Chapter 1: Contemporary Maternity Nursing
Copyright © 2006 by Mosby, Inc.

MULTIPLE CHOICE

	1.	Considering health trends in the United States today:
1.	one fifth of the population lacks health insurance for a year or more.	
2.	members of different racial and ethnic groups have roughly the same maternity health care outcomes.	
3.	less is spent on health care as a percent of GNP than in Japan.	
4.	reproductive health services for adolescents are readily available.	

ANS:	1
1. Correct. 58 million Americans do not have health insurance.
2. Incorrect. There is a significant disparity between racial and ethnic groups, but there is a serious problem of lack of health insurance across the country.
3. Incorrect. The United States spends 13.9%, Japan 8%. Lack of health insurance is a serious problem.
4. Incorrect. Lack of adolescent heath care is a major concern, and so is lack of health insurance.

PTS:	1	DIF:	Cognitive Level: Knowledge	REF:	p. 2

	2.	An important development that concerns maternity nursing is integrative health care. This:
1.	refers to the goal of providing the same health care for all racial and ethnic groups.	
2.	blends complementary and alternative therapies with conventional Western treatment.	
3.	focuses on the disease or condition rather than the background of the patient.	
4.	has been mandated by Congress.	

ANS:	2
1. Incorrect. It refers to the blending of new and traditional practices.
2. Correct. It tries to mix the old with the new at the discretion of the patient and the health care providers.
3. Incorrect. It focuses on the whole person, not just the disease or condition.
4. Incorrect. U.S. law supports complementary and alternative therapies but does not mandate them.

PTS:	1	DIF:	Cognitive Level: Knowledge	REF:	p. 3

	3.	In recent trends in childbirth practices in the United States:
1.	more than 15% of mothers had late prenatal care or no prenatal care.	
2.	the percent of Hispanics and non-Hispanic blacks and Caucasians receiving prenatal care was essentially the same.	
3.	99% of births were in the hospital.	
4.	Cesarean births have been declining as a percentage of live births.	

ANS:	3
1. Incorrect. Only 3.4% of mothers had either late care or no care.
2. Incorrect. Caucasians have a higher percentage of prenatal care.
3. Correct. Almost no births occur outside the hospital. 
4. Incorrect. The percentage of cesarean births is increasing.

PTS:	1	DIF:	Cognitive Level: Knowledge	REF:	p. 4

	4.	In recent trends in childbirth practice:
1.	delayed pushing is discouraged in the second stage of labor.	
2.	rates of episiotomies are increasing.	
3.	midwives perform more episiotomies than physicians.	
4.	newborn infants remain with the mother and are encouraged to breastfeed.	

ANS:	4
1. Incorrect. Delayed pushing is encouraged for several reasons.
2. Incorrect. The rates of episiotomies are declining.
3. Incorrect. Midwives perform fewer episiotomies than doctors do.
4. Correct. Breastfeeding is encouraged for newborns immediately after birth.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 5

	5.	Which of the following is an accurate example of a U.S. societal trend?
1.	The moral climate has caused companies to discourage breastfeeding on the job.	
2.	Federal law prohibits women to breastfeed in federal buildings and on federal property.	
3.	The Family Medical Leave Act of 1993 provides up to 12 weeks of unpaid leave for births.	
4.	The rate of AIDS among infants has continued to increase.	

ANS:	3
1. Incorrect. In fact, companies make provisions for women to breastfeed at work.
2. Incorrect. Federal law allows women to breastfeed in federal buildings and on federal property.
3. Correct. The leave is also for adoption and care of family members.
4. Incorrect. The rate of AIDS is declining among infants because of new therapies.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 6

	6.	Which of the following trends concerning birthrate in the United States is accurate?
1.	Births to unmarried women are more likely to have less favorable outcomes.	
2.	Birthrates for women 40 to 44 years of age are beginning to decline.	
3.	Cigarette smoking among pregnant women continues to increase.	
4.	The rates of pregnancy and abortion among teens are lower in the United States than any other industrial country.	

ANS:	1
1. Correct. Low birth weight and preterm birth are more likely because of the large number of teenagers in the unmarried group.
2. Incorrect. Birthrates for women in their early 40s continue to increase.
3. Incorrect. Fewer pregnant women smoke.
4. Incorrect. Teen pregnancy and abortion rates are higher in the United States than in any other industrial country.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 7

	7.	The current high cost of health care in the United States is most likely a result of:
1.	early postpartum discharge policies.	
2.	midwifery care.	
3.	involvement of nurses in the politics of cost containment.	
4.	emphasis of high technology in care.	

