Chapter 1 Current Issues in Maternal-Newborn Nursing(FREE) My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 1 Current Issues in Maternal-Newborn Nursing

1) The nurse is speaking to students about changes in maternal-newborn care. One change is that self-care has gained wide acceptance with clients and the healthcare community due to research findings that suggest that it has which effect?

1. Shortens newborn length of stay

2. Decreases use of home health agencies

3. Decreases healthcare costs

4. Decreases the number of emergency department visits

Answer: 3

Explanation: 3. Research indicates that self-care significantly decreases healthcare costs.

Page Ref: 4

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Self-Care

Standards: QSEN Competencies: I.A.2. Describe strategies to empower patients or families in all aspects of the health care process. | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Context and Environment: Health care economic policy; reimbursement structures; accreditation standards; staffing models and productivity; supply chain models | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Discuss the impact of the self-care movement on contemporary childbirth.

2) Care delivered by nurse-midwives can be safe and effective and can represent a positive response to the healthcare provider shortage. Nurse midwives tend to use less technology, which often results in which of the following?

1. There is less trauma to the mother.

2. More childbirth education classes are available.

3. They are instrumental in providing change in the birth environment at work.

4. They advocate for more home healthcare agencies.

Answer: 1

Explanation: 1. Nurse-midwife models of care can be one way to ensure that mothers receive excellent prenatal and intrapartum care.

Page Ref: 4

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: III.A. 6. Describe how the strength and relevance of available evidence influences the choice of interventions in provision of patient-centered care. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Planning

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Learning Outcome: 2 Compare the nursing roles available to the maternal-newborn nurse.

MNL LO: 1.1.2 Explore the role of the nurse in maternity care delivery.

3) The nurse is telling a new client how advanced technology has permitted the physician to do which of the following?

1. Treat the fetus and monitor fetal development.

2. Deliver at home with a nurse-midwife and doula.

3. Have the father present as the coach and cut the umbilical cord.

4. Breastfeed a new baby on the delivery table.

Answer: 1

Explanation: 1. The fetus is increasingly viewed as a patient separate from the mother, although treatment of the fetus necessarily involves the mother.

Page Ref: 11

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of health care team members, including overlaps | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6 Evaluate the potential impact of some of the special situations in contemporary maternity care.

MNL LO: 1.1.3 Relate various factors to their effect on pregnancy outcomes.

4) A nurse is examining different nursing roles. Which example best illustrates an advanced practice nursing role?

1. A registered nurse who is the manager of a large obstetrical unit

2. A registered nurse who is the circulating nurse during surgical deliveries (cesarean sections)

3. A clinical nurse specialist working as a staff nurse on a mother-baby unit

4. A clinical nurse specialist with whom other nurses consult for her expertise in caring for high-risk infants

Answer: 4

Explanation: 4. A clinical nurse specialist with whom other nurses consult for expertise in caring for high-risk infants is working in an advanced practice nursing role. This nurse has specialized knowledge and competence in a specific clinical area, and is masters prepared.

Page Ref: 7

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.A.2. Describe scopes of practice and roles of healthcare team members. | AACN Essentials Competencies: VI. 6. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education, and licensure requirements) | NLN Competencies: Teamwork: Scope of practice, roles, and

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responsibilities of health care team members, including overlaps. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Compare the nursing roles available to the maternal-newborn nurse.

MNL LO: 1.1.2 Explore the role of the nurse in maternity care delivery.

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5) A nursing student investigating potential career goals is strongly considering becoming a nurse practitioner (NP). The major focus of the NP is on which of the following?

1. Leadership

2. Physical and psychosocial clinical assessment

3. Independent care of the high-risk pregnant client

4. Tertiary prevention

Answer: 2

Explanation: 2. Physical and psychosocial clinical assessment is the major focus of the NP.

Page Ref: 7

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.A.2. Describe scopes of practice and roles of healthcare team members. | AACN Essentials Competencies: VI. 2. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education, and licensure requirements) | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of health care team members, including overlaps. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Compare the nursing roles available to the maternal-newborn nurse.

MNL LO: 1.1.2 Explore the role of the nurse in maternity care delivery.

6) The nurse manager is consulting with a certified nurse-midwife about a client. What is the role of the CNM?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Be prepared to manage independently the care of women at low risk for complications during pregnancy and birth.

