Current Issues in Maternal and Child Health

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A nurse who works in the emergency department (ED) is assigned to a patient who is experiencing heavy vaginal bleeding at 12 weeks’ gestation. An ultrasound has confirmed the absence of a fetal heart rate, and the patient is scheduled for a dilation and evacuation of the pregnancy. The nurse refuses to provide any further care for this patient 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 patient.”
  • B. “Because we are shorthanded today, you have to continue to provide care. There is no one else available to provide care for this patient.”
  • 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 patient.”
Correct Answer: D

Rationale: The nurse manager's initial response should prioritize patient care and safety. In this situation, the patient requires urgent medical attention due to heavy vaginal bleeding and the need for a dilation and evacuation procedure. The nurse's refusal to provide care based on personal moral principles can be considered as patient abandonment, which is a serious ethical and legal issue in healthcare. The nurse manager must advise the nurse to continue providing care for the patient to ensure that the patient's needs are met and to prevent harm resulting from abandonment. The nurse manager should also address the nurse's concerns separately through appropriate channels, such as discussing ethical considerations, providing support, and exploring options for accommodation or transfer if necessary.

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The clinic nurse often cares for patients who are considering an abortion. Which responsibilities does this nurse have in regard to this issue? (Select all that apply.)

  • A. Informing the patient about pro-life options
  • B. Informing the patient about pro-choice support groups
  • C. Being informed about abortion from a legal standpoint
  • D. Being informed about abortion from an ethical standpoint
Correct Answer: B

Rationale: B. Informing the patient about pro-choice support groups: It is important for the clinic nurse to provide patients with information about different support resources available, including pro-choice support groups, to ensure they have access to a variety of perspectives and guidance.

In consideration of the historic evolution of maternity care, which treatment options were used over the past century? (Select all that apply.)

  • A. During the nineteenth century, women of privilege were delivered by midwives in a hospital setting.
  • B. Granny midwives received their training through a period of apprenticeship.
  • C. The recognition of improved obstetric outcomes was related to increased usage of hygienic practices.
  • D. A shift to hospital-based births occurred as a result of medical equipment designed to facilitate birth.
Correct Answer: A

Rationale: A. During the nineteenth century, women of privilege were typically delivered by midwives in a hospital setting. This practice was common among the wealthier class, as midwives were often considered the primary caregivers during childbirth.

A nurse who works in the emergency department (ED) is assigned to a patient who is experiencing heavy vaginal bleeding at 12 weeks’ gestation. An ultrasound has confirmed the absence of a fetal heart rate, and the patient is scheduled for a dilation and evacuation of the pregnancy. The nurse refuses to provide any further care for this patient 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 patient.”
  • B. “Because we are shorthanded today, you have to continue to provide care. There is no one else available to provide care for this patient.”
  • 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 patient.”
Correct Answer: D

Rationale: The nurse manager's initial response should prioritize patient care and safety. In this situation, the patient requires urgent medical attention due to heavy vaginal bleeding and the need for a dilation and evacuation procedure. The nurse's refusal to provide care based on personal moral principles can be considered as patient abandonment, which is a serious ethical and legal issue in healthcare. The nurse manager must advise the nurse to continue providing care for the patient to ensure that the patient's needs are met and to prevent harm resulting from abandonment. The nurse manager should also address the nurse's concerns separately through appropriate channels, such as discussing ethical considerations, providing support, and exploring options for accommodation or transfer if necessary.

The nurse is providing education to the patient that is receiving a bisphosphate medication for osteoporosis. Which instructions should the nurse include in the teaching plan to reduce side effects and enhance absorption while taking bisphosphates? Select all that apply.

  • A. Take the medication with a small meal at the same time
  • B. Take the medication with at least 8 oz. of water.
  • C. Remain upright for at least 30 minutes after taking a dos
  • D. Take the medication on an empty stomach
Correct Answer: A

Rationale: A. Take the medication with a small meal at the same time: Bisphosphonate medications should be taken with a small meal rather than on an empty stomach to enhance absorption and reduce the risk of gastrointestinal side effects.

Which nursing intervention is an independent function of the professional nurse?

  • A. Administering oral analgesics
  • B. Requesting diagnostic studies
  • C. Teaching the patient perineal care
  • D. Providing wound care to a surgical incision
Correct Answer: A

Rationale: Administering oral analgesics is an independent function of the professional nurse. Independent nursing interventions are those that a nurse is licensed to initiate based on their knowledge and skills without needing an order from a healthcare provider. Nurses are educated and trained in medication administration, including oral analgesics, and can independently assess the need for and safely administer them within their scope of practice. While requesting diagnostic studies, teaching perineal care, and providing wound care are essential nursing interventions, they typically require some form of healthcare provider's order or supervision, making them more interdependent activities.

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