,Chapter01:21st CenturyMaternity andWomen’sHealthNursing Lowdermilk:
t t t t t t t t tt
Maternity & Women’s Health Care, 12th Edition
tt tt tt tt tt tt tt
MULTIPLE CHOICE tt
1. In evaluating the level of a pregnant woman’s risk of having a low-birth-weight (LBW)
tt tt tt tt tt t tt tt tt tt tt tt tt
infant, which factor is the most important for the nurse to consider?
tt tt tt tt tt tt tt tt tt tt tt tt
a. African-American race tt
b. Cigarette smoking tt
c. Poor nutritional status tt tt
d. Limitedmaternal education t tt
ANS: A t t
The rise in the overall LBW rates were due to increases in LBW births to non-Hispanic
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
black women (13.35%) and Hispanic women (7.21%); non-Hispanic black infants are
tt tt tt tt tt tt tt tt tt tt tt
almost twice as likely as non-Hispanic white infants to be of LBW and to die in the first
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
year of life.. Race is a nonmodifiable risk factor. Cigarettesmoking is an important factor in
tt t t tt tt tt t tt tt tt t tt t tt tt t
potential infant mortality rates, but it is not the most important. Additionally, smoking is a
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
modifiable risk factor. Poor nutrition is an important factor in potential infant mortality
tt tt tt tt tt tt tt tt tt tt tt tt tt
rates, but it is not the most important. Additionally, nutritional status is a modifiable risk
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
factor. Maternal education is an important factor in potential infant mortality rates, but it is
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
not the most important. Additionally, maternal education is a modifiable risk factor.
tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: CognitiveLevel: Understand t tt
TOP: Nursing Process: Assessment
tt t t tt tt
MSC: Client Needs: HealtN PrRoS
hU mI ioG
otN nTanBd.MCaO
inM
tenance, t t t t t t Antepartum t t Care
2. A 23-year-old African-American woman is pregnant with her first child. Based on current
tt tt tt tt tt tt tt tt tt tt tt tt
statistics for infant mortality, which intervention is most important for the nurse to include
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
in the client’s plan of care?
tt tt tt tt tt tt
a. Perform anutrition assessment. tt t tt
b. Refer the woman to a social worker. t tt tt tt tt tt
c. Advise the woman to see an obstetrician, not a midwife. t tt tt tt tt tt tt tt tt
d. Explain to the woman the importance of keeping her prenatal care appointments. t tt tt tt tt tt tt tt tt tt tt
ANS: D t t
Consistent prenatal care is the best method of preventing or controlling risk factors
tt tt tt tt tt tt tt tt tt tt tt tt
associated with infant mortality. Nutritional status is an important modifiable risk factor, but it
tt t tt tt tt tt t t tt t tt tt t tt
is not the most important action a nurse should take in this situation. The client may need
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
assistance from a social worker at some time during her pregnancy, but a referral to a social
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
worker is not the most important aspect the nurse should address at this time. If the
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
woman has identifiable high-risk problems, then her health care may need to be provided
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
by a physician. However, it cannot be assumed that all African-American women have
tt tt tt tt tt tt tt tt tt tt tt tt tt
high-risk issues. In addition, advising the woman to see an obstetrician is not the most
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
important aspect on which the nurse should focus at this time, and it is not appropriate for
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
a nurse to advise or manage the type of care a client is to receive.
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: CognitiveLevel: Understand t tt
TOP: Nursing Process: Planning
tt t t tt tt
, MSC: Client Needs: Health Promotion and Maintenance
tt t tt tt t tt
3. Thenurses working at a newly established birthing center have begun to compare their
t t t t t t t t tt tt t tt t
performance in providing maternal-newborn care against clinical standards. This
tt tt tt tt tt tt tt tt tt
comparison process is most commonly known as what?
tt tt tt tt tt tt tt tt
a. Bestpractices network t tt
b. Clinicalbenchmarking
c. Outcomes-oriented p r a cNt iUc eR S tt
d. Evidence-based practice tt
ANS: C t t
Outcomes-oriented practice measures the effectiveness of the interventions and quality of tt tt tt tt tt tt tt tt tt tt
care against benchmarks or standards. The term best practice refers to a program or service
tt tt tt tt tt tt t tt tt tt tt tt t tt tt
that has been recognized for its excellence. Clinical benchmarking is a process used to
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
compare one’s own performance against the performance of the best in an area of service.
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
The term evidence-based practice refers to the provision of care based on evidence gained
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
through research and clinical trials.
tt tt tt tt tt
PTS: 1 DIF: CognitiveLevel:Understand t t
TOP: Nursing Process: Evaluation
tt t t tt tt
MSC: Client Needs: Safe and Effective Care Environment
t t tt tt t tt tt tt
4. During a prenatal intake interview, the nurse is in the process of obtaining an initial
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
assessment of a 21-year-old Hispanic client with limited English proficiency. Which
tt tt t t tt tt tt tt tt tt tt
intervention is the most important for the nurse to implement?
tt tt tt tt tt tt tt tt tt tt
a. Use maternityjargon to enable the client to become familiar with these terms.
t t tt tt tt tt tt tt tt tt tt tt
b. Speak quickly and efficiently to expedite the visit.
tt tt tt tt tt t tt
c. Providethe client with handouts. t tt tt tt
d. Assess whether the client understands the discussion.
t t tt tt tt tt
ANS: D t t
Nurses contribute to health literacy by using simple, common words, avoiding jargon, and
tt tt tt tt tt tt tt tt tt tt tt tt
evaluating whether the client understands the discussion. Speaking slowly and clearly and
tt tt tt tt tt tt tt tt tt tt tt tt
focusing on what is important will increase understanding. Most client education materials
tt tt tt tt tt tt tt tt tt tt tt tt
are written at a level too high for the average adult and may not be useful for a client
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
with limited English proficiency.
tt tt tt tt
PTS: 1 DIF: CognitiveLevel:Apply t t
TOP: Nursing Process: Implementation
tt t t tt tt
MSC: Client Needs: Health Promotion and Maintenance
tt t tt tt t tt
5. Whichstatement best exemplifies contemporarymaternity nursing?
t tt tt tt t tt
a. Useof midwives for all vaginal deliveries
t tt tt tt tt tt
b. Family-centered care tt
c. Free-standing birth clinics tt tt
d. Physician-drivencare t
tt ANS: B t t
, Contemporary maternity nursing focuses on the family’s needs and desires. Fathers, tt tt tt tt tt tt tt tt tt tt
partners, grandparents, and siblings may be present for the birth and participate in activities
tt tt tt tt tt t tt tt t tt tt tt tt t
such as cutting the baby’s umbilical cord. Both midwives and physicians perform vaginal
tt tt tt tt tt tt tt tt tt tt tt tt tt
deliveries. Free-standing clinics are an example of alternative birth options. Contemporary
tt tt tt tt tt tt tt tt tt tt tt
maternity nursing is driven by the relationship between nurses and their clients.
tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: CognitiveLevel: Understand t tt
TOP: Nursing Process: Planning
tt t t tt tt
MSC: Client Needs: Health Promotion and Maintenance
tt t tt tt t tt
6. A 38-year-old Hispanic woman vaginallydelivered a 9-pound, 6-ounce baby girl after being in
t t t t t tt t t tt t t tt tt
labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
woman have a legitimate legal case for negligence?
tt tt tt tt tt tt tt tt
a. Inexperienced maternity nursewas assigned to care for the client. tt tt t tt tt tt tt tt tt
b. Client was past her due date by3 days. tt tt tt tt t tt t tt
c. Standard of care was not met. tt t tt tt tt
d. Clientrefused electronic fetal monitoring. t tt t tt
ANS: C t t
Not meeting the standard of care is a legitimate factor for a case of negligence. An
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
inexperienced maternity nurse would need to displaycompetencybefore being assigned to
tt t t tt t tt t t t tt t tt
care for clients on his or her own. This client may have been past her due date; however, a
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
term pregnancy often goes beyond 40 weeks of gestation. Although fetal monitoring is the
tt tt tt tt tt tt tt tt tt tt tt tt tt t
standard of care, the client has the right to refuse treatment. This refusal is not a case for
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
negligence, but informed consent should be properly obtained, and the client should have
tt tt tt tt tt tt tt tt tt tt tt tt tt
signed an against medical advice form when refusing any treatment that is within the
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
standard of care.
