Chapter 01: The Past, Present, and Future

MULTIPLE CHOICE

	1.	A patient chooses to have the certified nurse midwife (CNM) provide care during her pregnancy. What does the CNM’s scope of practice include?
a.	Practice independent from medical supervision	
b.	Comprehensive prenatal care	
c.	Attendance at all deliveries	
d.	Cesarean sections	

ANS:	B
The CNM provides comprehensive prenatal and postnatal care, attends uncomplicated deliveries, and ensures that a backup physician is available in case of unforeseen problems.

DIF:	Cognitive Level: Comprehension	REF:	Page 6	OBJ:	12
TOP:	Advance Practice Nursing Roles	KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

	2.	Which medical pioneer discovered the relationship between the incidence of puerperal fever and unwashed hands?
a.	Karl Credé	
b.	Ignaz Semmelweis	
c.	Louis Pasteur	
d.	Joseph Lister	

ANS:	B
Ignaz Semmelweis deduced that puerperal fever was septic, contagious, and transmitted by the unwashed hands of physicians and medical students.

DIF:	Cognitive Level: Knowledge	REF:	Page 2	OBJ:	1
TOP:	The Past	KEY:	Nursing Process Step: N/A	
MSC:	NCLEX: Safe, Effective Care Environment: Safety and Infection Control

	3.	A pregnant woman who has recently immigrated to the United States comments to the nurse, “I am afraid of childbirth. It is so dangerous. I am afraid I will die.” What is the best nursing response reflecting cultural sensitivity?
a.	“Maternal mortality in the United States is extremely low.”	
b.	“Anesthesia is available to relieve pain during labor and childbirth.”	
c.	“Tell me why you are afraid of childbirth.”	
d.	“Your condition will be monitored during labor and delivery.”	

ANS:	C
Asking the patient about her concerns helps promote understanding and individualizes patient care.

DIF:	Cognitive Level: Application	REF:	Page 7-8	OBJ:	8
TOP:	Cross-Cultural Care		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Psychosocial Integrity: Psychological Adaptation		

	4.	An urban area has been reported to have a high perinatal mortality rate. What information does this provide?
a.	Maternal and infant deaths per 100,000 live births per year	
b.	Deaths of fetuses weighing more than 500 g per 10,000 births per year	
c.	Deaths of infants up to 1 year of age per 1000 live births per year	
d.	Fetal and neonatal deaths per 1000 live births per year	

ANS:	D
The perinatal mortality rate includes fetal and neonatal deaths per 1000 live births per year.

DIF:	Cognitive Level: Comprehension	REF:	Page 12, Box 1-6	
OBJ:	9	TOP:	The Present-Child Care	
KEY:	Nursing Process Step: Implementation		
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	5.	What is the focus of current maternity practice?
a.	Hospital births for the majority of women	
b.	The traditional family unit	
c.	Separation of labor rooms from delivery rooms	
d.	A quality family experience for each patient	

ANS:	D
Current maternity practice focuses on a high-quality family experience for all families, traditional or otherwise.

DIF:	Cognitive Level: Comprehension	REF:	Page 6	OBJ:	7
TOP:	The Present-Maternity Care	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Health Promotion and Maintenance

	6.	Who advocated the establishment of the Children’s Bureau?
a.	Lillian Wald	
b.	Florence Nightingale	
c.	Florence Kelly	
d.	Clara Barton	

ANS:	A
Lillian Wald is credited with suggesting the establishment of a federal Children’s Bureau.

DIF:	Cognitive Level: Knowledge	REF:	Page 4	OBJ:	1 | 2
TOP:	The Past	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development

	7.	What was the result of research done in the 1930s by the Children’s Bureau?
a.	Children with heart problems are now cared for by pediatric cardiologists.	
b.	The Child Abuse and Prevention Act was passed.	
c.	Hot lunch programs were established in many schools.	
d.	Children’s asylums were founded.	

ANS:	C
School hot lunch programs were developed as a result of research by the Children’s Bureau on the effects of economic depression on children.

DIF:	Cognitive Level: Knowledge	REF:	Page 4	OBJ:	2 | 3
TOP:	The Past	KEY:	Nursing Process Step: N/A	
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated Care	

	8.	What government program was implemented to increase the educational exposure of preschool children?
a.	WIC	
b.	Title XIX of Medicaid	
c.	The Children’s Charter	
d.	Head Start	

ANS:	D
Head Start programs were established to increase educational exposure of preschool children.

