TEST BANK Test Bank ForMaternal-Child Nursing Care with The Women’s Health Companion: Maternal-Child Nursing Care with The Women’s Health Optimizing Outcomes for Mothers, Children, and Families- 2nd Companion: Optimizing Outcomes for Mothers, Children, and Families2ndSusan Edition, L. Susan L. Ward, Shelton M. Edition, Ward, Shelton M.Hisley Hisley (2024) | All Chapters 1-35 (2024 update) (All Chapters 1-35)
TEST BANK Chapter 1: Traditional and Community Nursing Care for Women, Families and Children Maternal-Child Nursing Care: Optimizing Outcomes for Mothers, Children, and Families 2nd Edition Test Bank
MULTIPLE CHOICE 1. The clinic nurse understands the new description of nursing art/aesthetics as the way that nurses and patients help each other through a circular process. What is the event that beginsthis process? A. A health threat B. Experiencing new possibilities for health C. Hope and understanding for the future D. Relationship building ANS: A Nursing aesthetics consists of the low-tech, high-touch caring in a nurse–patient encounter.This transformative process begins with a health threat. The event that begins the process isnot experiencing new possibilities for health, hope and understanding for the future, or relationship building. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate PTS: 1 2. A nurse manager in a community clinic is concerned because the local refugee populationdoes not seek health care routinely. What action by the nurse would be most helpful? A. Assess clinic staff and procedures for evidence of ethnocentrism. B. Put up flyers advertising the clinic’s services in local retailers. C. Reward preventative health patients with coupons for needed items. D. Try to meet with community leaders to work on the problem. ANS: A Ethnocentrism is the view that the beliefs, values, and behaviors of one culture are superior tothose of other cultures. Ethnocentrism is dangerous in health care because it is blind to the possibilities of other solutions and viewpoints and alienates people in need of health care. Thenurse manager would be wise to assess the clinic’s staff and procedures for ethnocentrism. Meeting with a community leader is always a good idea to learn the viewpoints of the community, but unless ethnocentric behaviors change, it is unlikely that the refugee community will increase its use of the clinic. Flyers and incentives may also be helpful insome cases, but not as helpful as reducing the barriers imposed by ethnocentrism. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Moderate
PTS: 1 3. The nursing faculty explains to students that ethnopluralism is an important force shaping
health care today. What concept is most important in understanding this trend? A. The decreased need for cultural competency B. The growth in one ethnic group in a single area C. The increased impact of diverse cultures on health care D. The percentage increase of the non-Caucasian population ANS: C
Ethnopluralism means diverse cultures. As the population of different ethnic (non-Euro-Caucasian) groups grows, their impact on health care will increase exponentially. Ethnopluralism is not just the growth of one ethnic group in one location. It is also more than just the percentage change in the non-Euro-Caucasian population, although that is part of the phenomenon. As ethnopluralism continues to impact health care, providers will need to be more, not less, culturally competent. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 4. A nursing faculty member is explaining recent shifts in nursing practice. What change has
been important in applying the nursing process? A. A change to a spiral or circular process B. A focus on more independent nursing actions C. A return to the nurse-as-expert model of care D. An emphasis on attaining a disease-free state ANS: A
The nursing process has recently changed from a linear one to a spiral or circular process in which the patient/family is motivated toward promotion, maintenance, and restoration of health. The focus has not changed to include more independent actions, a return to the nurse-as-expert model, or an emphasis on attaining a disease-free state of being. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 5. A nurse is working in an urban clinic with a diverse population. What action by the nurse is
most important? A. Determine patients’ definitions of health and desired outcomes of health care. B. Explain policies such as appointment cancellations to ensure compliance.
C. Learn to speak one or two common languages of the patients in the clinic. D. Read about different folk remedies common among the populations seen. ANS: A
Divergent populations enter the health-care system with differing beliefs about health care and wellness and differing expectations for the outcomes of such experiences. Understanding these expectations will help the nurse plan care that has a better chance of meeting these expectations. Learning languages and becoming familiar with folk remedies is helpful as well, but these two solutions are very limited in scope and a nurse cannot hope to become proficient in all the languages/behaviors of every population seen, leaving some patients with a lessened experience. Explaining policies is important too, but simply telling someone the rules does not take his or her cultural norms into account and may not be successful. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 6. A nurse is working with a minority group that has a high incidence of cardiovascular disease,
including hypertension and stroke. When participating in a community health fair with this group, what action by the nurse will be most effective? A. Educate the participants about weight loss and a low-sodium, low-fat diet. B. Explain the genetic basis for the high incidence of cardiovascular disease in the group. C. Help participants make lifestyle changes that are culturally congruent. D. Present statistics on the mortality and morbidity of cardiovascular disease. ANS: C
The ever-increasing culturally diverse population interacting with the health-care system brings its own beliefs, values, and health-related practices that impact health and well-being. In order to help people make healthy lifestyle changes, the changes must be culturally congruent and acceptable. Forcing an incongruent practice makes it highly unlikely to succeed. Education is important, but it must be done in a culturally congruent way. Pathophysiology and statistical knowledge, by itself, is not likely to be beneficial. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Difficult PTS: 1 7. What does the practicing nurse understand to be the most important influence on
interdependent, assertive nursing practice today? A. Higher education of registered nurses B. Improved working conditions and salaries C. Increased numbers of female physicians
D. Use of the nursing process for patient care ANS: D
Nurses were passive, deferential, and compliant to the knowledge and orders of mostly male physicians until the late 20th century. The nursing process changed that. The nursing process is a framework for systematic problem solving and implementation of both independent and dependent nursing actions. The nursing process allows nurses to make decisions regarding patient care based on critical thinking and clinical judgment. The other options listed were not vital in creating a nursing practice that is interdependent and assertive. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process Difficulty: Difficult PTS: 1 8. A child who has been hospitalized for a long time is preparing to go home, where care will be
continued. Which action by the nurse is most beneficial to assist the family in this transition? A. Advise the family to call the local visiting nurses association for home visits. B. Call the child’s school to inquire about requirements for returning to school. C. Consult a social worker to help evaluate insurance coverage and transportation. D. Give the family brochures for the local support group for chronically ill children. ANS: C
Preparing a family for home-based care, or other community-based care, involves ensuring that the family is able to provide the care needed by the child at home or in another setting. This can include discussing specialized equipment in the home, health insurance coverage, transportation, and/or returning to school. If the family needs or desires visiting nurses, the nursing staff or social worker at the hospital should arrange this for the family. Calling the school to get information about the child’s return to school yields helpful information, but may not be needed yet, and is too limited in scope to be the best answer. Simply giving parents brochures for support groups may or may not be helpful; the parents may not be literate or may not understand the benefit without discussion. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Communication and Documentation Difficulty: Difficult PTS: 1 9. A nurse manager wants to make the pediatric clinic a more family-centered health-care
setting. Which of the following actions by the nursing staff would best meet this goal? A. Encourage family members to be present in the exam room and to ask questions. B. Incorporate the use of a community health map for all new patients in the clinic. C. Recognize family members as experts on their child and incorporate them in decision making. D. Use evidence-based practice to develop policies and procedures used in the clinic.
