CHAPTER 4- PERINATAL NURSING

Question 1

1. Which medical risk factor contributes to a higher infant mortality rate?
   a. Diabetes mellitus
   b. Mitral valve prolapse (MVP)
   c. Chronic hypertension
   d. Anemia

Answer 1

ANS: C
Poor maternal health or chronic conditions such as hypertension are important contributors to a high infant mortality rate. Although diabetes mellitus, MVP, and anemia are concerns in pregnancy, they are not one of the most frequently reported maternal medical risk factors that contribute to a higher infant mortality.

Question 2

2. Which woman would be most at risk for the poorest perinatal outcome?
   a. A 25-year-old single mother on maternity leave with two existing children
   b. An unemployed 32-year-old lawyer in an inner-city neighbourhood
   c. An Indigenous woman in her mid-20s with no high school education
   d. A 19-year-old college student who lives at home with her parents

Answer 2

ANS: C
Both the Canadian Perinatal Surveillance System (CPSS) and the Maternity Experiences Survey note that poor women, Indigenous women, and young women with less education consistently have the poorest perinatal outcomes.

Question 3

3.Which is the main characteristic of the evolved role of the professional perinatal nurse?
a. Providing care to patients directly at the bedside
b. Planning patient care to cover longer hospital stays
c. Developing models and guidelines for interprofessional health care providers
d. Managing care to cure health problems once they have occurred

Answer 3

ANS: C
Professional nurses are part of the team of health and social care providers who collaboratively care for perinatal patients and their families. Perinatal nurses have helped to develop models and guidelines for interprofessional teams of professionals who work with child-bearing patients and their families. Providing care to patients directly at the bedside is one of a nurse’s tasks, but it does not encompass the concept of the evolved professional nurse. Patient hospital stays are decreasing in length of time rather than becoming longer stays. Nurses do not cure health problems; they work to promote well-being.

Question 4

4. A teenager is pregnant for the first time. Based on the statistics for infant mortality, which intervention is most important for the nurse to implement?
   a. Perform a nutrition assessment.
   b. Refer the patient to a social worker.
   c. Advise the patient to see an obstetrician, not a midwife.
   d. Explain to the patient the importance of keeping their prenatal care appointments.

Answer 4

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 it 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 their pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the teenager has identifiable high-risk problems, their health care may need to be provided by a physician. However, it cannot be assumed that all teenagers have high-risk issues. In addition, advising the patient to see an obstetrician is not the most important aspect on which the nurse should focus at this time.

Question 5

5. Which organization has developed entry to practice competencies for Child-bearing families?
   a. Canadian Nursing Association
   b. Canadian Association of Midwives
   c. Canadian Association of Schools of Nursing
   d. Society of Obstetrician & Gynecologists of Canada

Answer 5

ANS: C
The Canadian Association of Schools of Nursing (CASN) published Entry-to-Practice Competencies for Nursing Care of the Childbearing Family for Baccalaureate Programs in Nursing.

Question 6

6. When managing health care for pregnant patients at a prenatal clinic, which barrier to access prenatal care is considered most significant?
   a. Age
   b. Minority status
   c. Educational level
   d. Geographic location

Answer 6

ANS: D
The most significant barrier to health care access is geographic location. Inequities in access to good-quality prenatal care have developed particularly in rural, remote, inner city, and Indigenous communities. Although adolescent pregnant patients statistically receive less prenatal care, age is not the most significant barrier. Significant disparities in morbidity and mortality rates exist for minority patients; 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.

Question 7

7. Which time frame range is the perinatal continuum of care?
   a. 9 to 10 months
   b. 12 to 14 months
   c. 15 to 16 months
   d. 18 to 24 months

Answer 7

The perinatal continuum of care is 12 to 14 months.

Question 8

8. Which factor is mainly responsible for the steady increase in Caesarean birth?
   a. Higher rate of primary Caesarean births
   b. Higher rate of vaginal birth after Caesarean birth
   c. Increased nicotine use in pregnancy
   d. Lower medical indications for Caesarean birth

Answer 8

ANS: A
The proportion of patients giving birth by Caesarean section has increased steadily, from 17.6% in 1995 to 28.4% in 2014 to 2015 (PHAC, 2017b). Most of this increase is due to a higher rate of primary (first-time) Caesarean births. The vaginal birth after Caesarean (VBAC) rate has decreased over the same time period, not increased. Low medical indications would not increase the Caesarean birth rate.