DIF:	Cognitive Level: Knowledge	REF:	Page 3	OBJ:	5
TOP:	Government Influences in Maternity and Pediatric Care	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Health Promotion and Maintenance: Growth and Development

	9.	What guidelines define multidisciplinary patient care in terms of expected outcome and timeframe from different areas of care provision?
a.	Clinical pathways	
b.	Nursing outcome criteria	
c.	Standards of care	
d.	Nursing care plan	

ANS:	A
Clinical pathways, also known as critical pathways or care maps, are collaborative guidelines that define patient care across disciplines. Expected progress within a specified timeline is identified.

DIF:	Cognitive Level: Knowledge	REF:	Page 12	OBJ:	14
TOP:	Health Care Delivery Systems	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	10.	A nursing student has reviewed a hospitalized pediatric patient chart, interviewed her mother, and collected admission data. What is the next step the student will take to develop a nursing care plan for this child?
a.	Identify measurable outcomes with a timeline.	
b.	Choose specific nursing interventions for the child.	
c.	Determine appropriate nursing diagnoses.	
d.	State nursing actions related to the child’s medical diagnosis.	

ANS:	C
The nurse uses assessment data to select appropriate nursing diagnoses from the NANDA-I list. Outcomes and interventions are then developed to address the relevant nursing diagnoses.

DIF:	Cognitive Level: Application	REF:	Page 11	OBJ:	13
TOP:	Nursing Process		KEY:	Nursing Process Step: Nursing Diagnosis
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	11.	A nursing student on an obstetric rotation questions the floor nurse about the definition of the LVN/LPN scope of practice. What resource can the nurse suggest to the student?
a.	American Nurses Association	
b.	State’s board of nursing	
c.	Joint Commission	
d.	Association of Women’s Health, Obstetric and Neonatal Nurses	

ANS:	B
The scope of practice of the LVN/LPN is published by the state’s board of nursing.

DIF:	Cognitive Level: Comprehension	REF:	Page 3, Legal and Ethical Considerations
OBJ:	18	TOP:	Critical Thinking		
KEY:	Nursing Process Step: Implementation		
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	12.	What was recommended by Karl Credé in 1884?
a.	All women should be delivered in a hospital setting.	
b.	Chemical means should be used to combat infection.	
c.	Podalic version should be done on all fetuses.	
d.	Silver nitrate should be placed in the eyes of newborns.	

ANS:	D
In 1884 Karl Credé recommended the use of 2% silver nitrate in the eyes of newborns to reduce the incidence of blindness.

DIF:	Cognitive Level: Knowledge	REF:	Page 2	OBJ:	1
TOP:	Use of Silver Nitrate		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

	13.	What is the purpose of the White House Conference on Children and Youth?
a.	Set criteria for normal growth patterns.	
b.	Examine the number of live births in minority populations.	
c.	Raise money to support well-child clinics in rural areas.	
d.	Promote comprehensive child welfare.	

ANS:	D
White House Conferences on Children and Youth are held every 10 years to promote comprehensive child welfare.

DIF:	Cognitive Level: Knowledge	REF:	Page 4	OBJ:	3
TOP:	White House Conferences	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

	14.	How many hours of hospital stay does legislation currently allow for a postpartum patient who has delivered vaginally without complications?
a.	24	
b.	48	
c.	36	
d.	72	

ANS:	B
Postpartum patients who deliver vaginally stay in the hospital for an average of 48 hours; patients who have had a cesarean delivery usually stay 4 days.

DIF:	Cognitive Level: Knowledge	REF:	Page 6	OBJ:	7
TOP:	Hospital Terms for Postpartum Patients		
KEY:	Nursing Process Step: Planning	
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

	15.	How does the clinical pathway or critical pathway improve quality of care?
a.	Lists diagnosis-specific implementations	
b.	Outlines expected progress with stated timelines	
c.	Prioritizes effective nursing diagnoses	
d.	Describes common complications	

ANS:	B
Critical pathways outline expected progress with stated timelines. Any deviation from those timelines is called a variance.

