Chapter 1: 21st Century Maternity and Women’s Health Nursing

MULTIPLE CHOICE

1. In evaluating the level of a pregnant womans risk of having a low-birth-weight (LBW) infant, 

which factor is the most important for the nurse to consider?

a. African-American race

b. Cigarette smoking

c. Poor nutritional status

d. Limited maternal education

ANS: A

For African-American births, the incidence of LBW infants is twice that of Caucasian births. 

Race is a nonmodifiable risk factor. Cigarette smoking is an important factor in potential infant 

mortality rates, but it is not the most important. Additionally, smoking is a modifiable risk factor. 

Poor nutrition is an important factor in potential infant mortality rates, but it is not the most 

important. Additionally, nutritional status is a modifiable risk factor. Maternal education is an 

important factor in potential infant mortality rates, but it is not the most important. Additionally, 

maternal education is a modifiable risk factor.

DIF: Cognitive Level: Understand REF: IM:

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance, Antepartum Care

2. What is the primary role of practicing nurses in the research process?

a. Designing research studies

b. Collecting data for other researchers

c. Identifying researchable problems

d. Seeking funding to support research studies

ANS: C

When problems are identified, research can be properly conducted. Research of health care 

issues leads to evidence-based practice guidelines. Designing research studies is only one factor 

of the research process. Data collection is another 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: Understand REF: im: 14 TOP: Nursing Process: N/A 

MSC: Client Needs: Safe and Effective Care Environment

3. A 23-year-old African-American woman is pregnant with her first child. Based on the 

statistics for infant mortality, which plan 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 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 client 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, then her health care may need to be provided by a physician. However, it cannot be 

assumed that all African-American 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, and it is not appropriate for a nurse to advise or manage the type of care a client is to 

receive.

DIF: Cognitive Level: Understand REF: IM: TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

4. During a prenatal intake interview, the nurse is in the process of obtaining an initial 

assessment of a 21-year-old Hispanic client with limited English proficiency. Which action is the 

most important for the nurse to perform?

a. Use maternity jargon to enable the client to become familiar with these terms.

b. Speak quickly and efficiently to expedite the visit.

c. Provide the client with handouts.

d. Assess whether the client understands the discussion.

ANS: D

Nurses contribute to health literacy by using simple, common words, avoiding jargon, and 

evaluating whether the client understands the discussion. Speaking slowly and clearly and 

focusing on what is important will increase understanding. Most client education materials are 

written at a level too high for the average adult and may not be useful for a client with limited 

English proficiency.

DIF: Cognitive Level: Apply REF: im: 5 TOP: Nursing Process: Evaluation 

MSC: Client Needs: Health Promotion and Maintenance

5. The nurses working at a newly established birthing center have begun to compare their 

performance in providing maternal-newborn care against clinical standards. This comparison 

process is most commonly known as what?

a. Best practices network

b. Clinical benchmarking

c. Outcomes-oriented practice

d. Evidence-based practice 

ANS: C

Outcomes-oriented practice measures the effectiveness of the interventions and quality of care 

against benchmarks or standards. The term best practice refers to a program or service that has 

been recognized for its excellence. Clinical benchmarking is a process used to compare ones own 

performance against the performance of the best in an area of service. The term evidence-based 

practice refers to the provision of care based on evidence gained through research and clinical 

trials.

DIF: Cognitive Level: Understand REF: im: 11 TOP: Nursing Process: Evaluation 

MSC: Client Needs: Safe and Effective Care Environment

6. Which statement best exemplifies contemporary maternity nursing?

a. Use of midwives for all vaginal deliveries

b. Family-centered care

c. Free-standing birth clinics

d. Physician-driven care

ANS: B

Contemporary maternity nursing focuses on the familys needs and desires. Fathers, partners, 

grandparents, and siblings may be present for the birth and participate in activities such as 

cutting the babys umbilical cord. Both midwives and physicians perform vaginal deliveries. 

Free-standing clinics are an example of alternative birth options. Contemporary maternity 

nursing is driven by the relationship between nurses and their clients.

DIF: Cognitive Level: Understand REF: pp. 8-9 TOP: Nursing Process: Planning 

MSC: Client Needs: Health Promotion and Maintenance

7. A 38-year-old Hispanic woman vaginally delivered a 9-pound, 6-ounce baby girl after being in 

labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the woman 

have a legitimate legal case for negligence?

a. Inexperienced maternity nurse was assigned to care for the client.

b. Client was past her due date by 3 days.

c. Standard of care was not met.

d. Client refused electronic fetal monitoring.