ANS: C
The role of the family-centered nurse is to facilitate and assist the family in making informed choices that lead to the outcome the patient and family desire. This requires the nurse to give up the paternalistic role of authority on health care. The family knows the child best and should be assumed to make decisions that are in the best interests of both child and family. The other options are all good interventions, but are too limited in scope to be the best way to create a family-centered environment. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 10. A clinic nurse is explaining to a student nurse the function of the community health map in
assessing families. Which description of this assessment tool is most accurate? A. It assesses how the family interacts with outside social systems. B. It locates health-care settings in, or close to, their neighborhood. C. It outlines family problems and social resources to help with them. D. It shows how the health of the community impacts each family. ANS: A
A community health map is an assessment tool for family structure, function, and support networks. It displays significant related data and helps the nurse focus on the family as it interacts with the social systems within and around the family. Its purpose is not to locate local health-care settings. The focus is on family health and past successes and current strengths, not on family problems. Correlations can be made between the health of the community and the health of those living in that community, but this is not the purpose of the community health map. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 11. A nurse wishes to improve his or her cultural sensitivity while working with patients. Which
action by the nurse would best indicate progress toward this goal? A. Demonstrate good knowledge of different cultural health beliefs B. Effectively respond to the needs of people of different cultures C. Interact respectfully with patients who have differing health beliefs D. Recognizes that he or she will never be the expert in other cultures ANS: C
Cultural sensitivity is a way of approaching people who hold health beliefs different from one’s own. A nurse with this characteristic is respectful of and open to others. Cultural competence is the ability to interact effectively with people of different cultures and requires a certain level of knowledge about those cultures. Cultural humility is the recognition that one will never master all information about another culture. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 12. A nurse manager is evaluating staff members on their cultural competence. Which action best
demonstrates this characteristic? A. Attends workshops on cultural diversity and health practices B. Participates in community health events with minority populations C. Plans care with the family members within their cultural beliefs D. Uses family members as interpreters to make them feel important ANS: C
The culturally sensitive nurse is able to understand and respond to the needs of individuals and families from different cultures. This nurse plans interventions with a solid knowledge of the values and practices of the members of the culture. Being open, listening to the family, and involving them in care demonstrates respect, unifies the nurse–patient relationship, and will motivate the patient (and family) to make positive health changes. Attending workshops is a good way to learn about diverse cultures and attending community events with diverse populations can increase cultural knowledge, but these actions are too limited in scope to demonstrate cultural competence. Nurses should use professional interpreters when needed. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 13. A nurse is incorporating a cultural assessment into nursing care. Which assessment question
by the nurse leads the supervisor to conclude that this nurse needs further education on cultural assessment? A. What customs and traditions are important to you? B. What kind of insurance coverage do you have? C. When you are stressed or worried, what comforts you? D. Who in your family is important for support? ANS: B
Cultural influences include family support systems, religious and spiritual beliefs, customs and traditions, communication patterns, coping strategies, and problem-solving techniques. Asking about insurance coverage is not directly related to culture, although this can give information about the patient/family’s living environment and ability to access resources. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 14. A nurse is working with a cultural group that has many proscriptions against women seeking
health care. What action by women in this community would indicate that they have successfully negotiated a new role in seeking care? A. Are able to make and keep medical appointments B. Can afford to pay for desired health-care services C. Follow their traditional roles and responsibilities D. Seek health-care advice from family members ANS: A
Cultural proscriptions are beliefs, practices, and values of a group that tell women and children what they should not do. In many traditional cultures, women do not have permission, decision-making power, or means to access the health-care system. If the women from such a culture successfully negotiate their roles regarding health care, they can access the health-care system on their own. The ability to afford services is not related, although cultural proscriptions might forbid women from making such a transaction. If they follow their traditional roles or seek health care from family members, they have not demonstrated a successful negotiation of a new role. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Difficult PTS: 1 15. A patient wishes to use complementary therapy when managing a chronic health condition.
Which action by the nurse is most appropriate? A. Advise the patient that stopping medical treatment may cause it to worsen. B. Inform the patient that there are no complementary therapies for this condition. C. Investigate herbs that can be substituted for prescription drugs. D. Suggest the patient add massage therapy to the medical regimen. ANS: D
Complementary therapy is nontraditional treatment that is used in addition to traditional medical care. Alternative therapies are used in place of traditional therapies. Adding massage to the medical regimen is an example of using complementary therapy. Substituting herbs for prescription medication is an example of alternative therapy. Because the patient is asking about complementary therapy, there is no need to warn him or her of the effects of stopping treatment. There are always complementary therapies that can be added to a medical regimen. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 16. A nurse is working with a family that uses multiple complementary and alternative medicine
(CAM) modalities. What action by the nurse is best? A. Allow the family to continue these practices as desired. B. Assess how these practices reflect religious beliefs. C. Inform the family that most of these practices do not work. D. Provide evidence-based information about the therapies. ANS: D
The nurse working with individuals or families who use CAM practices should respect the beliefs, values, and desires of the patient. The nurse should encourage families to make decisions regarding CAM practices based on evidence and research into their effects. The nurse can best assist in this by providing and discussing information. Although the nurse cannot stop the family from using CAM, he or she should not pass up the teaching opportunity. Many CAM practices have demonstrated benefit, so telling the family they don’t work is false information. A culturally competent nurse will assess how religious and spiritual beliefs affect health-care practices, but the nurse needs to advocate for the patient/family by providing solid information. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 17. A nurse acting in the role of teacher is determining learning outcomes. Which action will
produce the best outcomes for teaching? A. Collaborate with the discharge planner on outcomes. B. Determine the teaching priority, then establish the outcome. C. Develop outcomes mutually agreed on with the patient. D. Enlist other staff members to help prioritize outcomes. ANS: C
The best nursing care (including teaching) is a collaborative effort between nurse and patient. Each participant has knowledge and shares the power of determining what is to be learned. The best outcomes result in patient cooperation, because the patient was instrumental in developing them. The other actions might be helpful in specific situations, but involving the patient (or family) is always appropriate and vital. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 18. A nurse uses Nightingale’s theory of nursing to pattern care for patients. Which action by the
nurse is most consistent with this theory? A. Does for the patient what he or she is unable to do for self B. Focuses patient interactions on caring, healing, and wholeness C. Keeps patient’s room clean and ensures good nutrition D. Incorporates culturally relevant actions in a caring encounter ANS: C
Nightingale focused on the spiritual, physical/environmental, emotional, mental, and social needs of the patient. A major area of emphasis was on improving the patient’s environment (internal and external). For this theorist, the base of nursing practice centered around observation, knowledge of sanitation, nutrition, caring, and compassion. The action most closely associated with Nightingale would be keeping the patient’s room clean and ensuring the patient gets good nutrition. A focus on caring, healing, and wholeness-centered interactions is reflective of Jean Watson’s theory. Incorporation of culture into nursing care reflects the theory of Leininger. Although not mentioned in the text, doing for others what they would do for themselves, if able, is the basis of Dorothea Orem’s self-care theory. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 19. An inpatient nursing unit uses Madeleine Leininger’s theory to organize nursing care. The
manager would conclude that a new nurse has successfully integrated this theory into practice when the nurse does which of the following actions? A. Emphasizes caring over curing in nursing actions B. Establishes trusting relationships with patients C. Knows the cultural practices of many different groups D. Organizes environmental factors for the patient’s benefit ANS: B
Establishing a trusting nurse–patient relationship is at the core of Leininger’s theory. In order to understand another person’s cultural beliefs, values, methods of providing or showing caring, causes of illness, and how wellness is achieved, the nurse must first establish a trusting relationship with the patient so the patient feels free to share. This is an ongoing process. The emphasis on caring over curing is part of Watson’s theory. Knowing the practices of several different cultural groups would be a valuable asset, but is not required for Leininger’s theory. Organizing the environment to benefit the patient is part of Nightingale’s theory. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 20. A nurse uses Watson’s theory as a framework for nursing practice. Which nursing action best
demonstrates the use of this theory? A. Actively clarifies the patient’s health beliefs and practices B. Allows children to visit an ill parent despite visitation restrictions C. Assesses both the physical and spiritual dimensions of the patient D. Ensures the patient is neither too warm nor too hot for comfort ANS: C
Jean Watson contends that caring as a nurse requires the nurse to pay attention to both the physical and spiritual dimensions of the patient. Clarifying health beliefs and practices is more related to Leininger’s theory. Allowing children to visit despite restrictions is a caring action, but is not tied to a specific theory. Manipulating the environment for patient comfort and well-being is a core component of Nightingale’s theory. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Moderate PTS: 1 21. A nursing manager wants to increase the staff’s attention to patients’ spirituality. Which
action by a nurse would best demonstrate this concept? A. Asked about the patient’s religion B. Assessed the patient’s meaning of life C. Consulted a chaplain for a patient case D. Inquired about religious rituals in health ANS: B
Spirituality does not necessarily equate with religion; it is more a concept related to a person’s beliefs about the meaning of life. Although all actions might be incorporated in a comprehensive discussion of spirituality, the best demonstration of attention to this characteristic is inquiring about the meaning the patient ascribes to life.
Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 22. A nurse is demonstrating the professional role of provider of care to a nursing student. Which
action by the nurse is most relevant to this professional role? A. Assesses the patient’s priority physical needs B. Gives the patient a bath instead of delegating it C. Supervises unlicensed assistive personnel D. Uses monitoring and IV equipment correctly ANS: D
One of the major responsibilities of the nurse as provider of care is to maintain competency in using monitoring and therapeutic equipment. This is a vital safety measure for the patient. The nurse as provider of care should assess all of the patient’s physical, psychosocial, and spiritual needs, not just the priority physical needs. Supervising other personnel may or may not be part of a nurse’s job description. Choosing to delegate an activity is not a core role of the provider of care. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process: Implementation Difficulty: Difficult PTS: 1 23. A nurse is caring for a patient from a culture with which the nurse is totally unfamiliar. What
action by the nurse will best promote effective communication? A. Call for a professional interpreter to translate information. B. Pattern voice tone and eye contact after the patient’s behaviors. C. Talk slowly and deliberately using simple language and cues. D. Use nonverbal communication as much as possible with the patient. ANS: B
In the situation where the nurse is unfamiliar with the patient’s culture, the nurse should pattern verbal and nonverbal communication after the patient’s own style. There is no indication that this patient does not speak English, so using an interpreter, talking slowly using simple language, and using mostly nonverbal communication is inappropriate. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Difficult PTS: 1
24. A nurse has been teaching a patient who seems impatient and does not retain much of what is
taught. What action by the nurse would be best to facilitate the patient’s learning? A. Assess for unmet personal needs such as pain or hunger. B. Determine why the patient is being uncooperative. C. Give information in writing and let the patient read it. D. Stop the teaching session and return at a later time. ANS: A
Learning is not likely to be effective if the patient has unmet basic human needs such as hunger, pain, a full bladder, or fear. The nurse should assess for those needs and meet them before continuing. Labeling a patient as uncooperative is counterproductive and judgmental and does nothing to enlist the patient’s cooperation. Written information (if the patient is literate) is always a good idea, but doing nothing more than that will not improve the patient’s learning when basic needs are unmet. Returning at a later time also does not meet the patient’s needs. Cognitive Level: Applying/Application Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 25. A nurse manager expects all employees to be patient advocates. Which nursing action best
demonstrates this nursing role? A. Arranging a family–physician conference to clarify treatment plans B. Encouraging treatment options based on personal beliefs and values C. Giving contact information for governmental assistance agencies D. Working on a political campaign to reduce poverty in the state ANS: A
In the advocate role, the nurse should promote patient-/family-centered care and work to provide the patient with more control, power, and self-determination in the health-care setting. The nurse who arranges a family–physician conference to clarify treatment plans is advocating for the patient. Giving contact information for assistance agencies and working on political campaigns are also ways of demonstrating advocacy, but are too limited in scope to be the best answer. The nurse advocate must ensure he or she is speaking for the patient and the patient’s desires, not inserting personal values and beliefs into the process. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Difficult PTS: 1 26. A nurse is describing the use of evidence-based practice (EBP) guidelines to a nursing
student. Which explanation of EBP is most accurate?