ANS:	4
1. Incorrect. Early discharges cut costs, as does midwifery care and the involvement of nurses in the process.
2. Incorrect. Midwifery cuts costs, as does early hospital discharge and the involvement of nurses in the process.
3. Incorrect. Involvement of nurses should cut costs. Early hospital discharge and midwifery care do as well.
4. Correct. Use of high technology increases costs.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 9

	8.	The most significant barrier to access of maternity care is:
1.	patients’ inability to pay.	
2.	government restrictions on types of care	
3.	inadequate transportation to care facilities.	
4.	lack of dependent child care.	

ANS:	1
1. Correct. Money is the biggest barrier to access of maternity care.
2. Incorrect. The government encourages a variety of maternity options. Inability of patients to pay is the biggest barrier to care.
3. Incorrect. Transportation is a minor problem compared with the patients’ inability to pay for maternity care.
4. Incorrect. Child care is not the most significant problem. Patients’ inability to pay is the biggest barrier to care.

PTS:	1	DIF:	Cognitive Level: Analysis	REF:	p. 9

	9.	Providing maternity nursing care based on knowledge gained through research and clinical trials is:
1.	derived from the Nursing Interventions Classification.	
2.	known as evidence-based practice.	
3.	is at odds with the Cochrane School of traditional nursing.	
4.	an outgrowth of telemedicine.	

ANS:	2
1. Incorrect. This is a method of standardizing language and categorizing care. Evidence-based practice applies the results of research.
2. Correct. Evidence-based practice is based on knowledge gained from research and clinical trials.
3. Incorrect. Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice movement.
4. Incorrect. Telemedicine uses communication technologies to support health care. Evidence-based practice applies the knowledge gained from research.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 10

	10.	The study by Dr. Brown and colleagues on the effect of early postnatal discharge concluded that:
1.	early discharge mothers were more likely to breastfeed.	
2.	fathers spend less time with babies discharged early.	
3.	early discharge appears to do no harm.	
4.	further research is not needed.	

ANS:	3
1. Incorrect. Research indicated no significant differences in breastfeeding.
2. Incorrect. Fathers spend significantly more time with babies who were discharged early.
3. Correct. Although no harm seems to have been done, limitations of the study may have obscured adverse outcomes.
4. Incorrect. Researchers believe larger trials are needed to clarify findings.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 11

	11.	The level of practice that a reasonably prudent nurse would provide is called:
1.	the standard of care.	3.	a sentinel event.	
2.	risk management.	4.	failure to rescue.	

ANS:	1
1. Correct. Guidelines for standards of care are published by various professional nursing organizations.
2. Incorrect. Risk management identifies risks and establishes preventive practices, but does not define the standard of care.
3. Incorrect. Sentinel events are unexpected negative occurrences. They do not establish the standard of care.
4. Incorrect. Failure to rescue is an evaluative process for nursing, but does not define the standard of care.

PTS:	1	DIF:	Cognitive Level: Knowledge	REF:	p. 15

	12.	Many alternative and complementary therapies share which of the following concepts?
1.	The use of herbs is a cornerstone of good health.	
2.	Patients are capable of decision making and should be a part of the health care team.	
3.	Touch should be used to relieve pain and reduce anxiety.	
4.	Patients should place the responsibility for their health and healing in the hands of alternative healers.	

ANS:	2
1. Incorrect. Proper nutrition, adequate rest, relaxation, exercise, and emotional health, not herbs, are cornerstones of good health.
2. Correct. The emphasis of alternative and complementary therapies is that the patient is viewed as a whole being, capable of decision making, and an integral part of the health care team.
3. Incorrect. The use of touch has many forms and is used for a multitude of purposes including increased circulation, decreasing edema, promoting lymphatic drainage, relieving muscle tension, and improving the functioning of certain body systems.
4. Incorrect. The road to healing is an individual journey; patients are encouraged to take responsibility for their health and healing.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 3

	13.	Managed care is gaining popularity. This rise in popularity is most often guided by which of the following considerations?
1.	Concern for the quality of care	3.	Greater access to physicians	
2.	Means of controlling costs of care	4.	Allowance for early discharge	

ANS:	2
1. Incorrect. Although quality control is important, it does not have any bearing on the rise of popularity of managed care.
2. Correct. Health care is one of the fastest growing sectors of the U.S. economy. Managed care was developed as a direct result of escalating health care costs.
3. Incorrect. Managed care tends to have a gatekeeper effect, which actually may limit the access to physicians, especially specialists.
4. Incorrect. Although early discharges were originally part of the managed care plan to reduce hospital expenditures, it has created a need for additional care in the home.