ANS: C

Not meeting the standard of care is a legitimate factor for a case of negligence. An inexperienced 

maternity nurse would need to display competency before being assigned to care for clients on 

his or her own. This client may have been past her due date; however, a term pregnancy often 

goes beyond 40 weeks of gestation. Although fetal monitoring is the standard of care, the client 

has the right to refuse treatment. This refusal is not a case for negligence, but informed consent 

should be properly obtained, and the client should have signed an against medical advice form 

when refusing any treatment that is within the standard of care.

DIF: Cognitive Level: Analyze REF: im: 13 

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

8. When the nurse is unsure how to perform a client care procedure that is high risk and low 

volume, his or her best action in this situation would be what?

a. Ask another nurse.

b. Discuss the procedure with the clients physician.

c. Look up the procedure in a nursing textbook.

d. Consult the agency procedure manual, and follow the guidelines for the 

procedure.

ANS: D

Following the agencys policies and procedures manual is always best when seeking information 

on correct client procedures. These policies should reflect the current standards of care and the 

individual states guidelines. Each nurse is responsible for his or her own practice. Relying on 

another nurse may not always be a safe practice. Each nurse is obligated to follow the standards

of care for safe client care delivery. Physicians are responsible for their own client care activity. 

Nurses may follow safe orders from physicians, but they are also responsible for the activities 

that they, as nurses, are to carry out. 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 the individual state or hospital policies.

DIF: Cognitive Level: Understand REF: im: 13

TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

9. The National Quality Forum has issued a list of never events specifically pertaining to 

maternal and child health. These include all of the following except:

a. infant discharged to the wrong person.

b. kernicterus associated with the failure to identify and treat hyperbilirubinemia.

c. artificial insemination with the wrong donor sperm or egg.

d. foreign object retained after surgery.

ANS: D

Although a foreign object retained after surgery is a never event, it does not specifically pertain 

to obstetric clients. A client undergoing any type of surgery may be at risk for this event. An 

infant discharged to the wrong person specifically pertains to postpartum care. Death or serious 

disability as a result of kernicterus pertains to newborn assessment and care. Artificial 

insemination affects families seeking care for infertility.

DIF: Cognitive Level: Remember REF: im: 4 

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

10. A nurse caring for a pregnant client should be aware that the U.S. birth rate shows what 

trend?

a. Births to unmarried women are more likely to have less favorable outcomes.

b. Birth rates for women 40 to 44 years of age are declining.

c. Cigarette smoking among pregnant women continues to increase.

d. Rates of pregnancy and abortion among teenagers are lower in the United States 

than in any other industrialized country.

ANS: A

LBW infants and preterm births are more likely because of the large number of teenagers in the 

unmarried group. Birth rates for women in their early 40s continue to increase. Fewer pregnant 

women smoke. Teen pregnancy and abortion rates are higher in the United States than in any 

other industrial country.

DIF: Cognitive Level: Understand REF: IM:

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

11. A recently graduated nurse is attempting to understand the reason for increasing health care 

spending in the United States. Which information gathered from her research best explains the 

rationale for these higher costs compared with other developed countries?

a. Higher rate of obesity among pregnant women

b. Limited access to technology

c. Increased use of health care services along with lower prices

d. Homogeneity of the population

ANS: A

Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.4% of the 

gross domestic product is spent on health care. Higher spending in the United States, as 

compared with 12 other industrialized countries, is related to higher prices and readily accessible 

technology along with greater obesity rates among women. More than one third of women in the 

United States are obese. In the population in the United States, 16% are uninsured and have

limited access to health care. Maternal morbidity and mortality are directly related to racial 

disparities.

DIF: Cognitive Level: Understand REF: im: 5 TOP: Nursing Process: N/A 

MSC: Client Needs: Safe and Effective Care Environment

12. Which statement best describes maternity nursing care that is based on knowledge gained 

through research and clinical trials?

a. Maternity nursing care is derived from the Nursing Intervention Classification.

b. Maternity nursing care is known as evidence-based practice.

c. Maternity nursing care is at odds with the Cochrane School of traditional nursing.

d. Maternity nursing care is an outgrowth of telemedicine.

ANS: B

Evidence-based practice is based on knowledge gained from research and clinical trials. The 

Nursing Intervention Classification is a method of standardizing language and categorizing care. 

Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice 

movement. Telemedicine uses communication technologies to support health care.

DIF: Cognitive Level: Understand REF: pp. 10-11 TOP: Nursing Process: Diagnosis 

MSC: Client Needs: Safe and Effective Care Environment

13. What is the minimum level of practice that a reasonably prudent nurse is expected to 

provide?

a. Standard of care

b. Risk management

c. Sentinel event

d. Failure to rescue 

ANS: A

Guidelines for standards of care are published by various professional nursing organizations. 

Risk management identifies risks and establishes preventive practices, but it does not define the 

standard of care. Sentinel events are unexpected negative occurrences. They do not establish the 

standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the 

standard of care.

DIF: Cognitive Level: Remember REF: im: 13 

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment