Class 1 & 2

trends of today:

_______ rate of cesarean delivers.

______ rate of forceps/vacuum delivers.

_______ rates of induction.

increased.

high.

increased.

induction

Labor induction — also known as inducing labor — is prompting the uterus to contract during pregnancy before labor begins on its own for a vaginal birth.

some trends

\-Multiple births have steadily increased \n -Preterm birth rates have steadily increased \n -Increased rate of STI’s \n - Increased rate of infertility \n

An Indigenous woman is pregnant with her first child. Which evidence-informed intervention 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, not a midwife.
4. Explain to the woman the importance of keeping her prenatal care appointments

Explain to the woman the importance of keeping her prenatal care appointments.

culture humility

A personal lifelong commitment to self-evaluation and self-critique whereby the individual not only learns about another's culture, but one starts with an examination of her/his own beliefs and cultural identities.

key components of practicing cultural humility

* Recognize disparity between one’s own culture and the clients
* Educate and promote healthy behaviors in a cultural context
* Apply abstract knowledge about other cultures in a practical way to enhance quality of care


* Communicate respectfulness for non-traditional healing practices and alternative therapies


* Recognize the importance of cultural uniqueness (communication style, problem-solving technique, concepts of space and time, involvement with care decisions)
* Anticipate the need to address individual literacy and language ability as well as barriers to care

Which is a characteristic of integrative healing?


1. It replaces conventional Western modalities of treatment.
2. It is used by only a small number of Canadian adults.
3. It recognizes the value of patients’ input into their health care.
4. It focuses primarily on the disease an individual is experiencing.

It recognizes the value of patients’ input into their health care.

integrative healing

blends complementary and alternative therapies with conventional western treatment

A married couple lives in a single-family house with their newborn son and the husband’s daughter from a previous marriage. Which family form best describes this family?


1. Blended family
2. Extended family
3. Nuclear family
4. Same-sex family

blended family

nuclear family

a family with a male and female partner along with children resulting from that union.

When planning interventions for diverse families, you realize that acceptance of the interventions will be most influenced by which factor?


1. Educational achievement
2. Income level
3. Subcultural group
4. Individual beliefs

individual beliefs

\# of live births in one year per 1000 population

birth rate

\# of births per woman aged 15 – 44 (inclusive), calculated on a yearly basis.

fertility rate

number of deaths of infants under 1 year of age per 1000 live births

infant mortality rate

maternal morbidity

Measure of maternal health complicated by gestational or pre-existing conditions.
• Results in a high risk pregnancy
• Includes conditions such as hypertension, diabetes and anemia, preeclampsia, pulmonary edema, postpartum hemorrhage etc.......

maternity mortality rate

number of maternal deaths occurring during pregnancy, childbirth or the puerperium (first 42 days after termination of a pregnancy) per 100 000 live births

Which characteristic is reflective of cultural safety?


1. Maximizing respectful relationships with diverse populations
2. Examining one's own values and beliefs of various cultures
3. Process and outcome to promote greater health equity
4. Valuing diversity and inclusivity

Process and outcome to promote greater health equity

genogram

depicts the relationship of family members over generations

which term describes the process by which people retain some of their own culture while adopting the practices of the dominant society?

a. acculturation

b. assimilation

c. ethnocentrism

d. cultural relativism

acculturation

Assimilation

a loss of cultural identity

Ethnocentrism

is the belief in the superiority of one’s own culture over the cultures of others

cultural relativism

recognizes the roles of different cultures

Which should the nurse do when using an interpreter to communicate with a patient who speaks a different language?


1. Respond promptly and positively to project authority.
2. Never use a family member as an interpreter.
3. Talk directly to the patient when communicating.
4. Involve the family in all communication.

talk directly to the patient when communicating

which topic would be appropriate for the nurse to explore to gather info related to cultural expectations about childbirth?

a. marital status

b. people present during labour

c. food intake during hospitalization

d. fears about being hospitalized

people present during labour

Which medical risk factor contributes to a higher infant mortality rate?


1. Diabetes mellitus
2. Mitral valve prolapse (MVP)
3. Chronic hypertension
4. Anemia

chronic hypertension

which woman would be at most risk for poorest perinatal outcome?

a. 25 y old single mom on maternity leave with 2 existing childern

b. an unemployed 32 y old lawyer in an inner city neighbourhood

c. an indigenous woman in her mid 20s with no high school education

d. a 19 y old college studnet who lives at home with her parents

c

An Indigenous woman is pregnant with her first child. Based on the statistics for infant mortality, which intervention 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, not a midwife.
4. Explain to the woman the importance of keeping her prenatal care appointments.

4

Which have contributed to decreasing maternity-related health care costs?


1. Prolonged postpartum hospital stays
2. Portable care technology
3. The reduction in acceptable genetic screening options
4. Rural health services outreach clinics

portable care technology

Which is the leading cause of maternal death?


1. Hypertension
2. Obesity
3. Gestational diabetes
4. Hemorrhage

hemorrhage

Which recent trend in childbirth practices in Canada is accurate?


1. Older women tend not to seek prenatal care.
2. Indigenous women have a decreased incidence of perinatal mood disorders.
3. The majority of births occurred in the hospital.
4. Immigrant and refugee women have a lower rate of chronic disease.