2. Give primary care for high-risk clients who are in hospital settings.

3. Give primary care for healthy newborns.

4. Obtain a physician consultation for any technical procedures at delivery.

5. Be educated in two disciplines of nursing.

Answer: 1, 3, 5

Explanation: 1. A CNM is prepared to manage independently the care of women at low risk for complications during pregnancy and birth and the care of healthy newborns.

3. A CNM is prepared to manage independently the care of women at low risk for complications during pregnancy and birth and the care of healthy newborns.

5. The CNM is educated in the disciplines of nursing and midwifery.

Page Ref: 7

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.A.2. Describe scopes of practice and roles of healthcare team members. | AACN Essentials Competencies: VI. 1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education, and licensure requirements) | NLN Competencies: Teamwork: Scope of practice, roles, and

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responsibilities of health care team members, including overlaps. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Compare the nursing roles available to the maternal-newborn nurse.

MNL LO: 1.1.2 Explore the role of the nurse in maternity care delivery.

7) The registered nurse who has completed a masters degree program and passed a national certification exam has clinic appointments with clients who are pregnant or seeking well-woman care. What would the role of this nurse be considered?

1. Professional nurse

2. Certified registered nurse (RNC)

3. Clinical nurse specialist

4. Nurse practitioner

Answer: 4

Explanation: 4. A nurse practitioner has completed either a masters or doctoral degree in nursing and passed a certification exam, and functions as an advanced practice nurse. Ambulatory care settings and the community are common sites for nurse practitioners to provide client care.

Page Ref: 7

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: II.A.2. Describe scopes of practice and roles of healthcare team members. | AACN Essentials Competencies: VI. 6. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education, and licensure requirements) | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of health care team members, including overlaps. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Compare the nursing roles available to the maternal-newborn nurse.

MNL LO: 1.1.2 Explore the role of the nurse in maternity care delivery.

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8) Several student nurses are discussing advanced practice, and know that the term advanced practice nurse includes which of the following types of nurses?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Nurse practitioners

2. Certified nurse-midwives

3. Clinical nurse specialists

4. Certified registered nurses

5. Professional nurses

Answer: 1, 2, 3

Explanation: 1. A nurse practitioner must have additional education and experience to hold advanced practice status.

2. A certified nurse-midwife must have additional education and experience to hold advanced practice status.

3. A clinical nurse specialist must have additional education and experience to hold advanced practice status.

Page Ref: 7

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.A. 2. Describe scopes of practice and roles of healthcare team members. | AACN Essentials Competencies: VI. 1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education, and licensure requirements) | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of health care team members, including overlaps. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Compare the nursing roles available to the maternal-newborn nurse.

MNL LO: 1.1.2 Explore the role of the nurse in maternity care delivery.

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9) While a child is being admitting to the hospital, the parent receives information about the pediatric units goals, including the statement that the unit practices family-centered care. The parent asks why that is important. The nurse responds that what communication dynamic is characteristic of the family-centered care paradigm?

1. The mother is the principal caregiver in each family.

2. The childs physician is the key person in ensuring the health of a child is maintained.

3. The family serves as the constant influence and continuing support in the childs life.

4. The father is the leader in each home; thus, all communications should include him.

Answer: 3

Explanation: 3. Family-centered care is characterized by an emphasis on the family and family involvement throughout the pregnancy, birth, and postpartum period.

Page Ref: 3

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 6. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in the patient and self; facilitate hope, trust and faith. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Identify specific factors that contribute to a familys value system.

MNL LO: 1.1.1 Relate the effect of culture and family to the childbearing experience.

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10) The current emphasis on healthcare reform and the implementation of the Affordable Care Act has yielded what unexpected benefit?

1. Assessment of the details of the familys income and expenditures

2. Case management to limit costly, unnecessary duplication of services

3. Many healthcare providers and consumers are becoming more aware of the vitally important role nurses play in providing excellent care to clients and families

4. Education of the family about the need for keeping regular well-child visit appointments

Answer: 3

Explanation: 3. Nurses must clearly articulate their role in the changing environment to define and differentiate practice roles and the educational preparation required for their new roles.

Page Ref: 6

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A. 4. Examine how the safety, quality and cost effectiveness of health care can be improved through the active involvement of patients and families. | AACN Essentials Competencies: VI. 1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education, and licensure requirements) | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Compare the nursing roles available to the maternal-newborn nurse.

MNL LO: 1.1.2 Explore the role of the nurse in maternity care delivery.

