Contents
Chapter 01: 21st Century Maternity Nursing ........................................................................................................................2
Chapter 02: Community Care: The Family and Culture................................................................................................... 15
Chapter 03: Assessment and Health Promotion ............................................................................................................... 24
Chapter 04: Reproductive System Concerns ...................................................................................................................... 40
Chapter 05: Infertility, Contraception, and Abortion ....................................................................................................... 60
Chapter 06: Genetics, Conception, and Fetal Development ........................................................................................... 77
Chapter 07: Anatomy and Physiology of Pregnancy ........................................................................................................ 92
Chapter 08: Nursing Care of the Family During Pregnancy ......................................................................................... 106
Chapter 09: Maternal and Fetal Nutrition ........................................................................................................................ 122
Chapter 10: Assessment of High Risk Pregnancy........................................................................................................... 138
Chapter 11: High Risk Perinatal Care: Preexisting Conditions ..................................................................................... 151
Chapter 12: High Risk Perinatal Care: Gestational Conditions .................................................................................... 170
Chapter 13: Labor and Birth Processes ............................................................................................................................ 190
Chapter 14: Pain Management............................................................................................................................................ 202
Chapter 15: Fetal Assessment During Labor ................................................................................................................... 218
Chapter 16: Nursing Care of the Family During Labor and Birth ............................................................................... 235
Chapter 17: Labor and Birth Complications .................................................................................................................... 257
Chapter 18: Maternal Physiologic Changes ...................................................................................................................... 273
Chapter 19: Nursing Care of the Family During the Postpartum Period ................................................................... 286
Chapter 20: Transition to Parenthood ............................................................................................................................... 299
Chapter 21: Postpartum Complications ............................................................................................................................ 314
Chapter 22: Physiologic and Behavioral Adaptations of the Newborn ...................................................................... 330
Chapter 23: Nursing Care of the Newborn and Family ................................................................................................ 348
Chapter 24: Newborn Nutrition and Feeding.................................................................................................................. 359
Chapter 25: The High Risk Newborn ............................................................................................................................... 375
Chapter 26: 21st Century Pediatric Nursing..................................................................................................................... 397
Chapter 27: Family, Social, Cultural, and Religious Influences on Child Health Promotion ................................... 403
Chapter 28: Developmental and Genetic Influences on Child Health Promotion.................................................... 411
Chapter 29: Communication, History, and Physical Assessment ................................................................................. 425
Chapter 30: Pain Assessment and Management in Children ......................................................................................... 443
Chapter 31: The Infant and Family.................................................................................................................................... 453
Chapter 32: The Toddler and Family................................................................................................................................. 473
Chapter 33: The Preschooler and Family ......................................................................................................................... 490
Chapter 34: The School-Age Child and Family ............................................................................................................... 502
Chapter 35: The Adolescent and Family........................................................................................................................... 517
Chapter 36: Impact of Chronic Illness, Disability, and End-of-Life Care for the Child and Family...................... 537
Chapter 37: Impact of Cognitive or Sensory Impairment on the Child and Family................................................. 553
Chapter 38: Family-Centered Care of the Child During Illness and Hospitalization ............................................... 570
1|Page
,Chapter 39: Pediatric Variations of Nursing Interventions ........................................................................................... 582
Chapter 40: Respiratory Dysfunction ................................................................................................................................ 602
Chapter 41: Gastrointestinal Dysfunction ........................................................................................................................ 619
Chapter 42: Cardiovascular Dysfunction .......................................................................................................................... 639
Chapter 43: Hematologic and Immunologic Dysfunction............................................................................................. 662
Chapter 44: Cancer ............................................................................................................................................................... 684
Chapter 45: Genitourinary Dysfunction ........................................................................................................................... 706
Chapter 46: Cerebral Dysfunction ..................................................................................................................................... 720
Chapter 47: Endocrine Dysfunction ................................................................................................................................. 739
Chapter 48: Musculoskeletal or Articular Dysfunction .................................................................................................. 753
Chapter 49: Neuromuscular or Muscular Dysfunction .................................................................................................. 768
Chapter 01: 21st Century Maternity Nursing
MULTIPLE CHOICE
1. When providing care for a pregnant woman, the nurse should be aware that one of the most frequently
reported maternal medical risk factors is:
a. Diabetes mellitus. c. Chronic hypertension.
b. Mitral valve prolapse (MVP). d. Anemia.
ANS: A
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
2. To ensure optimal outcomes for the patient, the contemporary maternity nurse must incorporate both
teamwork and communication with clinicians into her care delivery, The SBAR technique of communication is
an easy-to-remember mechanism for communication. Which of the following correctly defines this acronym?
a. Situation, baseline assessment, response
b. Situation, background, assessment, recommendation
c. Subjective background, assessment, recommendation
d. Situation, background, anticipated recommendation
ANS: B
2|Page
,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
3. The role of the professional nurse caring for childbearing families has evolved to emphasize:
a. Providing care to patients directly at the bedside.
b. Primarily hospital care of maternity patients.
c. Practice using an evidence-based approach.
d. Planning patient care to cover longer hospital stays.
ANS: C
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
4. 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 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
3|Page
, 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
5. During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-
old Hispanic patient with limited English proficiency. It is important for the nurse to:
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.
ANS: D
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
6. 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 womans:
a. Age. c. Educational level.
b. Minority status. d. Inability to pay.
ANS: D
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
7. What is the primary role of practicing nurses in the research process?
a. Designing research studies
4|Page