DIF:	Cognitive Level: Comprehension	REF:	Page 12	OBJ:	14
TOP:	Critical Pathway		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	16.	A patient asks the nurse to explain what is meant by “gene therapy.” What is the nurse’s best response?
a.	Gene therapy can replace missing genes.	
b.	Gene therapy evaluates the parent’s genes.	
c.	Gene therapy can change the sex of the fetus.	
d.	Gene therapy supports the regeneration of defective genes.	

ANS:	A
Gene therapy can replace missing or defective genes.

DIF:	Cognitive Level: Knowledge	REF:	Page 8	OBJ:	7
TOP:	Gene Therapy			KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

	17.	The nurse is clarifying information to a patient regarding diagnosis-related groups (DRGs). What is the nurse’s best response when the patient asks how DRGs reduce medical care costs?
a.	By determining payment based on diagnosis	
b.	By requiring two medical opinions to confirm a diagnosis	
c.	By organizing HMOs	
d.	By defining a person who will require hospitalization	

ANS:	A
DRGs determine the amount of payment and length of hospital stay based on the diagnosis.

DIF:	Cognitive Level: Comprehension	REF:	Page 8	OBJ:	11
TOP:	DRGs	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	18.	What is the best example of a Nursing Interventions Classification (NIC) intervention?
a.	Patient will ambulate in the hall independently for 10 minutes three times a day.	
b.	Nurse will report temperature elevations to the charge nurse.	
c.	Nurse will offer extra liquids at all meals.	
d.	Patient will express pain relief after massage.	

ANS:	C
NIC is a guide to nursing actions.

DIF:	Cognitive Level: Comprehension	REF:	Page 12 | Page 14	
OBJ:	15	TOP:	NICs	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	19.	How does electronic charting ensure comprehensive charting more effectively than handwritten charting?
a.	Provides a uniform style of chart	
b.	Requires certain responses before allowing the user to progress	
c.	All documentation is reflective of the nursing care plan	
d.	Requires a daily audit by the charge nurse	

ANS:	B
Comprehensive electronic documentation is ensured by requiring specific input in designated categories before the user can progress through the system.

DIF:	Cognitive Level: Comprehension	REF:	Page 15-16	OBJ:	22
TOP:	Computer Charting		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Safe, Effective Care Environment: Coordinated Care	

	20.	The nurse reminds family members that the philosophy of family-centered care is to provide control to the family over health care decisions. What is the appropriate term for this type of control?
a.	Empowerment	
b.	Insight	
c.	Regulation	
d.	Organization	

ANS:	A
The term empowerment refers to the control a family has over its own health care decisions.

DIF:	Cognitive Level: Knowledge	REF:	Page 2	OBJ:	7
TOP:	Empowerment			KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Physiological Integrity: Basic Care and Comfort		

	21.	A patient in the prenatal clinic is concerned about losing her job because of her pregnancy. The nurse instructs her that the Family Medical Leave Act (FMLA) allows an employee to be absent from work without pay. How many weeks does the FMLA allow a woman to recover from childbirth or care for a sick family member without loss of benefits or pay status?
a.	4	
b.	6	
c.	10	
d.	12	

ANS:	D
The FMLA allows for employees to leave work for up to 12 weeks to recover from childbirth or to care for an ill family member without losing benefits or pay status.

DIF:	Cognitive Level: Knowledge	REF:	Page 3	OBJ:	5
TOP:	FMLA	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Psychosocial Integrity: Coping and Adaptation

	22.	What term appropriately describes the nurse who is able to adapt health care practices to meet the needs of various cultures?
a.	Culturally aware	
b.	Culturally sensitive	
c.	Culturally competent	
d.	Culturally adaptive	

ANS:	C
The nurse who is able to adapt health care to meet the needs of various cultures is said to be culturally competent.

DIF:	Cognitive Level: Knowledge	REF:	Page 7	OBJ:	8
TOP:	Cultural Competency		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	23.	What is one major advantage to the application of critical thinking?
a.	Problem-free care	
b.	Limitation of approaches to care	
c.	Decreased need for assessment	
d.	Problem prevention	

ANS:	D
Critical thinking results in problem prevention in designing nursing care.

