When a nurse is unsure about how do you perform a client care procedure the best action would be to?

If you have a concern or complaint that you have not been able to resolve by talking with your service provider, the Aged Care Quality and Safety Commission (the Commission) can support you, with information and options, to resolve your concern with the service provider.

Índice Show

What we can do
What we cannot do
How can you submit a complaint?
Open complaint
Confidential complaint
Anonymous complaint
What can you expect when you first raise a concern with the Commission?
When we can look into your concerns
When examining your complaint through a 'resolution process'
What will we do with your personal information?
When providing care for the pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is: A. diabetes mellitus B. Mitral valve prolapse C. Chronic hypertension D. anemia
A. Diabetes mellitus 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 is one of the most frequently reported maternal medical risk factors, not chronic hypertension. Although anemia is a concern in pregnancy, it is not one of the most frequently reported maternal medical risk factors in pregnancy.
Managed care has gained in popularity. The nurse should understand that this rise in popularity is most often guided by which consideration?A. concern for the quality of care B. means of controlling costs of care C. greater access to physicians D. allowance for early discharge
B. means of controlling costs of care Health care is among the fastest growing sectors of the U.S. economy. Managed care was developed as a direct result of escalating health care costs. Although quality control is important, it does not have any bearing on the rise in popularity of managed care. Managed care tends to have a gatekeeper effect, which actually may limit access to physicians, especially specialists. Although early discharge originally was part of the managed care plan to reduce hospital expenditures, this practice has created a need for additional care in the home.
The role of the professional nurse has evolved to emphasize: A. providing care to clients directly at the bedside B. planning client care to cover longer hospital stays C. leading the activities of a team of interdisciplinary health care providers D. managing care to cure health problems once they have occurred
C. leading the activities of a team of interdisciplinary health care providers Professional nurses are part of the team of health care providers who collaboratively care for clients in the managed care model. Providing care to clients directly at the bedside is one of a nurse’s tasks, but it does not encompass the concept of the evolved professional nurse. One goal of managed care is a decreased, not an increased, length of stay. Nurses do not cure health problems; they care for clients with ailments.
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
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 client 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 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 client is to receive.
The nurse knows that teaching to increase self-care has been effective when the client makes what comment?a. “I’ll do whatever you say; you’re the nurse.”b. “I don’t think I can quit smoking.”c. “I exercise for 30 minutes 3 days a week.”d. “What do you think I should do?”
C. “I exercise for 30 minutes 3 days a week” indicates the client’s willing participation and understanding of healthy self-care behaviors. Doing is different from comprehension. The goal of teaching about self-care is to make sure the client understands the factors associated with her care. Generally an understanding of self-care practices increases the chance that clients will practice healthy behaviors. Smoking is only one behavior associated with self-care in pregnancy. In addition, the goal is for the client to seek self-care health behaviors, not discount them. The client’s question, “What do you think I should do?” indicates that she does not understand what measures she can take to increase her level of self-care.
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 woman’s:A. AgeB. Minority status C. Educational level D. Inability to pay
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.
What is the primary role of practicing nurses in the research process?a. Designing research studiesb. Collecting data for other researchersc. Identifying researchable problemsd. Seeking funding to support research studies
C. When problems are identified, research can be conducted properly. Research of health care issues leads to evidence-based practice guidelines. Designing research studies is only one factor of the research process. Data collection is one factor of research. Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.
When the nurse is unsure about how to perform a client care procedure, the best action would be to:a. Ask another nurse.b. Discuss the procedure with the client’s physician.c. Look up the procedure in a nursing textbook.d. Consult the agency procedure manual and follow the guidelines for the procedure.
D. It is always best to follow the agency’s policies and procedures manual when seeking information on correct client procedures. These policies should reflect the current standards of care and state guidelines. Each nurse is responsible for her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe client care delivery. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or individual state or hospital policies.
From the nurse’s perspective, what measure should be the focus of the health care system to reduce the rate of infant mortality further?a. Implementing programs to ensure women’s early participation in ongoing prenatal careb. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 daysc. Expanding the number of neonatal intensive care units (NICUs)d. Mandating that all pregnant women receive care from an obstetrician
A. Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. 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. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high risk infants after they are born. 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 obstetric care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have demonstrated reliable, safe care for pregnant women.
Alternative and complementary therapies:a. Replace conventional Western modalities of treatment.b. Are used by only a small number of American adults.c. Recognize the value of clients’ input into their health care.d. Focus primarily on the disease an individual is experiencing.
