Preview Extract
Chapter 1
1) During a prenatal visit, a patient expresses interest in accessing community-based care and
services. Which response allows the registered nurse to best describe services that are offered
by way of community-based care?
1. "Most healthcare services provided to childbearing women and their families take place in
a hospital setting."
2. "Community-based care can provide a patient with certain primary care services."
3. "Nurses are the sole providers of services related to home care."
4. "Due to lack of support from third-party payers, community-based care has decreased."
Answer: 2
Rationale 1:
The majority of health care provided to childbearing women and their families takes place
outside of hospital in clinics, offices, community-based organizations, and private homes.
Rationale 2:
Primary care includes health promotion and illness prevention, and it features services that
are best provided in community-based settings.
Rationale 3:
While nurses are the major providers of home care services, healthcare providers in various
other fields, such as physical therapy, also offer home care services.
Rationale 4:
As third-party payers begin to recognize the importance of primary care in containing costs
and maintaining health, community-based care has increased.
2) The labor and delivery nurse and a nurse new to the labor and delivery unit are admitting a
laboring patient. The patient is making groaning guttural sounds during contractions and
answering questions with one-word answers. The labor and delivery nurse simultaneously is
quickly setting up the instruments and sterile field for this delivery while asking the
admission questions between contractions. The experienced labor and delivery nurse has not
yet completed a pelvic exam. The nurse new to labor and delivery understands that this is an
example of:
1. An expert nurse assessing advanced labor and imminent delivery in the patient.
2. The correct order of steps when admitting a laboring patient.
3. Inconsistencies in an individual nurse’s approach to patient care.
4. Advanced nurse practice.
Answer: 1
Rationale 1:
An expert nurse utilizes multiple aspects of a patient’s behavior (including the length of each
response to a question and sounds the patient produces during contractions) in addition to the
more objective findings of the pelvic exam (including dilation of the cervix) in the
assessment of a laboring patient. The expert nurse has identified that the grunting and guttural
sounds during contractions are involuntary pushing and that the patient is very close to
delivery.
Rationale 2:
Although most nurses have a routine when admitting a patient, the order of the steps will vary
according to the situation at hand.
Rationale 3:
Changing the order of the steps of admission is not being inconsistent; changing the order of
the steps of admission is responsive to the needs of the patient at that point in time.
Rationale 4:
Advanced nurse practice describes educational and certification achievement and is not used
to describe the continuum from novice to expert.
3) Currently, one-third of children under 20 years old come from families of minority
populations. The new nurse is observing her preceptor assess the patient’s communication
pattern, religious beliefs, level of education, and support system. The new nurse understands
that the best reason for her preceptor to assess these areas is to increase the:
1. Patient’s cooperation with the plan of care.
2. Hospital’s compliance with the Joint Commission on Accreditation of Healthcare
Organizations JCAHO standards.
3. Nurse’s knowledge of cultural beliefs.
4. Patient’s satisfaction with her care.
Answer: 1
Rationale 1:
Gaining cooperation with the plan of care increases the outcome desired at discharge. When a
patient’s value system is not included in the plan of care, it will decrease compliance with the
treatment plan and possibly increase the length of stay and decrease the desired outcome at
discharge.
Rationale 2:
Although compliance with JCAHO standards is very important, it is more important to gain
patient cooperation with the plan of care.
Rationale 3:
The nurse’s knowledge of cultural beliefs increases the ability to care for the patient, but
without patient cooperation with the plan of care, the nurse’s knowledge is lost.
Rationale 4:
Patient satisfaction with care is important, but the prime reason for the satisfaction is the
nurse’s taking time to gain patient cooperation with the plan of care.
4) The patient at 30 weeks’ gestation expresses a desire for the registered nurse to
independently manage her perinatal care and the birth of her baby. When the nurse explains
she is not credentialed to independently manage the patient's perinatal care and delivery, the
nurse is recognizing principles related to:
1. Standards of care.
2. Scope of practice.
3. Right to privacy.
4. Informed consent.
Answer: 2
Rationale 1:
Standards of care pertain to established minimum criteria for competent, proficient actions
related to delivery of nursing care.
Rationale 2:
Scope of practice is defined as the limits of nursing practice set forth in state statutes.
Rationale 3:
Right to privacy involves the legal right of a person to keep her or his person and property
free from public scrutiny.
Rationale 4:
Informed consent is a legal concept that protects a patient’s right to autonomy and selfdetermination in terms of his or her care.
5) The certified nurse–midwife (CNM) role includes which of the following?
1. Is prepared to manage independently the care of women at low risk for complications
during pregnancy and birth
2. Gives primary care for high-risk patients who are in hospital settings
3. Gives primary care for healthy newborns
4. Obtains a physician consultation for any technical procedures at delivery
5. Is educated in two disciplines of nursing
Answer: 1,3,5
Rationale 1:
A CNM is prepared to manage independently the care of women at low risk for
complications during pregnancy and birth.
