Foundations Of Maternal Newborn and Women’s Health Nursing, 6th Edition by Sharon Smith Murray – Test bank
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Sample
Test
Chapter 03: Ethical, Social, and Legal Issues
MULTIPLE CHOICE
1. The
nurse is teaching a homeless pregnant teenager about prenatal care. Which
should the nurse emphasize in the teaching session?
a. |
The importance of naming
the baby |
b. |
Risk factors associated
with pregnancy |
c. |
Information about
employment opportunities |
d. |
Eating habits that will
provide adequate nutrition |
ANS: D
Homeless teens are more likely to have poor eating habits,
smoke, and have greater risks for preterm labor, anemia, and hypertension
during pregnancy and to deliver a low-birth-weight (LBW) infant. Teaching about
proper eating habits is the priority at this time. Naming the baby, risk
factors associated with pregnancy, and information about employment are not the
highest priorities to teach at this time.
PTS:
1
DIF: Cognitive Level:
Application
REF: 35
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Health Promotion and Maintenance
2. The
United States ranks 27th in terms of worldwide infant mortality rates. Which
factor has the greatest impact on decreasing the mortality rate of infants?
a. |
Providing more women’s
shelters |
b. |
Ensuring early and adequate
prenatal care |
c. |
Resolving all language and
cultural differences |
d. |
Enrolling pregnant women in
the Medicaid program by their eighth month of pregnancy |
ANS: B
Because preterm infants form the largest category of those
needing expensive intensive care, early pregnancy intervention is essential for
decreasing infant mortality. The women in shelters have the same difficulties
in obtaining health care as other poor people, particularly lack of
transportation and inconvenient clinic hours. Language and cultural differences
are not infant mortality issues but must be addressed to improve overall health
care. Medicaid provides health care for poor pregnant women, but the process
may take weeks to take effect. The eighth month is too late to apply and
receive benefits for this pregnancy.
PTS:
1
DIF: Cognitive Level: Understanding
REF: 35
OBJ: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance
3. Which
statement is true regarding the quality assurance or incident report?
a. |
Reports are a permanent
part of the patient’s chart. |
b. |
The report assures the
legal department that there is no problem. |
c. |
The nurse’s notes should
contain this statement: “Incident report filed and copy placed in chart.” |
d. |
This report is a form of
documentation of an event that may result in legal action. |
ANS: D
Documentation on the chart should include all factual
information regarding the client’s condition that would be recorded in any
situation. The nurse completes an incident report when something occurs that
might result in a legal action against the clinic or hospital. Incident reports
are not part of the patient’s chart. The report is a warning to the legal
department to be prepared for a potential legal action. Incident reports are
not mentioned in the nurse’s notes.
PTS:
1
DIF: Cognitive Level: Analysis
REF: 39
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe and Effective Care Environment
4. The
nurse is planning a teaching session for staff on ethical theories. Which
situation best reflects the deontologic theory?
a. |
Approving a
physician-assisted suicide |
b. |
Supporting the
transplantation of fetal tissue and organs |
c. |
Using experimental
medications for the treatment of AIDS |
d. |
Initiating resuscitative
measures on a 90-year-old patient with terminal cancer |
ANS: D
In the deontologic theory, life must be maintained at all costs,
regardless of quality of life. Approving a physician-assisted suicide,
supporting the transplantation of fetal tissue and organs, and using
experimental medications for the treatment of AIDS are examples of a
utilitarian model.
PTS:
1
DIF: Cognitive Level:
Application REF:
29
OBJ: Nursing Process Step:
Planning MSC: Client Needs:
Psychosocial Integrity
5. Which
step of the nursing process is being used when the nurse decides whether an
ethical dilemma exists?
a. |
Analysis |
b. |
Planning |
c. |
Evaluation |
d. |
Assessment |
ANS: A
When a nurse uses the collected data to determine whether an
ethical dilemma exists, the data are being analyzed. Planning is done after the
data have been analyzed. Evaluation occurs once the outcome has been achieved.