3

what trend has a + impact on the infant mortality rate?

a. delayed second stage pushing is discouraged in labour

b. episiotomy rates are increasing

c. midwives perform more episiotomies than physicians

d. newborn infants remain with the mother and are encouraged to breastfeed

d

what is a doula

a trained and experienced female labour attendant (may provide continuous and one on one caring presence throughout the labour and birth

Which is the correct definition of the perinatal mortality rate?


1. Number of live births in 1 year per 1000 population
2. Number of deaths of infants under 1 year of age per 1000 live births
3. Number of deaths of infants under 28 days of age per 1000 live births

. 4. Number of stillbirths and neonatal deaths per 1000 live births

4

What should nurses be aware of concerning the use and misuse of legal drugs or substances?


1. Although cigarette smoking causes a number of health problems, it has little direct

effect on maternity-related health.
2. About 75% of women age 15 and older report alcohol consumption.
3. Coffee is a stimulant that can interrupt body functions and has been related to birth

defects.
4. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus;

otherwise, they would not have been prescribed.

2

1\. The nurse caring for the newly pregnant woman would advise her that ideally prenatal care should begin at what time?


1. Prenatal care should begin before the first missed menstrual period.
2. Prenatal care should begin after the first missed menstrual period.
3. Prenatal care should begin after the second missed menstrual period.
4. Prenatal care should begin after the third missed menstrual period.

2

\
2\. A woman arrives at the clinic for a pregnancy test. The first day of her last menstrual period (LMP) was February 14, 2012. What would be her baby's expected date of birth (EDB)?


1. May 21, 2012
2. November 7, 2013
3. November 21, 2012
4. May 2, 2013

\

3. \

3\. For which women would prenatal testing for the human immunodeficiency virus (HIV) be recommended?


1. All women, regardless of risk factors
2. A woman who has had more than one sexual partner
3. A woman who has had a sexually transmitted infection
4. A woman who is monogamous with her partner

\

1

Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider?


1. Nausea with occasional vomiting
2. Fatigue
3. Urinary frequency
4. Vaginal bleeding

4

\
5\. A pregnant woman at 10 weeks of gestation jogs three or four times per week. Which is true about exercise during pregnancy?


1. There is no need to modify exercise regimes at any time during pregnancy.
2. Exercising is contraindicated during the third trimester of pregnancy.
3. Exercise routines may need to be modified as pregnancy progresses.
4. Walking is recommended during pregnancy, not jogging.

\n

3

6\. Which blood pressure (BP) finding during the second trimester indicates a risk for hypertension?


1. Baseline BP 120/80, current BP 126/85
2. Baseline BP 100/70, current BP 140/90
3. Baseline BP 140/85, current BP 130/80
4. Baseline BP 110/60, current BP 110/60

\

ANS: 2 \n A systolic BP (SBP) of 140 mm Hg or more and a diastolic BP (DBP) of 90 mm Hg or more, based on the average of at least two measurements, suggest the presence of hypertension. A slight increase in BP of 126/85 does not meet the criteria for concern. Although the baseline BP is worrisome (an absolute systolic BP of 140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher suggests hypertension), the subsequent pressures have decreased, not increased. The BP of 110/60 is within normal limits for both values and is not a concern.

Which is a danger sign of pregnancy at 32 weeks of gestation?

1\. Constipation

\

2. Alteration in the pattern of fetal movement
3. Heart palpitations
4. Edema in the ankles and feet at the end of the day

2

9. A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. What should the nurse recommend to the woman?
a. Do Kegel exercises.
b. Do pelvic rock exercises.
c. Use a softer mattress.
d. Stay in bed for 24 hours.

ANS: B Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain. Stretching and other exercises to relieve back pain should be performed several times a day.

10\. For which reason would breastfeeding be contraindicated?

a. A woman has hepatitis b

b.A woman has everted nipples.

c. A woman has a history of breast cancer 3 years ago. \n d. A woman is human immunodeficiency virus (HIV) positive.

d

Which behaviour indicates that a woman is “seeking safe passage” for herself and her infant?


1. She keeps all prenatal appointments.
2. She “eats for two.”
3. She drives her car slowly.
4. She wears only low-heeled shoes.

1

A 3-year-old girl’s mother is 6 months pregnant. What concern is this child likely to express?


1. How the baby will “get out”
2. What the baby will eat
3. Whether her mother will die
4. What colour eyes the baby has

\

\
ANS: 2 \n By age 3 or 4, children like to be told the story of their own beginning and accept its comparison with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby move. Sometimes they worry about how the baby is being fed and what it wears. School-age children take a more clinical interest in their mother’s pregnancy and may want to know, “How did the baby get in there?” and “How will it get out?” Whether the mother will die does not tend to be the focus of a child’s questions about the impending birth of a sibling. The baby’s eye colour does not tend to be the focus of children’s questions about the impending birth of a sibling.

What type of cultural concern is the most likely deterrent to many women seeking prenatal care?


1. Religion
2. Modesty
3. Ignorance
4. Belief that physicians are evil

2

Which statement about pregnancy is accurate?


1. A normal pregnancy lasts about 10 lunar months.
2. A trimester is one third of a year.
3. The prenatal period extends from fertilization to conception.
4. The estimated date of confinement (EDC) is how long the mother is on bedrest.

1