Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank
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Chapter 01: Maternity and Women’s Health Care Today
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Foundationsof Maternal-Newborn& Women’s HealthNursing, 7th Edition YFT YFT Y
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MULTIPLE CHOICE YFT
1. A nurse educator is teaching a group of nursing students about the history of family-centered
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maternity care. Which statement should the nurse include in the teaching session?
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a. The Sheppard-Towner Act of 1921 promoted family-centered care. YFT YFT YFT YFT YFT YFT YFT
b. Changes in pharmacologic management of labor prompted family-centered care. YFT YFT YFT YFT YFT YFT YFT Y FT
c. Demands by physicians for family involvement in childbirth increased the practice of YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
family-centered care. YFT YFT
d. Parental requests that infants be allowed to remain with them rather than in a YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
nursery initiated the practice of family-centered care.
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ANS: Y F T D
As research began to identify the benefits of early, extended parent–infant contact, parents
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began to insist that the infant remain with them. This gradually developed into the practice of
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rooming-in and finally to family-centered maternity care. The Sheppard-Towner Act provided
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funds for state-managed programs for mothers and children but did not promote
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family-centered care. The changes in pharmacologic management of labor were not a factor in YFT Y FT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
family-centered maternity care. Family-centered care was a request by parents, not physicians.
YFT YFT YFT Y FT YFT YFT YFT YFT YFT YFT YFT YFT
DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Planning MSC: Patient Needs: Health Promotion and Maintenance
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2. Expectant parents ask a prenatal nurse educator, “Which setting for childbirth limits the
NRIGB.C M
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amount of parent–infant interacUtionS?” N
WhT
ich Oer should the nurse provide for these
answ
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Y T
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Y
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parents in order to assist them in choosing an appropriate birth setting?
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a. Birth center YFT
b. Home birth YFT
c. Traditional hospital birth YFT YFT
d. Labor, birth, and recovery room YFT YFT YFT YFT
ANS: Y F T C
In the traditional hospital setting, the mother may see the infant for only short feeding periods, and
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the infant is cared for in a separate nursery. Birth centers are set up to allow an increase in parent–
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
infant contact. Home births allow the greatest amount of parent–infant contact. The labor, birth,
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recovery, and postpartum room setting allows for increased parent–infant contact.
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DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Planning MSC: Patient Needs: Health Promotion and Maintenance
YFT YFT Y F T YFT YFT YFT YFT YFT
3. Which statement best describes the advantage of a labor, birth, recovery, and postpartum
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(LDRP) room?
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a. The family is in a familiar environment. YFT Y FT YFT Y FT YFT Y FT
b. They are less expensive than traditional hospital rooms. YFT YFT YFT YFT YFT YFT YFT
c. The infant is removed to the nursery to allow the mother to rest. YFT YFT YFT YFT Y FT YFT YFT YFT YFT YFT YFT YFT
d. The woman’s support system is encouraged to stay until discharge.YFT YFT Y FT YFT YFT YFT YFT YFT YFT
ANS: Y F T D
NURSINGTB.COM
,Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank
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Sleeping equipment is provided in a private room. A hospital setting is never a familiar
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environment to new parents. An LDRP room is not less expensive than a traditional hospital
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room. The baby remains with the mother at all times and is not removed to the nursery for
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routine care or testing. The father or other designated members of the mother’s support system are
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
encouraged to stay at all times.
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DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Assessment MSC: Patient Needs: Health Promotion and Maintenance
YFT YFT Y F T YFT YFT YFT YFT YFT
4. Which nursing intervention is an independent function of the professional nurse?
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a. Administering oral analgesics YFT YFT
b. Requesting diagnostic studies YFT YFT
c. Teaching the patient perineal care YFT YFT YFT YFT
d. Providing wound care to a surgical incision YFT YFT YFT Y FT YFT Y FT
ANS: Y F T C
Nurses are now responsible for various independent functions, including teaching, counseling,
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and intervening in nonmedical problems. Interventions initiated by the physician and carried
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out by the nurse are called dependent functions. Administrating oral analgesics is a dependent
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function; it is initiated by a physician and carried out by a nurse. Requesting diagnostic studies
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is a dependent function. Providing wound care is a dependent function; however, the physician
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prescribes the type of wound care through direct orders or protocol.