Assessment is the data collection phase.
PTS:
1
DIF: Cognitive Level: Understanding
REF: 30
OBJ: Nursing Process Step: Evaluation
MSC: Client Needs: Safe and Effective Care Environment:
Coordinated Care
6. The
nurse is interviewing a 6-week pregnant client. The client asks the nurse, “Why
is elective abortion considered an ethical issue?” Which is the best response
that the nurse should make?
a. |
Abortion requires
third-party consent. |
b. |
The U.S. Supreme Court
ruled that life begins at conception. |
c. |
Abortion law is unclear
about a woman’s constitutional rights. |
d. |
There is a conflict between
the rights of the woman and the rights of the fetus. |
ANS: D
Elective abortion is an ethical dilemma because two opposing
courses of action are available. Abortion does not require third-party consent.
The Supreme Court has not ruled on when life begins. Abortion laws are clear
concerning a women’s constitutional rights.
PTS:
1
DIF: Cognitive Level:
Application REF:
31
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe and Effective Care Environment
7. At
the present time, surrogate parenting is governed by which of the following?
a. |
State law |
b. |
Federal law |
c. |
Individual court decision |
d. |
Protective child services |
ANS: C
Each surrogacy case is decided individually in a court of law.
Surrogacy is not governed by state law. Surrogacy is not governed by federal
law. Protective child services does not make decisions about surrogacy.
PTS:
1
DIF: Cognitive Level: Understanding
REF: 33
OBJ: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance
8. Which
client will most likely seek prenatal care?
a. |
Janice, 15 years old, tells
her friends, “I don’t believe I am pregnant.” |
b. |
Carol, 28 years old, is in
her second pregnancy and abuses drugs and alcohol. |
c. |
Margaret, 20 years old, is
in her first pregnancy and has access to a free prenatal clinic. |
d. |
Glenda, 30 years old, is in
her fifth pregnancy and delivered her last infant at home with the help of
her mother and sister. |
ANS: C
The client who acknowledges the pregnancy early, has access to
health care, and has no reason to avoid health care is most likely to seek
prenatal care. Being in denial about the pregnancy will prevent a client from
seeking health care. Substance abusers are less likely to seek health care.
Some women see pregnancy and birth as a natural occurrence and do not seek
health care.
PTS:
1
DIF: Cognitive Level: Understanding
REF: 35
OBJ: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance
9. A
medical surgical nurse is asked to float to a women’s health unit to care for
clients who are scheduled for therapeutic abortions. The nurse refuses to
accept this assignment and expresses her personal beliefs as being incongruent
with this medical practice. The nursing supervisor states that the unit is
short-staffed and that they could really use her expertise because it just
involves taking care of clients who have undergone a surgical procedure. In
consideration of legal and ethical practices, can the nursing supervisor
enforce this assignment?
a. |
The staff nurse has the
responsibility of accepting any assignment that is made while working for a
health care unit, so the nursing supervisor is within his or her rights to
enforce this assignment. |
b. |
Because the unit is
short-staffed, the staff nurse should accept the assignment to provide care
by benefit of her or his experience to clients who need care. |
c. |
The staff nurse has
expressed a legitimate concern based on his or her feelings; the nursing
supervisor does not have the authority to enforce this assignment. |
d. |
The nursing supervisor
should emphasize that this assignment requires care of a surgical client for which
the staff nurse is adequately trained and should therefore enforce the
assignment. |
ANS: C
The Nurse Practice Act allows nurses to refuse assignments that
involve practices that they have expressed as being opposed to their religious,
cultural, ethical, and/or moral values. Although the nursing supervisor has a
right to arrange assignments, the supervisor, if made aware of a potential bias
or limitation, must act accordingly and accept the nurse’s position. This
should be upheld regardless of staffing limitations and independent of
persuasive efforts to make the nurse feel guilty for her or his stated beliefs.
