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| 1. | For which reasons would a nurse review infant mortality statistics in the United States? (Select all that apply.) | |
| A) | Measures the quality of pregnancy care | |
| B) | Reviews information on overall nutrition | |
| C) | Compares health with those of other states | |
| D) | Determines infant health and available care | |
| E) | Provides an index of the country’s general health | |
| Ans: | A, B, D, E | |
| Feedback: | ||
| Infant mortality statistics provide an index of a country’s general health, measures the quality of pregnancy care, provides information on overall nutrition, and determines infant health and available care. Infant mortality statistics compares the health with those of other countries and not with those of other states. | ||
| 2. | The nurse is providing care in an organization that supports the maternal and child care continuum. Which type of patient care area is an example of this approach? | |
| A) | Primary care | |
| B) | Team nursing | |
| C) | Case management | |
| D) | Family-centered care | |
| Ans: | D | |
| Feedback: | ||
| Keeping the family at the center of care is important because the level of a family’s functioning is important to the health status of its members. A healthy family establishes an environment conducive to growth and health-promoting behaviors to sustain family members during crises. A family-centered approach enables nurses to better understand individuals and their effect on others and, in turn, to provide more holistic care. Primary nursing, team nursing, and case management do not necessary take into consideration the maternal and child care continuum. | ||
| 3. | Which actions should the nurse perform when supporting the goals of maternal and child health care? (Select all that apply.) | |
| A) | Advocates protecting the rights of the mother and fetus | |
| B) | Teaches family members interventions to improve health | |
| C) | Adheres to principles that focus on the needs of the mother | |
| D) | Encourages maternal hospitalization to regain strength and stamina | |
| E) | Assesses family members for strengths and specific needs or challenges | |
| Ans: | A, B, E | |
| Feedback: | ||
| Actions that the nurse should perform when supporting the goals of maternal and child health care include advocating the rights for the mother and fetus, teaching health promotion interventions, and assessing the family for strengths and specific needs or challenges. Adhering to principles that focus on the needs of the mother and encouraging maternal hospitalization to regain strength and stamina are not actions that support the goals of maternal and child health care. | ||
| 4. | The nurse is reviewing the 2020 National Health Goals and notes that which is a focus of these goals? | |
| A) | Health promotion and disease prevention | |
| B) | Early diagnosis of chronic health problems | |
| C) | Effective use of medication to treat disease | |
| D) | Reduce the cost of health care and medications | |
| Ans: | A | |
| Feedback: | ||
| The 2020 National Health Goals are intended to help citizens more easily understand the importance of health promotion and disease prevention and to encourage wide participation in improving health in the next decade. These goals do not focus on the early diagnosis of chronic problems, use of medications to treat disease, or reduce the cost of health care and medications. | ||
| 5. | The nurse has noticed a change in the type of care needed to support maternal and child health issues. What does the nurse realize as reasons for the changes in care? (Select all that apply.) | |
| A) | Smaller families | |
| B) | Less domestic violence | |
| C) | More employed mothers | |
| D) | Stable home environments | |
| E) | More single-parent families | |
| Ans: | A, C, E | |
| Feedback: | ||
| Nursing care for maternal and child is changing because families are smaller, more mothers are employed out of the home, and there are more single-parent families. There is an increase in domestic violence, and families are less stable and more mobile, which influences homelessness. | ||
| 6. | During an assessment, the nurse asks a patient from a non-English-speaking culture which types of home remedies and herbs the patient uses for health care. What is the purpose of asking the patient this question? | |
| A) | Analyze for herb–drug interactions | |
| B) | Understand the patient’s philosophy of alternative health care | |
| C) | Determine the types of medications the patient will need to be prescribed | |
| D) | Explain to the physician the patient’s preference for nontraditional medicine approaches | |
| Ans: | A | |
| Feedback: | ||