DIF:	Cognitive Level: Comprehension	REF:	Page 14	OBJ:	19
TOP:	Critical Thinking		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	24.	Student practical nurses are discussing the North American Nursing Diagnosis Association International (NANDA-I) taxonomy in post conference on the acute care clinical setting. The students are aware that the role of the LPN with nursing diagnosis formulation is what?
a.	To initiate and identify nursing diagnosis specific to patient	
b.	To update changes in nursing diagnosis as needed	
c.	To have an understanding of nursing diagnosis terminology	
d.	To accurately document nursing diagnosis on patient plan of care	

ANS:	C
The registered nurse is responsible to initiate, identify, update, and document nursing diagnoses. The licensed practical nurse is responsible to have an understanding of nursing diagnosis terminology.

DIF:	Cognitive Level: Comprehension	REF:	Page 14	OBJ:	17
TOP:	NANDA-I taxonomy		KEY:	Nursing Process Step: Nursing Diagnosis
MSC:	NCLEX: Health Promotion and Maintenance: Data Collection Techniques

MULTIPLE RESPONSE

	25.	What services are birthing centers able to provide? (Select all that apply.)
a.	Prenatal care	
b.	Labor and delivery services	
c.	Classes for new mothers	
d.	Adoption referrals	
e.	Family planning	

ANS:	A, B, C, E
Birthing centers are capable of providing full-service obstetric care, classes for new mothers, and family planning. Birthing centers do not offer adoption services.

DIF:	Cognitive Level: Comprehension	REF:	Page 6	OBJ:	7
TOP:	Birthing Centers		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated Care	

	26.	What developments in the early 20th century encouraged women to seek hospitalization for childbirth? (Select all that apply.)
a.	Use of specialized obstetric instruments	
b.	Use of anesthesia	
c.	Physicians’ closer relationships with hospitals	
d.	Focus on family-centered care	
e.	Insurance coverage	

ANS:	A, B, C
In the early 1900s, the development of specialized obstetric instruments, better modes of anesthesia, and the physician’s reliance on hospital services were instrumental in encouraging women to seek hospitalization for childbirth.

DIF:	Cognitive Level: Comprehension	REF:	Page 3	OBJ:	7
TOP:	Hospitalization for Childbirth	KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Safe, Effective Care Environment: Safety and Infection Control

	27.	What non–family-centered policies were prevalent in the 1960s? (Select all that apply.)
a.	Waiting room for fathers	
b.	Sedation of mother during labor	
c.	Delay of reunion of mother and infant	
d.	Lenient visiting hours	
e.	Restrictions of visitations by minor children	

ANS:	A, B, C, E
Hospital policies in the 1960s provided a separate waiting room for fathers while the mother went through labor in a sedated state. The reunion of mother and infant was delayed for several hours because of the sedation. Visiting hours were rigid and disallowed the visitation of minor children.

DIF:	Cognitive Level: Comprehension	REF:	Page 3	OBJ:	7
TOP:	Non–family-centered Practices	KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Safe, Effective Care Environment: Safety and Infection Control

	28.	The nurse is aware that there is a legal responsibility to report certain diseases and conditions to county or state health authorities. Which would be included? (Select all that apply.)
a.	Tuberculosis	
b.	Child abuse	
c.	Industrial accidents	
d.	Sexually transmitted diseases	
e.	Food-borne infections	

ANS:	A, B, D, E
The nurse has a legal responsibility to report communicable diseases (such as tuberculosis and sexually transmitted diseases), food-borne infections, child abuse, and threats of suicide.

DIF:	Cognitive Level: Comprehension	REF:	Page 6, Legal and Ethical Considerations box
OBJ:	6	TOP:	Reportable Diseases		
KEY:	Nursing Process Step: Planning	
MSC:	NCLEX: Safe, Effective Care Environment: Safety and Infection Control

	29.	An inservice program at a long-term care facility is reviewing the Nursing Outcomes Classification (NOC) with nursing staff. After the presentation the nurses review resident care plans. Which of the following are found to be appropriately written outcomes? (Select all that apply.)
a.	Suction patient orally every 4 hours and as needed.	
b.	Auscultate lung sounds every 2 hours.	
c.	Provide Tylenol as ordered by health care provider.	
d.	Patient states “Pain has decreased” after medication administration.	
e.	Patient blood pressure recorded as 120/72 after dressing change.	

ANS:	D, E
NOC was developed to identify outcomes of nursing care that are directly influenced by nursing actions. Outcomes are defined as the behaviors and feelings of the patient in response to the nursing care given. Suctioning patient, auscultating lung sounds, and providing Tylenol are nursing actions.