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DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Assessment MSC: Patient Needs: Safe and Effective Care Environment
YFT YFT Y F T YFT YFT YFT YFT YFT YFT
5. Which response by the nurse is the most therapeutic when the patient states, “I’m so afraid to
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have a cesarean birth”? YFT YFT YFT
NURSINGTB.COM
a. “Everything will be OK.” YFT YFT YFT
b. “Don’t worry about it. It will be over soon.” YFT YFT YFT YFT YFT YFT YFT YFT
c. “What concerns you most about a cesarean birth?” YFT YFT YFT YFT YFT YFT YFT
d. “The physician will be in later and you can talk to him.”
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ANS: Y F T C
The response, “What concerns you most about a cesarean birth” focuses on what the patient is saying
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and asks for clarification, which is the most therapeutic response. The response,
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“Everything will be ok” is belittling the patient’s feelings. The response, “Don’t worry about it. YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT
It will be over soon” will indicate that the patient’s feelings are not important. The
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response, “The physician will be in later and you can talk to him” does not allow the patient to
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verbalize her feelings when she wishes to do that.
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DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Implementation MSC: Patient Needs: Psychosocial Integrity
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6. In which step of the nursing process does the nurse determine the appropriate interventions for the
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identified nursing diagnosis?
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a. Planning
b. Evaluation
c. Assessment
d. Intervention
ANS: Y F T A
NURSINGTB.COM
,Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank
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The third step in the nursing process involves planning care for problems that were identified during
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assessment. The evaluation phase is determining whether the goals have been met.
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During the assessment phase, data are collected. The intervention phase is when the plan of care is
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carried out.
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DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Planning MSC: Patient Needs: Safe and Effective Care Environment
YFT YFT Y F T YFT YFT YFT YFT YFT YFT
7. Which goal is most appropriate for the collaborative problem of wound infection?
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a. The patient will not exhibit further signs of infection.
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b. Maintain the patient’s fluid intake at 1000 mL/8 hour. YFT YFT YFT YFT YFT YFT YFT YFT
c. The patient will have a temperature of 98.6F within 2 days.
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d. Monitor the patient to detect therapeutic response to antibiotic therapy. YFT YFT YFT YFT YFT YFT YFT YFT YFT
ANS: Y F T D
In a collaborative problem, the goal should be nurse-oriented and reflect the nursing
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interventions of monitoring or observing. Monitoring for complications such as further signs of
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infection is an independent nursing role. Intake and output is an independent nursing role.
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Monitoring a patient’s temperature is an independent nursing role.
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DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Planning MSC: Patient Needs: Safe and Effective Care Environment
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8. Which nursing intervention is written correctly?
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a. Force fluids as necessary. YFT YFT YFT
b. Observe interaction with the infant. YFT YFT Y FT YFT
c. Encourage turning, coughing, and deep breathing. YFT YFT YFT YFT YFT
d. Assist to ambulate for 10NmUinRuS
teIatG
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2OM, and 6 PM.
PM YFT YFT YFT YFT YFT T
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ANS: Y F T D
Interventions might not be carried out if they are not detailed and specific. “Force fluids” is not YFT Y FT YFT YFT Y FT YFT Y FT Y FT Y FT YFT Y FT Y FT Y FT Y FT Y FT YFT
specific; it does not state how much or how often. Encouraging the patient to turn, cough, and
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breathe deeply is not detailed or specific. Observing interaction with the infant does not state
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how often this procedure should be done. Assisting the patient to ambulate for 10 minutes
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within a certain timeframe is specific.
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DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Planning MSC: Patient Needs: Safe and Effective Care Environment
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9. The patient makes the statement: “I’m afraid to take the baby home tomorrow.” Which
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response by the nurse would be the most therapeutic?