A. B. C. D.
Includes clinical experience and patient preferences MEDLINE used as the primary source for EBP information Requires the staff to be active participants in research Uses research findings to plan interventions for care
ANS: A
EBP combines investigational guidelines and scientifically sound interventions with clinical expertise and the patient’s values and preferences. MEDLINE is one of three primary sources for EBP information; the other two are the Cochrane Database of Systematic Reviews Library and the Agency for Healthcare Research and Quality. The staff members do not have to be actively involved in research to use EBP. Using research findings to plan interventions is part, but not all, of the EBP process. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 27. A nurse uses evidence-based practice (EBP) to plan and implement nursing care. What action
by the nurse best demonstrates this process? A. Assesses, plans, implements, and evaluates nursing interventions B. Incorporates specific research findings into the nursing care plan C. Predicts and assesses for potential problems based on research D. Uses a concept map for nursing care instead of a nursing care plan ANS: C
The nurse who has incorporated EBP into nursing care is able to predict, and assess for, potential problems and complications because of knowledge of relevant research. Assessment, planning, implementation, and evaluating are steps in the traditional nursing process. Specific research findings do not need to be specifically incorporated into a nursing care plan and, in fact, without including clinical expertise and patient preferences, scientific findings are incomplete. A concept map is an alternative to the traditional nursing care plan. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 28. A patient and family have the nursing diagnosis of impaired verbal communication secondary
to a language barrier. What action by the patient/family would best indicate that short-term goals for this diagnosis have been met? A. Able to communicate long-term desires for health of the patient B. Demonstrates comprehension by head nodding and saying “yes” C. States understanding of condition and treatment via an interpreter D. Understands how nonverbal communication varies between cultures
ANS: C
For a language barrier, using a professional interpreter is not only the best way to manage communication, it is also legally required. The best short-term goal for the patient and family is to obtain understanding of the patient’s illness and treatment and state, through the interpreter, that this is the case. Communicating long-term desires is a better long-term outcome for this diagnosis. Nodding the head and saying “yes” do not always indicate agreement, understanding, or approval. In some cultures this behavior signifies respect. Understanding the differences in nonverbal communication between cultures is not an appropriate short-term goal. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 MULTIPLE RESPONSE 1. The perinatal nurse is aware of changes in women’s and children’s health-care settings that
affect family care. What factors do these changes include? (Select all that apply.) A decreased pediatric patient population A redesign of policies to include families Development of alternative care sites Increased liberalization of visiting policies Increased patient acuity across all settings
A. B. C. D. E.
ANS: B, C, D, E
Many changes have occurred across health-care settings that have affected family care. Hospitals have redesigned their policies to be family-friendly and have liberalized visiting policies to decrease stress on the family. Alternative care settings have been developed in part to combat escalating medical costs, and patients have high-acuity illnesses and needs across all of these settings. There has been no decrease in the population of pediatric patients. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Easy PTS: 1 2. A nurse wishes to improve critical thinking skills. Which of the following actions would be
helpful for this nurse? (Select all that apply.) A. Developing checklists for care activities B. Listening intently for true understanding C. Practicing new skills D. Remaining nonobjective in patient encounters
E. Searching the literature for new information ANS: B, C, D, E
Critical thinking evolves from experience, seeking knowledge, practicing skills, self-reflection, open-mindedness, calculated risk-taking, and devotion to listening with a goal of true comprehension and understanding. Making checklists is not part of critical thinking. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate PTS: 1 3. To be effective when providing information to a patient, the nurse should assess the patient
for which of the following? (Select all that apply.) A. Cultural beliefs and values B. Information desired C. Preferred learning style D. Level of understanding E. Past medical history ANS: A, B, C, D
An effective teacher should assess the patient’s cultural beliefs and values, information desired, preferred learning style, and level of current understanding before planning and implementing teaching. The patient’s past medical history is not essential information for teaching. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 4. The nurse listens to a mother and her 4-year-old child as they communicate with each other
primarily to determine which of the following? (Select all that apply.) A. Communication styles that need improvement B. The child’s level of language development C. The family’s culture and its influences D. The family’s personal and group values E. The family’s understanding of health care ANS: B, C, D
Listening to the cultural voices and experiences of family and patients affirms their value and is critically important to unifying the nurse–patient relationship. This method of interaction allows the nurse to understand family values, family developmental aspects, and the family’s cultural aspects. It also motivates patient movement toward positive health-promoting activities. It is not primarily to determine areas for improvement, although the nurse may be able to role model better communication for a patient/family. Listening to communication is also not primarily to determine the family’s understanding of health care. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 5. The nurse mentor explains to the new nurse that multiple societal changes have given families
greater power in health care. What changes have contributed to this shift? (Select all that apply.) A. Alternative community-based care sites B. Costs of obtaining health care C. Decreased health-care regulations D. Multimedia information E. Science and technology ANS: A, B, D, E
The infusion of multiple cultures and beliefs about health-care systems, along with exponential growth in scientific and technologic capabilities, has been a major force in shaping the structure and delivery of nursing care. In addition, increased consumer access to health-related information through the Internet, mass media, and other sources that may or may not be accurate; the unprecedented rise in health-care costs; and the increasing imposition of cumbersome regulations have also contributed to change. Changes in care settings to include new community-based sites have also led to increased power for families/consumers and family-centered decision making. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 6. The nurse understands that changes in family characteristics are related to which of the
following influences? (Select all that apply.) A. Birth control accessibility and knowledge B. Decreased mobility of people C. Increased feminist thinking D. Increased number of women in the workforce E. Mass media influences
ANS: A, C, D, E
Social and technological advances of the past half century have changed family structure, function, and definition. With the increasing acceptance and technological methods of birth control options made available to families since the 1970s, family size has also changed. The feminist movement of the 1970s sent large numbers of mothers outside the home and into the work environment. With increased population mobility and two-income families there are fewer support persons available than before, when living near a large extended family was the norm. Mass media is an important determinant of social behavior. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Easy PTS: 1 7. The nurse recognizes that caring for patients and families is challenging due to which of the
following factors? (Select all that apply.) A. Advances in medical care B. Decreased cultural diversity C. Decreased patient expectations D. Increased technology development E. Potential legal considerations ANS: A, D, E
Advances in medical care, increased technology, and the potential for legal ramifications should nurses not use EBP and best-practice guidelines all increase the complexity and challenges in providing nursing care. Neither cultural diversity nor patient expectations are decreasing. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Easy PTS: 1 8. The perinatal nurse caring for a 24-year-old mother of an infant born at 26 weeks' gestation is
providing discharge teaching. The patient is going to travel to the specialty center approximately 200 miles away, where her daughter is receiving care. The nurse tells the patient that it is normal for her to feel which emotions? (Select all that apply.) A. Afraid B. Anxious C. Guilty D. In control E. Overwhelmed ANS: A, B, C, E
Separation of family members needing care in specialty or tertiary care settings often leads to feelings of anxiety, abandonment, fear, and guilt, all of which can be overwhelming in the setting of a serious physical illness in a family member. It would not be common for a family member to feel in control. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 9. The nurse working with patients understands that health promotion can include which of the
following? (Select all that apply.) A. Belief in the power base of the patient B. Changed attitude to one of meaningfulness C. Nurse-defined state of unity and holism D. Shared understanding of the health threat E. Shared vision about hope for the future ANS: A, B, D, E
Health promotion can and should include a belief in the power base of the patient to make meaningful changes in his or her life, an attitude that finds meaning in the shared experience of illness, a shared understanding of the nature of the health threat, and a shared vision about hopes for the future. The nurse needs to recognize and honor the patient-defined state of unity and holism in order to engage nursing aesthetics in practice. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Easy PTS: 1 10. A clinic nurse is evaluating a child who has been treated for a cough and fever for several
weeks, without resolution of the symptoms. The child and family are recent immigrants to America. What actions by the nurse are most appropriate? (Select all that apply.) A. Ask the parents about culturally relevant health-care practices. B. Assess the family’s understanding of the illness and treatment. C. Investigate illnesses endemic to the family’s native country. D. Tell the family members they must stop using herbal or folk treatments. E. Utilize a professional interpreter to communicate with the family. ANS: A, B, C, E
Increased international travel and immigration require the nurse to be culturally sensitive and also aware of the possibility of a patient having a disease not commonly seen in the United States. In this scenario, the nurse should assess for culturally relevant health-care practices to ensure that the prescribed treatment is acceptable to the family members, investigate their understanding using a professional interpreter if needed, and research illnesses endemic to the family’s country of origin. The nurse should not simply tell the family members that they cannot use herbal or folk remedies. The nurse should attempt to include these traditional methods of healing when possible. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment and Implementation Difficulty: Moderate PTS: 1 11. The nursing faculty member explains to the nursing student that using nursing aesthetics
includes which of the following activities? (Select all that apply.) A. Care planning B. Imagery C. Medication administration D. Music therapy E. Touch ANS: B, D, E
Nursing aesthetics is the low-tech, high-touch art of nursing. Components can include imagery, music therapy, and touch. Care planning and administering medications do not fall under this category of nursing action. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 12. A new nurse manager wants to initiate changes on the inpatient pediatric unit at a regional
referral center. Which actions by the manager would be most helpful? (Select all that apply.) A. Create a system of nurse-driven care to allow families to rest and de-stress. B. Discuss proposed changes with families, soliciting feedback on potential impact. C. Ensure around-the-clock resources to help families with emotional needs. D. Make changes based on knowledge of growth and development theories. E. Use evidence-based practice to formulate new policies and procedures. ANS: B, C, D, E
Caring for children at regional referral centers creates problems for families who are impacted by the separation and the high-acuity illness of their child. Changes should consider the emotional needs of the families, both child and family growth and development theories, and evidence-based practice. Family partnering is a way to involve families in the care of their children and is more beneficial to families than nurse-driven care. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Caring Difficulty: Difficult PTS: 1 OTHER 1. Place the steps of creating a concept map in the correct order.