Rationale 2:
CNMs cannot give primary care for high-risk patients who are in hospital settings. The
physician provides the primary care for high-risk patients who are in hospital settings.
Rationale 3:
A CNM is prepared to manage independently the care of healthy newborns.
Rationale 4:
The CNM does not need to obtain a physician consultation for any technical procedures at
delivery.
Rationale 5:
The CNM is educated in the disciplines of nursing and midwifery.
6) The new graduate is learning about advanced practice nursing. Which of the following
situations best illustrates an advanced practice nursing role?
1. An experienced registered nurse who is the manager of a large obstetrical unit
2. A registered nurse who is the circulating nurse at surgical (cesarean) deliveries
3. A clinical nurse specialist who is working as a staff nurse on a mother–baby unit
4. A nurse practitioner who is consulting with a physician in the newborn nursery
5. A nurse–midwife attending vaginal deliveries of uncomplicated pregnancies
Answer: 4,5
Rationale 1:
Management roles are often held by professional nurses.
Rationale 2:
Unit-specific skills such as circulating during cesarean births do not require additional formal
education.
Rationale 3:
An advanced practice nurse working as a staff nurse is not working in the role of advanced
practice.
Rationale 4:
Advanced practice nurses have received additional specialized education beyond registered
nursing and tend to have a clinical focus. Nurse practitioners make clinical judgment and
begin treatment and consult a physician as needed.
Rationale 5: It is within the scope of practice for certified nurse–midwives to attend
deliveries of essentially normal patients with essentially normal pregnancies.
7) The major focus of the nurse practitioner is on:
1. Leadership.
2. Physical and psychosocial clinical assessment.
3. Independent care of the high-risk, pregnant patient.
4. Tertiary prevention.
Answer: 2
Rationale 1:
Leadership might be a quality of the NP, but it is not the major focus.
Rationale 2:
Physical and psychosocial clinical assessment is the major focus of the nurse practitioner
(NP), who provides care in many different clinical settings.
Rationale 3:
NPs cannot provide independent care of the high-risk pregnant patient but must work under a
physician’s supervision.
Rationale 4:
The NP cannot do tertiary prevention as a major focus.
8) The nurse is reviewing charts for quality improvement. A patient experienced a
complication during labor. The nurse is uncertain if the labor nurse took the appropriate
action during the situation. What is the best method for the quality improvement nurse to
determine what the appropriate action by the nurse 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
Rationale 1:
The nurse should find the standards herself and not rely on another person, such as the labor
and delivery nurse manager, to determine appropriateness of care.
Rationale 2:
Physician care and nursing care are very different; physicians might not be up to date on
nursing standards of care or nursing policies and procedures.
Rationale 3:
What nursing action was undertaken in a different situation might not be based on the
policies and procedures or other standards of care. The quality improvement nurse will obtain
the most accurate information by examining the policies, procedures, and standards of care.
Rationale 4:
Agency policies, procedures, and protocols contain guidelines for nursing action in specific
situations. Professional organizations such as the Association of Women’s Health,
Obstetrical, and Neonatal Nurses (AWHONN) also publish standards of practice that should
guide nursing care.
9) According to the 1973 U.S. Supreme Court decision in Roe v. Wade, abortion is legal if
induced:
1. At a federally funded clinic.
2. Before the period of viability.
3. To provide tissue for therapeutic research.
4. At a military hospital overseas.
Answer: 2
Rationale 1:
At a federally funded clinic, abortions can be provided legally if under United States laws.
Rationale 2:
Abortion can be performed legally until the period of viability; after viability, the rights of the
fetus take precedence.
Rationale 3:
Abortion cannot be used to provide tissue for therapeutic research.
Rationale 4:
At a military hospital overseas, abortions can be provided legally if under United States laws.
10) The nurse is caring for a patient who has delivered her first child. The patient states, “My
mother said that I have to have a bowel movement before I can go home, but my girlfriend
said that isn’t true anymore. What caused this change?” Which response by the nurse is best?
1. “Doctors just want patients to go home sooner these days.”
2. “It really doesn’t matter. Don’t worry about it.”
3. “Research indicates it is normal for bowel function to slow for a few days.”
4. “We used to give all patients laxatives, but now they cost too much.”
Answer: 3
Rationale 1:
Cost containment and managed care are the driving forces behind some changes in care
compared to a generation ago, not physician preference.
Rationale 2:
Always address a patient’s questions and avoid saying “don’t worry about it” to keep
communication therapeutic.
Rationale 3:
Evidence-based practice is the use of research findings to guide nursing actions, policies, and
procedures. Often research findings contradict care that used to be the norm, leading to
changes in policies and procedures.
Rationale 4:
Although laxatives are low-cost medications, there is no evidence indicating that all patients
should receive them after childbirth. The evidence indicates that bowel function slows
slightly after birth and normally resumes in a few days.
