF: Cognitive Level: Analyze REF: pp. 8-9
TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
4. Which methods help alleviate the problems associated 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 keep 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 care, 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 remote.

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