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The importance of recognizing barriers to healthcare access for pregnant women at a prenatal clinic, focusing on the issue of uninsurance and its impact on immunization recommendations and kidney function. It also covers various practices and considerations related to medications, blood pressure, and physical activity during pregnancy. Furthermore, it touches upon the topic of substance abuse screening and the need for inpatient management for pregnant women requiring withdrawal from alcohol.
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Chapter 01: 21st Century Maternity Nursing
MULTIPLE CHOICE
a. Diabetes mellitus. c. Chronic hypertension.
b. Mitral valve prolapse (MVP). d. Anemia.
The most frequently reported maternal medical risk factors are diabetes and hypertension associated with pregnancy. Both of these conditions are associated with maternal obesity. There are no studies that indicate MVP is among the most frequently reported maternal risk factors. Hypertension associated with pregnancy, not chronic hypertension, is one of the most frequently reported maternal medical risk factors. 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: 6
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
a. Situation, baseline assessment, response
b. Situation, background, assessment, recommendation
c. Subjective background, assessment, recommendation
d. Situation, background, anticipated recommendation
The situation, background, assessment, recommendation (SBAR) technique provides a specific framework for communication among health care providers. Failure to communicate is one of the major reasons for errors in health care. The SBAR technique has the potential to serve as a means to reduce errors.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 14
OBJ: Nursing Process: Assessment, Planning
MSC: Client Needs: Safe and Effective Care Environment
a. Providing care to patients directly at the bedside.
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b. Primarily hospital care of maternity patients.
c. Practice using an evidence-based approach.
d. Planning patient care to cover longer hospital stays.
Professional nurses are part of the team of health care providers who collaboratively care for patients throughout the childbearing cycle. Providing care to patients directly at the bedside is one of the nurses tasks; however, it does not encompass the concept of the evolved professional nurse. Throughout the prenatal period, nurses care for women in clinics and physicians offices and teach classes to help families prepare for childbirth. Nurses also care for childbearing families in birthing centers and in the home. Nurses have been critically important in developing strategies to improve the well-being of women and their infants and have led the efforts to implement clinical practice guidelines using an evidence-based approach. Maternity patients have experienced a decreased, rather than an increased, length of stay over the past 2 decades.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 1
OBJ: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
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.
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 a nutrition assessment 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 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 patient is to receive.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 6
OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance
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a. Use maternity jargon in order for the patient to become familiar with these terms.
b. Speak quickly and efficiently to expedite the visit.
c. Provide the patient with handouts.
d. Assess whether the patient understands the discussion.
Nurses contribute to health literacy by using simple, common words; avoiding jargon; and evaluating whether the patient understands the discussion. Speaking slowly and clearly and focusing on what is important increase understanding. Most patient education materials are written at too high a level for the average adult and may not be useful for a client with limited English proficiency.
PTS: 1 DIF: Cognitive Level: Application REF: 5
OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance
a. Age. c. Educational level.
b. Minority status. d. Inability to pay.
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. Although adolescent pregnant clients statistically receive less prenatal care, age is not the most significant barrier. Significant disparities in morbidity and mortality rates exist for minority women; 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.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 5
OBJ: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
a. Designing research studies
b. Collecting data for other researchers
c. Identifying researchable problems
d. Seeking funding to support research studies
Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant
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mortality. 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. 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 this factor is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetric care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have demonstrated reliable, safe care for pregnant women.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 10
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
a. Replace conventional Western modalities of treatment.
b. Are used by only a small number of American adults.
c. Recognize the value of clients input into their health care.
d. Focus primarily on the disease an individual is experiencing.
Many popular alternative healing modalities offer human-centered care based on philosophies that recognize the value of the patients input and honor the individuals beliefs, values, and desires. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of American adults are seeking alternative and complementary health care options. Alternative healing modalities offer an holistic approach to health, focusing on the whole person, not just the disease.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 4
OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
a. She is Hispanic. c. The standards of care were not met.
b. She delivered a girl. d. She refused fetal monitoring.
Not meeting the standards of care is a legitimate factor for a case of negligence. The clients race is not a factor for a case of negligence. The infants gender is not a factor for a case of negligence. Although fetal monitoring is the standard of care, the client has the right to refuse treatment. This refusal is not a case for negligence; however, informed consent should be properly obtained, and the client should sign an against medical advice form for refusal of any treatment that is within the standard of care.
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a. A higher rate of obesity among pregnant women.
b. Limited access to technology.
c. Increased usage of health care services along with lower prices.
d. Homogeneity of the population.
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 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. Of the U.S. population, 16% is uninsured and has limited access to health care. Maternal morbidity and mortality are directly related to racial disparities.
PTS: 1 DIF: Cognitive Level: Analysis REF: 5
OBJ: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
a. Collegiality. c. Evaluation.
b. Ethics. d. Accountability.
Accountability refers to legal and professional responsibility for practice. Collegiality refers to a working relationship with ones colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes.
PTS: 1 DIF: Cognitive Level: Evaluation REF: 12
OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance
a. Violation of patient privacy and confidentiality.
b. Institutions and colleagues may be cast in an unfavorable light.