11) Which of the following practices characterize the basic competencies related to evidencebased practice?
1. Clinical practice supported by good evidence
2. Clinical practice supported by intuitive evidence
3. Clinical practice supported by data
4. Clinical practice that promotes quality
5. Clinical practice that provides a useful approach to problem solving
Answer: 1,3,4,5
Rationale 1:
Clinical practice supported by good evidence is one of the hallmark characteristics of the
basic competencies related to evidence-based practice.
Rationale 2:
Clinical practice supported by intuitive evidence does not provide valid evidence and data for
the proper actions.
Rationale 3:
Clinical practice supported by data is one of the hallmark characteristics of the basic
competencies related to evidence-based practice.
Rationale 4:
Clinical practice that promotes quality is one of the hallmark characteristics of the basic
competencies related to evidence-based practice.
Rationale 5: Clinical practice that provides a useful approach to problem solving is one of
the hallmark characteristics of the basic competencies related to evidence-based practice.
12) 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). This would be an
example of:
1. Inferential statistics.
2. Descriptive statistics.
3. Evidence-based practice is the use of conclusions of research to improve nursing care.
4. Secondary use of data.
Answer: 2
Rationale 1:
Inferential statistics allow the investigator to draw conclusions from data to either support or
refute causation.
Rationale 2:
Descriptive statistics concisely describe phenomena such as births by providers.
Rationale 3:
Evidence-based practice.
Rationale 4:
Secondary use of data is analyzing data a different way than the original data analysis was
undertaken or looking at different variables from a data set.
13) An example of descriptive statistics is:
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
diseases.
4. The total number of spontaneous abortions in drug-abusing women as compared with nondrug-abusing women.
Answer: 2
Rationale 1:
A positive correlation between two or more variables is an example of inferential statistics.
Rationale 2:
The infant mortality rate in the state of Oklahoma is an example of a descriptive statistic
because it describes or summarizes a set of data.
Rationale 3:
A causal relationship between the number of sexual partners and sexually transmitted
diseases is an example of inferential statistics.
Rationale 4:
The total number of spontaneous abortions in drug-abusing women also would be an
inferential statistic.
14) The 2011 estimated infant mortality rate in the United States exceeds the infant mortality
rate of several other developed countries, including Sweden, Japan, France, Germany, and
Canada. Which research question most effectively explores variables that may potentially
influence these statistics?
1. What is the average age of healthcare providers in each country?
2. What is the level of racial diversity in each country?
3. What is the average age of children in each country?
4. What is the level of awareness related to contraception in each country?
Answer: 2
Rationale 1:
The age of healthcare providers does provide insight as to national infant mortality rates.
Rationale 2:
Racial background can impact infant mortality rates.
Rationale 3:
The average age of children does not provide insight as to the rate of infant mortality.
Rationale 4:
Awareness related to contraception has no direct impact on the survival of infants after birth.
15) The nurse knows the birth rate by age group in the state. Which research question could
be developed for further study from this data?
1. What is the average number of children per family in the United States?
2. How does educational level affect the incidence of unplanned pregnancy?
3. What is the overall nutritional status of adolescents?
4. Which high schools provide day care for student parents?
Answer: 2
Rationale 1:
Determining the average number of children nationally will not yield additional information
about this state.
Rationale 2:
Research questions often come from a nurse’s desire to further understand an issue. How
educational level affects the incidence of unplanned pregnancy is a question that flows from
the known data of birth rate by age group.
Rationale 3:
Studying the nutritional status of adolescents will not yield additional information about this
state.
Rationale 4:
Schools that provide student parent day care might indicate the incidence of teen pregnancy
in the population served by the school but not pregnancy rates of those who are not in high
school.
16) The major focus of the clinical nurse specialist (CNS) involves:
1. Conducting physical and psychosocial assessments, including history, physical
examination, and certain diagnostic tests and procedures.
2. Independently managing the care of women at low risk for complications during pregnancy
and birth and the care of healthy newborns.
3. Generating new research relevant to topics such as health care and administrative issues.
4. Demonstrating leadership within his or her specialty and working to improve inpatient care
both directly and indirectly.
Answer: 4
Rationale 1:
Physical and psychosocial clinical assessment is the major focus of the nurse practitioner
(NP), who provides care in many different clinical settings.
Rationale 2:
The certified nurse-midwife (CNM) is qualified to provide independent care of the low-risk
pregnant client while seeking physician consultation as needed.
Rationale 3:
Nurse researchers have an advanced doctoral degree, typically a PhD, and assume a
leadership role in generating new research.
Rationale 4:
The CNS assumes a leadership role within his or her specialty and works to improve inpatient
care both directly and indirectly.
Test Bank for Contemporary Maternal-Newborn Nursing
Patricia W Ladewig, Marcia L London, Michele Davidson
9780133429862, 9780134257020