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11) For prenatal care, the client is attending a clinic held in a church basement. The clients care is provided by registered nurses and a certified nurse-midwife. What is this type of prenatal care?

1. Secondary care

2. Tertiary care

3. Community care

4. Unnecessarily costly care

Answer: 3

Explanation: 3. Prenatal care is primary care. Community care is often provided at clinics in neighborhoods to facilitate clients access to primary care, including prenatal care and prevention of illness.

Page Ref: 8

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I.A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: VI. 1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education, and licensure requirements) | NLN Competencies: Context and Environment: Environmental health; health promotion/disease prevention (e.g. transmission of disease, disease patterns, epidemiological principles); chronic disease management; health care systems; transcultural approaches to health; family dynamics. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Describe the use of community-based nursing care in meeting the needs of childbearing families.

MNL LO: 1.1.2 Explore the role of the nurse in maternity care delivery.

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12) The nurse at an elementary school is performing TB screenings on all of the students. Permission slips were returned for all but the children of one family. When the nurse phones to obtain permission, the parent states in clearly understandable English that permission cannot be given because the grandmother is out of town for 2 more weeks. Which cultural element is contributing to the dilemma that faces the nurse?

1. Permissible physical contact with strangers

2. Beliefs about the concepts of health and illness

3. Religion and social beliefs

4. Presence and influence of the extended family

Answer: 4

Explanation: 4. The presence and influence of the extended family is contributing to the situation the nurse faces. In many cultures, a family elder is a primary decision maker when it comes to health care. In this case, the parent cannot grant permission to the nurse until the parent consults the grandmother.

Page Ref: 6

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Screening

Standards: QSEN Competencies: I. A. 2. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Context and Environment: Analyze ethical challenges presented by ambiguous and uncertain clinical situations; self-assess ones own tolerance for ambiguity and uncertainty; accept the possibility of multiple right answers (rather than one-right answer thinking) in patient care and other professional situations. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Identify specific factors that contribute to a familys value system.

MNL LO: 1.1.1 Relate the effect of culture and family to the childbearing experience.

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13) The nurse working in a community clinic is aware that differences in beliefs between families and healthcare providers are common in which areas?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Help-seeking behaviors

2. Pregnancy and childbirth practices

3. Causes of disease or illness

4. What defines a community

5. Educational level

Answer: 1, 2, 3

Explanation: 1. Specific differences in beliefs between families and healthcare providers are common in help-seeking behaviors.

2. Specific differences in beliefs between families and healthcare providers are common in pregnancy and childbirth practices.

3. Specific differences in beliefs between families and healthcare providers are common in identifying causes of diseases or illnesses.

Page Ref: 6

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. A. 2. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values. | AACN Essential Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Context and Environment: Analyze ethical challenges presented by ambiguous and uncertain clinical situations; self-assess ones own tolerance for ambiguity and uncertainty; accept the possibility of multiple right answers (rather than one-right answer thinking) in patient care and other professional situations. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Identify specific factors that contribute to a familys value system.

MNL LO: 1.1.1 Relate the effect of culture and family to the childbearing experience.

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14) The maternal-child nurse stresses to the recently graduated nurse that primary care focuses on which aspect?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Health promotion

2. Illness prevention

3. Hospital care

4. Skilled nursing care

5. Curing disease

Answer: 1, 2

Explanation: 1. Healthcare providers can help foster self-care by focusing on health promotion education during every client encounter.

2. By fostering health-promoting behaviors, many illnesses can be prevented.

Page Ref: 4

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: II. 8. Promote achievement of safe and quality outcomes of care for diverse populations. | NLN Competencies: Teamwork: Function competently within ones own scope of practice as leader or member of the health care team and manage delegation effectively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Describe the use of community-based nursing care in meeting the needs of childbearing families.

MNL LO: 1.1.2 Explore the role of the nurse in maternity care delivery.

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15) A maternity client is in need of surgery. Which healthcare member is legally responsible for obtaining informed consent for an invasive procedure?

1. The nurse

2. The physician

3. The unit secretary

4. The social worker

Answer: 2

Explanation: 2. Informed consent is a legal concept designed to allow clients to make intelligent decisions regarding their own health care. Informed consent means that a client, or a legally designated decision maker, has granted permission for a specific treatment or procedure based on full information about that specific treatment or procedure as it relates to that client under the specific circumstances of the permission. The individual who is ultimately responsible for the treatment or procedure should provide the information necessary to obtain informed consent. In most instances, this is a physician.