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a. “You’re afraid to take the baby home?” YFT Y FT YFT YFT YFT YFT
b. “Don’t you have a mother who can come and help?” YFT YFT YFT YFT YFT YFT Y FT YFT Y FT
c. “You should read the literature I gave you before you leave.” YFT YFT Y FT YFT Y FT YFT YFT Y FT Y FT YFT
d. “I was scared when I took my first baby home, but everything worked out.”
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ANS: Y F T A
NURSINGTB.COM
, Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank
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This response uses reflection to show concern and open communication. The other choices are blocks
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to communication. Asking if the patient has a mother who can come and assist blocks further
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communication with the patient. Telling the patient to read the literature before leaving does not allow
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the patient to express her feelings further. Sharing your own birth experience is inappropriate.
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DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Implementation MSC: Patient Needs: Psychosocial Integrity
YFT YFT Y F T YFT YFT YFT
10. The nurse is writing an expected outcome for the nursing diagnosis—acute pain related to
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tissue trauma, secondary to vaginal birth, as evidenced by patient stating pain of 8 on a scale of
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10. Which expected outcome is correctly stated for this problem?
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a. Patient will state that pain is a 2 on a scale of 10. YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT Y FT
b. Patient will have a reduction in pain after administration of the prescribed YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
analgesic. YFT
c. Patient will state an absence of pain 1 hour after administration of the prescribed YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
analgesic. YFT
d. Patient will state that pain is a 2 on a scale of 10, 1 hour after the administration of the
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prescribed analgesic.
YFT Y FT
ANS: Y F T D
The outcome should be patient-centered, measurable, realistic, and attainable and within a specified
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timeframe. Patient stating that her pain is now 2 on a scale of 10 lacks a timeframe. Patient having a
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reduction in pain after administration of the prescribed analgesic lacks a measurement. Patient
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stating an absence of pain 1 hour after the administration of prescribed analgesic is unrealistic.
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DIF: Cognitive Level: Appli cN
atiUonR S I N GOTBBJ : .C
NuOr sMi ng Process Step: Y F T Y F T Y F T Y F T
Planning MSC: Patient Needs: Physiologic Integrity
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11. Which nursing diagnosis should the nurse identify as a priority for a patient in active labor?
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a. Risk for anxiety related to upcoming birth YFT YFT YFT Y FT YFT YFT
b. Risk for imbalanced nutrition related to NPO status YFT YFT YFT YFT YFT YFT YFT
c. Risk for altered family processes related to new addition to the family
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d. Risk for injury (maternal) related to altered sensations and positional or physical
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YFT changes
ANS: Y F T D
The nurse should determine which problem needs immediate attention. Risk for injury is the problem
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that has the priority at this time because it is a safety problem. Risk for anxiety, imbalanced
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nutrition, and altered family processes are not the priorities at this time.
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DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Implementation MSC: Patient Needs: Safe and Effective Care Environment
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12. Regarding advanced roles of nursing, which statement related to clinical practice is the most
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accurate?
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a. Family nurse practitioners (FNPs) can assist with childbirth care in the hospital YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
setting. YFT
b. Clinical nurse specialists (CNSs) provide primary care to obstetric patients. YFT YFT YFT YFT YFT YFT YFT YFT YFT
c. Neonatal nurse practitioners provide emergency care in the postbirth setting to YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
NURSINGTB.COM
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
Chapter 01: Maternity and Women’s Health Care Today
YFT YFT YFT YFT YFT YFT YFT
Foundationsof Maternal-Newborn& Women’s HealthNursing, 7th Edition YFT YFT Y
FT YFT YFT YFT YFT YFT
MULTIPLE CHOICE YFT
1. A nurse educator is teaching a group of nursing students about the history of family-centered
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
maternity care. Which statement should the nurse include in the teaching session?
