Question 1

Which of the following people are eligible for membership to American College of Nurse-Midwives?
I.A certified nurse midwife
II.A certified midwife
III.A student enrolled in a program that is accredited by the ACNM Division of Accreditation.
IV.A registered nurse

A)I and II only
B)I and III only
C)I, II and III
D)All of the above are eligible.

I, II and III

Accepted Answer

Certified nurse midwives, certified midwives and students enrolled in programs that are accredited by the ACNM Division of Accreditation are eligible for ACNM membership. There are three types of memberships: active, associate and student. Active members may hold offices. Associate members can engage in volunteer work. Student members are eligible to take the certification exams.

Question 2

There are many reasons why nurse midwives should be concerned with professional ethics. Which of the following is the main and critical purpose of applied professional ethics?&#10;A)To foster professional identity.&#10;B)To protect consumers and care providers.&#10;C)To maintain internal regulation and avoid external regulation.&#10;D)To signal professional maturity.

Accepted Answer

The main and critical role of applied professional ethics is to maintain internal regulation and avoid external regulation. Self-regulation is preferred because no one knows midwifery better than its members. With self-regulation, external agencies are less likely to interfere with the practice. Ethical codes foster professional identity and encourage nurse midwives to define themselves and communicate who they are in relation to others. Through professional ethics, the consumers and care givers are protected, causing increased confidence in the profession. Ethical codes also signal professional maturity, which stimulates further development of ethical codes and guidelines.

Question 3

An obstetrician complains to a nurse midwife that the staff nurses in the labor and delivery unit are not informing him about the condition of his patients. The physician also says, "Your nurses do not even know how to document in my patients' records." Which of the following responses is most appropriate?

A)"Our staff nurses are well-trained and prepared to manage the patients. Your complaint about their substandard documentation skills is the first one of this type that has been received."
B)"I'll investigate your concerns and I will send you a written report. Thank you for bringing this matter to my attention."
C)"The unit has been admitting a lot of patients for the past two months. Give us sufficient time to improve the system in the unit."
D)"We are short-staffed. We are doing our best for the patients."

"I'll investigate your concerns and I will send you a written report. Thank you for bringing this matter to my attention."

Accepted Answer

The nurse midwife deals with this situation by informing the physician that an investigation will be conducted and that a written report will be provided. The nurse midwife should neither deny the problem (option A) nor make excuses (options C and D).

Question 4

A 43-year-old female client who is about to get married comes to the clinic with her boyfriend for a series of fertility tests. The client's boyfriend used to be the nurse midwife's patient from another facility, and the nurse midwife is certain that he tested positive for HIV. The client is unaware of her boyfriend's diagnosis. The nurse midwife talks to the boyfriend in private, and, although he acknowledges that that he used to be her patient, he denies that he tested positive for HIV and refuses to talk to his girlfriend about his diagnosis. What should the nurse midwife's next action be?

A)Decide not to inform the client but document that an attempt was made to convince the boyfriend to reveal the diagnosis to the female client.
B)Inform the female client that her boyfriend has HIV.
C)Obtain information from the boyfriend's past medical record without his permission.
D)Urge the female client to persuade her boyfriend to get an HIV test with her.

Accepted Answer

The next action of the nurse is to urge the female client to persuade her boyfriend to have an HIV test with her. This action may be supported by educating the client about the effects, risks and treatment options of HIV. The nurse midwife has the duty to protect the health of the female client, but she also has to respect the boyfriend's privacy. Urging the client to persuade her boyfriend to take the test with her is ethical. There are certain situations in which the nurse midwife has the legal duty to report cases that threaten public safety. The nurse may inform the female client about the boyfriend's diagnosis if she has attempted to resolve this issue through all other possible means.

Question 5

A 14-year-old comes to the clinic after a home pregnancy test indicated that she is pregnant. Physical examination and laboratory tests confirm that the client is 12 weeks pregnant. The nurse midwife also notes that the client has signs of anorexia nervosa. A series of tests are conducted, revealing anemia. On the second visit, the client informs the nurse midwife that she has decided to have an abortion and she wants to know her options. The nurse midwife tries to encourage the client to talk to her mother, but the client refuses. Which of the following is the next action of the nurse midwife?

A)Inform the client's mother about the pregnancy and the client's plan for abortion.
B)Thoroughly explain the effects of abortion on the adolescent's health and how having anorexia nervosa and anemia greatly increase her risk for life-threatening medical conditions after the procedure.
C)Keep silent about the client's pregnancy and planned abortion, but be sure to work closely with the client to help her mentally and physically before and after the abortion.
D)Inform the state about the client's condition.

Accepted Answer

The next action of the nurse is to thoroughly explain to the effects of abortion and the additional risks posed by anorexia nervosa and anemia. Knowing about the complications involved, the client may agree to inform her mother of the pregnancy. If the client refuses to inform her mother in spite of the teaching, the nurse midwife may report the client's condition to state officials. When caring for a pregnant adolescent, one of the main goals of a nurse midwife is to encourage the client's family members to participate in the care. The nurse midwife may implement other activities that may facilitate communication between mother and child before informing the state about the client's condition.

Question 6

A nurse midwife is monitoring a client who is in labor. In early labor, the client was cooperative and followed the instructions given to her by the nurse midwife. Now during the second stage of labor, as the frequency and intensity of the contractions increase, the client is uncooperative. The client bears down although the nurse midwife advises her not to, shouts and curses at the nurse midwife because the anesthesia does not seem to work. The nurse midwife says, "If you don't stop cursing and start following my instructions, I'll break your legs and stick them down your throat." The nurse midwife could be charged with which legal tort?

A)Assault
B)Battery
C)Slander
D)Intentional infliction of emotional distress

Accepted Answer

The nurse could be charged with assault. Assault is a wrongful and intentional action or statement that causes the client to feel immediate fear. Battery is intentional physical contact without the client's permission. Slander involves malicious and defamatory statements against another person. Intentional inflection of emotional distress involves an extreme action or conduct that causes another person to experience mental distress and anxiety.

Question 7

In which of the following situations can the nurse midwife be charged with false imprisonment?&#10;A)A nurse midwife asks the client to sign a release of liability before discharge. The client is requesting a release from the hospital against medical advice.&#10;B)A pregnant client is placed in the isolation room after hitting two other clients in the unit.&#10;C)A nurse administers an anesthetic to a client for a cesarean section without informed consent.&#10;D)A nurse midwife is caring for a client with eclampsia. The bed is in the lowest position with the side rails up.

Accepted Answer

Administering a medication without the client's consent is battery. A release of liability is signed by a client who goes home against medical advice. A client may be placed in isolation in cases where she threatens the safety of self or others. The side rails are kept up in for clients who are at risk for seizures.

Question 8

Before discharging a pregnant client against medical advice (AMA), which of the following actions by the nurse midwife is the most appropriate?&#10;A)Inform the client that she may not come back to the facility if complications occur.&#10;B)Ensure that the client is aware of the risks of leaving the facility.&#10;C)Inform the ethics committee about the client's case.&#10;D)Inform the client that follow-up care is not possible after discharge.

Accepted Answer

Before discharging a client AMA, the nurse midwife should ensure that the client is aware of the risks of leaving the facility. The nurse midwife should also inform the client that she can come back to the facility any time. Follow-up appointments should be arranged before discharge.

Deck 7: Professional-Issues