PTS:
1
DIF: Cognitive Level:
Analysis
REF: 31
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe Effective Care: Ethical
Practice/Assignment, Delegation and Supervision
10. With
regard to an obstetric litigation case, a nurse working in labor and birth is
found to be negligent. Which intervention performed by the nurse indicates that
a breach of duty has occurred?
a. |
The nurse did not document
fetal heart tones (FHR) during the second stage of labor. |
b. |
The client was only
provided ice chips during the labor period, which lasted 8 hours. |
c. |
The nurse allowed the
client to use the bathroom rather than a bedpan during the first stage of
labor. |
d. |
The nurse asked family
members to leave the room when she prepared to do a pelvic exam on the
client. |
ANS: A
A breach of duty is indicated by a nurse (or health care
provider) failing to provide treatment relative to the standard of care. In
this case, documentation of FHR during the second stage of labor is a standard
of care. Providing ice chips to laboring clients is within the standard of
care. The time period of 8 hours is not excessive. A client without any risk
factors can use the bathroom and be ambulatory during the first stage of labor.
Asking family members to leave during a vaginal exam helps maintain client
privacy.
PTS:
1
DIF: Cognitive Level:
Analysis
REF: 37
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe Effective Care: Legal Rights and
Responsibilities
11. A
nurse is working with a labor client who is in preterm labor and is designated
as a high-risk client. The client is very apprehensive and asks the nurse, “Is
everything going to be all right?” The nurse tells the client, “Everything will
be okay.” Following birth via an emergency cesarean section, the newborn
undergoes resuscitation and does not survive. The client is distraught over the
outcome and blames the nurse for telling her that everything would be okay.
Which ethical principle did the nurse violate?
a. |
Autonomy |
b. |
Fidelity |
c. |
Beneficence |
d. |
Accountability |
ANS: B
In this type of situation, the nurse (and/or health care
provider) cannot make statements (promises) that cannot be kept. Telling the
client that everything will be okay is not based on the accuracy of medical
diagnosis and should not be conveyed to the client. The other ethical
principles of autonomy (self-determination), beneficence (greatest good), and
accountability (accepting responsibility) do not apply.
PTS:
1
DIF: Cognitive Level:
Analysis
REF: 30
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe Effective Care: Legal Rights and
Responsibilities
12. A
nurse is working in the area of labor and birth. Her assignment is to take care
of a gravida 1 para 0 who presents in early labor at term. Vaginal exam
reflects the following: 2 cm, cervix posterior, -1 station, and vertex with
membranes intact. The client asks the nurse “if she can break her water so that
her labor can go faster?” The nurse’s response, based on the ethical principle
of nonmaleficence, is which of the following?
a. |
Tell the client that she
will have to wait until she has progressed further on the vaginal exam and
then she will perform an amniotomy. |
b. |
Have the client write down
her request and then call the physician for an order to implement the
amniotomy. |
c. |
Instruct the client that
only a physician or certified midwife can perform this procedure. |
d. |
Give the client an enema to
stimulate labor. |
ANS: C
The ethical principle of nonmaleficence conveys the concept that
one should avoid risk taking or harm to others. The procedure of amniotomy is
performed by a physician and/or certified nurse midwife. It is not in the scope
of practice of a RN, so option C validates that the nurse is upholding this
ethical principle. Options A and B are not within the scope of practice. The
use of an enema as a labor stimulant is no longer considered to be part of
labor and birth practices.
PTS:
1
DIF: Cognitive Level:
Analysis
REF: 30
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe Effective Care: Legal Rights and
Responsibilities
13. A
nurse working in a labor and birth unit is asked to take care of two high-risk
clients in the labor and birth suite: a 34 weeks’ gestation 28-year-old gravida
3, para 2 in preterm labor and a 40-year-old gravida 1, para 0 who is severely
preeclamptic. The nurse refuses this assignment telling the charge nurse that
based on individual client acuity, each client should have one-on-one care.
Which ethical principle is the nurse advocating?
a. |
Accountability |
b. |
Beneficence |
c. |
Justice |
d. |
Fidelity |
ANS: B
In this situation, the clients are each exhibiting significant
high-risk conditions and should receive individual nursing care. The nurse is
advocating the principle of beneficence in that she is trying to do the
“greatest good or the least harm” to improve client outcomes. The other ethical
principles do not apply in this situation.