C. Many popular alternative healing modalities offer human-centered care based on philosophies that recognize the value of the client's input and honor the individual's beliefs, values, and desires. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of American adults are seeking alternative and complementary health care options. Alternative healing modalities offer a holistic approach to health, focusing on the whole person, not just the disease.
A 38-year-old Hispanic woman delivered a 9-pound, 6-ounce baby girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds would the woman potentially have a legitimate legal case for negligence?A. she is Hispanic B. she delivered a girl C. the standards of care were not met D. she refused fetal monitoring
C. Not meeting the standards of care is a legitimate factor for a case of negligence. The client’s race is not a factor for a case of negligence. The infant’s gender is not a factor for a case of negligence. Although fetal monitoring is the standard of care, the client has the right to refuse treatment. This refusal is not a case for negligence, but informed consent should be properly obtained, and the client should sign an against medical advice form for refusal of any treatment that is within the standard of care.
All of the following conditions have contributed to the increase in maternity-related health care costs except:a. Early postpartum discharges.b. Liability costs.c. The use of high-tech equipment.d. The cost of care for low-birth-weight (LBW) infants.
A. Early postpartum discharges have reduced costs. The liability costs of a litigious society contribute to higher health costs. High-tech equipment increases health costs, as do LBW or high risk infants.
The term used to describe legal and professional responsibility for practice for maternity nurses is: A. collegiality B. ethics C. evaluation D. accountability
D. Accountability refers to legal and professional responsibility for practice. Collegiality refers to a working relationship with one’s colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes.
Maternity nurses can work to dispel the health disparities among women through:a. Increased education for mothers.b. Late prenatal care.c. Increased number of cesarean sections.d. Making all women take more vitamins.
A. Educating mothers enables them to recognize problems they should report to their health care provider and teaches them ways to take better care of themselves. Late prenatal care is one factor that contributes to health disparities. Cesarean sections are performed for various reasons, although they may be the result of health concerns related to the mother. Taking vitamins may improve overall health, but it does not necessarily ensure health or dispel health disparities.
An important development that concerns maternity nursing is integrative health care, which:a. Seeks to provide the same health care for all racial and ethnic groups.b. Blends complementary and alternative therapies with conventional Western treatment.c. Focuses on the disease or condition rather than the background of the client.d. Has been mandated by Congress.
B. Integrative health care tries to mix the old with the new at the discretion of the client and health care providers. Integrative health care is a blending of new and traditional practices. Integrative health care focuses on the whole person, not just the disease or condition. U.S. law supports complementary and alternative therapies but does not mandate them
Recent trends in childbirth practices in the United States indicate that:a. More than 15% of mothers had late or no prenatal care.b. The percentage of Hispanics, non-Hispanic African-Americans, and Caucasians who received prenatal care was essentially the same.c. Ninety-nine percent of births occurred in the hospital.d. Cesarean births have been declining as a percentage of live births.
C. Almost no births occur outside of the hospital. Only 3.4% of mothers had either late care or no care. A higher percentage of Caucasians received prenatal care. The percentage of cesarean births is increasing.
Recent trends in childbirth practice indicate that:a. Delayed pushing is now discouraged in the second stage of labor.b. Episiotomy rates are increasing.c. Midwives perform more episiotomies than physicians.d. Newborn infants remain with the mother and are encouraged to breastfeed.
D. Breastfeeding is encouraged for newborns immediately after birth. Delayed pushing is encouraged for several reasons. Episiotomy rates are declining. Midwives perform fewer episiotomies than do physicians.
The nurse should be cognizant that one accurate example of a U.S. societal trend is:a. The moral climate has caused companies to discourage breastfeeding on the job.b. Federal law allows women to breastfeed in federal buildings and on federal property.c. The Family and Medical Leave Act of 1993 provides up to 6 weeks of unpaid leave for births.d. The incidence of acquired immunodeficiency syndrome (AIDS) among infants has continued to rise.
B. Since 1999 federal law allows women to breastfeed in federal buildings and on federal property. In fact, companies make provisions for women to breastfeed at work. This also allows for 12 weeks of unpaid leave and also applies to adoption and the care of family members. The incidence of AIDS is declining among infants because of new therapies.
The nurse caring for the pregnant client should be aware that the U.S. birth rate shows what trend?a. Births to unmarried women are more likely to have less favorable outcomes.b. Birth rates for women 40 to 44 years of age are beginning to decline.c. Cigarette smoking among pregnant women continues to increase.d. The rates of pregnancy and abortion among teens are lower in the United States than in any other industrial country.
A. Low-birth-weight infants and preterm birth are more likely because of the large number of teenagers in the unmarried group. Birth rates for women in their early forties continue to increase. Fewer pregnant women smoke. Teen pregnancy and abortion rates are higher in the United States than in any other industrial country.
Maternity nursing care that is based on knowledge gained through research and clinical trials is:a. Derived from the Nursing Intervention Classification.b. Known as evidence-based practice.c. At odds with the Cochrane School of traditional nursing.d. An outgrowth of telemedicine.