Question 9

9. From a nurse’s perspective, what measure should be the focus of the health care system to further reduce the rate of infant mortality?
   a. Implementing programs that focus on health promotion and preventive care
   b. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days
   c. Expanding the number of neonatal intensive care units (NICUs)
   d. Mandating that all pregnant women receive care from an obstetrician

Answer 9

ANS: A
To address factors that are associated with infant mortality, there needs to be a shift from the current emphasis on highly technological medical intervention toward a focus on health promotion and preventive care. 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. NICUs offer care to high-risk infants after they are born; therefore, 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 obstetrical care would be nearly impossible to e

Question 10

10. Which have contributed to decreasing maternity-related health care costs?
    a. Prolonged postpartum hospital stays
    b. Portable care technology
    c. The reduction in acceptable genetic screening options
    d. Rural health services outreach clinics

Answer 10

ANS: B
Some women who experience pregnancy complications are now cared for in the home by antepartum home care nurses, thus decreasing maternity-related health care costs. This is a direct result of having access to portable fetal monitors and other forms of technology that previously were available only in the hospital but now are portable and can be used in the patient’s home. Prolonged postpartum hospital stays have increased costs, not decreased them. Genetic screening options have increased, not decreased, and they affect the ways in which women and their families experience pregnancy. Outreach clinics have increased health care costs as compared to the cost of home-based care.

Question 11

11. Which reflects a future goal for perinatal nursing?
    a. Limiting interprofessional teams
    b. Maintaining existing power structures
    c. Advocating for an increased number of Caesarean sections
    d. Addressing health inequities by creating healthy public policies

Answer 11

ANS: D
Addressing health inequities by creating health policy and services that focus on both resources needed for health and access to health services is a future goal of perinatal nurses. Nurses should be expanding interprofessional teams rather than limiting their existence. Existing power structures and practices need to be disrupted rather than maintained. Advocating for an increased number of Caesarean births is not a future goal for perinatal nursing.

Question 12

12. Which is the leading cause of maternal death?
    a. Hypertension
    b. Obesity
    c. Gestational diabetes
    d. Hemorrhage

Answer 12

ANS: D
Worldwide, approximately 800 women die each day of problems related to pregnancy or childbirth, with hemorrhage being the leading cause of death.

Question 13

13. Which recent trend in childbirth practices in Canada is accurate?
    a. Older women tend not to seek prenatal care.
    b. Indigenous women have lower incidence of perinatal mood disorders.
    c. The majority of births occurred in the hospital.
    d. Immigrant and refugee women have a lower rate of chronic disease.

Answer 13

ANS: C
The majority of births occur in the hospital. Older women tend to seek early prenatal care. Indigenous women do not have a lower incidence of perinatal mood disorders. Immigrant and refugee women have a higher rate of chronic disease.

Question 14

14. Which best describes a doula?
    a. Advanced practice labour and birth nurse
    b. A trained and experienced labour attendant
    c. Clinical nurse specialist in neonatal and postpartum care
    d. Leader of a interprofessional, intrapartum health care team

Answer 14

ANS: B
A doula is a trained and experienced labour attendant and may provide continuous one-on-one caring presence throughout the labour and birth. A doula does not need to be a nurse. An advanced practice labour and birth nurse is not a doula. A clinical nurse specialist in neonatal and postpartum care is not a doula. A doula may be a leader of a interprofessional intrapartum health care team but this is not the main role of a doula.