YFT Y FT Y FT YFT YFT YFT YFT Y FT YFT Y FT Y FT Y FT
a. The Sheppard-Towner Act of 1921 promoted family-centered care. YFT YFT YFT YFT YFT YFT YFT
b. Changes in pharmacologic management of labor prompted family-centered care. YFT YFT YFT YFT YFT YFT YFT Y FT
c. Demands by physicians for family involvement in childbirth increased the practice of YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
family-centered care. YFT YFT
d. Parental requests that infants be allowed to remain with them rather than in a YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
nursery initiated the practice of family-centered care.
YFT YFT Y FT Y FT YFT YFT YFT
ANS: Y F T D
As research began to identify the benefits of early, extended parent–infant contact, parents
YFT Y FT YFT Y FT Y FT Y FT YFT YFT Y FT YFT YFT YFT
began to insist that the infant remain with them. This gradually developed into the practice of
YFT YFT Y FT YFT Y FT Y FT YFT YFT YFT Y FT YFT YFT Y FT YFT Y FT Y FT
rooming-in and finally to family-centered maternity care. The Sheppard-Towner Act provided
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
funds for state-managed programs for mothers and children but did not promote
YFT Y FT YFT Y FT YFT Y FT Y FT Y FT Y FT Y FT YFT Y FT
family-centered care. The changes in pharmacologic management of labor were not a factor in YFT Y FT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
family-centered maternity care. Family-centered care was a request by parents, not physicians.
YFT YFT YFT Y FT YFT YFT YFT YFT YFT YFT YFT YFT
DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Planning MSC: Patient Needs: Health Promotion and Maintenance
YFT YFT Y F T YFT YFT YFT YFT YFT
2. Expectant parents ask a prenatal nurse educator, “Which setting for childbirth limits the
NRIGB.C M
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
amount of parent–infant interacUtionS?” N
WhT
ich Oer should the nurse provide for these
answ
T
F
Y T
F
Y T
F
Y T
F
Y T
F
Y
YFT YFT YFT YFT YFT Y F T YFT YFT YFT YFT YFT YFT
parents in order to assist them in choosing an appropriate birth setting?
YFT YFT Y FT Y FT YFT YFT YFT Y FT YFT Y FT YFT YFT
a. Birth center YFT
b. Home birth YFT
c. Traditional hospital birth YFT YFT
d. Labor, birth, and recovery room YFT YFT YFT YFT
ANS: Y F T C
In the traditional hospital setting, the mother may see the infant for only short feeding periods, and
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
the infant is cared for in a separate nursery. Birth centers are set up to allow an increase in parent–
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
infant contact. Home births allow the greatest amount of parent–infant contact. The labor, birth,
YFT Y FT Y FT YFT Y FT Y FT YFT YFT Y FT Y FT YFT YFT YFT
recovery, and postpartum room setting allows for increased parent–infant contact.
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Planning MSC: Patient Needs: Health Promotion and Maintenance
YFT YFT Y F T YFT YFT YFT YFT YFT
3. Which statement best describes the advantage of a labor, birth, recovery, and postpartum
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
(LDRP) room?
YFT Y FT
a. The family is in a familiar environment. YFT Y FT YFT Y FT YFT Y FT
b. They are less expensive than traditional hospital rooms. YFT YFT YFT YFT YFT YFT YFT
c. The infant is removed to the nursery to allow the mother to rest. YFT YFT YFT YFT Y FT YFT YFT YFT YFT YFT YFT YFT
d. The woman’s support system is encouraged to stay until discharge.YFT YFT Y FT YFT YFT YFT YFT YFT YFT
ANS: Y F T D
NURSINGTB.COM
,Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
Sleeping equipment is provided in a private room. A hospital setting is never a familiar
Y FT Y FT YFT YFT Y FT Y FT YFT YFT YFT YFT Y FT YFT YFT Y FT
environment to new parents. An LDRP room is not less expensive than a traditional hospital
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
room. The baby remains with the mother at all times and is not removed to the nursery for
YFT Y FT Y FT Y FT Y FT YFT Y FT Y FT Y FT YFT YFT Y FT YFT YFT Y FT YFT YFT Y FT
routine care or testing. The father or other designated members of the mother’s support system are
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
encouraged to stay at all times.