PTS:
1
DIF: Cognitive Level:
Analysis
REF: 30
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe Effective Care: Legal Rights and
Responsibilities
14. A
charge nurse is working on a postpartum unit and discovers that one of the
clients did not receive AM care during her shift assessment. The charge nurse
questions the nurse assigned to provide care and finds out that the nurse
thought that “the client should just do it by herself because she will have to
do this at home.” On further questioning of the nurse, it is determined that
the rest of her assigned clients were provided AM care. The assigned nurse has
violated which ethical principle?
a. |
Justice |
b. |
Truth |
c. |
Confidentiality |
d. |
Autonomy |
ANS: A
The ethical principle of justice indicates that all clients
should be treated equally and fairly. In this case, the charge nurse
ascertained that the AM care was not equally applied to all the nurse’s
assigned clients. The other ethical principles do not apply to this situation.
PTS: 1
DIF: Cognitive Level:
Analysis
REF: 30
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe Effective Care: Legal Rights and
Responsibilities
15. A
nurse is entering information on the client’s electronic health record (EHR)
and is called to assist in an emergency situation with regard to another client
in the labor and birth suite. The nurse rushes to the scene to assist but
leaves the chart open on the computer screen. The emergent client situation is resolved
satisfactorily, and the nurse comes back to the computer entry screen to
complete charting. At the end of the shift, the nurse manager asks to speak
with the nurse and tells her that she is concerned with what happened today on
the unit because there was a breach in confidentiality. Which response by the
nurse indicates that she understands the nurse manager’s concerns?
a. |
The nurse acknowledges that
she should have made sure that her client was safe before assisting with the
emergency. |
b. |
The nurse states that she
should have logged out of the EHR prior to attending to the emergency. |
c. |
The nurse indicates that
the unit was understaffed. |
d. |
The nurse indicates that
the she changed her password following the clinical emergency to maintain
confidentiality. |
ANS: B
With the use of electronic health records, it is necessary to
take all steps to maintain confidentiality and limit access to non–health care
personnel. In an emergent care situation, the nurse should have logged out of
the system to maintain confidentiality. Although it is important to make sure
that one’s client is safe, there is no information here to suggest that there
were any safety issues applicable to her assigned client. The staffing of the
unit should not affect confidentiality. Changing the password for logging in to
a system is an option for clinical practice but does not affect the situation
as described.
PTS:
1
DIF: Cognitive Level:
Analysis
REF: 30
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe Effective Care: Legal Rights and
Responsibilities
16. Which
of the following statements is true regarding late preterm infants?
a. |
These infants are born
before 32 weeks’ gestation and thus are at higher risk than LBW infants. |
b. |
These infants do better
than LBW infants because their weight provides added protection against
physiologic stressors. |
c. |
Care of these infants has
led to increased health care costs compared with LBW infants. |
d. |
These infants suffer fewer
respiratory problems than LBW infants. |
ANS: C
Late preterm infants are born between 34 and 36 weeks and
present with more complications than LBW infants, according to evidence-based
practice. The added weight does not provide protection, and these infants are
more likely to experience respiratory distress.
PTS:
1
DIF: Cognitive Level:
Application REF:
36
OBJ: Nursing Process Step: Assessment
MSC: Client Needs: Physiologic Adaptation
17. A
nurse is admitting a client to the labor and birth unit in early labor who was
sent to the facility following her checkup with her health care provider in the
office. The client is a gravida 1, para 0, and is at term. No health issues are
discerned from the initial assessment, and the nurse prepares to initiate
physician orders based on standard procedures. Which action is warranted by the
nurse manager in response to this situation?
a. |
No action is indicated
because the nurse is acting within the scope of practice. |
b. |
The nurse manager should
intervene and ask the nurse to clarify admission orders directly with the
physician. |
c. |
The nurse manager should
review standard procedures with the nurse to validate that orders are being
carried out accurately. |
d. |
The nurse manger should
review the admission procedure with the nurse. |
ANS: A
Standard procedures are often used in labor and birth settings
because they are based on physician-directed orders that apply to general
admissions. The nurse is acting appropriately because the client was sent
directly to the unit by the health care provider. The nurse manager does not
have to intervene at this point. There is no additional need to review standard
procedures or the admission process with the nurse at this time. There is no
evidence that the nurse needs additional training and/or does not have the
prerequisite knowledge to admit the client.