B. Evidence based practice is based on knowledge gained from research and clinical trials. The Nursing Intervention Classification is a method of standardizing language and categorizing care. Dr. Chochrane systematically reviewed research trials and is part of the evidence based practice movement. Telemedicine uses communication technologies to support health care.
The level of practice a reasonable prudent nurse provides is called: A. the standard of careB. risk management C. a sentinel event D. failure to rescue
A. Guidelines for standards of care are published by various professional nursing organizations. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events are unexpected negative occurrences. They do not establish the standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the standard of care.
During a prenatal intake interview, the client informs the nurse that she would prefer a midwife to both provide her care during pregnancy and deliver her infant. What information would be most appropriate for the nurse to share with this client?a. Midwifery care is only available to clients who are uninsured because their services are less expensive than an obstetrician. Costs are often lower than an obstetric provider.b. The client will receive fewer interventions during the birth process.c. She should be aware that midwives are not certified.d. Her delivery can take place only at home or in a birth center.
B. This client will be able to participate actively in all decisions related to the birth process and is likely to receive fewer interventions during the birth process. Midwifery services are available to all low risk pregnant women, regardless of the type of insurance they have. Midwifery care in all developed countries is strictly regulated by a governing body that ensures that core competencies are met. In the United States this body is the American College of Nurse-Midwives. Midwives can provide care and delivery at home, in freestanding birth centers, and in community and teaching hospitals.
While obtaining a detailed history from a woman who has recently emigrated from Somalia, the nurse realizes that the client has undergone female genital mutilation (FGM). The nurse’s best response to this client is:a. “This is a very abnormal practice and rarely seen in the United States.”b. “Do you know who performed this so that it can be reported to the authorities?”c. “We will be able to fully restore your circumcision after delivery.”d. “The extent of your circumcision will affect the potential for complications.”
D. “The extent of your circumcision will affect the potential for complications” is the most appropriate response. The client may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. With the growing number of immigrants from countries where FGM is practiced, nurses will increasingly encounter women who have undergone the procedure. Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Responding with, “This is a very abnormal practice and rarely seen in the United States” is culturally insensitive. The infibulation may have occurred during infancy or childhood. The client 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 International Council of Nurses has spoken out against this procedure as harmful to a woman’s health.
To ensure client safety the practicing nurse must have knowledge of the current Joint Commission’s “Do Not Use” list of abbreviations. Which abbreviation is acceptable for use?A. q.o.d. or Q.O.D.B. MSO4 or MgSO4C. International Unit D. lack of a leading zero
C. “i.u.” and “I.U.” are no longer acceptable because they could be misread as “I.V.” or the number “10.” This abbreviation should be written out as “every other day.” The period after the “Q” could be mistaken for an “I”; the “o” could also be mistaken for an “i.” It is too easy to confuse one medication for another. These medications are used for very different purposes and could put a client at risk for an adverse outcome. They should be written as morphine sulfate and magnesium sulfate. The decimal point should never be missed before a number to avoid confusion, i.e., 0.4 rather than .4.
Healthy People 2010 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and providing care across the perinatal continuum. Therefore it is important for the nurse to be aware that significant progress has been made in:a. The reduction of fetal deaths and use of prenatal care.b. Low birth weight and preterm birth.c. Elimination of health disparities based on race.d. Infant mortality and the prevention of birth defects.
A. Trends in maternal child health indicate that progress has been made in relation to reduced infant and fetal deaths and increased prenatal care. Notable gaps remain in the rates of low birth weight and preterm births. According to the March of Dimes, persistent disparities still exist between African-Americans and non-Hispanic Caucasians. Many of these negative outcomes are preventable through access to prenatal care and the use of preventive health practices. This demonstrates the need for comprehensive community-based care for all mothers, infants, and families.
Which methods would help alleviate the problems associated with access to health care for the maternity client? Choose all that apply.a. Provide transportation to prenatal visits.b. Provide child care so that a pregnant woman may keep prenatal visits.c. Mandate that physicians make house calls.d. Provide low-cost or no-cost health care insurance.e. Provide job training.
A. B. D. Lack of transportation to visits, lack of child care, and lack of affordable health insurance are prohibitive factors associated with lack of prenatal care. House calls are not a cost-effective approach to health care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote.
Which statements indicate that the nurse is practicing appropriate family-centered care techniques? Choose all that apply.a. The nurse commands the mother to do as she is told.b. The nurse allows time for the partner to ask questions.c. The nurse allows the mother and father to make choices when possible.d. The nurse informs the family about what is going to happen.e. The nurse tells the client’s sister, who is a nurse, that she cannot be in the room during the delivery.
B. C. Including the partner in the care process and allowing the couple to make choices are important elements of family-centered care. The nurse should never tell the mother what to do. Family-centered care involves collaboration between the health care team and the client. Unless an institutional policy limits the number of attendants at a delivery, the client should be allowed to have whomever she wants present (except when the situation is an emergency and guests are asked to leave).