PTS:	1	DIF:	Cognitive Level: Knowledge	REF:	p. 9

	14.	The role of the professional nurse has evolved to emphasize:
1.	providing care to patients directly at the bedside.	
2.	planning patient care to cover longer hospital stays.	
3.	leading the activities of a team of interdisciplinary health care providers.	
4.	managing care to cure health problems once they have occurred.	

ANS:	3
1. Incorrect. This is one task of the role of a nurse but is not what encompasses the notion of the evolved professional nurse.
2. Incorrect. One goal of managed care is decreased, not increased, length of stays.
3. Correct. Professional nurses are part of the team of health care providers who collaboratively care for patients in the managed care model.
4. Incorrect. Nurses do not cure health problems; they care for patients with health care ailments.

PTS:	1	DIF:	Cognitive Level: Knowledge	REF:	p. 2

	15.	To assess for the risk of having a low-birth-weight (LBW) infant, which of the following factors is the most important for the nurse to consider?
1.	African-American race	3.	Poor nutritional status	
2.	Cigarette smoking	4.	Limited maternal education	

ANS:	1
1. Correct. For African-American births, the incidence of LBW infants is twice that of Caucasian births. Race is a nonmodifiable risk factor.
2. Incorrect. Cigarette smoking is an important factor in potential infant mortality rates but is not the most important. Additionally, smoking is a modifiable risk factor.
3. Incorrect. Poor nutrition is an important factor in potential infant mortality rates but is not the most important. Additionally, nutritional status is a modifiable risk factor.
4. Incorrect. Maternal education is an important factor in potential infant mortality rates but is not the most important. Additionally, maternal education is a modifiable risk factor.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 7

	16.	A 23-year-old African-American woman is pregnant with her first child. Based on the statistics related to infant mortality, which of the following plans is most important for the nurse to implement?
1.	Perform a nutrition assessment.	
2.	Refer the woman to a social worker.	
3.	Advise the woman to see an obstetrician and not a midwife.	
4.	Explain to the woman the importance of keeping her prenatal care appointments.	

ANS:	4
1. Incorrect. Nutritional status is an important modifiable risk factor, but is not the most important action for a nurse to take in this situation.
2. Incorrect. The patient may need assistance from a social worker at some time during her pregnancy but it is not the most important aspect for the nurse to address at this time.
3. Incorrect. If the woman were to have identifiable high risk issues, her health care may be provided by a physician. However, it cannot be assumed that all African-American women have high risk issues. Additionally, it is not the most important aspect for the nurse to focus on at this time, nor is it appropriate for a nurse to advise or manage the type of care a patient is to receive.
4. Correct. Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 7

	17.	A nurse will know that teaching to increase self-care is effective when a female patient makes which of the following comments?
1.	“I’ll do whatever you say; you’re the nurse.”	
2.	“I don’t think I can quit smoking.”	
3.	“I exercise for 30 minutes 3 days a week.”	
4.	“What do you think I should do?”	

ANS:	3
1. Incorrect. Doing is different from comprehension. The goal of teaching about self-care is for the patient to understand the factors associated with her care. Generally, an understanding of self-care practices increases the chances of patients practicing healthy behaviors.
2. Incorrect. Smoking is only one behavior associated with self-care in pregnancy. Additionally, the goal is for the patient to seek self-care health behaviors, not discount them.
3. Correct. This statement indicates the patient’s willing participation and understanding of healthy self-care behaviors.
4. Incorrect. The patient’s question indicates that she does not understand what measures she can take to increase her level of self-care.

PTS:	1	DIF:	Cognitive Level: Application	REF:	p. 8

	18.	When managing health care for pregnant women at a prenatal clinic, the nurse should recognize that the most significant barrier to access to care is the pregnant woman’s:
1.	age.	3.	educational level.	
2.	minority status.	4.	inability to pay.	