PTS:
1
DIF: Cognitive Level:
Application REF:
36, 37
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Health Promotion Maintenance
18. A
nurse who works in the emergency department (ED) is assigned to a client who is
experiencing heavy vaginal bleeding at 12 weeks’ gestation. An ultrasound has
confirmed the absence of a fetal heart rate, and the client is scheduled for a
dilation and evacuation of the pregnancy. The nurse refuses to provide any
further care for this client based on moral principles. What is the nurse
manager’s initial response to the nurse?
a. |
“I recall you sharing that
information in your interview. I will arrange for another nurse to take
report on this client.” |
b. |
“Because we are shorthanded
today, you have to continue to provide care. There is no one else available
to provide care for this client.” |
c. |
“I understand your point of
view. You were hired to work here in the ED so you had to know this situation
was possible.” |
d. |
“Abandonment is a serious
issue. I have to advise you to continue to provide care for this client.” |
ANS: A
Nurses do not have to provide care if the care is in violation
of their moral, ethical, or religious principles. However, it is the
responsibility of the nurse to share these views at the time of the initial
interview. Disclosing beliefs that would affect the care of clients at the
point of care and refusing to provide care is unethical on behalf of the nurse.
The manager cannot force the nurse to provide care if the nurse’s principles
were shared at the time of the initial interview. It is the manager’s
responsibility to disclose the type of care delivered in the department at the
time of the interview. Threats of abandonment are unwarranted at this time.
PTS:
1
DIF: Cognitive Level:
Application REF:
32
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Health Promotion and Maintenance
19. The
nurse is providing care to a patient who was just admitted to the labor and
birth unit in active labor at term. The patient informed the nurse that she has
not received any prenatal care because “I cannot afford to go to the doctor.
And, this is my third baby, so I know what to expect.” What is the nurse’s
primary concern when developing the patient’s plan of care?
a. |
Low birth weight |
b. |
Oligohydramnios |
c. |
Gestational diabetes |
d. |
Gestational hypertension |
ANS: A
Because of adverse living conditions, poor health care, and poor
nutrition, infants born to low-income women are more likely to begin life with
problems such as low birth weight. Oligohydramnios is too little amniotic fluid
and is not directly correlated with poverty. Gestational diabetes and
gestational hypertension are associated with poverty but are seen during
pregnancy. This client is in active labor and the primary concern is the fetus.
PTS: 1
DIF: Cognitive Level:
Application
REF: 34
OBJ: Nursing Process Step:
Planning MSC: Client Needs: Health
Promotion and Maintenance
MULTIPLE RESPONSE
20. Which
of the following complications are associated with late preterm infants? (Select all that apply.)
a. |
Hyperglycemia |
b. |
Tachycardia |
c. |
Jaundice |
d. |
Thermoregulation problems |
e. |
Require mechanical
ventilation |
f. |
Feeding problems |
ANS: C, D, E, F
Complications associated with preterm infants include ventilator
assistance, thermoregulation problems, feeding problems, bradycardia, jaundice,
and possible sepsis.