tt tt tt
PTS: 1 DIF: CognitiveLevel:Analyze t t
TOP: Nursing Process: Implementation
tt t t tt tt
MSC: Client Needs: Safe and Effective Care Environment
t t tt tt t tt tt tt
7. When the nurse is unsure how to perform a client care procedure that is high risk and low
t t t t tt tt tt tt tt tt tt t tt t tt tt tt
volume, his or her best action in this situation would be what?
tt tt tt tt tt tt tt tt tt tt tt tt
a. Ask another nurse. tt tt
b. Discuss the procedure with the client’s physician. tt t tt tt t tt
c. Look up the procedure in a nursing textbook. tt tt tt tt tt tt tt
d. First consult the agency procedure manual tt tt tt tt tt
ANS: D t t
Following the agency’s policies and procedures manual is always best when seeking
tt tt tt tt tt tt tt tt tt tt tt
information on correct client procedures. These policies should reflect the current standards
tt tt tt tt tt tt tt tt tt tt tt tt
of care and the individual state’s guidelines. Each nurse is responsible for his or her own
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
practice. Relying on another nurse may not always be a safe practice. Each nurse is
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
obligated to follow the standards of care for safe client care delivery. Physicians are
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
responsible for their own client care activity. Nurses may follow safe orders from
tt tt tt tt tt tt tt tt tt tt tt tt tt
physicians, but they are also responsible for the activities that they, as nurses, are to carry
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
out. Information provided in a nursing textbook is basic information for general knowledge.
tt tt tt tt t tt t t t tt t t tt
Furthermore, the information in a textbook may not reflect the current standard of care or
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
the individual state or hospital policies.
tt tt tt tt tt tt
t t t t t t t t tt
Maternity & Women’s Health Care, 12th Edition
tt tt tt tt tt tt tt
MULTIPLE CHOICE tt
1. In evaluating the level of a pregnant woman’s risk of having a low-birth-weight (LBW)
tt tt tt tt tt t tt tt tt tt tt tt tt
infant, which factor is the most important for the nurse to consider?
tt tt tt tt tt tt tt tt tt tt tt tt
a. African-American race tt
b. Cigarette smoking tt
c. Poor nutritional status tt tt
d. Limitedmaternal education t tt
ANS: A t t
The rise in the overall LBW rates were due to increases in LBW births to non-Hispanic
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
black women (13.35%) and Hispanic women (7.21%); non-Hispanic black infants are
tt tt tt tt tt tt tt tt tt tt tt
almost twice as likely as non-Hispanic white infants to be of LBW and to die in the first
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
year of life.. Race is a nonmodifiable risk factor. Cigarettesmoking is an important factor in
tt t t tt tt tt t tt tt tt t tt t tt tt t
potential infant mortality rates, but it is not the most important. Additionally, smoking is a
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
modifiable risk factor. Poor nutrition is an important factor in potential infant mortality
tt tt tt tt tt tt tt tt tt tt tt tt tt
rates, but it is not the most important. Additionally, nutritional status is a modifiable risk
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
factor. Maternal education is an important factor in potential infant mortality rates, but it is
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
not the most important. Additionally, maternal education is a modifiable risk factor.
tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: CognitiveLevel: Understand t tt
TOP: Nursing Process: Assessment
tt t t tt tt
MSC: Client Needs: HealtN PrRoS
hU mI ioG
otN nTanBd.MCaO
inM
tenance, t t t t t t Antepartum t t Care
2. A 23-year-old African-American woman is pregnant with her first child. Based on current
tt tt tt tt tt tt tt tt tt tt tt tt
statistics for infant mortality, which intervention is most important for the nurse to include
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
in the client’s plan of care?