Question 15

15. Which is the correct definition of the perinatal mortality rate?
    a. Number of live births in 1 year per 1000 population
    b. Number of deaths of infants under 1 year of age per 1000 live births
    c. Number of deaths of infants under 28 days of age per 1000 live births
    d. Number of stillbirths and neonatal deaths per 1000 live births

Answer 15

ANS: D
The perinatal mortality rate is the number of stillbirths and neonatal deaths per 1000 live births. The number of live births in 1 year per 1000 population is the birth rate. Number of deaths of infants under 1 year of age per 1000 live births is the infant mortality rate. Number of deaths of infants under 28 days of age per 1000 live births is the neonatal mortality rate.

Question 16

16. Which factor is associated with higher infant mortality rates?
    a. Advanced maternal education
    b. Maternal age greater than 35 years
    c. Access to prenatal care
    d. Poverty

Answer 16

ANS: D
Limited maternal education, young maternal age, poverty, and the lack of prenatal care appear to be associated with higher infant mortality rates.

Question 17

17. What is required for women and their families to make informed health care choices?
    a. A patient-centred care approach
    b. Information and accurate knowledge
    c. Fewer multidisciplinary care teams
    d. Standardized maternal and newborn care

Answer 17

ANS: B
To make informed choices, women and their families require knowledge about their care. A family-centred approach is to be practiced. More, rather than fewer, multidisciplinary teams can provide better holistic care. Maternal and newborn care is to be individualized, not standardized.

Question 18

18. What information is a component of the midwifery care model?
    a. Midwives provide care in collaboration with a physician.
    b. Midwifery care is not a choice for patients in Canada.
    c. Midwives work with clients in a non-authoritarian manner.
    d. The birth can take place only at home or in a birth centre.

Answer 18

ANS: C
The midwifery model encourages patients to become active participants in their decisions and provide non-authoritarian and collaborative partnerships with their patients. Although Canada has a low percentage of well-woman care provided by midwives, these services are available. Midwives are autonomous care providers and although may collaborate with other health care providers in some situations, this is not the standard. Midwives can provide care at home, in freestanding birth centres, and in community and teaching hospitals.

Question 19

19. While obtaining a detailed history from a woman who has recently emigrated from Somalia, the nurse realizes that the patient has undergone female genital cutting (FGC). Which is the nurse’s best response based on?
    a. FGM is abnormal and rarely seen in Canada.
    b. Gathering information on who performed the FGM.
    c. Restoration plans for FGM after birth.
    d. The extent of FGM will affect potential for complications

Answer 19

ANS: D
The extent of FGM will affect the potential for complications and is the most appropriate information on which the nurses’
response should be based. The patient may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. With the growing number of immigrants from countries where FGC is practiced, nurses will increasingly encounter women who have undergone the procedure. Responding that this is a very abnormal practice rarely seen in Canada is culturally insensitive. The infibulation may have occurred during infancy or childhood. The patient will have little to no recollection of the event. She would have considered this to be a normal milestone during her growth and development. The World Health Organization and The International Council of Nurses has spoken out against this procedure as harmful to a woman’s health and a violation of human rights.

Question 20

1. Which are principles of family-centred maternal and newborn care? (Select all that apply.)
   a. Pregnancy and birth are normal, healthy processes.
   b. Childbirth should take place in hospitals for best outcomes.
   c. Health care providers can work autonomously for best patient outcomes.
   d. Care should be provided in a culturally safe manner.
   e. Care providers need to be aware of the language that they use related to
   childbirth.

Answer 20

ANS: A, D, E
This report provides detailed information on many issues of concern for nurses, for example, alcohol use, prenatal class attendance, social support, and stress.

Question 21

1. Which reflects one purpose of preconception care?
   a. Ensure that pregnancy complications do not occur.
   b. Identify women who should not become pregnant.
   c. Encourage healthy lifestyles for families desiring pregnancy.
   d. Ensure that women know about prenatal care.

Answer 21

ANS: C
Preconception counselling guides couples in how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and their environment, and how to identify healthy behaviours that promote the well-being of the woman and her potential fetus. Preconception care does not ensure that pregnancy complications will not occur. In many cases, problems can be identified and treated and may not recur in subsequent pregnancies. In many instances, counselling enables behaviour modification before damage is done, or a woman can make an informed decision about her willingness to accept potential hazards. If a woman is seeking preconception care, she likely is aware of prenatal care

Question 22

2. A nurse who provides preconception care understands which about preconception care?
   a. It is designed for women who have never been pregnant.
   b. It includes risk factor assessments for potential medical and psychological
   problems but does not consider socioeconomic status.
   c. It avoids teaching about safer sex, as the woman is seeking pregnancy.
   d. It could include interventions to reduce substance use.