Determine beneficial goals and outcomes. Categorize assessment data under patient problem areas. Assess the patient and draw a skeleton diagram. Evaluate the patient’s response to the interventions. Analyze the relationships among factors and prioritize diagnoses. ANS:
4, 2, 1, 5, 3 A concept map is similar to the nursing process and uses five steps. Begin with assessing the patient and draw a skeleton diagram using the medical diagnosis as the center. Next, categorize all the assessment data under patient problem areas. Step 3 is to analyze relationships among the factors and to prioritize patient responses. The fourth step is to determine beneficial goals and outcomes with the patient/family. The final step is evaluation. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process Difficulty: Easy PTS: 1
Chapter 2: Contemporary Issues in Women’s, Families’, and Children’s Health Care MULTIPLE CHOICE 1. The clinic nurse is working with a mother and her 3-year-old child who have arrived for the
child’s routine checkup. The nurse encourages the mother to return for her child’s measles-mumps-rubella immunization prior to the child's entering school. This intervention is an example of what type of care? A. Mandatory health care B. Primary health prevention C. Secondary health prevention D. Tertiary health prevention ANS: B
Of the three levels of prevention, the most desirable level is primary prevention. This encompasses health promotion and activities specifically meant to prevent disease from occurring—in this case, scheduling vaccinations. Secondary prevention refers to early identification and prompt treatment of a health problem before it has an opportunity to spread or become more serious. Tertiary prevention is intended to restore health to the highest functioning state that is possible. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 2. A nurse wishing to be an advocate for access to health care would most likely choose to
participate in which of the following activities? A. Lobby for improved insurance access for all individuals, whether or not they are
employed. B. Help establish fast-track or minor illness areas in local emergency rooms. C. Partner with medical centers to provide free services for low-income patients. D. Work with visiting nurses associations to create on-site clinics at day-care centers. ANS: A
The biggest determinant of access to and quality of health care is one’s insurance status. The other actions might help improve access too, but would not be as effective as lobbying for improved ability for all individuals to get insurance. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1
3. A nurse working with an after-school program is concerned about the lack of health literacy in
the students’ parents. What action would best address this need? A. Conduct a monthly health-related seminar for parents. B. Investigate grants or other funding for a computer bank. C. Invite parents to healthy cooking demonstrations. D. Provide brochures on a variety of health problems. ANS: B
The disparity between people who have access to technology and those who do not is directly related to health literacy and knowledge. The amount of information doubles every 6 years, so it is not possible to keep track of all the latest health news by accessing brochures, books, or periodicals. Having access to computers would greatly increase health literacy. The other options are certainly helpful, but would not be as far-reaching as providing access to online material. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Difficult PTS: 1 4. A nurse is caring for a patient near the end of life whose wishes regarding care are not known.
The two sons disagreed with the two daughters about future medical plans for the patient during a recent family conference, and now the sons and daughters are not talking to one another. What action by the nurse would be best to help resolve this dilemma? A. Call the facility’s ethics committee and request a formal consultation. B. Have social work coordinate another family meeting to discuss the issue. C. Meet with the sons and daughters separately to discuss their wishes. D. Request that the physician tell the family what is in the patient’s best interests. ANS: A
Ethical principles in health care are often in conflict, and it takes a skilled person to negotiate and mediate these situations. Ethics committees exist in most health-care facilities that are experienced in confronting these difficult situations. The best response would be for the nurse to request a consultation from the ethics committee. Another family meeting may not work, as the family already disagrees and tensions are high. The other options may be helpful, but are not as vital as a formal ethics committee consultation. Meeting privately with the sons and daughters might give the nurse some insight into their positions, but would not be as effective as utilizing the expertise on the committee. The physician should not decide what is in the patient’s best interests, as this is paternalistic and violates the principle of autonomy. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1
5. A mother and her 12-year-old daughter visit the clinic often because of the daughter’s asthma.
The clinic nurse recognizes that one of the most important nursing actions in this situation is which of the following? A. Continue to schedule regular clinic visits for the child to follow her condition. B. Give the mother time to talk about her daughter’s illness while she is present. C. Listen patiently to the child as she talks about her illness, letting her tell her story. D. Regulate and modify the child’s medications in response to her asthma symptoms. ANS: C
Research shows that children feel that health-care providers don’t really listen to them. It is important to advocate for the child and to develop a therapeutic relationship characterized by a caring attitude. The nurse should encourage the child to discuss her asthma and modify interventions accordingly. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Difficult PTS: 1 6. The nurse managing a pediatric clinic often sees single mothers with children. What action by
the nurse would best help this population of women access health care? A. Arrange to have evening and weekend hours. B. Offer sample medications instead of prescriptions. C. Provide a play center for waiting children. D. Provide bus tokens for transportation to the clinic. ANS: A
Single mothers with children constitute 82% of the poverty population. ―Welfare to work‖ programs are now compulsory, and women must work in order to receive aid. Offering evening and weekend hours could accommodate more women who cannot afford to miss time off from work. The other options might be helpful for some patients and families, but to have the greatest impact on the largest group of people, accommodating work schedules is important for this population of women. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Easy PTS: 1 7. A community health nurse explains to the nursing student that the best health-related
programming includes which of the following elements? A. Has both individual and societal components B. Is directed toward individual responsibility C. Provides incentives to compensate healthy choices D. Requires legislation to truly be effective
ANS: A
Intervention programs must be multi-tiered and oriented to the broader social context in which they occur, because that is where patients are located. Programs directed toward only individuals are less successful. Programs and interventions do not need to include legislation or incentives. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 8. A nursing student wishes to investigate national health goals. Where should the student
research this information? A. Cochrane Database B. Cumulative Index of Nursing and Allied Health Literature C. Government websites D. Healthy People initiative ANS: D
The Healthy People initiative is the blueprint for the nation’s health goals. Updated every 10 years, it lists national health priorities. Information related to the Healthy People initiative can be found on the other sites, but they are secondary sources. The student would do best to investigate the primary source. Cognitive Level: Application: Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 9. A nurse is interested in primary prevention programs. Which of the following activities would
this nurse choose to do? A. Assist with blood pressure screening at the local mall. B. Collect and distribute used eyeglasses for poor people. C. Staff a mobile mammogram unit for underserved groups. D. Teach teenagers about the dangers of texting and driving. ANS: D
Primary prevention includes activities designed to keep health problems from happening. It often includes education. Teaching teens the dangers of texting and driving will (hopefully) prevent motor vehicle crashes. Secondary prevention is screening, early detection, and prompt treatment for health problems. Providing blood pressure screening and mammograms are examples of secondary prevention. Tertiary prevention attempts to restore health to its highest level of functioning. Providing eyeglasses for needy people with vision problems is an example of tertiary prevention.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 10. A nurse wants to work in the community providing secondary prevention activities. Which
action would this nurse choose to do? A. Educate teenage girls about birth control options. B. Provide STD/STI testing at the local youth center. C. Staff the county health department flu shot clinic. D. Volunteer to drive cancer patients to receive their treatments. ANS: B
Secondary prevention is screening, early detection, and prompt treatment for health problems. Testing youths for STD/STIs is an example of secondary prevention. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Educating teenage girls about birth control options will (hopefully) prevent unintentional pregnancies and is an example of primary prevention. Likewise, staffing the flu shot clinic is also an example of primary prevention. Tertiary prevention attempts to restore health to its highest level of functioning. Driving cancer patients to their treatments is an example of tertiary prevention. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 11. A nurse is interested in providing tertiary prevention activities. Which of the following
activities would this nurse choose to do? A. Assist with low-cost swimming lessons at the YMCA. B. Conduct monthly educational seminars at a church. C. Join the county pandemic outbreak response team. D. Provide glucose and cholesterol screening at the mall. ANS: C
Tertiary prevention attempts to restore health to its highest level of functioning. Working with a county response team in the event of a pandemic outbreak would be an example of tertiary prevention. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Assisting with swimming lessons and conducting monthly seminars will educate the target audiences in order to prevent a health problem. Secondary prevention is screening, early detection, and prompt treatment for health problems. Providing glucose and cholesterol screening is an example of secondary prevention. Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 12. A practicing nurse tells a student nurse that beyond the World Health Organization’s