DIF:	Cognitive Level: Application	REF:	Page 12-14	OBJ:	16
TOP:	Nursing Outcomes Classification (NOC)		
KEY:	Nursing Process Step: Evaluation	
MSC:	NCLEX: Physiological Integrity: Basic Care and Comfort		

	30.	Practical nursing students are using critical thinking skills to study for an upcoming test. What will these students include when studying? (Select all that apply.)
a.	Memorization of facts first	
b.	Prioritizing information	
c.	Relating facts to other facts	
d.	Making assumptions	
e.	Reviewing before the test	

ANS:	B, C, E
Using critical thinking when studying involves understanding facts before memorizing, prioritizing information to be memorized, relating facts to other facts, using all five senses, reviewing before tests, and reading critically. Critical thinking does not involve assumption as does general thinking.

DIF:	Cognitive Level: Comprehension	REF:	Page 15	OBJ:	20
TOP:	Critical Thinking		KEY:	Nursing Process Step: Evaluation
MSC:	NCLEX: Safe, Effective Care Environment	

	31.	What factors have played a role in meeting the goals of Healthy People 2020 as it relates the goals for outcomes of pregnancy? (Select all that apply.)
a.	Early prenatal care	
b.	Increased number of surgical births	
c.	NICU care	
d.	Use of prenatal glucocorticoids	
e.	Fetal surgery	

ANS:	A, C, D, E
Early prenatal care, fetal surgery, use of prenatal glucocorticoids, technology, and NICU care have played a role in increasing the positive outcome of pregnancy, and the goals of Healthy People 2020 may well be met. Increase in surgical births and multiple gestations do not work toward meeting the goals of Healthy People 2020.

DIF:	Cognitive Level: Comprehension	REF:	Page 16-17	OBJ:	21
TOP:	Healthy People 2020		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

	32.	A community health nurse is providing specialized care to patients in the home setting. What kind of specialized care may this nurse be providing? (Select all that apply.)
a.	Glucose monitoring	
b.	Heparin therapy	
c.	Family education	
d.	Total parenteral nutrition	
e.	Provision of referral services	

ANS:	A, B, D
Glucose monitoring, heparin therapy, and total parenteral nutrition are categorized as specialized care that may be provided by the community health nurse. Family education and provision of referral are categorized as therapeutic care.

DIF:	Cognitive Level: Application	REF:	Page 16-17	OBJ:	23
TOP:	Community Health		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Physiological Integrity: Basic Care and Comfort		

COMPLETION

	33.	The nurse who is very conscientious about hand hygiene is following the concepts set out by ____________________ and ____________________.

ANS:	
Lister, Pasteur OR Pasteur, Lister

Both Lister and Pasteur set out that handwashing could reduce incidence of infection by cross-contamination.

DIF:	Cognitive Level: Knowledge	REF:	Page 2	OBJ:	1
TOP:	Handwashing			KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Safety and Infection Control

	34.	The first White House Conference on Children and Youth was called by President ______________ ________________.

ANS:	
Theodore Roosevelt

Theodore Roosevelt called the first White House Conference in 1909.

DIF:	Cognitive Level: Knowledge	REF:	Page 4	OBJ:	1
TOP:	White House Conferences	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

	35.	The nurse reviewing the specific recovery goals set out on a clinical pathway observed that two goals were not met by their designated timeline. The nurse records a negative _____________ for these two goals.

ANS:	
variance

Using a clinical pathway model with goals and associated timelines, the nurse must record a negative variance when a timeline is not met and consider a new approach or an extended timeline.

DIF:	Cognitive Level: Comprehension	REF:	Page 12	OBJ:	14
TOP:	Variances	KEY:	Nursing Process Step: Evaluation	
MSC:	NCLEX: Safe, Effective Care Environment: Management of Care	

	36.	__________________ . __________________  is purposeful, goal-directed thinking based on scientific evidence rather than assumption or memorization.

ANS:	
Critical thinking

Critical thinking is purposeful and goal-directed thinking as opposed to general thinking, which involves random or memorized thoughts.

DIF:	Cognitive Level: Knowledge	REF:	Page 14	OBJ:	18
TOP:	Critical Thinking		KEY:	Nursing Process Step: Evaluation
MSC:	NCLEX: Safe, Effective Care Environment: Management of Care