When you contact us, we will listen to you and ask you questions about your concern to help us understand the issues and your expectations. We will let you know if your concern or complaint is an issue that we can help you with.

What we can do

We can help you with concerns and complaints about a service provider’s responsibilities under the Aged Care Act 1997 or under their funding agreement with the Commonwealth. Some concerns we can assist with include:

health care, for example wound care, medication and care assessment
personal care assistance, for example showering, dispensing medication, feeding and mobility
communication, for example how information is shared with you and how your questions are responded to, including complaints
staff roles, for example how they do their job and provide care
living environment, for example safety, security, and cleaning
some fees and charges in care agreements
choice and preferences, for example showering and meal arrangements and tailored activities.

We treat each concern or complaint on its own merits and we will carefully assess the information we receive and obtain.

We can select one or more approaches to resolve the complaint you raise: either service provider resolution, conciliation, mediation or investigation. More information about these approaches can be found in our Resolving concerns about aged care fact sheet (PDF, 866.47 KB).

What we cannot do

There are some things we are unable to do:

provide advice on the availability of care or services in your local area
provide advice on who should make financial, legal or health decisions on behalf of a person
comment on industrial matters such as wages or employment conditions
ask service providers to terminate someone’s employment
provide legal advice or what to include in your care agreement
provide clinical advice about what treatment a person should be receiving
investigate the cause of death (this is the role of the coroner)
determine whether or not a specific event occurred (especially if we receive conflicting accounts of the event)

Even when a complaint relates to an issue we can look at, we may not be able to take action. For example, where the issue is part of legal proceedings or a coronial inquiry, or the consumer does not want the complaint to be examined.

If we can’t help you we can refer complaints to other organisations that may be able to address the issue you raised. For example, the Department of Health, professional registration boards or other complaints bodies.

How can you submit a complaint?

Complaints can be lodged by phone, in writing or online. To find out how you can make a complaint, read the Lodge a complaint page.

If you are lodging a complaint about the care someone else is receiving – it could be your mother, father, a friend – it is important that they or their representative know you are lodging a complaint.

You have the right to complain anonymously or confidentially; we will explain how these options may limit what we can do to resolve your concern. It is best to submit your complaint openly; that is, provide your name and contact details. We can talk about the difference between open, anonymous and confidential complaints when you contact us.

Open complaint

we will know your identity and contact details
the service provider will know your identity
we will keep you informed about the progress of your complaint and you will be able to provide us with more information
you may have review rights.

Confidential complaint

we will know your identity and contact details
we will endeavour not to disclose your identity to the service provider when we discuss your complaint issues with them
we will keep you informed about the progress of your complaint and you will be able to provide us with more information
you may have review rights.

Anonymous complaint

we will not know your identity
the service provider will not know your identity
we will not be able to keep you informed about the complaint’s progress or outcome and you will not be able to provide more information
you will not have review rights.

What can you expect when you first raise a concern with the Commission?

When you first contact us we will promptly acknowledge your complaint. One of our complaints officers will assess your concerns, record your information and discuss your options and our complaints process.

In raising a complaint, you have the right to expect:

your personal information will be handled appropriately
to be informed about the process and involved in decisions that affect you
to be treated with dignity and respect
to be informed about your review rights.

We will examine complaints regardless of a person’s cultural background, disability, gender, sex and gender identity, sexual orientation or any other status.

We will gather information to understand the issues and the outcome you are seeking. You can help us by giving as much information about your complaint as early as possible, our page on how to make an effective complaint may help you.