definition of health, providers must also consider which of the following factors when determining the health of a community? A. The definition of health as described by the community B. The incidence of preventable health problems in the group C. The morbidity caused by genetically related health problems D. The mortality rates that could be lowered with primary prevention ANS: A
The World Health Organization (WHO) defines health as ―a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.‖ According to Purnell and Paulanka (2008), one must also consider the definition of health as it is described by people within their own ethnocultural group. The other options are not part of this consideration. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 13. A nurse wants to know the trend concerning death due to cardiovascular disease. What source
should the nurse consult? A. Epidemiology data B. Morbidity data C. Mortality data D. Primary prevention data ANS: C
Mortality refers to death. Government agencies keep both mortality and morbidity records on public health threats. Morbidity refers to illness. Epidemiology is the statistical analysis of factors related to disease in populations over time. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1
14. A nurse enjoys working with patients who have chronic illnesses. What group of people
would this nurse enjoy working with most? A. Ethnic minorities B. Men and boys C. Older adults D. Women and girls ANS: C
The older adult population is growing steadily and rapidly and will have a huge impact on health care in the future, due to the prevalence of chronic illness in this group. Chronic illness occurs in all groups, but for the older adult population, it is a special concern. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Easy PTS: 1 15. A nurse would like to improve the health of the community. Which action by the nurse would
have the greatest impact? A. Blood glucose screening at the local Korean church B. Blood pressure screening at a predominantly black church C. Teaching immigrants heart-healthy cooking for traditional foods D. Teaching men the signs and symptoms of heart attacks ANS: B
Although all activities are good nursing interventions for specific communities, more than half of black women aged 45–64 years have hypertension, so a blood pressure screening at a predominantly black church could have the greatest impact. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 16. A nurse is working with a parent–teacher association to combat school bullying. What action
can the nurse suggest that would best help to decrease this form of interpersonal violence? A. Advise that victims’ parents call law enforcement and press charges. B. Begin offering martial arts classes in the school for bullied children. C. Encourage the school to adopt no-tolerance policies for bullying. D. Suggest limiting television viewing, especially for younger children. ANS: D
Some research has shown that violent media exposure is linked to violent behavior. Included in media are computer games, which can also be violent. Younger children may not be able to distinguish between real and fantasy and may be overly influenced by violent images. No-tolerance policies can be helpful, as can a social environment in which children and their parents are held accountable legally. Offering martial arts classes may send the wrong message and would most likely not diminish the incidence of bullying. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 17. A school nurse is increasingly concerned with a growing absentee problem. To best address
this issue, which of the following actions should the nurse take? A. Begin a structured follow-up program for asthmatic children. B. Hold informational meetings on the importance of childhood vaccines. C. Partner with providers on continuity plans for kids with chronic illness. D. Work with law enforcement to develop a truancy response team. ANS: A
All plans sound like they could be innovative strategies for dealing with school absenteeism. But because asthma is the most common reason for a child to miss school (and the primary reason for visits to pediatric emergency rooms), the nurse’s best response is to develop a structured follow-up program for kids with asthma. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 18. A nurse is working with a patient who misses appointments frequently and doesn’t always fill
prescriptions for herself or her children. On reviewing the patient’s chart, the nurse sees that the patient has insurance. What action by the nurse would be the most helpful? A. Ask the patient to describe her health insurance coverage. B. Educate the patient about the consequences of skipping medicines. C. Find out if the patient is seeing other health-care providers. D. Remind the patient that she is responsible for her children’s health. ANS: A
An important factor in access to health care is insurance. Employer-provided plans are becoming more uncommon, and even those with insurance often have gaps in their coverage, which leads to missed appointments, unfilled prescriptions, and other services being underutilized. The other actions might be useful, although it probably will sound judgmental if the nurse merely tells the patient that she is responsible for her children’s health.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 19. A nurse reads in the paper that the death rate for women overall has declined substantially. To
what does the nurse correlate this finding? A. Abundant new choices in contraception B. Better detection and treatment of breast cancer C. Greater access to sources of fresh produce D. Improved diagnosis of heart disease in women ANS: D
The leading cause of death in women overall is heart disease. Women face significant barriers to timely diagnosis and treatment of heart disease than do men. The nurse can conclude that this has improved, leading to the significant decrease in the female death rate. Contraception choices would not lead to a significant decrease in mortality, as childbirth is not a common fatal event, although the number of perinatal deaths has not declined in recent years. And even with multiple choices in contraception, at least half of all pregnancies are unintended or mistimed. Access to fresh produce could improve many health conditions for women. Cancer is the second leading cause of death in women. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Evaluation Difficulty: Moderate PTS: 1 20. A nurse working with the elderly population is distressed that in order to obtain public
funding for long-term care, the elderly must expend nearly all of their resources. When considering bioethical principles, which principle should the nurse choose to act from to make the biggest difference in this situation? A. Autonomy B. Fidelity C. Justice D. Veracity ANS: C
The principle of justice means treating everyone fairly. Requiring the elderly to divest themselves of their resources in order to obtain funding for housing could be seen as a justice issue. Autonomy is having free will and acting according to one’s own wishes when making decisions. Fidelity is keeping promises. Veracity is truth telling. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Caring Difficulty: Difficult PTS: 1 21. A nurse considers beneficence as the guiding ethical principle for nursing practice. Working
within that framework, which action by the nurse best demonstrates that concept? A. Administering a pain medication before therapy so that the patient can participate B. Allowing the patient to make informed choices as to his or her plan of care C. Promising a pain medication in 1 hour and returning with it on time D. Turning patients to prevent pressure sores, despite causing temporary discomfort ANS: A
Beneficence means acting for the patient’s benefit, or doing good. Giving a pain medication before a therapy session helps the patient fully participate, improving his or her recovery. Allowing the patient to make informed choices demonstrates autonomy. Returning when promised is an example of fidelity. Turning patients, even though it causes temporary discomfort, is non-maleficence. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate PTS: 1 22. A nurse ensures that a patient does not have questions regarding the upcoming surgical
procedure and verifies that the signature on the consent form is the patient’s signature. Which ethical principle is this nurse demonstrating? A. Autonomy B. Beneficence C. Fidelity D. Justice ANS: A
Autonomy is the right to make decisions and to have the information necessary to make such decisions. Beneficence is doing good. Fidelity is keeping promises. Justice is treating everyone fairly. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate PTS: 1
23. A 45-year-old woman presents to the emergency department complaining of chest pain and
feeling anxious. She asks to have an electrocardiogram (EKG) but is told that ―heart disease is a man’s disease‖ and is given a prescription for lorazepam (Ativan). What can the nurse conclude? A. If the woman were older, she may have received an EKG. B. Sex hormones play a powerful role in determining heart disease. C. Stereotyping seriously impacted the care the woman received. D. Women under the age of 45 are at low risk of having heart disease. ANS: C
A stereotype is a mental image that portrays members of a specific group with the same attributes. Believing that heart disease is a ―man’s disease‖ is an example of a stereotype. Because the practitioner held this view, the woman’s health care was compromised. The other statements cannot be justified from this example. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 24. A nurse has heard of the ―digital divide‖ between people who have access to technology and
those who don’t. The nurse asks a mentor how this can affect health care. What response by the mentor is most accurate? A. ―It’s just easier and faster to make appointments online.‖ B. ―Much health-care information is available only digitally.‖ C. ―The so-called digital divide really doesn’t have much impact.‖ D. ―You can chat with your doctor on social media sites.‖ ANS: B
The explosion in information makes digital access to health-care resources vital. There are even applications for smart phones that have a health-care function. Not all clinics and physician offices have online appointment scheduling. Most people surveyed would like to connect with their physicians via email but not on social networking sites. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 25. One goal of the Healthy People 2020 initiative is to increase the number of people who have
some form of health insurance. What percentage of the population is the target? A. 25% B. 35% C. 55% D. 100%
ANS: D
Healthy People 2020 has the ambitious goal of increasing the proportion of people with health insurance to 100%. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Easy PTS: 1 26. A nurse is working with a woman who is 4 months pregnant. The woman has had a series of