tt tt tt tt tt tt
a. Perform anutrition assessment. tt t tt
b. Refer the woman to a social worker. t tt tt tt tt tt
c. Advise the woman to see an obstetrician, not a midwife. t tt tt tt tt tt tt tt tt
d. Explain to the woman the importance of keeping her prenatal care appointments. t tt tt tt tt tt tt tt tt tt tt
ANS: D t t
Consistent prenatal care is the best method of preventing or controlling risk factors
tt tt tt tt tt tt tt tt tt tt tt tt
associated with infant mortality. Nutritional status is an important modifiable risk factor, but it
tt t tt tt tt tt t t tt t tt tt t tt
is not the most important action a nurse should take in this situation. The client may need
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
assistance from a social worker at some time during her pregnancy, but a referral to a social
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
worker is not the most important aspect the nurse should address at this time. If the
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
woman has identifiable high-risk problems, then her health care may need to be provided
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
by a physician. However, it cannot be assumed that all African-American women have
tt tt tt tt tt tt tt tt tt tt tt tt tt
high-risk issues. In addition, advising the woman to see an obstetrician is not the most
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
important aspect on which the nurse should focus at this time, and it is not appropriate for
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
a nurse to advise or manage the type of care a client is to receive.
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: CognitiveLevel: Understand t tt
TOP: Nursing Process: Planning
tt t t tt tt
, MSC: Client Needs: Health Promotion and Maintenance
tt t tt tt t tt
3. Thenurses working at a newly established birthing center have begun to compare their
t t t t t t t t tt tt t tt t
performance in providing maternal-newborn care against clinical standards. This
tt tt tt tt tt tt tt tt tt
comparison process is most commonly known as what?
tt tt tt tt tt tt tt tt
a. Bestpractices network t tt
b. Clinicalbenchmarking
c. Outcomes-oriented p r a cNt iUc eR S tt
d. Evidence-based practice tt
ANS: C t t
Outcomes-oriented practice measures the effectiveness of the interventions and quality of tt tt tt tt tt tt tt tt tt tt
care against benchmarks or standards. The term best practice refers to a program or service
tt tt tt tt tt tt t tt tt tt tt tt t tt tt
that has been recognized for its excellence. Clinical benchmarking is a process used to
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
compare one’s own performance against the performance of the best in an area of service.
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
The term evidence-based practice refers to the provision of care based on evidence gained
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
through research and clinical trials.
tt tt tt tt tt
PTS: 1 DIF: CognitiveLevel:Understand t t
TOP: Nursing Process: Evaluation
tt t t tt tt
MSC: Client Needs: Safe and Effective Care Environment
t t tt tt t tt tt tt
4. During a prenatal intake interview, the nurse is in the process of obtaining an initial
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
assessment of a 21-year-old Hispanic client with limited English proficiency. Which
tt tt t t tt tt tt tt tt tt tt
intervention is the most important for the nurse to implement?
tt tt tt tt tt tt tt tt tt tt
a. Use maternityjargon to enable the client to become familiar with these terms.
t t tt tt tt tt tt tt tt tt tt tt
b. Speak quickly and efficiently to expedite the visit.
tt tt tt tt tt t tt
c. Providethe client with handouts. t tt tt tt
d. Assess whether the client understands the discussion.
t t tt tt tt tt
ANS: D t t
Nurses contribute to health literacy by using simple, common words, avoiding jargon, and
tt tt tt tt tt tt tt tt tt tt tt tt
evaluating whether the client understands the discussion. Speaking slowly and clearly and
tt tt tt tt tt tt tt tt tt tt tt tt
focusing on what is important will increase understanding. Most client education materials
tt tt tt tt tt tt tt tt tt tt tt tt
are written at a level too high for the average adult and may not be useful for a client
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
with limited English proficiency.