YFT YFT Y FT Y FT Y FT Y FT
DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Assessment MSC: Patient Needs: Health Promotion and Maintenance
YFT YFT Y F T YFT YFT YFT YFT YFT
4. Which nursing intervention is an independent function of the professional nurse?
YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT
a. Administering oral analgesics YFT YFT
b. Requesting diagnostic studies YFT YFT
c. Teaching the patient perineal care YFT YFT YFT YFT
d. Providing wound care to a surgical incision YFT YFT YFT Y FT YFT Y FT
ANS: Y F T C
Nurses are now responsible for various independent functions, including teaching, counseling,
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
and intervening in nonmedical problems. Interventions initiated by the physician and carried
YFT Y FT YFT Y FT YFT YFT YFT YFT Y FT Y FT YFT YFT
out by the nurse are called dependent functions. Administrating oral analgesics is a dependent
YFT YFT Y FT YFT YFT YFT YFT Y FT Y FT YFT YFT YFT YFT YFT
function; it is initiated by a physician and carried out by a nurse. Requesting diagnostic studies
YFT Y FT YFT YFT YFT Y FT YFT YFT YFT Y FT YFT YFT Y FT Y FT Y FT Y F T
is a dependent function. Providing wound care is a dependent function; however, the physician
YFT YFT YFT YFT YFT Y FT Y FT Y FT Y FT Y FT Y FT Y FT Y FT Y FT
prescribes the type of wound care through direct orders or protocol.
YFT Y FT Y FT Y FT Y FT YFT Y FT Y FT YFT YFT YFT
DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Assessment MSC: Patient Needs: Safe and Effective Care Environment
YFT YFT Y F T YFT YFT YFT YFT YFT YFT
5. Which response by the nurse is the most therapeutic when the patient states, “I’m so afraid to
YFT YFT YFT YFT YFT YFT YFT Y FT YFT YFT YFT YFT YFT YFT YFT YFT
have a cesarean birth”? YFT YFT YFT
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a. “Everything will be OK.” YFT YFT YFT
b. “Don’t worry about it. It will be over soon.” YFT YFT YFT YFT YFT YFT YFT YFT
c. “What concerns you most about a cesarean birth?” YFT YFT YFT YFT YFT YFT YFT
d. “The physician will be in later and you can talk to him.”
YFT YFT YFT YFT Y FT YFT YFT YFT Y FT YFT Y FT
ANS: Y F T C
The response, “What concerns you most about a cesarean birth” focuses on what the patient is saying
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
and asks for clarification, which is the most therapeutic response. The response,
YFT Y FT Y FT YFT YFT YFT Y FT Y FT YFT YFT YFT Y FT
“Everything will be ok” is belittling the patient’s feelings. The response, “Don’t worry about it. YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT
It will be over soon” will indicate that the patient’s feelings are not important. The
YFT Y FT YFT YFT Y FT Y FT YFT YFT YFT Y FT YFT YFT YFT Y FT YFT
response, “The physician will be in later and you can talk to him” does not allow the patient to
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
verbalize her feelings when she wishes to do that.
YFT YFT YFT Y FT YFT YFT YFT Y FT Y FT
DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Implementation MSC: Patient Needs: Psychosocial Integrity
YFT YFT Y F T YFT YFT YFT
6. In which step of the nursing process does the nurse determine the appropriate interventions for the
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT
identified nursing diagnosis?
YFT Y FT Y FT
a. Planning
b. Evaluation
c. Assessment
d. Intervention
ANS: Y F T A
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,Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
The third step in the nursing process involves planning care for problems that were identified during
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT
assessment. The evaluation phase is determining whether the goals have been met.
YFT Y FT YFT YFT YFT Y FT Y FT Y FT Y FT Y FT YFT YFT
During the assessment phase, data are collected. The intervention phase is when the plan of care is
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT
carried out.