temporary housing, has no job, and is wearing clothing that is obviously way too big for her. What action can the nurse take to most improve the health of this woman and child? A. Arrange transportation for her to get to a community food bank. B. Consult a social worker to help her apply for the WIC program. C. Encourage the woman to make her return appointment before leaving. D. Ask the woman to fill out an application for the federal Medicare program. ANS: B
WIC, or the Women, Infants, and Children Program, targets pregnant women, infants, and children up to age 5 who are nutritionally at risk. WIC provides supplemental nutritious foods and nutrition counseling. Forty-five percent of infants born in this country participate in the WIC program. Helping with transportation needs and facilitating return appointments is helpful too, but not to the degree that improving this woman’s nutrition will be. The woman might be eligible for Medicaid, but not Medicare, which is for the elderly. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Moderate PTS: 1 MULTIPLE RESPONSE 1. A nurse working in a women’s health clinic has several patients who are from a minority
culture, live in the inner city, lack employment that offers benefits, have large families, and often lack transportation to health care. Which of these factors are considered broad determinants of health? (Select all that apply.) A. Access to health care B. Employment C. Environment D. Family size E. Race ANS: A, B, C, E
Broad determinants of health care are personal, community, and societal systems and include environment, employment, insurance, class, race, social support, access to health services, genetic endowment, and personal histories. Family size itself is not a broad determinant of health care; however, it could be included in the larger category of personal history. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 2. The community health nurse knows that the public health intervention model is focused on
which of the following intervention levels? (Select all that apply.) A. Community B. Family C. Government D. Hospitals E. Patient ANS: A, B, E
The public health intervention model is an inclusive framework that encompasses three levels at which interventions can be initiated, from the micro-level of the individual to the macro-level environment. Interventions are targeted toward individuals/families, communities, and larger institutional and societal systems. Government and hospitals are not one of the three levels. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 3. A nurse working in the community uses the public health intervention model to combat
diabetes mellitus type 2. Using this model, which interventions are appropriate? (Select all that apply.) A. Community: Encourage high-risk patients to have glucose screening. B. Community: Lobby for funds to build walking and biking trails. C. Community: Subsidize community gardens in areas where produce is expensive. D. Individual/family: Educate about the benefits of daily exercise. E. Societal: Pressure Congress for laws requiring insurance incentives for health promotion. ANS: B, C, D, E
The public health intervention model, also known as the Intervention Wheel, is a framework that contains three levels for health-care interventions, from the micro-level of the individual to the macro-level of the environment. Interventions are aimed at individuals/families, communities, and larger institutional and social systems. Lobbying to build walking/biking trails and assisting with community gardens are examples of community-level interventions. Encouraging high-risk individuals to have glucose screening is at the individual/family level, as is education about the benefits of daily exercise. An example of an institutional or societal intervention would be lobbying Congress to pass laws requiring insurance companies to provide incentives for health promotion activities. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Difficult PTS: 1 4. The community health nurse is aware that the goals of Healthy People 2020 include which of
the following? (Select all that apply.) A. Creating physical environments that promote health B. Developing healthy behaviors in children and teens C. Eliminating health disparities and increasing equity D. Improving the health of all groups in the country E. Increasing the average life span for all adults ANS: A, C, D
Goals of the Healthy People 2020 document include the following: (1) To attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) to achieve health equity, eliminate disparities, and improve the health of all groups; (3) to create social and physical environments that promote good health for all; and (4) to promote quality of life, healthy development, and healthy behaviors across all life stages. The blueprint does not call for developing healthy behaviors only in children and teens, nor does it call for simply increasing the average life span. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Planning Difficulty: Difficult PTS: 1 5. What does the nursing student understand about health disparities in the United States? (Select
all that apply.) A. African American babies die by age 1 at a rate times that of European Americans. B. Asian American babies have the highest rate of preterm birth of any other group. C. Despite large expenditures, health resources are unevenly distributed. D. European Americans have double the number of low-birth-weight babies than
other groups. E. Sudden infant death syndrome is most prevalent in American Indian and Alaska
native babies. ANS: A, C, E
Many health disparities exist in America, despite huge outlays of money. A major problem is that health resources are not distributed evenly across demographic and geographic groups. This leads to such problems as the high rate at which African American babies die before age 1, and the high incidence of sudden infant death syndrome in American Indian and Alaska Native populations. Asian American babies do not have the highest rate of preterm birth, and European American women do not have double the number of low-birth-weight babies of other groups. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 6. The public health nurse explains to students that diversity is an increasing phenomenon in this
country. What facts about this phenomenon does the nurse share with the students? (Select all that apply.) A. As immigrants acculturate, their unique cultural care needs will diminish. B. By 2050, the minority population in America is estimated to be 50%. C. Hispanics, blacks, and Asians are the historically designated minority groups. D. One in five people in this country will be over the age of 65 by the year 2030. E. Racial differences are rooted in biological factors that explain illness trends. ANS: B, D
The population of ethnic minorities is expected to reach 50% by the year 2050, which increases the need for culturally competent health care. One in five people will be over the age of 65 by 2030, increasing the impact of chronic illnesses. Hispanics, blacks, Asians, and Native Americans are the historically designated minority groups. There is no biologic basis for race; racial and ethnic categories are socially created. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 7. Which of the following activities should the perinatal nurse encourage women who come for
preconceptional counseling to consider? (Select all that apply.) A. Choosing breastfeeding or bottle feeding B. Decreasing risk for exposure to toxoplasmosis C. Decreasing fetal risks related to the work environment D. Ensuring folic acid supplementation
E. Ensuring iron supplementation ANS: B, C, D
Folic acid supplementation helps to prevent certain birth defects. A fetus’s exposure to harm could potentially be prevented if a woman were counseled prior to pregnancy about the adverse effects of alcohol, tobacco, toxoplasmosis, and other teratogens in her home or workplace. During the preconception period, it is too early for the woman to take iron supplements (unless she is anemic), and debating infant feeding methods is not the priority at this time. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 8. A mother brings her 6-month-old infant and 18-month-old child to the health clinic for a
routine visit. The nurse counsels the mother about lead exposure testing. Which information should the nurse include? (Select all that apply.) A. ―About one-fourth of all homes where kids under 6 live are contaminated by lead.‖ B. ―Both of your children should have testing for lead at this time.‖ C. ―Lead exposure may cause anemia, seizures, and mental retardation if not treated.‖ D. ―Lead testing for children is recommended by the American Academy of Pediatrics.‖ E. ―We can test your older child for lead exposure, but it is too early for the 6-month-old.‖ ANS: A, C, D, E
The American Academy of Pediatrics recommends that all children between the ages of 1 and 2 years receive testing for lead exposure, as 25% of homes presently occupied by children under the age of 6 have known lead contamination. Lead exposure has been linked to a number of medical and developmental problems, including anemia, seizures, and mental retardation. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 9. The clinic nurse is interviewing a woman and her daughter who describe their address
as―temporary.‖ The mother appears thin, pale, and tired. Her blood work confirms anemia and pregnancy. What actions by the nurse would be most helpful? (Select all that apply.) A. Call the Department of Children and Family Services. B. Discuss nutrition needs for pregnancy. C. Facilitate the woman’s opportunity to return for prenatal care. D. Determine if the family is in a safe location.
E. Provide shelter information for this family. ANS: C, D, E
A priority for this family is to provide information regarding shelters, to facilitate follow-up clinic visits for the mother to address her pregnancy and anemia, and to determine if the family is currently in a safe place or if the family is vulnerable to violence. Nutrition in pregnancy should be discussed, but it is not the priority intervention at this point. There is no reason to call the Department of Children and Family Services unless abuse is suspected. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 10. The clinic nurse explains to a student that an appropriate nursing action is screening all
children for child abuse. What other information does the nurse give the student about child abuse? (Select all that apply.) A. It is frequently carried out by a stranger. B. The most common form is neglect. C. It is most often perpetrated by a parent. D. Only 1 out of 1,000 girls is sexually abused. E. It is part of an ongoing cycle of violence. ANS: B, C, E
The National Child Abuse and Neglect Data System reports that three children die of child abuse in the home each day. Children are most commonly abused by someone they know, and in 79% of cases, the perpetrator is a parent. Child abuse can set up a perpetuating cycle of suffering and more violence later in life, potentially reaching to future generations. Neglect is the most common form of child abuse. One out of every four girls will be sexually abused by the time she reaches 18. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 11. The jail nurse is interviewing a woman who has been brought to the clinic for prenatal care.