| Assessing what alternative measures are being used is important because the action of an herb can interfere with prescribed medications. Assessing the use of herbal remedies is not done to understand the patient’s philosophy of alternative health care, determine the types of medications the patient will need to be prescribed, or explain the patient’s preferences for nontraditional medicine approaches to the physician. | ||
| 7. | The nurse notes that statistics on maternal mortality had improved but are again becoming elevated. What does the nurse realize as a reason for this change in maternal mortality rates? | |
| A) | Earlier prenatal care | |
| B) | Gestational hypertension | |
| C) | Increased vaginal deliveries | |
| D) | Treatment for chronic diseases | |
| Ans: | B | |
| Feedback: | ||
| This increasing rate in maternal mortality is associated with more cesarean births, more gestational hypertension related to preexisting hypertensive disorders, and lack of health insurance for many Americans. This increase is not because of earlier prenatal care, increased vaginal deliveries, or treatment for chronic diseases. | ||
| 8. | A new mother asks the nurse if all of the new baby’s injections can be given in one visit because the mother is losing income from missing work because of the office visits. What does this new mother’s issue indicate to the nurse? | |
| A) | The mother needs to find an alternative employer. | |
| B) | The mother’s income is more important that the baby’s health. | |
| C) | Missing work does not support the baby’s health maintenance visits. | |
| D) | The federal government needs to do more to support well-baby visits. | |
| Ans: | C | |
| Feedback: | ||
| An area that needs additional research is finding effective stimuli to encourage women to bring children for health maintenance visits. The mother losing income because of missing work for well-baby visits will deter health maintenance visits for the baby going forward. This mother’s issue does not indicate that the mother needs to find another job, that the mother’s income is more important that the baby’s health, or that the federal government needs to do more to support well-baby visits. | ||
| 9. | The nurse works in a maternal and child care area that supports health promotion. Which activities will the nurse perform to support this philosophy of health care? (Select all that apply.) | |
| A) | Planning care | |
| B) | Patient teaching | |
| C) | Family counseling | |
| D) | New mother advocacy | |
| E) | Identifying nursing diagnoses | |
| Ans: | B, C, D | |
| Feedback: | ||
| Extensive changes in the scope of maternal and child health nursing have occurred as health promotion has become a greater priority in care. The nursing activities for health promotion include teaching, counseling, and advocacy. Planning care and identifying nursing diagnoses are a part of the nursing process and not specific to health promotion. | ||
| 10. | During a care conference, a nurse provides everyone with a copy of the latest research on improving the success of breastfeeding for first-time mothers. Which Quality & Safety Education for Nurses competency does this nurse’s action support? | |
| A) | Quality improvement | |
| B) | Patient-centered care | |
| C) | Evidence-based practice | |
| D) | Teamwork and collaboration | |
| Ans: | C | |
| Feedback: | ||
| Providing research material supports the Quality & Safety Education for Nurses competency of evidence-based practice because the nurse is integrating the best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Providing research evidence does not support the Quality & Safety Education for Nurses competencies of quality improvement, patient-centered care, or teamwork and collaboration. | ||
| 11. | The nurse is caring for a mother who has just given birth to twins of 28 weeks gestation, each weighing 2 kg. What is the health risk for the mother and the twins? | |
| A) | Child mortality | |
| B) | Neonatal death | |
| C) | Infant mortality | |
| D) | Maternal mortality | |
| Ans: | B | |
| Feedback: | ||
| Neonatal death reflects the quality of care available to women during pregnancy and childbirth and the quality of care available to infants during the first month of life. The leading causes of death during this time are prematurity with associated low birth weight. Child mortality is the number of people who die during childhood years. Infant mortality is the number of infants who die before the age of 1 year. Maternal mortality is the number of women who die from activities related to childbirth. | ||
| 12. | The nurse is planning an educational session for community members to address the issue of school-age child mortality. Which topic should the nurse identify as the highest priority for this population? | |
| A) | Cancer | |
| B) | Assault | |
| C) | Suicide | |
| D) | Accidents | |
| Ans: | D | |
| Feedback: | ||
| For the school-age child between the ages of 5 and 14 years, the number one cause of mortality is from unintentional injuries or accidents. Other top five causes for child mortality include cancer, assault, and suicide. | ||