If we are unable to look into your concern, we will try to refer you to someone who can.

If we can look into your concern, we will explain how we resolve complaints and what might be achieved.

When we can look into your concerns

We will undertake a detailed assessment of the issues you raise in your concern and establish the level of risk to the consumer. We consider the safety, dignity and choice of the consumer and the quality of care and services being delivered. We might also:

contact the consumer (or their representative) to confirm if they wish us to examine the concern or complaint
review basic information about the consumer
undertake a more detailed review of the service provider’s history
engage with relevant people, for example the laundry staff if the complaint is about laundry
review any other information that is necessary and relevant to your complaint.

Once the detailed assessment is complete, we may assist you to resolve your concern directly with the service provider. Alternatively, we may commence a formal complaint resolution process. A complaints officer will explain the next steps and keep you informed about the progress of your complaint.

When examining your complaint through a 'resolution process'

We will select one or more of the following approaches to resolve the issues in your complaint:

Conciliation

We can help you and the service provider to discuss the issues and reach an agreement that resolves your concern. This may involve phone calls, discussions and meetings.

Investigation

We can investigate an issue. Investigations can be simple, for example gathering information and discussing the issues with both parties; or they can be more complex, involving visits to the service, analysing records and conducting interviews.

Service provider resolution

We can ask the service provider to examine your concern within a specified time frame. This may involve working with you to achieve an outcome. We will check with you whether your concerns have been addressed.

Mediation

If we are unable to achieve the outcome you are seeking, we may suggest that you and the service provider engage an independent mediator. There would be a cost involved, which you and the service provider would need to discuss and agree to.

While resolving your complaint through the approaches above we may:

consult professionals about clinical or technical matters
ask for information from you, the service provider or other people
visit the service involved
review any relevant information given to us
refer an issue to another organisation if they can more appropriately deal with it.

To help us achieve the best possible resolution to your complaint, we have put together some tips for How to make an effective complaint.

What will we do with your personal information?

The Privacy Act 1988 (Privacy Act) and Australian Privacy Principles (APPs) regulate how Australian Government agencies handle an individual’s personal information, including how they collect, store, use and/or disclose personal information.

In resolving complaints the Commission complies with the Privacy Act and APPs.

Our Privacy Policy and Notice of Collection outlines how we manage personal information. This includes how personal information is used, when this information may be disclosed to other parties, and how individuals can access or seek correction of personal information held about them.

When providing care for the pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is: A. diabetes mellitus B. Mitral valve prolapse C. Chronic hypertension D. anemia

A. Diabetes mellitus 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 is one of the most frequently reported maternal medical risk factors, not chronic hypertension. Although anemia is a concern in pregnancy, it is not one of the most frequently reported maternal medical risk factors in pregnancy.

Managed care has gained in popularity. The nurse should understand that this rise in popularity is most often guided by which consideration?A. concern for the quality of care B. means of controlling costs of care C. greater access to physicians D. allowance for early discharge

B. means of controlling costs of care Health care is among the fastest growing sectors of the U.S. economy. Managed care was developed as a direct result of escalating health care costs. Although quality control is important, it does not have any bearing on the rise in popularity of managed care. Managed care tends to have a gatekeeper effect, which actually may limit access to physicians, especially specialists. Although early discharge originally was part of the managed care plan to reduce hospital expenditures, this practice has created a need for additional care in the home.

The role of the professional nurse has evolved to emphasize: A. providing care to clients directly at the bedside B. planning client care to cover longer hospital stays C. leading the activities of a team of interdisciplinary health care providers D. managing care to cure health problems once they have occurred

C. leading the activities of a team of interdisciplinary health care providers Professional nurses are part of the team of health care providers who collaboratively care for clients in the managed care model. Providing care to clients directly at the bedside is one of a nurse’s tasks, but it does not encompass the concept of the evolved professional nurse. One goal of managed care is a decreased, not an increased, length of stay. Nurses do not cure health problems; they care for clients with ailments.

The nurse knows that teaching to increase self-care has been effective when the client makes what comment?a. “I’ll do whatever you say; you’re the nurse.”b. “I don’t think I can quit smoking.”c. “I exercise for 30 minutes 3 days a week.”d. “What do you think I should do?”

C. “I exercise for 30 minutes 3 days a week” indicates the client’s willing participation and understanding of healthy self-care behaviors. Doing is different from comprehension. The goal of teaching about self-care is to make sure the client understands the factors associated with her care. Generally an understanding of self-care practices increases the chance that clients will practice healthy behaviors. Smoking is only one behavior associated with self-care in pregnancy. In addition, the goal is for the client to seek self-care health behaviors, not discount them. The client’s question, “What do you think I should do?” indicates that she does not understand what measures she can take to increase her level of self-care.