Which of the following are appropriate actions for the nurse to perform? (Select all that apply.) A. Assess the woman for drug and alcohol abuse and possible withdrawal. B. Assess the woman’s health knowledge and health literacy. C. Ask if the woman has other children and who is caring for them. D. Determine if the woman has risk factors for pregnancy complications. E. Inquire about the woman’s criminal history and background.
ANS: A, B, C, D
A nurse who is able to deliver culturally competent care to incarcerated women quickly becomes cognizant of the challenges of caring for this population. These women tend to have many health problems, including substance abuse and dependency. They frequently have not had access to health-related knowledge. Because nearly 1.3 million children of incarcerated women have no mother figure in their lives, women in prison or jail are often deeply concerned about their welfare. This demonstrates caring and can often be the motivation for making changes. The nurse needs to complete a thorough obstetrical history, including determining risk factors for high-risk pregnancy. The nurse does not need to know about the woman’s criminal history. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 12. Which childhood illnesses are the subject of a Healthy People initiative regarding
vaccinations? (Select all that apply.) A. Asthma B. Measles C. Meningitis D. Mumps E. Pertussis ANS: B, D, E
One goal of the Healthy People initiative is to reduce vaccine-preventable illnesses such as measles, mumps, and rubella to zero cases and to reduce pertussis in children under 7 to no more than 2,000 cases/year. Asthma and meningitis are not included in this goal. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Planning Difficulty: Easy PTS: 1 13. A nurse is working with a patient determined to have low health literacy and has taught the
patient vital self-care measures for a chronic illness. How will the nurse best determine if the patient has understood the information? (Select all that apply.) A. Ask for a return demonstration of the skills taught. B. Assess if the patient will take brochures written for this illness. C. Encourage the patient to explain how the information fits into his or her daily life. D. Give the patient a written quiz at the end of the teaching session. E. Have the patient repeat the information in her or his own words. ANS: A, C, E
Communicating with people who have low health literacy can be challenging. Some strategies the nurse can employ are: specific training, asking open-ended questions, asking patients to restate information or provide a return demonstration of skills, using plain and culturally sensitive language, and developing health information tailored to specific populations. To assess for cultural congruency, the nurse can ask the patient to explain how the self-care measures fit into the patient’s life. Simply giving the patient brochures does not guarantee that the patient understands or will use them, or even whether the patient can read. Giving a quiz might be seen as intimidating. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Evaluation Difficulty: Difficult PTS: 1 14. A nurse has helped organize and staff a free vaccination clinic for underserved populations in
a central location of the city. The nurse is unhappy that so few people came to the clinic. In evaluating this outcome, what factors does the nurse recognize as potentially leading to the problem? (Select all that apply.) A. Clinic hours B. Inability to miss work C. Lack of insurance D. Lack of transportation E. Language barriers ANS: A, B, D, E
Underserved, typically poor, populations face multiple obstacles to obtaining health care that need to be considered when organizing events. If the clinic hours were during the day, parents might be reluctant to pull children out of school for fear of being labeled as truant. Parents participating in ―welfare to work‖ programs or who have low-skill, low-wage jobs might not be able to miss work, or would forfeit pay by doing so. Participants need transportation to the clinic, which is located in one area of town. Language barriers could lead to confusion or misunderstanding or lack of awareness of the clinic. The lack of insurance shouldn’t be a concern because the vaccinations are free, but it is possible this was a point that some misunderstood. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Moderate PTS: 1
Chapter 3: The Evolving Family MULTIPLE CHOICE 1. The clinic nurse is taking a history from a woman who came to the clinic to get test results.
The patient brought a coworker with her because she is worried. The patient asks to have her coworker remain in the exam room when the doctor describes the test findings. The patient states that the friend is “like a sister.” The nurse would most correctly identify the two women as which of the following? A. Extended family B. Family C. Family of choice D. Family of origin ANS: A
A family consists of two or more members who self-identify as a “family” and interact and depend on one another socially, emotionally, and financially. Because the patient self-identifies the friend as “like a sister,” the patient and friend consider themselves a family. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 2. The clinic nurse understands that children who come for well-child visits at age 10 are in the
process of developing which of the following attributes? A. Attachment B. Coordination C. Personal values D. Self-identity ANS: D
During the school-aged and adolescent/teenage developmental stage, personal values are shaped and clarified and ethical development occurs. This stage provides the optimal opportunity for teaching about drugs, sex, and health promotion.
Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1
3. A new mother with a 2-month-old daughter tells the family clinic nurse that she is
experiencing a lack of sleep because of infant night feedings and her husband‟s shift work and excessive overtime. Which of the following is the best description of this family concern? A. Caregiver strain B. Coping stress C. Lack of support D. Parental maladaptation ANS: A
Caregiver strain occurs when the main caregiver becomes overwhelmed and feels “underhelped” regarding the tasks concerned with the care of the family member. In this situation, mounting bitterness and withdrawal from other family members may cause caregivers to push away any potential helpers. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 4. A patient describes her spouse‟s dependence on oxycodone terephthalate (Percocet), which
began following knee surgery last year. Although the prescription was finished some time ago, the spouse continues to obtain and take Percocet. Because of the spouse‟s “need” for the medication, the patient “has to” do all the yard work, child care, and meal preparation. How would the nurse describe the patient‟s behavior? A. Enabler B. Impaired caregiver C. Inadequate dyad partner D. Overstressed parent ANS: A
An enabler is a common role in families with addictions. The enabler makes excuses for the addicted person‟s behavior. The patient‟s behavior allows the spouse to continue with the addiction without being held accountable. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 5. A mother brings her 8-year-old daughter to the clinic for the third time in 2 months. The
mother states that her daughter is very active and often falls down. The mother states that her daughter eats well, but the child‟s weight falls below the 10th percentile. The clinic record shows the child had multiple bruises on her arms at the time of the last two visits. Today the nurse notes that the child has areas of ecchymosis on her left leg and ankle. Which action by the nurse is best?
A. B. C. D.
Ask the child and her mother again about the child‟s bruises. Question the child about her accident-prone behaviors. Speak with the child alone, asking if she feels safe at home. Teach the mother to keep a diary of what her child is eating.
ANS: C
This child‟s presentation is suspicious. If child abuse is suspected, the nurse should question the child privately. In all situations the nurse is legally obligated to report the abuse to the proper investigating agency. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 6. The clinic nurse notices that each time a child with leukemia is brought in to see the doctor,
her mother and aunt accompany her. The mother states that she finds her daughter‟s illness to be very traumatic and is having difficulty coping. The child‟s aunt encourages the child‟s mother and distracts the child while her blood work is being drawn. The child‟s aunt could be described as taking on which of the following roles? A. Child-caregiver role B. Kinship role C. Socializer role D. Therapist role ANS: D
Structural-functional theory focuses on the functioning of the family and the roles assumed by each family member to promote family function. Necessary roles include provider, housekeeper, child caregiver, socializer, sexual partner, therapist, recreational organizer, and kinship member. The therapist role is assumed when one family member expresses concern for another‟s health or emotional well-being. The aunt does not appear to be the primary caregiver (child-caregiver role). There is no indication that the aunt fills the socializer role by organizing family social activities. The kinship role includes maintaining family and social ties by things like remembering important dates, and the aunt does not appear to function in that role either. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1
7. The nurse observes a woman and her sister who live together. They are trying to support one
another and provide extended care to their mother who has recently been diagnosed with Alzheimer‟s disease. The two sisters describe their experience with a homemaker who visits their home to help bathe their mother. They say she is “humorous and cheerful” and absorbs their mother‟s attention for the whole time she is present. This is a positive description of which component of Bowen‟s family systems theory? A. Communication B. Family relationship building C. Family rituals D. Triangulation ANS: D
According to Bowen, triangulation occurs when a dyad (the sisters) focuses on a third person who draws attention away from their conflicts. The homemaker is serving this function in this family. Bowen‟s theory looks at family problems that are rooted in family processes, such as communication. Relationship building and rituals are not part of this theory. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 8. A nurse is assessing a single person at a clinic visit. How would the nurse classify this
patient‟s family? A. Family of choice B. Family of origin C. Not in a family D. Nuclear family ANS: C
Most definitions of family require at least two people who self-define as being part of that family. Thus, a single individual cannot be a family. A family of choice is the family adopted through marriage or cohabitation. A family of origin includes the individuals who reared the person of interest. A nuclear family consists of a male partner, a female partner, and their children. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 9. A patient tells the nurse about living in a commune. What does the nurse understand about
this family structure? A. Family with distant relatives included B. Group of men, women, and children
C. Kinship care provided to children D. Unmarried man and woman living together ANS: B
A commune is a group of men, women, and children all living together. Families with relatives beyond the nuclear family are called extended families. Kinship care provided to children constitutes a no-parent family. An unmarried man and woman living together is called cohabitation. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 10. A nurse is assessing a child with very poor social skills. What conclusion can the nurse make
about the child‟s family? A. Emotional or mental illness B. Not filling socialization needs C. Poorly educated, poor job skills D. Probably lower-income status ANS: B
Families should fulfill five functions: physical needs, economic needs, reproductive needs, affective and coping needs, and socialization needs. A child with poor social skills probably (but not necessarily) comes from a family that is not fulfilling the child‟s socialization needs. Assuming that the child has an emotional or mental illness without further assessment is unhelpful. Assuming that the family is lower income, is poorly educated, and has poor job skills is stereotypical. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 11. A nurse is working with family members who have been striving to improve their functioning
as a family unit. What behavior would suggest to the nurse that the family is meeting its goals? A. The children are in multiple activities to develop talents. B. The desire to be understood guides most communication. C. Family members gave up some activities in order to eat dinner together on most nights. D. The parents have a strong desire for the children to succeed. ANS: C
Effective tools for families include ways to enhance family performance. One very effective tool is to put the family first in this very chaotic world. Giving up some activities in order to eat dinner together shows the family is putting the unit as a whole first over individual desires. This is the opposite of children being in multiple activities, which often cuts into family time and can be disruptive. Communication should be guided by the desire to understand the other first, then to be understood. A strong desire for the children‟s success does not guarantee successful family functioning. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Evaluation Difficulty: Difficult PTS: 1 12. A nurse works a great deal with refugees and is frustrated because, as a group, they don‟t
seem to want to implement desired health behaviors. What action by the nurse would be most helpful? A. Conduct a health screening and educational event each month. B. Provide written information in the group‟s native language. C. Teach selected group representatives to be lay health educators. D. Try to establish relationships within the refugee community. ANS: C
According to family systems theory, each family system contains boundaries that affect how the outside world interacts with the family. Families that have recently immigrated to the United States might have closed boundaries and may only be receptive to health information provided by extended family members or members of their community. Establishing a lay health educator program in which community members can be taught health information with the intent of delivering it to their communities would be a good way to work with these families while respecting their boundaries. Regularly occurring health events might improve the nurse‟s standing in the community. Written information may or may not be helpful; many refugees are illiterate in their native languages and some languages do not have a written form. Establishing relationships within the community is advisable, but does not go far enough to solve the problem. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Difficult PTS: 1 13. A patient is dismissed from the hospital and is receiving nursing care at home to help in the
recovery from a serious illness and operation. The visiting nurse notes that the family is in a state of disarray and members are disorganized and not communicating. The patient is trying to direct everyone‟s actions. The nurse calls a family meeting. What action by the nurse is best?