Page Ref: 10

Cognitive Level: Remembering

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. B. 12. Facilitate informed patient consent for care. | AACN Essentials Competencies: VIII. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Context and Environment: Code of ethics (e.g. American Nurses Association 2005; International Council of Nurses, 2006); regulatory and professional standards (ANA Social Policy Statement [ANA, 2003]; HIPAA [Health Insurance Portability and Accountability Act]); ethical decision making modes; scope of practice considerations; principles of informed consent, confidentiality, patient self-determination. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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16) A nurse who tells family members the sex of a newborn baby without first consulting the parents would have committed which of the following?

1. A breach of privacy

2. Negligence

3. Malpractice

4. A breach of ethics

Answer: 1

Explanation: 1. A breach of privacy would have been committed in this situation, because informing other family members of the gender without the parents consent violates the parents right to privacy. The right to privacy is the right of a person to keep his person and property free from public scrutiny (or even from other family members).

Page Ref: 10

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Ethical Practice

Standards: QSEN Competencies: I. B. 13. Assess own level of communication skill in encounters with patient and families. | AACN Essentials Competencies: IV. 8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients right to privacy. | NLN Competencies: Context and Environment: Code of ethics (e.g. American Nurses Association 2005; International Council of Nurses, 2006); regulatory and professional standards (ANA Social Policy Statement [ANA, 2003]; HIPAA [Health Insurance Portability and Accountability Act]); ethical decision making modes; scope of practice considerations; principles of informed consent, confidentiality, patient self-determination. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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17) The nursing instructor explains to the class that according to the 1973 Supreme Court decision in Roe v. Wade, abortion is legal if induced:

1. Before the 30th week of pregnancy.

2. Before the period of viability.

3. To provide tissue for therapeutic research.

4. Can be done any time if mother, doctor, and hospital all agree.

Answer: 2

Explanation: 2. Abortion can be performed legally until the period of viability.

Page Ref: 11

Cognitive Level: Remembering

Client Need/Sub: Safe and Effective Care Environment: Ethical Practice

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IV. 8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients right to privacy. | NLN Competencies: Context and Environment: Code of ethics (e.g. American Nurses Association 2005; International Council of Nurses, 2006); regulatory and professional standards (ANA Social Policy Statement [ANA, 2003]; HIPAA [Health Insurance Portability and Accountability Act]); ethical decision making modes; scope of practice considerations; principles of informed consent, confidentiality, patient self-determination. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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18) The nurse reviewing charts for quality improvement notes that a client experienced a complication during labor. The nurse is uncertain whether the labor nurse took the appropriate action during the situation. What is the best method for the nurse to take to determine what the appropriate action should have been?

1. Call the nurse manager of the labor and delivery unit and ask what the nurse should have done.

2. Ask the departmental chair of the obstetrical physicians what the best nursing action should have been.

3. Examine other charts to find cases of the same complication, and determine how it was handled in those situations.

4. Look in the policy and procedure book, and examine the practice guidelines published by a professional nursing organization.

Answer: 4

Explanation: 4. Agency policies, procedures, and protocols contain guidelines for nursing action in specific situations. Professional organizations such as the Association of Womens Health, Obstetrical, and Neonatal Nurses (AWHONN) also publish standards of practice that should guide nursing care.

Page Ref: 9

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: IV. A. 4. Explain the importance of variation and measurement in assessing quality of care. | AACN Essentials Competencies: V. 1. Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments; including local, state, national, and global healthcare trends. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strength of evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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19) The nurse is reviewing care of clients on a mother-baby unit. Which situation should be reported to the supervisor?

1. A 2-day-old infant has breastfed every 3 hours and voided four times.

2. An infant was placed in the wrong crib after examination by the physician.

3. The client who delivered by cesarean birth yesterday received oral narcotics.

4. A primiparous client who delivered today is requesting discharge within 24 hours.

Answer: 2

Explanation: 2. Placing an infant in the wrong crib is malpractice. Malpractice is negligent action by a professional person.

Page Ref: 9

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: VIII. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Quality and Safety: Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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20) The nurse manager is planning a presentation on ethical issues in caring for childbearing families. Which example should the nurse manager include to illustrate maternal-fetal conflict?