ANS:	4
1. Incorrect. Although adolescent pregnant patients statistically receive less prenatal care, this factor is not the most significant barrier.
2. Incorrect. Significant disparities in morbidity and mortality rates exist for minority women. However, this is not the most significant barrier to access of care.
3. Incorrect. Disparities in educational level are associated with morbidity and mortality rates; educational level is not the most significant barrier to access of care.
4. Correct. The most significant barrier to health care access is the inability to pay for services. This is compounded by the fact that many physicians refuse to care for women who cannot pay.

PTS:	1	DIF:	Cognitive Level: Knowledge	REF:	p. 9

	19.	What is the primary role of practicing nurses in the research process?
1.	Designing research studies	
2.	Collecting data for other researchers	
3.	Identifying researchable problems	
4.	Seeking funding to support research studies	

ANS:	3
1. Incorrect. Designing research studies is only one factor of the research process.
2. Incorrect. Data collection is one factor of research.
3. Correct. By identifying problems, research can be properly conducted. Research of health care issues leads to evidence-based practice guidelines.
4. Incorrect. Financial support is necessary to conduct research but it is not the primary role of the nurse in the research process.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 17

	20.	When a nurse is unsure about how to perform a patient care procedure, the nurse’s best action would be to:
1.	ask another nurse.	
2.	discuss the procedure with the patient’s physician.	
3.	look up the procedure in a nursing textbook.	
4.	consult the agency procedure manual and follow the guidelines for the procedure.	

ANS:	4
1. Incorrect. Each nurse is responsible for his/her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe patient care delivery.
2. Incorrect. Physicians are responsible for their own patient care activity. Nurses may follow safe orders from physicians but are also responsible for the activities that they as nurses are to carry out.
3. Incorrect. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or individual state/hospital policies.
4. Correct. It is always best to follow the agency’s policies and procedures manual when seeking information on correct patient procedures. These policies should reflect the current standards of care and state guidelines.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 16

	21.	Which of the following measures should be the focus of the health care system in order to further reduce the rate of infant mortality?
1.	Implementing programs to ensure women’s early participation in ongoing prenatal care	
2.	Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days	
3.	Expanding the number of neonatal intensive care units	
4.	Mandating that all pregnant women receive care from an obstetrician	

ANS:	1
1. Correct. Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality.
2. Incorrect. An increased length of stay has shown improved self-care and parental education. However, it does not prevent the incidence of leading causes of infant mortality rates such as LBW.
3. Incorrect. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high risk infants after they are born. Expanding the number of NICUs would offer better access for high risk care, but is not the factor that needs to be the primary focus for further reduction of infant mortality rates.
4. Incorrect. A mandate that all pregnant women receive obstetric care would be nearly impossible to enforce. Furthermore, CNMs have demonstrated reliable, safe care for pregnant women.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 7

	22.	Alternative and complementary therapies:
1.	replace conventional Western modalities of treatment.	
2.	are used by only a small number of American adults.	
3.	recognize the value of patients’ input into their health care.	
4.	focus primarily on the disease an individual is experiencing.	

ANS:	3
1. Incorrect. Alternative and complementary therapies are part of an integrative approach to health care.
2. Incorrect. An increasing number of American adults are seeking alternative and complementary health care options.
3. Correct. Many popular alternative healing modalities offer human-centered care based on philosophies that recognize the value of the patient’s input and honor the individual’s beliefs, values, and desires.
4. Incorrect. Alternative healing modalities offer a holistic approach to health, focusing on the whole person, not just the disease.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 3

	23.	When caring for pregnant women, a nurse should be aware that one of the most frequently reported maternal medical risk factors is:
1.	diabetes mellitus.	3.	chronic hypertension.	
2.	mitral valve prolapse.	4.	anemia.	

ANS:	1
1. Correct. The two most frequently reported maternal medical risk factors are hypertension associated with pregnancy and diabetes.
2. Incorrect. There are no studies that indicate that MVP is among the most frequently reported maternal risk factors.
3. Incorrect. Hypertension associated with pregnancy is one of the most frequently reported maternal medical risk factors, not chronic hypertension.
4. Incorrect. Although anemia is a concern in pregnancy, it is not one of the most frequently reported maternal medical risk factors in pregnancy.