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 woman’s:A. AgeB. Minority status C. Educational level D. Inability to pay

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.

What is the primary role of practicing nurses in the research process?a. Designing research studiesb. Collecting data for other researchersc. Identifying researchable problemsd. Seeking funding to support research studies

C. When problems are identified, research can be conducted properly. Research of health care issues leads to evidence-based practice guidelines. Designing research studies is only one factor of the research process. Data collection is one factor of research. Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.

When the nurse is unsure about how to perform a client care procedure, the best action would be to:a. Ask another nurse.b. Discuss the procedure with the client’s physician.c. Look up the procedure in a nursing textbook.d. Consult the agency procedure manual and follow the guidelines for the procedure.

D. It is always best to follow the agency’s policies and procedures manual when seeking information on correct client procedures. These policies should reflect the current standards of care and state guidelines. Each nurse is responsible for her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe client care delivery. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or individual state or hospital policies.

From the nurse’s perspective, what measure should be the focus of the health care system to reduce the rate of infant mortality further?a. Implementing programs to ensure women’s early participation in ongoing prenatal careb. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 daysc. Expanding the number of neonatal intensive care units (NICUs)d. Mandating that all pregnant women receive care from an obstetrician

A. Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. 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. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high risk infants after they are born. 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 obstetric care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have demonstrated reliable, safe care for pregnant women.

Alternative and complementary therapies:a. Replace conventional Western modalities of treatment.b. Are used by only a small number of American adults.c. Recognize the value of clients’ input into their health care.d. Focus primarily on the disease an individual is experiencing.

C. Many popular alternative healing modalities offer human-centered care based on philosophies that recognize the value of the client's input and honor the individual's beliefs, values, and desires. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of American adults are seeking alternative and complementary health care options. Alternative healing modalities offer a holistic approach to health, focusing on the whole person, not just the disease.

A 38-year-old Hispanic woman delivered a 9-pound, 6-ounce baby girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds would the woman potentially have a legitimate legal case for negligence?A. she is Hispanic B. she delivered a girl C. the standards of care were not met D. she refused fetal monitoring

A. Early postpartum discharges have reduced costs. The liability costs of a litigious society contribute to higher health costs. High-tech equipment increases health costs, as do LBW or high risk infants.

The term used to describe legal and professional responsibility for practice for maternity nurses is: A. collegiality B. ethics C. evaluation D. accountability

D. Accountability refers to legal and professional responsibility for practice. Collegiality refers to a working relationship with one’s colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes.

Maternity nurses can work to dispel the health disparities among women through:a. Increased education for mothers.b. Late prenatal care.c. Increased number of cesarean sections.d. Making all women take more vitamins.

An important development that concerns maternity nursing is integrative health care, which:a. Seeks to provide the same health care for all racial and ethnic groups.b. Blends complementary and alternative therapies with conventional Western treatment.c. Focuses on the disease or condition rather than the background of the client.d. Has been mandated by Congress.

B. Integrative health care tries to mix the old with the new at the discretion of the client and health care providers. Integrative health care is a blending of new and traditional practices. Integrative health care focuses on the whole person, not just the disease or condition. U.S. law supports complementary and alternative therapies but does not mandate them

Recent trends in childbirth practices in the United States indicate that:a. More than 15% of mothers had late or no prenatal care.b. The percentage of Hispanics, non-Hispanic African-Americans, and Caucasians who received prenatal care was essentially the same.c. Ninety-nine percent of births occurred in the hospital.d. Cesarean births have been declining as a percentage of live births.

C. Almost no births occur outside of the hospital. Only 3.4% of mothers had either late care or no care. A higher percentage of Caucasians received prenatal care. The percentage of cesarean births is increasing.

Recent trends in childbirth practice indicate that:a. Delayed pushing is now discouraged in the second stage of labor.b. Episiotomy rates are increasing.c. Midwives perform more episiotomies than physicians.d. Newborn infants remain with the mother and are encouraged to breastfeed.

D. Breastfeeding is encouraged for newborns immediately after birth. Delayed pushing is encouraged for several reasons. Episiotomy rates are declining. Midwives perform fewer episiotomies than do physicians.

