CHAPTER 4- PERINATAL NURSING Flashcards
(41 cards)
- Which medical risk factor contributes to a higher infant mortality rate?
a. Diabetes mellitus
b. Mitral valve prolapse (MVP)
c. Chronic hypertension
d. Anemia
ANS: C
Poor maternal health or chronic conditions such as hypertension are important contributors to a high infant mortality rate. Although diabetes mellitus, MVP, and anemia are concerns in pregnancy, they are not one of the most frequently reported maternal medical risk factors that contribute to a higher infant mortality.
- Which woman would be most at risk for the poorest perinatal outcome?
a. A 25-year-old single mother on maternity leave with two existing children
b. An unemployed 32-year-old lawyer in an inner-city neighbourhood
c. An Indigenous woman in her mid-20s with no high school education
d. A 19-year-old college student who lives at home with her parents
ANS: C
Both the Canadian Perinatal Surveillance System (CPSS) and the Maternity Experiences Survey note that poor women, Indigenous women, and young women with less education consistently have the poorest perinatal outcomes.
3.Which is the main characteristic of the evolved role of the professional perinatal nurse?
a. Providing care to patients directly at the bedside
b. Planning patient care to cover longer hospital stays
c. Developing models and guidelines for interprofessional health care providers
d. Managing care to cure health problems once they have occurred
ANS: C
Professional nurses are part of the team of health and social care providers who collaboratively care for perinatal patients and their families. Perinatal nurses have helped to develop models and guidelines for interprofessional teams of professionals who work with child-bearing patients and their families. Providing care to patients directly at the bedside is one of a nurse’s tasks, but it does not encompass the concept of the evolved professional nurse. Patient hospital stays are decreasing in length of time rather than becoming longer stays. Nurses do not cure health problems; they work to promote well-being.
- A teenager is pregnant for the first time. Based on the statistics for infant mortality, which intervention is most important for the nurse to implement?
a. Perform a nutrition assessment.
b. Refer the patient to a social worker.
c. Advise the patient to see an obstetrician, not a midwife.
d. Explain to the patient the importance of keeping their prenatal care appointments.
ANS: D
Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation. The patient may need assistance from a social worker at some time during their pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the teenager has identifiable high-risk problems, their health care may need to be provided by a physician. However, it cannot be assumed that all teenagers have high-risk issues. In addition, advising the patient to see an obstetrician is not the most important aspect on which the nurse should focus at this time.
- Which organization has developed entry to practice competencies for Child-bearing families?
a. Canadian Nursing Association
b. Canadian Association of Midwives
c. Canadian Association of Schools of Nursing
d. Society of Obstetrician & Gynecologists of Canada
ANS: C
The Canadian Association of Schools of Nursing (CASN) published Entry-to-Practice Competencies for Nursing Care of the Childbearing Family for Baccalaureate Programs in Nursing.
- When managing health care for pregnant patients at a prenatal clinic, which barrier to access prenatal care is considered most significant?
a. Age
b. Minority status
c. Educational level
d. Geographic location
ANS: D
The most significant barrier to health care access is geographic location. Inequities in access to good-quality prenatal care have developed particularly in rural, remote, inner city, and Indigenous communities. Although adolescent pregnant patients statistically receive less prenatal care, age is not the most significant barrier. Significant disparities in morbidity and mortality rates exist for minority patients; however, minority status is not the most significant barrier to access of care. Disparities in educational level are associated with morbidity and mortality rates; however, educational level is not the most significant barrier to access of care.
- Which time frame range is the perinatal continuum of care?
a. 9 to 10 months
b. 12 to 14 months
c. 15 to 16 months
d. 18 to 24 months
The perinatal continuum of care is 12 to 14 months.
- Which factor is mainly responsible for the steady increase in Caesarean birth?
a. Higher rate of primary Caesarean births
b. Higher rate of vaginal birth after Caesarean birth
c. Increased nicotine use in pregnancy
d. Lower medical indications for Caesarean birth
ANS: A
The proportion of patients giving birth by Caesarean section has increased steadily, from 17.6% in 1995 to 28.4% in 2014 to 2015 (PHAC, 2017b). Most of this increase is due to a higher rate of primary (first-time) Caesarean births. The vaginal birth after Caesarean (VBAC) rate has decreased over the same time period, not increased. Low medical indications would not increase the Caesarean birth rate.