PTS:	1	DIF:	Cognitive Level: Knowledge	REF:	p. 9

	24.	The nurses working at a newly established birthing center have begun to compare their performances in providing maternal-newborn care with the performances of nurses working in similar settings. This comparison process, designed to improve the quality of patient care, is called:
1.	best practices network.	3.	outcomes-oriented care.	
2.	clinical benchmarking.	4.	evidence-based practice.	

ANS:	2
1. Incorrect. Best practices refers to a program or service that has been recognized for excellence.
2. Correct. Clinical benchmarking is a process used to compare one’s own performance against the performance of the best in an area of service.
3. Incorrect. Outcomes-oriented care measures effectiveness of interventions and quality of care.
4. Incorrect. Evidence-based practice refers to providing care based on evidence gained through research and clinical trials.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 13

	25.	Contemporary maternity nursing is exemplified by:
1.	the use of midwives for all vaginal deliveries.	
2.	family-centered care.	
3.	free-standing birth clinics.	
4.	physician-driven care.	

ANS:	2
1. Incorrect. Midwives and physicians are used for vaginal deliveries.
2. Correct. Contemporary maternity nursing focuses on the family’s needs and desires.
3. Incorrect. Free-standing clinics are an example of alternative birth options.
4. Incorrect. Contemporary maternity nursing is driven by the relationship of nurses with patients.

PTS:	1	DIF:	Cognitive Level: Comprehension	REF:	p. 5

	26.	Sally, a 38-year-old Hispanic woman, delivered a 9 pound, 6 ounce baby girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds would Sally potentially have a legitimate legal case for negligence?
1.	She is Hispanic.	3.	The standards of care were not met.	
2.	She delivered a girl.	4.	She refused fetal monitoring.	

ANS:	3
1. Incorrect. The patient’s race is not a factor for a case of negligence.
2. Incorrect. The infant’s sex is not a factor for a case of negligence.
3. Correct. Not meeting the standards of care is a legitimate factor for a case of negligence.
4. Incorrect. Although fetal monitoring is the standard of care, the patient has the right to refuse treatment. This refusal is not a case for negligence, but the patient should be properly consented and sign an AMA form for refusal of any treatment that is within the standard of care.

PTS:	1	DIF:	Cognitive Level: Analysis	REF:	p. 15

	27.	All of the following have contributed to the increase in maternity-related health care costs except:
1.	early postpartum discharges.	
2.	maternal medical risk factors such as diabetes.	
3.	the use of high-tech equipment.	
4.	the cost of care for LBW infants.	

ANS:	1
1. Correct. Early postpartum discharges have reduced costs.
2. Incorrect. High risk factors increase health costs.
3. Incorrect. High-tech equipment increases health costs.
4. Incorrect. LBW or high risk infants increase health costs.

PTS:	1	DIF:	Cognitive Level: Evaluation	REF:	p. 9

	28.	One method that maternity nurses can take to dispel the health disparities among women is through:
1.	increasing education provided for mothers.	
2.	late prenatal care.	
3.	increasing the number of cesarean sections.	
4.	making all women take more vitamins.	

ANS:	1
1. Correct. Education for mothers will enable them to recognize problems to report to their provider and teach them how to take better care of themselves.
2. Incorrect. Late prenatal care is one factor that contributes to health disparities.
3. Incorrect. Cesarean sections occur for various reasons, but may be the result of health concerns related to the mother.
4. Incorrect. Taking vitamins may improve overall health but does not necessarily ensure health or dispel health disparities.

PTS:	1	DIF:	Cognitive Level: Application	REF:	p. 8

SHORT ANSWER

	1.	What methods would help alleviate the problems associated with access to health care? (Choose all that apply.)
1. Provide transportation to prenatal visits.
2. Provide child care so that a pregnant mother may attend prenatal visits.
3. Mandate that physicians make house calls.
4. Provide low-cost or no-cost health care insurance.
5. Provide job training.

ANS:	
1, 2, 4
1, 2, 4. Correct. No transportation to visits, lack of child care, and no affordable health insurance are prohibitive factors associated with lack of prenatal care.
3. Incorrect. House calls are not a cost-effective approach to health care.
5. Incorrect. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy are remote.

PTS:	1	DIF:	Cognitive Level: Evaluation	REF:	p. 9 | p. 10