Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 15 Pregnancy in Selected Populations

1. The pregnant 16-year-old is seeing the nurse during a prenatal visit. Based on the client's developmental level, which statement would the nurse expect the client to make?
2. "My friends and I all wear totally different styles of clothing."
3. "Having a baby will change my college plans."
4. "I drink alcohol at parties most weekends."
5. "My mom is my best friend."

Page Ref: 306

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Coping Mechanisms

Standards: Q S E N Competencies: Ⅰ. B. 9. Assess level of patient's decisional conflict and provide access to resources. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The school nurse is planning a presentation on pregnancy for 13- and 14-year-olds who are currently pregnant. When planning the content of this presentation, what should the nurse keep in mind about these teens?
2. They are working on independence and autonomy.
3. They are no longer developing a sense of achievement.
4. They are confident in their own identity.
5. They are in control of their impulses.

Page Ref: 306

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Describe the scope of the problem and the impact of adolescent pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse working in an adolescent prenatal clinic knows which of the following about the clients who are 15-17 years old?
2. They are more at ease with their individuality.
3. They see authority as resting with parents.
4. They are able to solve problems and make decisions.
5. They seek independence and identify with their peer group.

Page Ref: 306

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 1. Integrate theories and concepts from liberal education into nursing practice. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is working at a clinic for pregnant teens. What issues related to development will the nurse expect to encounter in most of the pregnant clients?
2. Peer pressure to stop using alcohol once pregnancy is diagnosed
3. Contraception failure that resulted in this pregnancy
4. The baby's father being emotionally supportive to the client
5. Feelings of not living up to parents' expectations

Page Ref: 306

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅴ. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe atmosphere that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is preparing an in-service presentation for a group of middle-school nurses. Which statements by the nurse would indicate that the middle-school nurse understood the role of culture in adolescent pregnancy?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "Studies show that 85% of teen mothers are middle class, and give birth to gain adult status."
2. "Teenage pregnancy is the leading reason why adolescent women drop out of school."
3. "Teens of color are more likely to become pregnant."
4. "Intelligence and academic ability are positively associated with delayed sexual activity, greater use of contraception, and lower rates of pregnancy."
5. "Over 50% of adolescents who have had an abortion or recent birth become pregnant again within two years."

Page Ref: 307—308

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅰ. B. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse who is counseling a group of middle-school girls on pregnancy avoidance should include which statement?
2. "Although sexuality is common in the media, peer pressure to have sex is not an important factor."
3. "It has become far less acceptable to give birth during your teenage years than it used to be."
4. "Although condom use is growing, there is still an increasing rate of S T Is among teens."
5. "You have learned enough from your friends and families to understand how pregnancy occurs."

Page Ref: 308

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse has given a community presentation on adolescent pregnancy. Which statements indicate that further teaching is necessary?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "Low educational achievement is major risk factor for adolescent pregnancy."
2. "Teens who are on a low economic trajectory are more likely to become pregnant."
3. "When a teen plans to attend college, abortion is less likely."
4. "In the United States, the adolescent birth rate is higher among white teens."
5. "Teens from low-income households are less likely to become pregnant."

Page Ref: 307—308

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 1 Describe the scope of the problem and the impact of adolescent pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. During the initial prenatal visit, the pregnant teenager states that she does not know how she got pregnant. The nurse can help to educate her regarding anatomy by doing what?
2. Allowing her to witness a pelvic exam on another teenager
3. Encouraging her to ask her mother about the physiology of pregnancy
4. Including anatomic models and drawings in the teaching session
5. Discussing the process of fetal development with the client

Page Ref: 312

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 5 Describe successful community approaches to prevention of adolescent pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. Which statements might a pregnant teenager be likely to make at her initial prenatal examination?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "I didn't know I could get pregnant the first time I had sex."
2. "Several of my friends go to clinics to get contraception."
3. "It's no big deal; two of my best friends have babies, too."
4. "I was 13 years old when I had sex the first time."
5. "My family and my boyfriend are really happy and supportive."

Page Ref: 307—308

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. Several adolescent female students are waiting to be seen by the school sexual health clinic nurse. Which student should the nurse see first?
2. 14-year-old whose 17-year-old sister is pregnant
3. 15-year-old who reports using condoms regularly
4. 16-year-old who had chlamydia treated 2 weeks ago
5. 17-year-old with a history of child abuse

Page Ref: 308

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. In planning a conference for adolescents, the nurse researches the most common socioeconomic and cultural factors that contribute to adolescent pregnancy. Which true statements should be included in this conference?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Economic status has a relatively low impact on an adolescent's sexual activity.
2. Nearly three quarters of all teens ages 15-19 have had sex at least once.
3. Poor self-esteem contributes to adolescent pregnancy.
4. 38% percent of sexually active students use a condom.
5. Sexual abuse is not an issue with teen mothers.

