Chapter 01: Contemporary Perinatal and Pediatric Nursing in Canada
Perry: Maternal Child Care Nursing in Canada, 2nd Canadian Edition

MULTIPLE CHOICE

	1.	Which is true regarding perinatal nurses?
a.	They provide care for only mothers and babies.	
b.	They require advanced practice education beyond an entry to practice degree.	
c.	They work with women and families from preconception throughout the child-bearing year.	
d.	They provide care for families with children up to age 18 years.	

ANS:	C
Perinatal nurses are those nurses who work collaboratively with women and families from the preconception period throughout the child-bearing year. Pediatric nurses care for children from birth up to age 18 years. Perinatal or pediatric nurses also provide care for the family. Perinatal nurses often do have advanced education, but this is not a requirement.

DIF:	Cognitive Level: Knowledge	REF:	p. 3	
OBJ:	Nursing Process: Assessment

	2.	Which is true regarding pediatric nurses?
a.	They provide care for children up to and including 13 years of age.	
b.	They require advanced practice education beyond an entry to practice degree.	
c.	They work with women and families throughout the child-bearing year.	
d.	They provide care for children and families up to age 18 years.	

ANS:	D
Pediatric nurses care for children from birth up to age 18 years. Perinatal nurses are those nurses who work collaboratively with women and families from the preconception period throughout the child-bearing year. Perinatal and pediatric nurses also provide care for the family. Pediatric nurses often do have advanced education, but this is not a requirement.

DIF:	Cognitive Level: Analysis	REF:	p. 3	
OBJ:	Nursing Process: Assessment

	3.	According to the Institute of Safe Medication Practices Canada (ISMP) “Do Not Use” list, which is correct?
a.	Administer heparin 100 U S/C QID	
b.	Administer insulin 7 units OD	
c.	Administer polysporin gtts to both eyes daily	
d.	Administer 5 cc heparin into saline lock daily	

ANS:	C
Polysporin gtts to both eyes daily is correct. Units should be written out and not abbreviated as “U”; S/C should be “SUBCUT”; OD should be written out as “daily”; and “cc” is not to be used, but “mL” is to be used for volume measurements.

DIF:	Cognitive Level: Application	REF:	p. 10 | Table 1-2	
OBJ:	Nursing Process: Implementation

	4.	An Indigenous woman is pregnant with her first child. Which evidence-informed intervention is most important for the nurse to implement?
a.	Perform a nutrition assessment.	
b.	Refer the woman to a social worker.	
c.	Advise the woman to see an obstetrician, not a midwife.	
d.	Explain to the woman the importance of keeping her prenatal care appointments.	

ANS:	D
Consistent prenatal care is associated with healthier infants. 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 her pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, her health care may need to be provided by a physician. However, it cannot be assumed that all Indigenous women have high-risk issues. In addition, advising the woman to see an obstetrician is not the most important aspect on which the nurse should focus at this time.

DIF:	Cognitive Level: Application	REF:	p. 8	OBJ:	Nursing Process: Planning

	5.	Which social determinant of health has the greatest influence on health status and behaviours?
a.	Education and literacy	
b.	Income and social status	
c.	Employment and working conditions	
d.	Biology and genetic endowment	

ANS:	B
Income and social status has the greatest influence on health status and behaviours and use of health care services. Lower-income Canadians have poorer health, with more chronic illness and earlier death, than that of higher-income Canadians, regardless of age, gender, culture, race, or residence.

DIF:	Cognitive Level: Application	REF:	p. 5 | Table 1-1	
OBJ:	Nursing Process: Evaluation

	6.	Which is an example of invisible poverty?
a.	Insufficient clothing	
b.	Limited employment opportunities	
c.	Poor sanitation	
d.	Deteriorating housing	

ANS:	B
Invisible poverty refers to social and cultural deprivation, such as limited employment opportunities, inferior educational opportunities, lack of or inferior medical services and health care facilities, and an absence of public services. Visible poverty refers to lack of money or material resources, which includes insufficient clothing, poor sanitation, and deteriorating housing.

