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OB R&R ch 1(intro to maternity nursing) questions with answers
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OB R&R ch 1(intro to maternity nursing)questions with answers.
A client who is 38 weeks pregnant with a history of hypertension and proteinuria is admitted with severe
upper abdominal pain, nausea, and a persistent headache. The nurse notes an elevated blood pressure
(BP) on two readings 20 minutes apart. When notifying the physician 20 minutes after the second BP
reading, the nurse reported the elevated BP, abdominal pain, nausea, and inability to void. The nurse did
not report the client's headache, so the physician concluded the client had gastric disturbance from the
flu. Later, the client had a grand mal seizure. Why would the nurse be considered negligent in this
situation?
1. The nurse did not maintain clear, concise, and accurate documentation of the client's condition.
2. The nurse was not thorough in reporting assessment data to the physician.
3. The nurse did not develop a positive empowering relationship with the client.
4. The nurse told another nurse of not know ANS - Answer: 2
Rationale: Reporting all information gathered, such as the headache, may have heightened the
physician's concern about progressing preeclampsia. It is the nurse's responsibility to report all
information from an assessment. The nurse furthered the negligence by not recognizing all the signs of
preeclampsia, an accepted standard of maternal-newborn practice, but the immediate concern of this
situation was not reporting all information to the physician. There is no evidence that the nurse failed to
document correctly or develop a positive relationship with the client. Cognitive Level: Analyzing Client
Need: Management of Care Integrated Process: Nursing Process: Implementation Content Area:
Fundamentals Strategy: The focus of the question is reporting of assessment data. Only the correct
option addresses this nursing action. Critical words are headache and elevated BP and proteinuria, all
indicating preeclampsia. Knowledge of signs and symptoms of preeclampsia would eliminate all
incorrect options. Knowledge of the scope of practice and standards of care helps the nurse to practice
within legal parameters. Reference: Ricci, S. (2009). Essentials of maternity, newborn, and women's
health nursing (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins, pp. 545-549.
The newborn nursery nurse is working with a client who has given birth and is planning on placing the
infant for adoption. When considering the legal issues of this situation rather than the ethical aspects,
the nurse would look to which of the following?
1. Values and beliefs
2. Motives, attitudes, and culture
3. What is good for the individual
, 4. Rules and regulations ANS - Answer: 4
Rationale: The legal system is founded on rules and regulations that are external to oneself and that
guide society in a formal and binding manner. Ethical issues are subject to an individual's values, beliefs,
culture, and interpretation. What is good for a particular individual may vary from person to person,
while the law contains rules that guide all who are in the same situation. Cognitive Level: Applying Client
Need: Management of Care Integrated Process: Communication and Documentation Content Area:
Fundamentals Strategy: The three incorrect options are individually and internally focused. The legal
system is external to the nurse and only the correct option offers an external influence. Reference:
Ladewig, P., London, M., & Davidson, M. (2009). Contemporary maternal-newborn nursing care (7th
ed.). Upper Saddle River, NJ: Pearson Education, pp. 149-150.
An unlicensed assistant asks the maternal-newborn nurse why the nurse needs to sign a client's consent
form as a witness. The nurse responds that the signature affirms which of the following?
1. That the client agreeing to the procedure was the person who signed the consent.
2. That the client understood the information about the procedure before making a decision.
3. That the physician explained all components of the informed consent.
4. That the nurse explained all the components of the informed consent. ANS - Answer: 1
Rationale: A nurse signs the consent form as witness to the client's signature. The nurse's signature does
not attest to the client's understanding of the procedure, or that the physician fully explained all aspects
of the procedure. It is not the nurse's role to explain a procedure to the client, only to reinforce
information provided by the physician and clarify any misunderstandings. Cognitive Level: Applying
Client Need: Management of Care Integrated Process: Communication and Documentation Content
Area: Fundamentals Strategy: The critical word is witness, which means validating the signature. The
other answers all deal with understanding and explaining, which are not included in the details of the
question or part of witnessing the event. Reference: Ricci, S. (2009). Essentials of maternity, newborn,
and women's health nursing (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins, p. 20.
When picking up the dinner tray, the maternal-newborn nurse notices that a Vietnamese client did not
eat any roast beef or mashed potatoes. Later, her family members brought in some steamed fish and
vegetables with rice, which she ate. The nurse draws which conclusion about why the client prefers the
food the family brought in?
1. The client is acculturated to American foods and prefers hamburgers and french fries.
2. Eating culturally desired foods is preferable to eating strange or taboo foods.
3. The foods on the dinner tray are considered hot foods and should be avoided.
4. The client's appetite was decreased because of her recent delivery. ANS - Answer: 2
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