Answer 22

ANS: D
If assessment indicates problematic substance use, treatment can be suggested or arranged. Preconception care is designed for all women of child-bearing potential, not just those who have never been pregnant. Risk factor assessment includes consideration of socioeconomic status and its effect on the determinants of health. Health promotion can include teaching about safer sex.

Question 23

3. What should nurses be aware of concerning the use and misuse of legal drugs or substances?
   a. Although cigarette smoking causes a number of health problems, it has little
   direct effect on maternity-related health.
   b. About 75% of women age 15 and older report alcohol consumption.
   c. Coffee is a stimulant that can interrupt body functions and has been related to
   birth defects.
   d. Prescription psychotherapeutic medications taken by the mother do not affect the
   fetus; otherwise, they would not have been prescribed.

Answer 23

ANS: B
In 2012, 74% of Canadian women age 15 and older reported drinking alcohol; based on the amount of alcohol abused, 16% of those women are at risk for long-term complications and 10% at risk for acute illness. Although a very small percentage of child-bearing patients have alcohol-related problems, alcohol use during pregnancy has been associated with a number of negative outcomes. Cigarette smoking impairs fertility and is a cause of low birth weight. Caffeine consumption has not been related to birth defects. Psychotherapeutic medications have some effect on the fetus, and that risk must be weighed against their benefit to the mother.

Question 24

4. The use of methamphetamine has been steadily increasing in Canada. What must the nurse be cognizant of in relation to methamphetamine use, to provide adequate nursing care to this patient population?
   a. It is used only by those of a higher socioeconomic status, because of the expense.
   b. It contains amphetamine, a central nervous system stimulant, as the active
   ingredient.
   c. It manifests a response similar to marijuana when smoked.
   d. Its use by fertile women decreases their sexual activity.

Answer 24

ANS: B
The active metabolite of methamphetamine is amphetamine, a central nervous system stimulant known as both “speed” and “meth.” Meth is relatively cheap and is “hooking” more people across the socioeconomic spectrum. When smoked, the behaviour of the patient is similar to that resulting from use of cocaine, not similar to marijuana use. Users of meth can experience feeling hypersexual and uninhibited, leading to unsafe sexual practices.

Question 25

5. Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has increased risk of pregnancy complications?
   a. Heroin
   b. Alcohol
   c. PCP
   d. Cocaine

Answer 25

ANS: A
The opiates include opium, heroin, meperidine, morphine, codeine, and methadone. The signs and symptoms of heroin use are euphoria, relaxation, relief from pain, detachment from reality, impaired judgement, drowsiness, constricted pupils, nausea, constipation, slurred speech, and respiratory depression. Women who use opiates during pregnancy have a six-times higher risk for negative outcomes. Alcohol, PCP, and cocaine are not opiates.

Question 26

6. What would be the best method for a nurse to use when teaching a new parent how to give a baby bath?
   a. Group discussion
   b. Lecture
   c. Role play
   d. Return demonstration

Answer 26

ANS: D
A baby bath is a psychomotor skill that is best taught using a return demonstration as the nurse can provide feedback as the parent is completing the skill. Group discussions and lecture are not the best method of teaching a psychomotor skill. Role play is best used for affective learning.

Question 27

7. The use of which during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications?
   A. Alcohol
   b. Caffeine
   c. Tobacco
   d. Vitamin A

Answer 27

ANS: C
Smoking in pregnancy is known to cause a decrease in placental perfusion and is the cause of low birth weight. Prenatal alcohol exposure is the single greatest preventable cause of mental problems. Alcohol use during pregnancy can cause high blood pressure, miscarriage, premature birth, stillbirth, and anemia. Caffeine may interfere with certain medications and make arrhythmias worse.