1. A client chooses an abortion after her fetus is diagnosed with a genetic anomaly.

2. A 39-year-old nulliparous client undergoes therapeutic insemination.

3. A family of a child with leukemia requests cord-blood banking at this birth.

4. A cesarean delivery of a breech fetus is court ordered after the client refuses.

Answer: 4

Explanation: 4. Maternal-fetal conflict is a special ethical situation where the rights of the fetus and the rights of the mother are considered separately. Forced cesarean birth, coercion of mothers who practice high-risk behaviors, and, perhaps most controversial, mandating experimental in utero therapy or surgery in an attempt to correct a specific birth defect are interventions that infringe on the mothers autonomy.

Page Ref: 11

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. B. 9. Assess level of patients decisional conflict and provide access to resources. | AACN Essentials Competencies: VIII. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Context and Environment: Show respect for others values; appreciate diversity; be civil during relationships and work; value community empowerment and social justice; work to improve social conditions affecting health; adopt inclusive language. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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21) The maternal-newborn nurse reviewing charts recognizes that negligence (malpractice) occurs when which action occurs?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. There is no notification to the physician of change in condition.

2. There is a failure to give an ordered medication.

3. An infant is placed in the wrong crib.

4. There is compliance with medication administration principles.

5. There is compliance with the standards of care.

Answer: 1, 2, 3

Explanation: 1. The physician must be notified when there is a change in client status. Failure to do so is negligence.

2. A failure to give a medication or giving the wrong medication is negligence.

3. Placing an infant in the wrong crib is negligence.

Page Ref: 9

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. A. 7. Explore ethical and legal implications of patient-centered care. | AACN Essentials Competencies: VIII. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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22) Client safety goals, which are evaluated and updated regularly, are requirements for what?

1. Clinical practice guidelines

2. Scope of practice

3. Accreditation

4. Standards of care

Answer: 3

Explanation: 3. The Joint Commission has identified client safety as an important responsibility of healthcare providers.

Page Ref: 9

Cognitive Level: Remembering

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: V. A. 7. Discuss potential and actual impact of national patient safety resources, initiatives, and regulations. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Value and encourage nurses involvement in the design, selection, implementation, and evaluation of information technologies to support patient care (e.g. as recommended by QSEN). | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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23) The recently graduated nurse recognizes that standards provide information and guidelines for which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Nurses in their practice

2. Development of policies and protocols

3. Developing basic nursing care

4. Writing a states nurse practice act

5. Who can and cannot consent to treatment

Answer: 1, 2

Explanation: 1. Standards of care provide information and guidelines for nurses in their practice.

2. Standards of care provide information and guidelines for development of policies and protocols in healthcare settings.

Page Ref: 9

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II. A. 2. Describe scopes of practice and roles of health care team members. | AACN Essentials Competencies: V. 5. Describe state and national statues, rules and regulations that authorize and define professional nursing practice. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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24) A fetus has been diagnosed with myelomeningocele. Which of the following surgeries would be performed to correct this condition?

1. Tubal ligation

2. Intrauterine fetal surgery

3. Cesarean section

4. Sterilization

Answer: 2

Explanation: 2. Intrauterine fetal surgery, which is generally considered experimental, is a therapy for anatomic lesions that can be corrected surgically and are incompatible with life if not treated. Examples include surgery for myelomeningocele and some congenital cardiac defects.

Page Ref: 12

Cognitive Level: Remembering

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: II. B. 8. Integrate the contributions of others who play a role in helping patient/family achieve health goals. | AACN Essentials Competencies: VI. 1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education, and licensure requirements) | NLN Competencies: Teamwork: Function competently within ones own scope of practice as leader or member of the health care team and manage delegation effectively | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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25) Therapeutic insemination has legal concerns for the donor of the sperm. To eliminate legal issues, the clinic nurse will have the donor do which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Sign a form waiving all parental rights.

2. Furnish accurate health information.

3. Agree to adopt the child.

4. Furnish a complete family tree.

5. Sign an agreement if married to the recipient.

Answer: 1, 2, 5

Explanation: 1. When the recipient is single, the donor must waive all parental rights.

2. The donor must provide accurate health information, especially in regard to genetic traits or diseases.

5. Husbands often are requested to sign a form to agree to the insemination and to assume parental responsibility for the child.

Page Ref: 12

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. A. 7. Explore ethical and legal implications of patient-centered care. | AACN Essentials Competencies: VIII. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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26) A nurse is providing guidance to a group of parents of children in the infant-to-preschool age group. After reviewing statistics on the most common cause of death in this age group, the nurse includes information about prevention of which of the following?