| 13. | While providing care to a child, the nurse informs the parents about the treatment plans and helps the parents make decisions about the child’s care needs. What do this nurse’s actions support? | |
| A) | Autonomy | |
| B) | Empowerment | |
| C) | Accountability | |
| D) | Informed consent | |
| Ans: | B | |
| Feedback: | ||
| Nurses promote empowerment of parents and children by respecting their views and concerns, regarding parents as important participants in their own or their child’s health, keeping them informed, and helping and supporting them to make decisions about care. The nurse’s actions are not being done to support autonomy, accountability, or informed consent. | ||
| 14. | The nurse has been hired to provide care to patients on a maternal and child unit. What will the nurse use to as a guide to legally provide care to this patient population? | |
| A) | Code of ethics | |
| B) | Nursing research | |
| C) | Standards of practice | |
| D) | Evidence-based guidelines | |
| Ans: | C | |
| Feedback: | ||
| Understanding standards of care can help nurses practice within appropriate legal parameters. The Code of Ethics will help with ethical situations. Nursing research and evidence-based guidelines will help with providing care that is based upon best practices. | ||
| 15. | The nurse is providing care to a new mother and infant according to the Quality & Safety Education for Nurses competency approach. Which action should the nurse perform to demonstrate the skill for the competency of safety? | |
| A) | Assess the mother for preferences based on personal values. | |
| B) | Ensure the mother and newborn have intact identification bands. | |
| C) | Introduce all members of the care team to the mother and family. | |
| D) | Document patient care using computerized spreadsheets and forms. | |
| Ans: | B | |
| Feedback: | ||
| Action to demonstrate the skill of the competency of safety is to ensure that the mother and newborn have intact identification bands. Assessing the mother for preferences based on personal values is the skill associated with patient-centered care. Introducing all members of the care team to the mother and family is the skill associated with teamwork and collaboration. Documenting patient care using computerized spreadsheets and forms is the skill associated with quality improvement. | ||
| 1. | After an examination, a pregnant patient is diagnosed with a cystocele. How should the nurse explain this finding to the patient? | |
| A) | A fold of peritoneum behind the uterus | |
| B) | Pouching of the bladder into the vaginal wall | |
| C) | A part of the rectum is pushing into the vaginal wall. | |
| D) | Folds of peritoneum that cover the uterus front and back | |
| Ans: | B | |
| Feedback: | ||
| Pouching of the bladder into the vaginal wall is a cystocele. A fold of peritoneum behind the uterus is posterior ligament. A part of the rectum pushing into the vaginal wall is a rectocele. Folds of peritoneum that cover the uterus front and back are the broad ligaments. | ||
| 2. | A pregnant patient is concerned about a sharp pain that is felt in the lower abdomen when making a quick move. What action should the nurse take to help this patient? | |
| A) | Assess when the patient’s last bowel movement occurred. | |
| B) | Explain that the sharp pain is tension on a uterine ligament. | |
| C) | Notify the physician because of manifestations of appendicitis. | |
| D) | Instruct that the pain is a pulled muscle and a heating pad will help. | |
| Ans: | B | |
| Feedback: | ||
| If a pregnant woman moves quickly, she may pull one of the round or broad ligaments causing a quick, sharp pain of frightening intensity in one of the lower abdominal quadrants. This pain is not associated with bowel function. Pain of this type calls for conscientious assessment or it can be mistaken for labor or appendicitis pain. This pain is not because of a pulled muscle and application of heat is not indicated. | ||
| 3. | After an assessment, a pregnant patient asks the nurse questions about her changing uterus and body. Which nursing diagnosis would be appropriate for the patient at this time? | |
| A) | Anxiety related to being pregnant | |
| B) | Ineffective coping related to being pregnant | |
| C) | Health-seeking behaviors related to reproductive functioning | |
| D) | Disturbance in body image related to body changes with pregnancy | |
| Ans: | C | |
| Feedback: | ||
| The patient is asking questions related to reproductive functioning which indicates health-seeking behaviors. The patient’s questions do not indicate that the patient is experiencing anxiety, ineffective coping, or a disturbance in body image. | ||
| 4. | The nurse is planning expected outcomes for a female patient who will be celebrating her 40th birthday in a few months. Which outcome would be appropriate for this patient? | |