Question 28

8. Which is true in relation to Kegel exercises?
   a. They were developed to control or reduce incontinent urine loss.
   b. They are the best exercises for a pregnant woman because they are so pleasurable.
   c. They help to manage stress.
   d. They are ineffective without sufficient calcium in the diet.

Answer 28

ANS: A
Kegel exercises help control the urge to urinate. They may be fun for some, but the most important matter is the control they provide over incontinence. Kegel exercises help manage urination, not stress. Calcium in the diet is important but is not related to Kegel exercises.

Question 29

9. Body mass index is an important part of the health screening process, because obesity is closely associated with what?
   a. Lower infant mortality rates
   b. A large number of chronic conditions
   c. Mostly acute illnesses
   d. Improved mental well-being

Answer 29

ANS: B
Overweight and obesity are known risk factors for diabetes, heart disease, dyslipidemia, stroke, hypertension, arthritis, osteoporosis, and some types of cancer. Overweight and obesity are most frequently linked to chronic conditions. It is a myth that obesity is associated with improved mental well-being. In fact, obesity is associated with depression and increased stress.

Question 30

10. A nurse is most likely aware of the psychological symptoms of stress, such as anxiety and depression; however, a number of physiological symptoms may also occur. To best assist the patient in managing these symptoms, the nurse should be aware that stress may also result in which response?
    a. Decreased heart rate and blood pressure
    b. Rapid digestion resulting in heartburn
    c. Decrease in hormone levels
    d. Flare-ups of arthritis and asthma

Answer 30

ANS: D
Flare-ups of arthritis, asthma, frequent colds, infections, and cardiovascular problems may be the result of constant stress. Stress results in increased blood pressure and heart rate. Stress often causes slowed digestion and eating disorders. Stress often causes an increase in the level of both hormones and neurotransmitters, which may result in infertility or a weakened immune system.

Question 31

11. When evaluating the care of a person in an abusive situation, which is a nurse’s best measure?
    a. The abused person’s decision to leave their partner
    b. The abused person’s declaration of a safety plan
    c. The couple’s follow-through on a referral for counselling
    d. The abused person’s gratitude to the nurse for the helpful information

Answer 31

ANS: B
Safety is the most significant part of the intervention. This statement would be a positive step for the abused person, but it is not the most significant part of the intervention. In addition, many abused people choose to return to the relationship. Couples counselling generally is not recommended. Initially, individual counselling is more beneficial. Neither is a measure of success in the evaluation of the care plan of an abused person. The abused person may express their gratitude to the nurse in an effort to end the conversation. This does not indicate the person’s readiness to leave the relationship or to make a plan for safety

Question 32

12. Intervention for the survivor of sexual abuse often is not attempted by perinatal and women’s health nurses because of their concern about increasing the person’s distress and the lack of expertise in counselling. Which initial intervention is appropriate and most important in facilitating the abused person’s care?
    a. Initiate a referral to an expert counsellor.
    b. Set limits on what the patient discloses.
    c. Listen and encourage therapeutic communication skills.
    d. Acknowledge the nurse’s discomfort to the patient as an expression of empathy.

Answer 32

ANS: C
The survivor needs support on many different levels, and a women’s health nurse may be the first person to whom they relate their story. Therapeutic communication skills and listening are initial interventions. Referring this patient to a counsellor is an appropriate measure but not the most important initial intervention. A patient should be allowed to disclose any information they believe the need to discuss. A nurse should provide a safe environment in which they can do so. Either verbal or nonverbal shock and horror reactions from the nurse are particularly devastating. Professional demeanor and professional empathy are essential.

Question 33

13. Which is one of the Five A’s of the Interventions for Smoking Cessation? a. Abuse
    b. Advise
    c. Advocate
    d. Accommodate

Answer 33

ANS: B
Advise is one of the Five A’s of the Interventions for Smoking Cessation, in addition to Ask, Assess, Assist, and Arrange follow-up. Abuse, advocate, or accommodate are not one of Interventions for Smoking Cessation Five A’s

Question 34

14. Which is true in relation to intimate partner violence?
    a. Alcohol and drug use cause battering.
    b. Many offenders are successful professionals.
    c. Battering occurs in a small percentage of the population.
    d. Only people who come from abusive families end up in abusive relationsh

Answer 34

ANS: B
Many offenders are successful professionals; research indicates that only a small number of abusers have psychological problems. Although alcohol and drugs may be involved in abusive incidents, it is not the cause. Battering occurs in more than a small percentage of the population; about one in six women experience violence by an intimate partner. Most women report that their partners were the first person to beat them; therefore, it is a myth that only people who come from abusive families end up in abusive relationships.