1. Cancer by reducing the use of pesticides in the home

2. Accidental injury by reducing the risk of pool and traffic accidents

3. Heart disease by incorporating heart-healthy foods into the childs diet

4. Pneumonia by providing a diet high in vitamin C from fruits and vegetables

Answer: 2

Explanation: 2. Unintentional injuries cause death in infants more often than cancer, heart disease, and pneumonia.

Page Ref: 15

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: V. A. 1. Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work-arounds and dangerous abbreviations) | AACN Essentials Competencies: II. 7. Promote factors that create a culture of safety and caring. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Contrast descriptive and inferential statistics.

27) The nurse researcher will use descriptive statistics for a research project that has been assigned. A characteristic of descriptive statistics is that they provide which of the following?

1. They can answer specific questions.

2. They can generate theories.

3. They allow the investigator to draw conclusions.

4. They are the starting point for the formation of a research question.

Answer: 4

Explanation: 4. Descriptive statistics are the starting point for the formation of a research question.

Page Ref: 14

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: II. A. 2. Describe EBP to include the components of research evidence, clinical expertise and patient/family values. | AACN Essentials Competencies: III. 2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strength of evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7 Contrast descriptive and inferential statistics.

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28) The student nurse working for a nurse researcher recognizes that the researcher will use descriptive statistics to do which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Describe a set of data.

2. Summarize a set of data.

3. Report the facts.

4. Identify certain trends.

5. Allow conclusions to be drawn.

6. Use a small sample size.

Answer: 1, 2, 3, 4

Explanation: 1. Descriptive statistics describe a set of data.

2. Descriptive statistics summarize a set of data.

3. Descriptive statistics report the facts.

4. Descriptive statistics identify certain trends.

Page Ref: 14

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III. A. 2. Describe EBP to include the components of research evidence, clinical expertise and patient/family values. | AACN Essentials Competencies: III. 2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strength of evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7 Contrast descriptive and inferential statistics.

29) The nurse is preparing a report on the number of births by three service providers at the facility (certified nurse-midwives, family practitioners, and obstetricians). What is this an example of?

1. Inferential statistics

2. Descriptive statistics

3. Evidence-based practice

4. Secondary use of data

Answer: 2

Explanation: 2. Descriptive statistics concisely describe phenomena such as births by providers.

Page Ref: 14

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III. A. 2. Describe EBP to include the components of research evidence, clinical expertise and patient/family values. | AACN Essentials Competencies: III. 2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the

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strength of evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7 Contrast descriptive and inferential statistics.

30) The nurse is explaining the difference between descriptive statistics and inferential statistics to a group of student nurses. To illustrate descriptive statistics, what would the nurse use as an example?

1. A positive correlation between breastfeeding and infant weight gain

2. The infant mortality rate in the state of Oklahoma

3. A causal relationship between the number of sexual partners and sexually transmitted infections

4. The total number of spontaneous abortions in drug-abusing women as compared with non-drug-abusing women

Answer: 2

Explanation: 2. The infant mortality rate in the state of Oklahoma is a descriptive statistic, because it describes or summarizes a set of data.

Page Ref: 14

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: III. A. 2. Describe EBP to include the components of research evidence, clinical expertise, and patient/family values. | AACN Essentials Competencies: III. 2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strength of evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7 Contrast descriptive and inferential statistics.

31) The nurse manager is examining the descriptive statistics of increasing teen pregnancy rates in the community. Which inferential statistical research question would the nurse manager find most useful in investigating the reasons for increased frequency of teen pregnancy?

1. What providers do pregnant teens see for prenatal care?

2. What are the ages of the parents of pregnant teens in the community?

3. Do pregnant teens drink caffeinated beverages?

4. What do pregnant teens do for recreation?

Answer: 1

Explanation: 1. Understanding which providers pregnant teens are most likely to seek out for prenatal care can lead to further investigation on why prenatal care with that provider is more acceptable to teens, which in turn can lead to greater understanding of the issue of teen pregnancy.

Page Ref: 14

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: III. A. 2. Describe EBP to include the components of research evidence, clinical expertise, and patient/family values. | AACN Essentials Competencies: III. 2. Demonstrate an understanding of the basic elements of the research process and models for applying e

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vidence to clinical practice. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strength of evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 7 Contrast descriptive and inferential statistics.