- From a nurse’s perspective, what measure should be the focus of the health care system to further reduce the rate of infant mortality?
a. Implementing programs that focus on health promotion and preventive care
b. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days
c. Expanding the number of neonatal intensive care units (NICUs)
d. Mandating that all pregnant women receive care from an obstetrician
ANS: A
To address factors that are associated with infant mortality, there needs to be a shift from the current emphasis on highly technological medical intervention toward a focus on health promotion and preventive care. An increased length of stay has been shown to foster improved self-care and parental education; however, it does not prevent the incidence of leading causes of infant mortality rates such as low birth weight. NICUs offer care to high-risk infants after they are born; therefore, expanding the number of NICUs would offer better access for high-risk care, but this factor is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetrical care would be nearly impossible to e
- Which have contributed to decreasing maternity-related health care costs?
a. Prolonged postpartum hospital stays
b. Portable care technology
c. The reduction in acceptable genetic screening options
d. Rural health services outreach clinics
ANS: B
Some women who experience pregnancy complications are now cared for in the home by antepartum home care nurses, thus decreasing maternity-related health care costs. This is a direct result of having access to portable fetal monitors and other forms of technology that previously were available only in the hospital but now are portable and can be used in the patient’s home. Prolonged postpartum hospital stays have increased costs, not decreased them. Genetic screening options have increased, not decreased, and they affect the ways in which women and their families experience pregnancy. Outreach clinics have increased health care costs as compared to the cost of home-based care.
- Which reflects a future goal for perinatal nursing?
a. Limiting interprofessional teams
b. Maintaining existing power structures
c. Advocating for an increased number of Caesarean sections
d. Addressing health inequities by creating healthy public policies
ANS: D
Addressing health inequities by creating health policy and services that focus on both resources needed for health and access to health services is a future goal of perinatal nurses. Nurses should be expanding interprofessional teams rather than limiting their existence. Existing power structures and practices need to be disrupted rather than maintained. Advocating for an increased number of Caesarean births is not a future goal for perinatal nursing.
- Which is the leading cause of maternal death?
a. Hypertension
b. Obesity
c. Gestational diabetes
d. Hemorrhage
ANS: D
Worldwide, approximately 800 women die each day of problems related to pregnancy or childbirth, with hemorrhage being the leading cause of death.
- Which recent trend in childbirth practices in Canada is accurate?
a. Older women tend not to seek prenatal care.
b. Indigenous women have lower incidence of perinatal mood disorders.
c. The majority of births occurred in the hospital.
d. Immigrant and refugee women have a lower rate of chronic disease.
ANS: C
The majority of births occur in the hospital. Older women tend to seek early prenatal care. Indigenous women do not have a lower incidence of perinatal mood disorders. Immigrant and refugee women have a higher rate of chronic disease.
- Which best describes a doula?
a. Advanced practice labour and birth nurse
b. A trained and experienced labour attendant
c. Clinical nurse specialist in neonatal and postpartum care
d. Leader of a interprofessional, intrapartum health care team
ANS: B
A doula is a trained and experienced labour attendant and may provide continuous one-on-one caring presence throughout the labour and birth. A doula does not need to be a nurse. An advanced practice labour and birth nurse is not a doula. A clinical nurse specialist in neonatal and postpartum care is not a doula. A doula may be a leader of a interprofessional intrapartum health care team but this is not the main role of a doula.
- Which is the correct definition of the perinatal mortality rate?
a. Number of live births in 1 year per 1000 population
b. Number of deaths of infants under 1 year of age per 1000 live births
c. Number of deaths of infants under 28 days of age per 1000 live births
d. Number of stillbirths and neonatal deaths per 1000 live births
ANS: D
The perinatal mortality rate is the number of stillbirths and neonatal deaths per 1000 live births. The number of live births in 1 year per 1000 population is the birth rate. Number of deaths of infants under 1 year of age per 1000 live births is the infant mortality rate. Number of deaths of infants under 28 days of age per 1000 live births is the neonatal mortality rate.
- Which factor is associated with higher infant mortality rates?
a. Advanced maternal education
b. Maternal age greater than 35 years
c. Access to prenatal care
d. Poverty
ANS: D
Limited maternal education, young maternal age, poverty, and the lack of prenatal care appear to be associated with higher infant mortality rates.
- What is required for women and their families to make informed health care choices?
a. A patient-centred care approach
b. Information and accurate knowledge
c. Fewer multidisciplinary care teams
d. Standardized maternal and newborn care
ANS: B
To make informed choices, women and their families require knowledge about their care. A family-centred approach is to be practiced. More, rather than fewer, multidisciplinary teams can provide better holistic care. Maternal and newborn care is to be individualized, not standardized.
- What information is a component of the midwifery care model?
a. Midwives provide care in collaboration with a physician.
b. Midwifery care is not a choice for patients in Canada.
c. Midwives work with clients in a non-authoritarian manner.
d. The birth can take place only at home or in a birth centre.
