1. MC An experienced nurse is working with a new graduate. The experienced nurse suspects that the multiparous client is going to deliver precipitously, while the new graduate is unaware that the labor is proceeding rapidly. One reason for this difference in interpretation of the client situation is because experienced nurses are able to view situations more holistically because they:  
	A.*	Are more aware of subtle cues that indicate client changes.  
	B.	Need less supervision in managing complex clinical situations.  
	C.	Spend less time providing direct client care.  
	D.	Know more about the pathophysiology of diseases.  

2. MC Self-care has gained wide acceptance with clients, the healthcare community, and third-party payors due to research findings that suggest that it has:  
	A.	Shortened newborn length of stay.  
	B.	Decreased use of home health agencies.  
	C.*	Reduced health care costs.  
	D.	Decreased the number of emergency room visits.  

3. MC The new graduate is learning about advanced practice nursing. Which of the following situations best illustrates an advanced practice nursing role? (Select all that apply.)  
	A.	An experienced registered nurse who is the manager of a large obstetrical unit  
	B.	A registered nurse who is the circulating nurse at surgical (cesarean) deliveries  
	C.	A clinical nurse specialist who is working as a staff nurse on a mother-baby unit  
	D.*	A nurse practitioner who is consulting with a physician in the newborn nursery  
	E.*	A nurse-midwife attending vaginal deliveries of uncomplicated pregnancies.  

4. MC The nurse at an elementary school is performing TB screenings on all of the students. Permission slips were returned for all children except for the Nguyen children. When the nurse phones to obtain permission, the mother states in clearly-understandable English that she is unable to give permission at this time because her grandmother is out of town for two more weeks. Which of the following elements of culture is contributing to the dilemma that faces the nurse?  
	A.	Permissible physical contact with strangers  
	B.	Belief and understanding about the concepts of health and illness  
	C.	Religion and social beliefs  
	D.*	Presence and influence of the extended family  

5. MC The insurance company is demanding that a client who is experiencing complications be discharged in two days, because her benefits will run out. The physician and nurses who are involved in this client's care all feel that, because there is no one at home to provide assistance, it is an ethical breach of duty to send this client home when she cannot care for herself. Which of the six components of ethical decision making is the nurse considering when evaluating the driving and restraining forces and assessing the likelihood of a successful outcome?  
	A.	Data gathering  
	B.*	Conflict resolution  
	C.	Plan formulation  
	D.	Action and implementation  

6. MC The nurse is reviewing care of clients on a mother-baby unit. Which of the following situations should be reported to the supervisor?  
	A.	A 2-day-old infant has breastfed every three hours and voided four times.  
	B.*	An infant was placed in the wrong crib after examination by the physician.  
	C.	The client who delivered by cesarean delivery yesterday received oral narcotics.  
	D.	A primiparous client who delivered today is requesting discharge within 24 hours.  

7. MC The nurse manager is planning a presentation on ethical issues in caring for the childbearing families. Which of the following should the nurse manager include as an example of maternal-fetal conflict?  
	A.	A client chooses an abortion after her fetus is diagnosed with a genetic anomaly.  
	B.	A 39-year-old nulliparous client undergoes therapeutic insemination.  
	C.	A family of a child with leukemia requests cord blood banking at this birth.  
	D.*	A cesarean delivery of a breech fetus is court-ordered after the client refuses.  

8. MC The nurse is working at a community clinic. For which of the following clients must the nurse seek parental permission to obtain informed consent?  
	A.	A 16-year-old who is seeking information on contraceptive use  
	B.	An emancipated minor who is requesting treatment for a urinary tract infection  
	C.	A married 17-year-old who is recommended for a planned cesarean birth  
	D.*	A 12-year-old with an ectopic (tubal) pregnancy who requires surgery  

9. MC In explaining descriptive statistics to the student nurse, the experienced nurse should include which of the following examples?  
	A.*	Comparison of maternal mortality rates across racial groups  
	B.	Determining why the infant mortality is declining in the United States  
	C.	Assessment of maternal nutrition with age and birth weight  
	D.	Understanding the behavioral variations within a cultural group  

10. MC The nurse knows the birth rate by age group in the state. Which research question could be developed for further study from this data?  
	A.	What is the average number of children per family in the United States?  
	B.*	How does educational level affect the incidence of unplanned pregnancy?  
	C.	What is the overall nutritional status of adolescents?  
	D.	Which high schools provide day care for student parents?  

11. MC The nurse manager is leading an in-service educational session about evidence-based nursing practice. Which participant statement indicates the need for additional information? "Evidence-based nursing practice:  
	A.	Incorporates research findings into clinical practice."  
	B.*	Is unnecessary on a unit with established policies."  
	C.	Is supported by current, valid research."  
	D.	Is a lifelong learning approach to client care."  

12. MC State nurse practice acts define the legal scope of nursing practice. How can the policies of an institution or organization such as a hospital influence nursing practice? The institution: (Select all that apply.)  
	A.*	Can restrict nurses from doing some things that are allowed by the state nurse practice act.  
	B.	Can permit nurses to do some things that are forbidden by the state practice act.  
	C.	Cannot redefine in any way the limits set by the practice act.  
	D.	Can either restrict or expand the limits of the practice act.  
	E.*	Should remain aware of changes or updates as they are enacted.  

13. MC The maternity nurse has been named in a negligence malpractice suit. The best defense against the accusation of negligence is if the nurse:  
	A.	Followed the physician's written orders.  
	B.*	Met the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) standards of practice.  
	C.	Is a certified nurse midwife or nurse practitioner. 
	D.	Was acting on the advice of the nurse manager.  

14. MC The nurse is planning care in a labor and delivery unit. Which of the following families is most likely to request cord blood banking?  
	A.*	A family with a history of leukemia  
	B.	A family with a history of infertility  
	C.	A family who wishes to select the sex of a future child  
	D.	A family who wishes to avoid a future intrauterine fetal surgery  

15. MC A nurse has attended a cesarean birth. Without first consulting the parents the nurse goes to the waiting room and tells family members the sex of a newborn baby. In this situation, the nurse would be considered to have committed:  
	A.*	A breach of privacy.  
	B.	Negligence.  
	C.	Malpractice.  
	D.	A breach of ethics.