Page Ref: 306, 308

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Describe the scope of the problem and the impact of adolescent pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. A 16-year-old is making her first prenatal visit to the clinic in her fourth month of pregnancy. What is the nurse's first responsibility?
2. Contact the social worker.
3. Develop a trusting relationship.
4. Schedule the client for prenatal classes.
5. Teach the client about proper nutrition.

Page Ref: 315

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. Which statement made by the pregnant adolescent would indicate to the nurse that she understood her increased risk of physiologic complications during pregnancy?
2. "It's no big deal that I started prenatal care in my seventh month."
3. "My anemia and eating mostly fast food are not important."
4. "I need to take good care of myself so my baby doesn't come early."
5. "Smoking and using crack cocaine won't harm my baby."

Page Ref: 310

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The 19-year-old pregnant woman begins a job to "save money for the baby." What is the most significant developmental task the nurse understands this statement to demonstrate?
2. Striving for gaining autonomy and independence
3. Completed development of a sense of identity
4. Attainment of a sense of achievement
5. Having developed an intimate relationship

Page Ref: 306

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 5. Apply knowledge of social and cultural factors to the care of diverse populations. | N L N Competencies: Knowledge and Science: Systematically reflect on practice as a basis for the generations of new knowledge and innovation. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. Which of the following is the most prevalent medical complication of pregnant adolescents?
2. Constipation
3. Preeclampsia-eclampsia
4. Heartburn
5. Rapid enlargement and sensitivity of breasts

Page Ref: 308

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is working with a group of pregnant teens. Which statement indicates that teaching has been successful?
2. "Pregnant teens are more likely to quit school prior to graduation."
3. "Because I am young, I have a low risk for preeclampsia."
4. "My baby could come late because I am a teenager."
5. "I am more likely to use birth control after I have this baby."

Page Ref: 308

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is teaching a pregnant 14-year-old client who is at 10 weeks' gestation about the expected body changes that will occur during pregnancy. Which client statement indicates that additional information is needed?
2. "My breasts are going to get even bigger than they've gotten over the past couple of years."
3. "My belly will gradually get more round, especially from the middle of pregnancy on."
4. "I will feel my baby move in about 16 weeks."
5. "My diet can stay the same even though I'm pregnant."

Page Ref: 313

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse seeks to involve the adolescent father in the prenatal care of his girlfriend. What is the rationale for this nursing strategy?
2. Having the father more involved with the birth
3. Avoiding conflict between the adolescent father and pregnant teenager
4. Including his name on the birth certificate
5. Avoiding legal action by the adolescent father's family

Page Ref: 309—310

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships to promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 3 Delineate the characteristics of the fathers of children of adolescent mothers.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is working with male teens whose partners are pregnant. What statement by the father-to-be requires that the nurse intervene?
2. He will be the only other person who will be present for the birth, although his girlfriend wants her mother to be with her.
3. He was very sexually active at an earlier age and he has had more sexual partners than his girlfriend.
4. The pregnancy does not seem real to him, and he is not sure what he should do to plan for the future.
5. He does not want to be married.

Page Ref: 309—310

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Systematically reflect on practice as a basis for the generation of new knowledge and innovations. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 3 Delineate the characteristics of the fathers of children of adolescent mothers.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. A 14-year-old girl is brought to the clinic by her mother. The nurse determines that the teen is about 28 weeks pregnant. The mother states, "We knew she was gaining weight, but we can't tell anyone she is pregnant." The nurse understands that the client's mother's behavior exemplifies which of the following?
2. Low self-esteem
3. Anger
4. Shame
5. Ignorance

Page Ref: 311

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Family Dynamics

Standards: Q S E N Competencies: Ⅰ. C. 14. Appreciate shared decision-making with empowered patients and families, even when conflicts occur. | A A C N Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 4 Discuss the possible reactions of the adolescent's family and social network to her pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is talking with the parents of a pregnant 15-year-old. Which statement by one of the parents is expected?
2. "We're very happy for her. It will be easier to focus on education with a new baby."
3. "I'm not going to get involved. She understands how her health insurance works."
4. "Her father told her to stop dating that boy. Now look at the trouble she's gotten into."
5. "An abortion is the best choice for her. She can deal with our Catholic priest later."

Page Ref: 311

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 4 Discuss the possible reactions of the adolescent's family and social network to her pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. After telling a mother that her 13-year-old daughter is pregnant, the nurse would expect the mother to respond with which statement?
2. "We had such high hopes for you."
3. "But you have always been a happy child."
4. "I've always liked that boy."
5. "This is just one of those things that happen."

Page Ref: 311

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅰ. C. 2. Respect and encourage individual expression of patient values, preferences, and expressed needs. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Promote and accept the patient's emotions; accept and respond to distress to patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 4 Discuss the possible reactions of the adolescent's family and social network to her pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse's goals for prenatal classes may include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Increasing self-esteem
2. Preparing the participants for childrearing
3. Offering information on the risks of breastfeeding
4. Providing anticipatory guidance about pregnancy
5. Helping participants develop more adaptive coping skills

Page Ref: 317

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. Recommendations for parents to help their teens avoid pregnancy include which of the following?
2. Parents need to encourage frequent and steady dating.
3. Parents need to let their children set their own goals for the future.
4. Parents need to have their children taught about sex by school programs and community resources.
5. Parents should be clear about their own sexual attitudes and values.