ANS: C
The midwifery model encourages patients to become active participants in their decisions and provide non-authoritarian and collaborative partnerships with their patients. Although Canada has a low percentage of well-woman care provided by midwives, these services are available. Midwives are autonomous care providers and although may collaborate with other health care providers in some situations, this is not the standard. Midwives can provide care at home, in freestanding birth centres, and in community and teaching hospitals.
- While obtaining a detailed history from a woman who has recently emigrated from Somalia, the nurse realizes that the patient has undergone female genital cutting (FGC). Which is the nurse’s best response based on?
a. FGM is abnormal and rarely seen in Canada.
b. Gathering information on who performed the FGM.
c. Restoration plans for FGM after birth.
d. The extent of FGM will affect potential for complications
ANS: D
The extent of FGM will affect the potential for complications and is the most appropriate information on which the nurses’
response should be based. The patient may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. With the growing number of immigrants from countries where FGC is practiced, nurses will increasingly encounter women who have undergone the procedure. Responding that this is a very abnormal practice rarely seen in Canada is culturally insensitive. The infibulation may have occurred during infancy or childhood. The patient will have little to no recollection of the event. She would have considered this to be a normal milestone during her growth and development. The World Health Organization and The International Council of Nurses has spoken out against this procedure as harmful to a woman’s health and a violation of human rights.
- Which are principles of family-centred maternal and newborn care? (Select all that apply.)
a. Pregnancy and birth are normal, healthy processes.
b. Childbirth should take place in hospitals for best outcomes.
c. Health care providers can work autonomously for best patient outcomes.
d. Care should be provided in a culturally safe manner.
e. Care providers need to be aware of the language that they use related to
childbirth.
ANS: A, D, E
This report provides detailed information on many issues of concern for nurses, for example, alcohol use, prenatal class attendance, social support, and stress.
- Which reflects one purpose of preconception care?
a. Ensure that pregnancy complications do not occur.
b. Identify women who should not become pregnant.
c. Encourage healthy lifestyles for families desiring pregnancy.
d. Ensure that women know about prenatal care.
ANS: C
Preconception counselling guides couples in how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and their environment, and how to identify healthy behaviours that promote the well-being of the woman and her potential fetus. Preconception care does not ensure that pregnancy complications will not occur. In many cases, problems can be identified and treated and may not recur in subsequent pregnancies. In many instances, counselling enables behaviour modification before damage is done, or a woman can make an informed decision about her willingness to accept potential hazards. If a woman is seeking preconception care, she likely is aware of prenatal care
- A nurse who provides preconception care understands which about preconception care?
a. It is designed for women who have never been pregnant.
b. It includes risk factor assessments for potential medical and psychological
problems but does not consider socioeconomic status.
c. It avoids teaching about safer sex, as the woman is seeking pregnancy.
d. It could include interventions to reduce substance use.
ANS: D
If assessment indicates problematic substance use, treatment can be suggested or arranged. Preconception care is designed for all women of child-bearing potential, not just those who have never been pregnant. Risk factor assessment includes consideration of socioeconomic status and its effect on the determinants of health. Health promotion can include teaching about safer sex.
- What should nurses be aware of concerning the use and misuse of legal drugs or substances?
a. Although cigarette smoking causes a number of health problems, it has little
direct effect on maternity-related health.
b. About 75% of women age 15 and older report alcohol consumption.
c. Coffee is a stimulant that can interrupt body functions and has been related to
birth defects.
d. Prescription psychotherapeutic medications taken by the mother do not affect the
fetus; otherwise, they would not have been prescribed.
ANS: B
In 2012, 74% of Canadian women age 15 and older reported drinking alcohol; based on the amount of alcohol abused, 16% of those women are at risk for long-term complications and 10% at risk for acute illness. Although a very small percentage of child-bearing patients have alcohol-related problems, alcohol use during pregnancy has been associated with a number of negative outcomes. Cigarette smoking impairs fertility and is a cause of low birth weight. Caffeine consumption has not been related to birth defects. Psychotherapeutic medications have some effect on the fetus, and that risk must be weighed against their benefit to the mother.
- The use of methamphetamine has been steadily increasing in Canada. What must the nurse be cognizant of in relation to methamphetamine use, to provide adequate nursing care to this patient population?
a. It is used only by those of a higher socioeconomic status, because of the expense.
b. It contains amphetamine, a central nervous system stimulant, as the active
ingredient.
c. It manifests a response similar to marijuana when smoked.
d. Its use by fertile women decreases their sexual activity.
ANS: B
The active metabolite of methamphetamine is amphetamine, a central nervous system stimulant known as both “speed” and “meth.” Meth is relatively cheap and is “hooking” more people across the socioeconomic spectrum. When smoked, the behaviour of the patient is similar to that resulting from use of cocaine, not similar to marijuana use. Users of meth can experience feeling hypersexual and uninhibited, leading to unsafe sexual practices.