DIF:	Cognitive Level: Knowledge	REF:	p. 4	
OBJ:	Nursing Process: Assessment

	7.	What is the primary role of practicing nurses in the research process?
a.	Designing research studies	
b.	Collecting data for other researchers	
c.	Identifying areas for further research	
d.	Seeking funding to support research studies	

ANS:	C
The primary role of the practicing nurse is to identify areas for further research in the health and health care of women, children, and families. When problems are identified, research can be conducted properly. Research of health care issues leads to evidence-informed practice guidelines. Designing research studies is only one factor of the research process. Data collection is one factor of research. Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.

DIF:	Cognitive Level: Comprehension	REF:	p. 8	
OBJ:	Nursing Process: Implementation

	8.	Which event shifted the focus of the Public Health Agency of Canada (PHAC) away from a population health and health promotion focus?
a.	Shift to home births	
b.	Emergence of avian influenza	
c.	United Nations Millennium Goals	
d.	Increase in the maternal mortality rate	

ANS:	B
The emergence of the avian influenza shifted the focus of the PHAC from population health and a health promotion focus to a focus on planning for a pandemic. There has been no shift to home births from hospital births in Canada. The United Nations Millennium Goals did not cause a focal shift for the PHAC. There has not been an increase in the maternal mortality rate.

DIF:	Cognitive Level: Comprehension	REF:	p. 4	
OBJ:	Nursing Process: Implementation

	9.	It is estimated that there are approximately how many homeless people in Canada?
a.	100 000	
b.	200 000	
c.	500 000	
d.	1 000 000	

ANS:	B
It is estimated that there is approximately 200 000 homeless people in Canada in any given year.

DIF:	Cognitive Level: Knowledge	REF:	p. 6	
OBJ:	Nursing Process: Assessment

	10.	Which is a characteristic of integrative healing?
a.	It replaces conventional Western modalities of treatment.	
b.	It is used by only a small number of Canadian adults.	
c.	It recognizes the value of patients’ input into their health care.	
d.	It focuses primarily on the disease an individual is experiencing.	

ANS:	C
Integrative healing encompasses complementary and alternative therapies and healing modalities that offer human-centred care based on philosophies that recognize the value of the patient’s input and honor the individual’s beliefs, values, and desires. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of Canadian adults are seeking alternative and complementary health care options. Alternative healing modalities offer a holistic approach to health, focusing on the whole person, not just the disease.

DIF:	Cognitive Level: Comprehension	REF:	p. 7	OBJ:	Nursing Process: Planning

	11.	Which was highlighted in the Truth and Reconciliation Report (2015)?
a.	Increased transportation for Indigenous people to travel to tertiary care centers for health care	
b.	Recognize the value of Indigenous healing practices and their use in the health care system	
c.	Treat health concerns of Indigenous people with Western ways of healing	
d.	Educate health care providers about Indigenous healing practices to eliminate the role of the Elder	

ANS:	B
The TRC (2015) final report calls on health care providers to recognize the value of Indigenous healing practices and to use them in the treatment of Indigenous patients in collaboration with Indigenous healers and Elders where requested by Indigenous patients. It is imperative that health care providers become knowledgeable in Indigenous healing practices, not to eliminate the role of the Elder but to work collaboratively with Elders. Health care services need to be available where Indigenous people work and live and not require increased transportation to tertiary care centres for health care.

DIF:	Cognitive Level: Comprehension	REF:	p. 6	OBJ:	Nursing Process: Planning

	12.	Which has directly increased the life expectancy of children experiencing a chronic disease?
a.	Early postpartum discharges	
b.	Enhanced technology	
c.	The reduction in acceptable genetic screening options	
d.	Rural health services delivered via telehealth	

ANS:	B
Enhanced technology has increased the life expectancy of many children with chronic diseases. Early postpartum discharges and genetic screening options have not increased the life expectancy of children with chronic disease. Rural health services delivered via telehealth are altering how services are delivered and may indirectly increase life expectancy, but it is not a direct contributing factor.