| A) | Patient will follow safer sex practices. | |
| B) | Patient will explain the process of reproduction. | |
| C) | Patient will perform breast self-examination every 2 months. | |
| D) | Patient will schedule a mammogram shortly after 40th birthday. | |
| Ans: | D | |
| Feedback: | ||
| To help patients better understand reproductive functioning and sexual health throughout their life, an expected outcome might include encouraging women over 40 to have mammograms. The process of reproduction would be appropriate for younger patients. Teaching on safer sex practices would be appropriate for an adolescent. Breast self-examinations should be conducted every month. | ||
| 5. | A patient is diagnosed with a uterus that is slightly retroverted. When discussing the implications of this finding, what should the nurse include? | |
| A) | This finding indicates the need for surgery. | |
| B) | This finding will render the patient infertile. | |
| C) | This finding should not cause fertility issues. | |
| D) | This finding could interfere with conception. | |
| Ans: | C | |
| Feedback: | ||
| A retroverted uterus means the uterus tips back. Minor variations of these positions do not tend to cause reproductive problems. A retroverted uterus does not mean that the patient needs surgery. A retroverted uterus does not interfere with fertility. The only way that a retroverted uterus will interfere with conception is if the abnormal position is extreme because the sharp bend can block the deposition or migration of sperm. | ||
| 6. | A patient sustains a vaginal tear during the labor and delivery process and is experiencing profuse vaginal bleeding. What should the nurse instruct the patient about this injury? | |
| A) | This injury will heal rapidly. | |
| B) | Surgery is needed to repair the tear. | |
| C) | Future vaginal deliveries will be compromised. | |
| D) | Bleeding will continue for several weeks to months. | |
| Ans: | A | |
| Feedback: | ||
| The blood supply to the vagina is furnished by the vaginal artery, a branch of the internal iliac artery. Vaginal tears at childbirth tend to bleed profusely because of this rich blood supply. The same rich blood supply is the reason any vaginal trauma at birth heals rapidly. Surgery is not needed to repair the tear. Future vaginal deliveries will not be compromised. Bleeding will not continue for several weeks to months. | ||
| 7. | An adolescent female patient asks the nurse questions about menstruation. What should the nurse include when instructing the patient? | |
| A) | Keeping active increases discomfort. | |
| B) | A prostaglandin inhibitor best relieves pain. | |
| C) | Eating sour foods contributes to discomfort. | |
| D) | Hair permanents do not take during a menstrual flow. | |
| Ans: | B | |
| Feedback: | ||
| Prostaglandin inhibitors such as ibuprofen (Motrin) are most effective for menstrual pain because they reduce inflammation as well as relieve pain. Activity reduces the discomfort of menstrual pain. Eating sour foods does not influence menstruation. Menstruation does not affect hair care needs. | ||
| 8. | The nurse is preparing instruction about the menstrual cycle for adolescent patients. What will the nurse include about changes in the uterine endometrium during the second half of the cycle? | |
| A) | It is corkscrew-like because of progesterone stimulation. | |
| B) | It is thick and purple-hued because of estrogen stimulation. | |
| C) | It is thin and transparent because of progesterone stimulation. | |
| D) | It is twisted and ragged because of follicle-stimulating hormone. | |
| Ans: | A | |
| Feedback: | ||
| During the second half of the menstrual cycle, the formation of progesterone in the corpus luteum causes the glands of the uterine endometrium to become corkscrew or twisted in appearance and dilated. The uterine endometrium is thin and transparent immediately after the end of the menstrual cycle. The uterine endometrium does not become thick and purple in color because of estrogen stimulation. The uterine endometrium does not become twisted and ragged because of follicle-stimulating hormone. | ||
| 9. | The nurse completes an assessment of an adolescent patient’s menstrual pattern. Which finding should the nurse identify as being within normal limits? | |
| A) | The usual cycle is 19 days. | |
| B) | Flow usually lasts 4 to 6 days. | |
| C) | Menstruation started at age 10 years. | |
| D) | The average amount of flow is 500 ml. | |
| Ans: | B | |
| Feedback: | ||
| The duration of menstrual flow averages between 4 and 6 days. The average menstrual cycle is 28 days. The average age at onset of menstruation is 12.4 years. The average amount of flow is 30 to 80 ml per menstrual period. | ||
| 10. | The nurse is preparing an educational session about menstruation for a group of adolescents. Which hormone should the nurse instruct as initiating ovulation? | |