The nurse should be cognizant that one accurate example of a U.S. societal trend is:a. The moral climate has caused companies to discourage breastfeeding on the job.b. Federal law allows women to breastfeed in federal buildings and on federal property.c. The Family and Medical Leave Act of 1993 provides up to 6 weeks of unpaid leave for births.d. The incidence of acquired immunodeficiency syndrome (AIDS) among infants has continued to rise.

B. Since 1999 federal law allows women to breastfeed in federal buildings and on federal property. In fact, companies make provisions for women to breastfeed at work. This also allows for 12 weeks of unpaid leave and also applies to adoption and the care of family members. The incidence of AIDS is declining among infants because of new therapies.

The nurse caring for the pregnant client should be aware that the U.S. birth rate shows what trend?a. Births to unmarried women are more likely to have less favorable outcomes.b. Birth rates for women 40 to 44 years of age are beginning to decline.c. Cigarette smoking among pregnant women continues to increase.d. The rates of pregnancy and abortion among teens are lower in the United States than in any other industrial country.

A. Low-birth-weight infants and preterm birth are more likely because of the large number of teenagers in the unmarried group. Birth rates for women in their early forties continue to increase. Fewer pregnant women smoke. Teen pregnancy and abortion rates are higher in the United States than in any other industrial country.

Maternity nursing care that is based on knowledge gained through research and clinical trials is:a. Derived from the Nursing Intervention Classification.b. Known as evidence-based practice.c. At odds with the Cochrane School of traditional nursing.d. An outgrowth of telemedicine.

B. Evidence based practice is based on knowledge gained from research and clinical trials. The Nursing Intervention Classification is a method of standardizing language and categorizing care. Dr. Chochrane systematically reviewed research trials and is part of the evidence based practice movement. Telemedicine uses communication technologies to support health care.

The level of practice a reasonable prudent nurse provides is called: A. the standard of careB. risk management C. a sentinel event D. failure to rescue

A. Guidelines for standards of care are published by various professional nursing organizations. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events are unexpected negative occurrences. They do not establish the standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the standard of care.

While obtaining a detailed history from a woman who has recently emigrated from Somalia, the nurse realizes that the client has undergone female genital mutilation (FGM). The nurse’s best response to this client is:a. “This is a very abnormal practice and rarely seen in the United States.”b. “Do you know who performed this so that it can be reported to the authorities?”c. “We will be able to fully restore your circumcision after delivery.”d. “The extent of your circumcision will affect the potential for complications.”

D. “The extent of your circumcision will affect the potential for complications” is the most appropriate response. The client may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. With the growing number of immigrants from countries where FGM is practiced, nurses will increasingly encounter women who have undergone the procedure. Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Responding with, “This is a very abnormal practice and rarely seen in the United States” is culturally insensitive. The infibulation may have occurred during infancy or childhood. The client 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 International Council of Nurses has spoken out against this procedure as harmful to a woman’s health.

To ensure client safety the practicing nurse must have knowledge of the current Joint Commission’s “Do Not Use” list of abbreviations. Which abbreviation is acceptable for use?A. q.o.d. or Q.O.D.B. MSO4 or MgSO4C. International Unit D. lack of a leading zero

C. “i.u.” and “I.U.” are no longer acceptable because they could be misread as “I.V.” or the number “10.” This abbreviation should be written out as “every other day.” The period after the “Q” could be mistaken for an “I”; the “o” could also be mistaken for an “i.” It is too easy to confuse one medication for another. These medications are used for very different purposes and could put a client at risk for an adverse outcome. They should be written as morphine sulfate and magnesium sulfate. The decimal point should never be missed before a number to avoid confusion, i.e., 0.4 rather than .4.

Healthy People 2010 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and providing care across the perinatal continuum. Therefore it is important for the nurse to be aware that significant progress has been made in:a. The reduction of fetal deaths and use of prenatal care.b. Low birth weight and preterm birth.c. Elimination of health disparities based on race.d. Infant mortality and the prevention of birth defects.

A. Trends in maternal child health indicate that progress has been made in relation to reduced infant and fetal deaths and increased prenatal care. Notable gaps remain in the rates of low birth weight and preterm births. According to the March of Dimes, persistent disparities still exist between African-Americans and non-Hispanic Caucasians. Many of these negative outcomes are preventable through access to prenatal care and the use of preventive health practices. This demonstrates the need for comprehensive community-based care for all mothers, infants, and families.

Which methods would help alleviate the problems associated with access to health care for the maternity client? Choose all that apply.a. Provide transportation to prenatal visits.b. Provide child care so that a pregnant woman may keep prenatal visits.c. Mandate that physicians make house calls.d. Provide low-cost or no-cost health care insurance.e. Provide job training.