YFT Y FT
DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Planning MSC: Patient Needs: Safe and Effective Care Environment
YFT YFT Y F T YFT YFT YFT YFT YFT YFT
7. Which goal is most appropriate for the collaborative problem of wound infection?
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT
a. The patient will not exhibit further signs of infection.
YFT YFT YFT YFT YFT YFT YFT YFT
b. Maintain the patient’s fluid intake at 1000 mL/8 hour. YFT YFT YFT YFT YFT YFT YFT YFT
c. The patient will have a temperature of 98.6F within 2 days.
YFT Y FT YFT YFT YFT YFT Y FT YFT YFT Y FT
d. Monitor the patient to detect therapeutic response to antibiotic therapy. YFT YFT YFT YFT YFT YFT YFT YFT YFT
ANS: Y F T D
In a collaborative problem, the goal should be nurse-oriented and reflect the nursing
Y FT YFT Y FT YFT Y FT Y FT YFT YFT Y FT YFT YFT YFT
interventions of monitoring or observing. Monitoring for complications such as further signs of
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
infection is an independent nursing role. Intake and output is an independent nursing role.
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
Monitoring a patient’s temperature is an independent nursing role.
YFT Y FT YFT YFT Y FT Y FT Y FT YFT Y FT
DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Planning MSC: Patient Needs: Safe and Effective Care Environment
YFT YFT Y F T YFT YFT YFT YFT YFT YFT
8. Which nursing intervention is written correctly?
YFT YFT YFT YFT YFT
a. Force fluids as necessary. YFT YFT YFT
b. Observe interaction with the infant. YFT YFT Y FT YFT
c. Encourage turning, coughing, and deep breathing. YFT YFT YFT YFT YFT
d. Assist to ambulate for 10NmUinRuS
teIatG
sN 8TAB
M.,C
2OM, and 6 PM.
PM YFT YFT YFT YFT YFT T
F
Y T
F
Y YFT YFT Y FT
ANS: Y F T D
Interventions might not be carried out if they are not detailed and specific. “Force fluids” is not YFT Y FT YFT YFT Y FT YFT Y FT Y FT Y FT YFT Y FT Y FT Y FT Y FT Y FT YFT
specific; it does not state how much or how often. Encouraging the patient to turn, cough, and
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
breathe deeply is not detailed or specific. Observing interaction with the infant does not state
YFT Y FT YFT Y FT YFT YFT Y FT Y FT Y FT YFT YFT Y FT YFT Y FT YFT
how often this procedure should be done. Assisting the patient to ambulate for 10 minutes
YFT Y FT Y FT YFT Y FT YFT Y FT Y FT Y FT YFT Y FT Y FT Y FT YFT Y FT
within a certain timeframe is specific.
YFT YFT YFT YFT YFT Y FT
DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Planning MSC: Patient Needs: Safe and Effective Care Environment
YFT YFT Y F T YFT YFT YFT YFT YFT YFT
9. The patient makes the statement: “I’m afraid to take the baby home tomorrow.” Which
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
response by the nurse would be the most therapeutic?
YFT YFT YFT YFT Y FT YFT Y FT Y FT YFT
a. “You’re afraid to take the baby home?” YFT Y FT YFT YFT YFT YFT
b. “Don’t you have a mother who can come and help?” YFT YFT YFT YFT YFT YFT Y FT YFT Y FT
c. “You should read the literature I gave you before you leave.” YFT YFT Y FT YFT Y FT YFT YFT Y FT Y FT YFT
d. “I was scared when I took my first baby home, but everything worked out.”
YFT YFT Y FT Y FT YFT YFT YFT Y FT YFT YFT YFT YFT Y FT
ANS: Y F T A
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, Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
This response uses reflection to show concern and open communication. The other choices are blocks
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT
to communication. Asking if the patient has a mother who can come and assist blocks further
YFT YFT YFT Y FT Y FT Y FT Y FT Y FT Y FT YFT YFT Y FT YFT Y FT YFT YFT
communication with the patient. Telling the patient to read the literature before leaving does not allow
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT YFT YFT
the patient to express her feelings further. Sharing your own birth experience is inappropriate.