DIF:	Cognitive Level: Analysis	REF:	p. 7	
OBJ:	Nursing Process: Implementation

	13.	Which is the focus of the Code of Ethics for Registered Nurses?
a.	Collegiality	
b.	Dependent role	
c.	Evaluation	
d.	Accountability	

ANS:	D
The Code of Ethics for Registered Nurses, by the Canadian Nurses Association (CNA), provides the framework and core responsibilities for nursing practice. The Code of Ethics focuses on the nurse’s accountability and responsibility to the patient (CNA, 2008) and emphasizes the nursing role as an independent professional, one that upholds its own legal liability. Collegiality refers to a working relationship with one’s colleagues. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes.

DIF:	Cognitive Level: Evaluation	REF:	p. 11	OBJ:	Nursing Process: Evaluation

	14.	Which reflects a future goal for perinatal and pediatric nursing?
a.	Limiting multiprofessional teams	
b.	Maintaining existing power structures	
c.	Advocating for an increased number of Caesarean births	
d.	Addressing health inequities by engaging in policy analysis and advocacy	

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 multiprofessional 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.

DIF:	Cognitive Level: Knowledge	REF:	p. 4	
OBJ:	Nursing Process: Implementation

	15.	Which statement is true related to integrative healing?
a.	Its aim is to provide the same health care for all racial and ethnic groups.	
b.	It blends complementary and alternative therapies with conventional Western treatment.	
c.	It focuses on the disease or condition rather than the background of the patient.	
d.	It has been mandated by Health Canada.	

ANS:	B
Integrative healing tries to mix the old with the new at the discretion of the patient and health care providers. Integrative healing is a blending of new and traditional practices and focuses on the whole person, not just the disease or condition. Health Canada supports complementary and alternative therapies but does not mandate them.

DIF:	Cognitive Level: Application	REF:	p. 7	
OBJ:	Nursing Process: Implementation

	16.	Which is an accurate statistic related to Indigenous people in Canada?
a.	There are approximately half a million Indigenous people in Canada.	
b.	Indigenous people comprise approximately 2% of the total Canadian population.	
c.	The Indigenous population is increasing at a slower rate than non-Indigenous populations.	
d.	Children 14 years and under comprise approximately 28% of the total Indigenous population.	

ANS:	D
Indigenous children aged 14 and under made up 28% of the total Indigenous population and 7% of all children in Canada. There are approximately 1.4 million Indigenous people in Canada and they comprise 4.3% of the total Canadian population. The Indigenous population increased by 20% compared with 5.2% for the non-Indigenous population.

DIF:	Cognitive Level: Knowledge	REF:	p. 6	OBJ:	Nursing Process: Planning

	17.	Approximately what percentage of hospitalized patients experience an adverse event?
a.	2.5%	
b.	5%	
c.	7.5%	
d.	10%	

ANS:	C
According to the Canadian Adverse Events Study (Baker et al., 2004), the most quoted study in Canada regarding medical errors, 7.5% of hospitalized patients had an adverse event, and of these, 16% died as a result.

DIF:	Cognitive Level: Knowledge	REF:	p. 9	OBJ:	Nursing Process: Planning

	18.	What does the “A” in the SBAR technique for communication represent?
a.	Awareness	
b.	Accountability	
c.	Accessibility	
d.	Assessment	

ANS:	D
The situation-background-assessment-recommendation (SBAR) technique gives a specific framework for communication among health care providers; the “A” represents assessment.

DIF:	Cognitive Level: Comprehension	REF:	p. 9	
OBJ:	Nursing Process: Planning | Nursing Process: Implementation	

	19.	Which is a United Nations Millennium Development Goal?
a.	Safe, compassionate, and competent care	
b.	Improve family health	
c.	Reduce child morbidity	
d.	Ensure environmental sustainability	

ANS:	D
One of the eight United Nations Millennium Development Goals is to ensure environmental sustainability. Safe, compassionate care is included in the Code of Ethics for RNs. The Millennium Development Goals include improving maternal health and reducing child mortality.