| A) | Estrogen | |
| B) | Progesterone | |
| C) | Luteinizing hormone | |
| D) | Follicle-stimulating hormone | |
| Ans: | C | |
| Feedback: | ||
| Luteinizing hormone is responsible for ovulation or release of the mature egg cell from the ovary. Estrogen, progesterone, and follicle-stimulating hormone are not hormones responsible for initiating ovulation. | ||
| 11. | The nurse is determining the topics to include in an educational program to meet the 2020 National Health Goals for sexuality and reproductive health. What should the nurse include when planning this program? (Select all that apply.) | |
| A) | Outline safer sex practices. | |
| B) | Discuss the disadvantages of annual mammography. | |
| C) | Review skills to use to negate unwanted sexual advances. | |
| D) | Stress the importance of abstinence when teaching adolescent patients. | |
| E) | Explain the advantages of obtaining the human papillomavirus vaccination. | |
| Ans: | A, C, D, E | |
| Feedback: | ||
| The nurse can help the nation achieve the 2020 National Health Goals for sexuality and reproductive health by outlining safer sex practices, reviewing refusal skills, teaching about abstinence, and explaining the advantages of obtaining the human papillomavirus vaccination. Annual mammography is not a disadvantage for women of a specific age range. | ||
| 12. | The nurse is determining a patient’s gender role. What is the nurse doing to make this determination? | |
| A) | Assessing the patient’s sexual preferences | |
| B) | Asking what gender the patient identifies with | |
| C) | Analyzing the patient’s chromosomal inheritance | |
| D) | Analyzing the patient’s demonstrated sexual behaviors | |
| Ans: | D | |
| Feedback: | ||
| Gender role is the male or female behavior a person exhibits which may or may not be the same as biologic gender or gender identity. Assessing the patient’s sexual preferences, asking what gender the patient identifies, and analyzing the patient’s chromosomal inheritance will not determine the patient’s gender role. | ||
| 13. | A patient with vaginismus has attended counseling to treat the disorder. Which patient statement indicates that treatment has been effective? | |
| A) | “Lacking an interest in sex is a normal part of aging.” | |
| B) | “I can learn to tolerate sex if I want to have a family.” | |
| C) | “I can use lubricants to help with the pain of having sex.” | |
| D) | “Sex is not a bad thing but can be enjoyed with my husband.” | |
| Ans: | D | |
| Feedback: | ||
| Vaginismus is involuntary contraction of the muscles at the outlet of the vagina when coitus is attempted that prohibits penile penetration and may occur in women who have been raped. Other causes are unknown, but it could also be the result of early learning patterns in which sexual relations were viewed as bad or sinful. As with other sexual problems, sexual or psychological counseling to reduce this response may be necessary. A lack of interest in sex is not a normal part of aging. Learning to tolerate sex and using lubricants does not help with the problem of vaginismus. | ||
| 14. | The nurse is planning an education seminar on safer sexual practices for a group of young adults. Which information should the nurse include in this teaching? (Select all that apply.) | |
| A) | Use a latex condom for intercourse. | |
| B) | Void immediately after having sex. | |
| C) | Avoid sex with intravenous drug users. | |
| D) | Hand-to-genital sex is the safest sexual practice. | |
| E) | Inspect your sexual partner for lesions in the genital area. | |
| Ans: | A, B, C, E | |
| Feedback: | ||
| Safer sexual practices include using a latex condom for intercourse, voiding immediately after having sex, avoiding sex with intravenous drug users, and inspecting the sexual partner for genital lesions. Hand-to-genital sex is not the safest sexual practice. Abstinence is the only 100% guarantee against not contracting a sexually transmitted infection. | ||
| 15. | The nurse is teaching a male patient about sildenafil citrate (Viagra) prescribed for erectile dysfunction. Which patient statement indicates that teaching has been effective? | |
| A) | “A change in vision is to be expected.” | |
| B) | “This medication is birth control for men.” | |
| C) | “I can take this medication several times a day.” | |
| D) | “I should report to my health care provider an erection that lasts longer than 4 hours.” | |
| Ans: | D | |
| Feedback: | ||
| An erection lasting more than 4 hours can occur when taking sildenafil citrate (Viagra). This condition can lead to penile tissue damage and should be reported to a health care provider. A change in vision should be reported to the health care provider. Sildenafil citrate (Viagra) is not birth control. This medication should be taken up to one dose per day. | ||