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT YFT YFT YFT
DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Implementation MSC: Patient Needs: Psychosocial Integrity
YFT YFT Y F T YFT YFT YFT
10. The nurse is writing an expected outcome for the nursing diagnosis—acute pain related to
YFT Y FT YFT Y FT Y FT Y FT Y FT YFT YFT Y FT YFT YFT YFT
tissue trauma, secondary to vaginal birth, as evidenced by patient stating pain of 8 on a scale of
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
10. Which expected outcome is correctly stated for this problem?
YFT YFT YFT Y FT YFT YFT Y FT Y FT YFT YFT
a. Patient will state that pain is a 2 on a scale of 10. YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT Y FT
b. Patient will have a reduction in pain after administration of the prescribed YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
analgesic. YFT
c. Patient will state an absence of pain 1 hour after administration of the prescribed YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
analgesic. YFT
d. Patient will state that pain is a 2 on a scale of 10, 1 hour after the administration of the
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
prescribed analgesic.
YFT Y FT
ANS: Y F T D
The outcome should be patient-centered, measurable, realistic, and attainable and within a specified
YFT YFT Y FT YFT Y FT YFT YFT YFT YFT YFT YFT Y FT
timeframe. Patient stating that her pain is now 2 on a scale of 10 lacks a timeframe. Patient having a
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT Y FT
reduction in pain after administration of the prescribed analgesic lacks a measurement. Patient
YFT YFT Y FT Y FT Y FT YFT YFT YFT YFT Y FT YFT Y FT YFT
stating an absence of pain 1 hour after the administration of prescribed analgesic is unrealistic.
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT YFT YFT
DIF: Cognitive Level: Appli cN
atiUonR S I N GOTBBJ : .C
NuOr sMi ng Process Step: Y F T Y F T Y F T Y F T
Planning MSC: Patient Needs: Physiologic Integrity
Y F T YFT Y F T YFT YFT YFT
11. Which nursing diagnosis should the nurse identify as a priority for a patient in active labor?
YFT YFT YFT YFT YFT YFT Y FT YFT YFT YFT YFT YFT Y FT YFT YFT
a. Risk for anxiety related to upcoming birth YFT YFT YFT Y FT YFT YFT
b. Risk for imbalanced nutrition related to NPO status YFT YFT YFT YFT YFT YFT YFT
c. Risk for altered family processes related to new addition to the family
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
d. Risk for injury (maternal) related to altered sensations and positional or physical
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
YFT changes
ANS: Y F T D
The nurse should determine which problem needs immediate attention. Risk for injury is the problem
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT Y FT
that has the priority at this time because it is a safety problem. Risk for anxiety, imbalanced
YFT YFT Y FT Y FT YFT YFT YFT YFT Y FT YFT YFT Y FT Y FT Y FT YFT Y FT Y FT
nutrition, and altered family processes are not the priorities at this time.
YFT YFT YFT Y FT YFT YFT YFT Y FT Y FT YFT Y FT YFT
DIF: Cognitive Level: Application OBJ: Nursing Process Step: YFT YFT Y F T YFT YFT
Implementation MSC: Patient Needs: Safe and Effective Care Environment
YFT YFT Y F T YFT YFT YFT YFT YFT YFT
12. Regarding advanced roles of nursing, which statement related to clinical practice is the most
YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
accurate?
YFT
a. Family nurse practitioners (FNPs) can assist with childbirth care in the hospital YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
setting. YFT
b. Clinical nurse specialists (CNSs) provide primary care to obstetric patients. YFT YFT YFT YFT YFT YFT YFT YFT YFT
c. Neonatal nurse practitioners provide emergency care in the postbirth setting to YFT YFT YFT YFT YFT YFT YFT YFT YFT YFT
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