Page Ref: 316

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅴ. C. 4. Value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the healthcare team. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 5 Describe successful community approaches to prevention of adolescent pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse developing a care plan for a pregnant teen knows that what plan is best suited to pregnant teens?
2. Assess menstrual history and the presence of any food allergies.
3. Inquire about family relationships and location of the home.
4. Ask what her body image is, then correct her misconceptions.
5. Determine whether there are substance abuse issues.

Page Ref: 307

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of a clinical interview, implementation of care plan, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is working in a teen pregnancy clinic. In order to give the pregnant adolescent a role in her prenatal care, the nurse should allow the teen to do which of the following?
2. Choose the type of prenatal vitamin she takes
3. Measure and record her weight at each visit
4. Choose the schedule of her prenatal visits
5. Decide whether she wants her labor to be induced

Page Ref: 311

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse discussing different pregnancy programs explains that which of the following is critical to the success of an adolescent pregnancy-prevention program?
2. Including role models from the same cultural and racial backgrounds as the participants
3. Focusing on the adolescent female
4. Having short-term, informal programs available twice per year
5. Focusing on the expectations of the adolescents' parents

Page Ref: 316

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: Q S E N Competencies: Ⅲ. B. 6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 5 Describe successful community approaches to prevention of adolescent pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse has been asked by a community organization to give a presentation on prevention of teen pregnancy. Which statement indicates appropriate steps toward reduction of the local teen pregnancy rate?
2. Abstinence-only education will be offered in the school and clinics.
3. Classes on how to parent will be mandatory in high school.
4. A low-cost reproductive health clinic will be planned.
5. Parents will be encouraged to avoid discussing sexual activity.

Page Ref: 316

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: Q S E N Competencies: Ⅲ. B. 6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice. | A A C N Essentials Competencies: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 5 Describe successful community approaches to prevention of adolescent pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is preparing an educational session for parents of adolescents. In which order should the nurse explain the psychosocial development for this population?
2. Thinks abstractly
3. Lack impulse control
4. Formal operational thought
5. Egocentric and a concrete thinker
6. Experiments with drugs and alcohol

Page Ref: 306—307

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 1 Describe the scope of the problem and the impact of adolescent pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The community nurse is preparing to visit the home of an adolescent who is 18 weeks pregnant. Which health problems should the nurse focus on when assessing this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Preeclampsia
2. Preterm birth
3. Low-birth-weight
4. Gestational diabetes
5. Iron deficiency anemia

Page Ref: 308—309

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. An adolescent in the third trimester of pregnancy comes into the clinic for a routine examination. What should the nurse assess to determine if the patient is working through this trimester's developmental tasks?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Amount of weight gained
2. Adequacy of nutritional intake
3. Supplies purchased for the baby
4. Presence of heartburn or constipation
5. Place in the home identified for the baby

Page Ref: 308—309

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is preparing an educational program for pregnant adolescents in the community. What goals should the nurse identify as appropriate for this teaching?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Managing finances
2. Increasing self-esteem
3. Preparing for labor and birth
4. Developing adaptive coping skills
5. Providing information about resources

Page Ref: 308—310

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Teaching/Learning.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. A pregnant adolescent is scheduled for her first prenatal visit. For which sexually transmitted infections (S T Is) should the nurse anticipate testing will occur?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. H P V
2. Candida
3. Gonorrhea
4. Chlamydia
5. Trichomonas

Page Ref: 308

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Nursing Process.

Learning Outcome: 2 Identify the physical, psychologic, and sociologic risks a pregnant adolescent faces.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is presenting a class to women who are currently pregnant or are planning pregnancy in the near future. Which client statement indicates that additional teaching is required?
2. "The older a woman is when she conceives, the safer the pregnancy is."
3. "Pregnant teens can have additional nutritional needs."
4. "A woman whose sisters all had hypertension will be watched carefully."
5. "Pregnancy may be more difficult to achieve in my 40s."

Page Ref: 317

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 7 Summarize the nursing care needs of an expectant woman over age 35.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.

1. The nurse is preparing a brochure for couples considering pregnancy after the age of 35. Which statements should be included?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. There is a decreased risk of Down syndrome.
2. Preexisting medical conditions can complicate pregnancy.
3. Preterm births are more common.
4. Amniocentesis can be performed to detect genetic anomalies.
5. The increased fertility of women over age 35 makes conception easier.

Page Ref: 317

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 7 Summarize the nursing care needs of an expectant woman over age 35.

M N L L O: Demonstrate use of the nursing process in the care of the pregnant adolescent and woman over 35, and women with special needs.