tt tt tt tt
PTS: 1 DIF: CognitiveLevel:Apply t t
TOP: Nursing Process: Implementation
tt t t tt tt
MSC: Client Needs: Health Promotion and Maintenance
tt t tt tt t tt
5. Whichstatement best exemplifies contemporarymaternity nursing?
t tt tt tt t tt
a. Useof midwives for all vaginal deliveries
t tt tt tt tt tt
b. Family-centered care tt
c. Free-standing birth clinics tt tt
d. Physician-drivencare t
tt ANS: B t t
, Contemporary maternity nursing focuses on the family’s needs and desires. Fathers, tt tt tt tt tt tt tt tt tt tt
partners, grandparents, and siblings may be present for the birth and participate in activities
tt tt tt tt tt t tt tt t tt tt tt tt t
such as cutting the baby’s umbilical cord. Both midwives and physicians perform vaginal
tt tt tt tt tt tt tt tt tt tt tt tt tt
deliveries. Free-standing clinics are an example of alternative birth options. Contemporary
tt tt tt tt tt tt tt tt tt tt tt
maternity nursing is driven by the relationship between nurses and their clients.
tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: CognitiveLevel: Understand t tt
TOP: Nursing Process: Planning
tt t t tt tt
MSC: Client Needs: Health Promotion and Maintenance
tt t tt tt t tt
6. A 38-year-old Hispanic woman vaginallydelivered a 9-pound, 6-ounce baby girl after being in
t t t t t tt t t tt t t tt tt
labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
woman have a legitimate legal case for negligence?
tt tt tt tt tt tt tt tt
a. Inexperienced maternity nursewas assigned to care for the client. tt tt t tt tt tt tt tt tt
b. Client was past her due date by3 days. tt tt tt tt t tt t tt
c. Standard of care was not met. tt t tt tt tt
d. Clientrefused electronic fetal monitoring. t tt t tt
ANS: C t t
Not meeting the standard of care is a legitimate factor for a case of negligence. An
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
inexperienced maternity nurse would need to displaycompetencybefore being assigned to
tt t t tt t tt t t t tt t tt
care for clients on his or her own. This client may have been past her due date; however, a
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
term pregnancy often goes beyond 40 weeks of gestation. Although fetal monitoring is the
tt tt tt tt tt tt tt tt tt tt tt tt tt t
standard of care, the client has the right to refuse treatment. This refusal is not a case for
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
negligence, but informed consent should be properly obtained, and the client should have
tt tt tt tt tt tt tt tt tt tt tt tt tt
signed an against medical advice form when refusing any treatment that is within the
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
standard of care.
tt tt tt
PTS: 1 DIF: CognitiveLevel:Analyze t t
TOP: Nursing Process: Implementation
tt t t tt tt
MSC: Client Needs: Safe and Effective Care Environment
t t tt tt t tt tt tt
7. When the nurse is unsure how to perform a client care procedure that is high risk and low
t t t t tt tt tt tt tt tt tt t tt t tt tt tt
volume, his or her best action in this situation would be what?
tt tt tt tt tt tt tt tt tt tt tt tt
a. Ask another nurse. tt tt
b. Discuss the procedure with the client’s physician. tt t tt tt t tt
c. Look up the procedure in a nursing textbook. tt tt tt tt tt tt tt
d. First consult the agency procedure manual tt tt tt tt tt
ANS: D t t
Following the agency’s policies and procedures manual is always best when seeking
tt tt tt tt tt tt tt tt tt tt tt
information on correct client procedures. These policies should reflect the current standards
tt tt tt tt tt tt tt tt tt tt tt tt
of care and the individual state’s guidelines. Each nurse is responsible for his or her own
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
practice. Relying on another nurse may not always be a safe practice. Each nurse is
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
obligated to follow the standards of care for safe client care delivery. Physicians are
tt tt tt tt tt tt tt tt tt tt tt tt tt tt
responsible for their own client care activity. Nurses may follow safe orders from
tt tt tt tt tt tt tt tt tt tt tt tt tt
physicians, but they are also responsible for the activities that they, as nurses, are to carry
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
out. Information provided in a nursing textbook is basic information for general knowledge.
tt tt tt tt t tt t t t tt t t tt
Furthermore, the information in a textbook may not reflect the current standard of care or
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
the individual state or hospital policies.
tt tt tt tt tt tt