DIF:	Cognitive Level: Knowledge	REF:	p. 11 | Box 1-3		
OBJ:	Nursing Process: Assessment

	20.	Which statement is true of nursing care that is based on knowledge gained through various forms and sources of information?
a.	An outgrowth of telemedicine	
b.	Known as evidence-informed practice	
c.	Exclusive to maternity nursing practice	
d.	At odds with the Cochrane Pregnancy and Childbirth Database	

ANS:	B
Evidence-informed practice (EIP) is the collection, interpretation, and integration of valid, important, and applicable patient-reported, nurse-observed, and research-derived information. Evidence-informed practice is practised within all disciplines of nursing and is not exclusive to maternity nursing practice. The Cochrane Pregnancy and Childbirth Database is based on systematically reviewed research trials and is part of the evidence-informed practice movement. Telemedicine uses communication technologies to support health care.

DIF:	Cognitive Level: Comprehension	REF:	p. 8	
OBJ:	Nursing Process: Assessment

	21.	Which is a principle of the Canada Health Act?
a.	Justice	
b.	Universality	
c.	Health and well-being	
d.	Informed decision making	

ANS:	B
Universality is one of the five principles of the Canada Health Act. Justice is a guiding principle for perinatal and pediatric nursing in Canada. Informed decision making is a guiding principle for perinatal and pediatric nursing in Canada. Health and well-being is a guiding principle for perinatal and pediatric nursing in Canada.

DIF:	Cognitive Level: Knowledge	REF:	p. 4	
OBJ:	Nursing Process: Assessment

	22.	Which is true of the Muskoka Accord?
a.	It focused on a commitment to increase global health across the lifespan.	
b.	It provided assistance in developing countries to address health inequities with mothers and infants.	
c.	It expressed an international commitment to develop a global partnership for development of future health care goals.	
d.	It was a strategy to promote gender equality and empower women in health care decisions.	

ANS:	B
In 2010, with the signature of the Muskoka Accord, the Canadian government promised to assist developing countries in addressing health inequities that affect mothers and infants.

DIF:	Cognitive Level: Knowledge	REF:	p. 11	
OBJ:	Nursing Process: Assessment

	23.	The obligation to minimize or prevent harm is which ethical principle?
a.	Autonomy	
b.	Nonmaleficence	
c.	Beneficence	
d.	Justice	

ANS:	B
Nonmaleficence is the obligation to minimize or prevent harm. Autonomy is the patient’s right to be self-governing; beneficence is the obligation to promote the patient’s well-being; and justice is the concept of fairness.

DIF:	Cognitive Level: Comprehension	REF:	p. 11	OBJ:	Nursing Process: Planning

MULTIPLE RESPONSE

	1.	Which abbreviations are included on the ISMP “Do Not Use” list? Select all that apply. Express answer in small letters, with a comma followed by a space—e.g., a, b, c, d.
a.	OD	
b.	mcg	
c.	mL	
d.	D/C	
e.	U	
f.	IU	
g.	cc	

ANS:	A, D, E, F, G
The following are not to be used: U, IU, OD, QOD, OS, OD, OU, D/C, μg, and cc. Acceptable abbreviations to use include mcg and mL.

DIF:	Cognitive Level: Knowledge	REF:	p. 10 | Table 1-2	
OBJ:	Nursing Process: Assessment

	2.	Which are included in the International Nurse Regulator Collaborative 6 P’s for social media use? Select all that apply. Express answer in small letters, followed by a comma and a space—e.g., a, b, c, d.
a.	Positive	
b.	Pause	
c.	Probability	
d.	Purpose	
e.	Privacy	
f.	Performance	
g.	Professional	

ANS:	A, B, E, G
The 6 P’s of social media use are professional, positive, patient/person-free, protect, privacy, and pause. Probability, purpose, and performance are not part of the 6 P’s as identified by the International Nurse Regulator Collaborative.

DIF:	Cognitive Level: Knowledge	REF:	p. 8 | Box 1-1		
OBJ:	Nursing Process: Implementation