PTS:
1
DIF: Cognitive Level:
Application REF:
36
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Physiologic Adaptation
21. The
RN is delegating tasks to the unlicensed assistive personnel (UAP). Which tasks
can the nurse delegate? (Select
all that apply.)
a. |
Teaching the client about
breast care |
b. |
Assessment of a client’s
lochia and perineal area |
c. |
Assisting a client to the
bathroom for the first time after birth |
d. |
Vital signs on a postpartum
client who delivered the night before |
e. |
Assisting a postpartum
client to take a shower on the second postpartum day |
ANS: D, E
Nurses must be aware that they remain legally responsible for
patient assessments and must make the critical judgments necessary to ensure
patient safety when delegating tasks to unlicensed personnel. The nurse cannot
delegate assessment, teaching, or evaluation. The two tasks that the nurse can
delegate are vital signs on a stable postpartum client and assisting a stable
postpartum client on the second postpartum day to take a shower.
PTS:
1
DIF: Cognitive Level:
Application
REF: 40
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe and Effective Care Environment
22. The
clinic nurse often cares for clients who are considering an abortion. Which responsibilities
does this nurse have in regard to this issue? (Select all that apply.)
a. |
Informing the client about
pro-life options |
b. |
Informing the client about
pro-choice support groups |
c. |
Being informed about
abortion from a legal standpoint |
d. |
Being informed about
abortion from an ethical standpoint |
e. |
Recognizing that this issue
may result in confusion for the client |
ANS: C, D, E
Nurses have several responsibilities that cannot be ignored in
the conflict about abortion. First, they must be informed about the complexity
of the abortion issue from a legal and an ethical standpoint and know the
regulations and laws in their state. Second, they must realize that for many
people, abortion is an ethical dilemma that results in confusion, ambivalence,
and personal distress. Informing the client about pro-life options or
pro-choice support groups would not be appropriate because it is the client’s
decision and these interventions show bias on the nurse’s part.
PTS:
1
DIF: Cognitive Level:
Analysis
REF: 32
OBJ: Nursing Process Step: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
23. A
couple asks the nurse about the procedure for surrogate parenting. Which
correct responses should the nurse give to the couple? (Select all that apply.)
a. |
Donated embryos can be
implanted into the surrogate mother. |
b. |
The surrogate mother needs
to have carried one previous birth to term. |
c. |
You both need to be
infertile to be eligible for surrogate parenting. |
d. |
Conception can take place
outside the surrogate mother’s body and then implanted. |
e. |
The surrogate mother can be
inseminated artificially with sperm from the intended father. |
ANS: A, D, E
In surrogate parenting, conception may take place outside the
body using ova and sperm from the couple who wishes to become parents. These
embryos are then implanted into the surrogate mother, or the surrogate mother
may be inseminated artificially with sperm from the intended father. Donated
embryos may also be implanted into a surrogate mother. The couple does not need
to be infertile. The surrogate parent does not need to have previously carried
a pregnancy to term.
PTS:
1
DIF: Cognitive Level: Application
REF: 33
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Health Promotion and Maintenance
24. Which
actions by the nurse indicate compliance with the Health Insurance Portability
and Accountability Act (HIPAA)? (Select
all that apply.)
a. |
The nurse posts an update
about a client on Facebook. |
b. |
The nurse gives the report
to the oncoming nurse in a private area. |
c. |
The nurse gives information
about the client’s status over the phone to the client’s friend. |
d. |
The nurse logs off any
computer screen showing client data before leaving the computer unattended. |
e. |
The nurse puts any
documentation with the client’s information in the shred bin at the hospital
before leaving for the day. |
ANS: B, D, E
HIPAA regulations provide consumers with significant power over
their records, including the right to see and correct their records, the
application of civil and criminal penalties for violations of privacy
standards, and protection against deliberate or inadvertent misuse or
disclosure. Discussions about a patient with other professionals should be
restricted to those who need to know and should occur in a private location.
Nurses must take care to avoid violating patient confidentiality when using
electronic patient data formats. For example, nurses must promptly log off
terminals when finished so that unauthorized individuals cannot gain access to
the system. Shredding documentation with client identifiers should be done
before leaving the hospital. Discussing a client’s status in any online forum
is a violation of HIPAA. Giving information to a client’s friend over the
phone, without the client’s consent, is a violation of HIPAA.
PTS:
1
DIF: Cognitive Level:
Application REF:
33
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Safe and Effective Care Environment
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