32) The Quality and Safety Education for Nurses (QSEN) project focused on competencies in which areas?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Client-centered care

2. Teamwork and collaboration

3. Evidence-based practice

4. Family planning

5. Injury and violence prevention

Answer: 1, 2, 3

Explanation: 1. The Quality and Safety Education for Nurses (QSEN) project is designed to meet the challenge of preparing future nurses who will have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work, which includes client-centered care.

2. The Quality and Safety Education for Nurses (QSEN) project, is designed to meet the challenge of preparing future nurses who will have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work, which includes teamwork and collaboration.

3. The Quality and Safety Education for Nurses (QSEN) project, is designed to meet the challenge of preparing future nurses who will have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work, which includes evidence-based practice.

Page Ref: 9

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: V. B. 8. Use national patient safety resources for own professional development and to focus attention on safety in care settings. | AACN Essentials Competencies: VIII. 12. Act to prevent unsafe, illegal, or unethical care practices. | NLN Competencies: Quality and Safety: Value and encourage nurses involvement in the design, selection, implementation, and evaluation of information technologies to support patient care (e.g., as recommended by QSEN). | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Delineate significant legal and ethical issues that influence the practice of nursing for childbearing families.

MNL LO: 1.1.4 Examine the legal and ethical influences on the delivery of nursing care to the childbearing family.

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33) The nurse is serving on a panel to evaluate the hospital staffs reliance on evidence-based practice in their decision-making processes. Which practices characterize the basic competencies related to evidence-based practice?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Recognizing which clinical practices are supported by good evidence

2. Recognizing and including clinical practice supported by intuitive evidence

3. Using data in clinical work to evaluate outcomes of care

4. Including quality-improvement measures in clinical practice

5. Appraising and integrating scientific bases into practice

Answer: 1, 3, 5

Explanation: 1. Recognizing which clinical practices are supported by sound evidence is a basic competency related to evidence-based practice.

3. Using data in clinical work to evaluate outcomes of care is one of the basic competencies related to evidence-based practice.

5. Appraising and integrating scientific bases into practice is one of the characteristics of the basic competencies related to evidence-based practice.

Page Ref: 13

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III. A. 2. Describe EBP to include the components of research evidence, clinical expertise and patient/family values. | AACN Essentials Competencies: II. 5. Participate in quality and patient safety initiatives, recognizing that these are complex system issues, which involve individuals, families, groups, communities, populations and other members of the healthcare team. | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8 Identify the impact of evidence-based practice in improving the quality of nursing care for childbearing families.

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34) As a clinician, the nurse must meet what basic competencies related to evidence-based practice?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Recognize which clinical practices are supported by sound evidence.

2. Recognize that superiors, such as charge nurses, are the ones who know which clinical practices are supported by sound evidence.

3. Use data in clinical work to evaluate outcomes of care.

4. Integrate scientific basics into practice.

5. Be able to identify which practices have no sound evidence to support their use.

Answer: 1, 3, 4, 5

Explanation: 1. Knowing what is sound evidence is a function of nursing related to evidence-based practice.

3. The nurse should always practice with the data that have proven to be sound.

4. This is a competency and responsibility for each nurse.

5. The nurse should be able to identify which practices have no sound evidence to support their use.

Page Ref: 13

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III. B. 3. Base individualized care plan on patient values, clinical expertise and evidence. | AACN Essentials Competencies: II. 6. Apply concepts of quality and safety using structure, process, and outcome measures to identify clinical questions and describe the process of changing current practice. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strength of evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8 Identify the impact of evidence-based practice in improving the quality of nursing care for childbearing families.

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35) Nursing research is vital to do which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Expand the science of nursing.

2. Foster evidence-based practice.

3. Improve client care.

4. Visually depict nursing management.

5. Plan and organize care.

Answer: 1, 2, 3

Explanation: 1. Research is vital to expanding the science of nursing.

2. Research is vital to fostering evidence-based practice.

3. Research is vital to improving client care.

Page Ref: 13

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III. A. 7. Discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences. | AACN Essentials Competencies: III. 5. Participate in the process of retrieval, appraisal and synthesis of evidence in collaboration with other members of the healthcare team to improve patient outcomes. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strength of evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 8 Identify the impact of evidence-based practice in improving the quality of nursing care for childbearing families.

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