Question 35

15. What should a nurse be aware of related to intimate partner violence (IPV)?
    a. Relationship violence usually consists of a single episode that the couple can put
    behind them.
    b. Violence often declines or ends with pregnancy.
    c. Economic abuse is considered part of IPV.
    d. People who are battered generally are poorly educated and come from a deprived
    social background.

Answer 35

ANS: C
Economic abuse accompanies physical assault and psychological attacks. IPV almost always follows an escalating pattern. It includes psychological attacks and economic coercion. IPV often begins with and escalates during pregnancy. Race, religion, social background, age, and education level are not significant factors in differentiating people at risk.

Question 36

16. What percentage of Canadians live with deep income poverty?
    a. 3.1%
    b. 4.6%
    c. 6.9%
    d. 8.5%

Answer 36

ANS: B
It was reported that 4.6% of Canadians were living in deep income poverty in 2018.

Question 37

17. During which phase of the cycle of violence does the batterer become contrite and remorseful?
    a. Battering phase
    b. Honeymoon phase
    c. Tension-building phase
    d. Increased drug-taking phase

Answer 37

ANS: B
During the tension-building phase, the batterer becomes increasingly hostile, swears, threatens, and throws things. This is followed by the battering phase where violence actually occurs, and the victim feels powerless. During the honeymoon phase, the victim of IPV wants to believe that the battering will never happen again, and the batterer will promise anything to get back into the home. Often the batterer increases the use of drugs during the tension-building phase.

Question 38

18. A patient who is older than 35 years may have difficulty achieving pregnancy primarily because
    a. personal risk behaviours influence fertility.
    b. They have used contraceptives for an extended time.
    c. their ovaries may be affected by the aging process.
    d. prepregnancy medical attention is lacking.

Answer 38

ANS: C
Once the mature person decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. Older adults participate in fewer risk behaviours than younger adults. The past use of contraceptives is not the problem. Prepregnancy medical care is both available and encouraged.

Question 39

1. Which are correlated with the occurrence of sleep disorders? (Select all that apply.)
   a. Anxiety
   b. Depression
   c. Fibromyalgia
   d. Hypertension
   e. Pain
   f. Obesity

Answer 39

ANS: B, C, E
Sleep disorders are correlated with physical and mental health problems, including depression, pain, and fibromyalgia.

Question 40

2. Which aspects should be included in well-women care for a healthy 23-year-old? (Select all that apply.)
   a. Contraception information
   b. Pre-conception counselling
   c. Diabetes screening
   d. Clinical breast examination
   e. Papanicolaou (Pap) test

Answer 40

ANS: A, B
Young adults often require information on contraception as well as it is important to provide pre-conception counselling prior to any pregnancy. This allows people to make informed decisions about their reproductive future. Clinical breast examination is not recommended for young adults and Pap tests should begin after age 25. Diabetes screening would not be done in a healthy young adult.

Question 41

To promote wellness and prevent illness throughout the life span, it is important for a nurse to be cognizant of immunization recommendations for women older than 18 years. Match each immunization with the correct schedule.
a. Tetanus-diphtheria-pertussis (Tdap)
b. Measles, mumps, rubella
c. Herpes Zoster
d. Hepatitis B
e. Influenza
f. Human papillomavirus (HPV)

1. Three injections for girls between the ages 9 to 26
2. Primary series of three injections
3. Annually
4. Once and then a booster every 10 years
5. One dose after age 65
6. Once if born after 1956

Answer 41

1. ANS: F
2. ANS: D
3. ANS: E
4. ANS: A
5. ANS: C
6. ANS: B