A. B. D. Lack of transportation to visits, lack of child care, and lack of affordable health insurance are prohibitive factors associated with lack of prenatal care. House calls are not a cost-effective approach to health care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote.

Which statements indicate that the nurse is practicing appropriate family-centered care techniques? Choose all that apply.a. The nurse commands the mother to do as she is told.b. The nurse allows time for the partner to ask questions.c. The nurse allows the mother and father to make choices when possible.d. The nurse informs the family about what is going to happen.e. The nurse tells the client’s sister, who is a nurse, that she cannot be in the room during the delivery.

B. C. Including the partner in the care process and allowing the couple to make choices are important elements of family-centered care. The nurse should never tell the mother what to do. Family-centered care involves collaboration between the health care team and the client. Unless an institutional policy limits the number of attendants at a delivery, the client should be allowed to have whomever she wants present (except when the situation is an emergency and guests are asked to leave).

When a nurse is unsure about how do you perform a client care procedure the best action would be to?

What we can do

What we cannot do

How can you submit a complaint?

Open complaint

Confidential complaint

Anonymous complaint

What can you expect when you first raise a concern with the Commission?

When we can look into your concerns

When examining your complaint through a 'resolution process'

Conciliation

Investigation

Service provider resolution

Mediation

What will we do with your personal information?

When providing care for the pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is: A. diabetes mellitus B. Mitral valve prolapse C. Chronic hypertension D. anemia

Managed care has gained in popularity. The nurse should understand that this rise in popularity is most often guided by which consideration?A. concern for the quality of care B. means of controlling costs of care C. greater access to physicians D. allowance for early discharge

The nurse knows that teaching to increase self-care has been effective when the client makes what comment?a. “I’ll do whatever you say; you’re the nurse.”b. “I don’t think I can quit smoking.”c. “I exercise for 30 minutes 3 days a week.”d. “What do you think I should do?”

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 woman’s:A. AgeB. Minority status C. Educational level D. Inability to pay

What is the primary role of practicing nurses in the research process?a. Designing research studiesb. Collecting data for other researchersc. Identifying researchable problemsd. Seeking funding to support research studies

Alternative and complementary therapies:a. Replace conventional Western modalities of treatment.b. Are used by only a small number of American adults.c. Recognize the value of clients’ input into their health care.d. Focus primarily on the disease an individual is experiencing.

All of the following conditions have contributed to the increase in maternity-related health care costs except:a. Early postpartum discharges.b. Liability costs.c. The use of high-tech equipment.d. The cost of care for low-birth-weight (LBW) infants.

A. Early postpartum discharges have reduced costs. The liability costs of a litigious society contribute to higher health costs. High-tech equipment increases health costs, as do LBW or high risk infants.

The term used to describe legal and professional responsibility for practice for maternity nurses is: A. collegiality B. ethics C. evaluation D. accountability

D. Accountability refers to legal and professional responsibility for practice. Collegiality refers to a working relationship with one’s colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes.

Maternity nurses can work to dispel the health disparities among women through:a. Increased education for mothers.b. Late prenatal care.c. Increased number of cesarean sections.d. Making all women take more vitamins.

C. Almost no births occur outside of the hospital. Only 3.4% of mothers had either late care or no care. A higher percentage of Caucasians received prenatal care. The percentage of cesarean births is increasing.

Recent trends in childbirth practice indicate that:a. Delayed pushing is now discouraged in the second stage of labor.b. Episiotomy rates are increasing.c. Midwives perform more episiotomies than physicians.d. Newborn infants remain with the mother and are encouraged to breastfeed.

D. Breastfeeding is encouraged for newborns immediately after birth. Delayed pushing is encouraged for several reasons. Episiotomy rates are declining. Midwives perform fewer episiotomies than do physicians.

Maternity nursing care that is based on knowledge gained through research and clinical trials is:a. Derived from the Nursing Intervention Classification.b. Known as evidence-based practice.c. At odds with the Cochrane School of traditional nursing.d. An outgrowth of telemedicine.

The level of practice a reasonable prudent nurse provides is called: A. the standard of careB. risk management C. a sentinel event D. failure to rescue

To ensure client safety the practicing nurse must have knowledge of the current Joint Commission’s “Do Not Use” list of abbreviations. Which abbreviation is acceptable for use?A. q.o.d. or Q.O.D.B. MSO4 or MgSO4C. International Unit D. lack of a leading zero

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