A. B. C. D.
Encourage family members to make “to do” lists and assign chores. Explain that changes in one person require changes in the others. Make a referral to a counselor or mental health nurse practitioner. Tell the family members that for the patient to recover, they have to assume his or her role.
ANS: B
Family systems theory recognizes that changes in one member of a family affect every other member of the family. In order for the family to function effectively, all members need to adapt to the major changes in one of the members. Making lists and assigning chores are simple tasks that might help with organization, but this does not go far enough in solving the problem. The family may or may not need a referral for counseling. Simply telling the family members a fact does not give them enough information to adapt. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 14. A nurse who works with families uses Duvall‟s family developmental theory as the core of
nursing practice. What action by this nurse takes priority? A. Assessing the developmental stage of the family B. Determining how the family interacts with society C. Observing what roles each family member assumes D. Tailoring teaching to the specific needs of the family ANS: A
Developmental theory has as its core the idea that every person moves through developmental stages with tasks that must be mastered before they can move on to the next stage. Family developmental theory assumes the same progression for families as a unit. Duvall‟s theory identifies eight family stages. The nurse using Duvall's family developmental theory must first assess the stage the family is in, because teaching and all other interventions must be tailored to that stage. Only tailoring the teaching to specific needs does not necessarily require assessment of the family using a developmental approach. Determining how the family interacts with society is more in line with systems theory. Observing roles is part of structural-functional theory. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 15. A nurse is working with a blended family of 1 year with five children aged 3, 7, 13 (twins),
and 19. The parents seem overly stressed and anxious and do not seem to work well as a unit. What can the nurse conclude about this family?
A. B. C. D.
Communication problems are the core of the parents‟ stress. Economic stressors are impacting the parental dyad. The family is in too many developmental stages to master any of them. There are too many children to give each one adequate attention.
ANS: C
In family developmental theory, the age of the child determines the stage the family is in. If there is more than one child, the family is probably in multiple developmental stages at the same time. The family is probably in a combination of beginning families, preschool, school-aged and adolescent, and launching stages. The competing priorities of all of these stages pave the way for chaos. Without further information, the nurse cannot conclude that economic stressors or communication problems are the root cause of the issue. Simply concluding that the family has too many children is judgmental and does not leave any room for interventions. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 16. A family practice nurse is working with a patient who is asking for anti-anxiety medications
to deal with the stress and frustration of an adult child who won‟t leave the home. Based on knowledge of the tasks of launching children, which resource should the nurse suggest first? A. Anger management counseling B. Contact numbers for vocational training C. Information on a parenting workshop D. Marriage and couples counseling ANS: B
An adult child who still lives at home is either using home base as a temporary arrangement while continuing education or as a “nonaction” until more permanent ties have been established elsewhere. With the parent‟s frustration and anxiety, this situation of incomplete launching needs to be addressed. The first suggestion should be about vocational assessment and training for the adult child. There is no indication the patient needs anger management, a parenting workshop, or marriage counseling. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1
17. A patient has been dismissed from the hospital after a serious illness and needs several weeks
of home care and rehabilitation. When the visiting nurse comes to the house, it is apparent that the family is not functioning. The house is dirty, there is little food available, and one parent and an older child are arguing about picking up a younger sibling from school. What action by the nurse is most appropriate? A. Ask the parents if they need financial resources for the basic necessities. B. Assess each family member for the roles he or she plays in the family. C. Contact child protective services or social work to assess the home environment. D. Provide referrals for family and couples counseling in the community. ANS: B
According to structural-functional theory, each person in a family unit occupies a specific role. Sometimes roles are shared. A problem can occur when one member of the family is unable to fill his or her role and no one else is doing it. That appears to be the situation here. The nurse should assess what roles each family member plays and assist them to see how they can fulfill the role formerly held by the patient. The family may need financial resources if the patient was the breadwinner. There is no need to conduct an environmental assessment, as it does not appear that any family member is in danger. The family may or may not need counseling at this time. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 18. A nurse who uses the structural-functional theory would assess which of the following when
working with families? A. Communication patterns B. How things get done C. If goals are being met D. Looseness of boundaries ANS: C
The structural-functional theory focuses on the outcomes, not the processes, within the family. The nurse using this theory would assess if the family goals are being met. Communication patterns are critical to communication theory. Processes are important to family developmental theory, and boundaries are important in family systems theory. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 19. A nurse is providing anticipatory guidance to a mother of a toddler. Using communication
theory, which information is the most appropriate?
A. B. C. D.
“Don‟t nod your head „yes‟ when you say „no.‟” “Explain things in several different ways.” “There is no need to see if a toddler understands.” “You shouldn‟t yell at such a young child.”
ANS: A
According to communication theory, verbal and nonverbal messages should be congruent. A verbal “no” accompanied by nodding the head “yes” is sending inconsistent messages. Messages should be clear, so explaining things in many different ways would not be recommended. Good communicators determine if the listener has understood. Good communication demonstrates love and support clearly, but the advice to not yell is vague and seems to send the message that yelling at an older child would be more acceptable. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Difficult PTS: 1 20. A nurse is working with a woman who is newly married and pregnant and says she is
distressed because she and her husband seem to be so different and they argue over petty issues. What action by the nurse using group theory would be best? A. Ask the woman if she can remember why she and her husband fell in love. B. Caution her that this level of disagreement will cause stress to the unborn baby. C. Offer the woman a referral to a community counseling center for couples therapy. D. Reassure her that this is normal and help her brainstorm ways to work cooperatively. ANS: D
According to group theory, groups evolve through the distinct stages of forming, storming, norming, performing, and adjourning. Storming often occurs when a group that has recently formed notices differences in members, leading to chaos or confusion. This couple is in this stage. At this point, the nurse‟s best action is to reassure the woman and help her brainstorm ways of working together cooperatively, which might include forming rules or procedures that both parties agree to follow. Asking about their early relationship does not give the woman information that will help the present situation. Warning the patient about the negative effects of stress on her unborn baby sounds judgmental and threatening. A referral for counseling might be needed at a future date. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1
21. A clinic nurse is using group theory to assess a family whose youngest child recently moved
back home after graduating from college and is unable to find a job. Which statement by a parent would indicate to the nurse that goals for norming have been met? A. “I‟m glad my son stays in his room in the basement all day so he doesn‟t bother us.” B. “It‟s hard to decide how much food to buy because we don‟t know where he‟s eating.” C. “My son is gone a lot of the time, so we really don‟t notice that he moved back in.” D. “We have agreed not to have a curfew as long as we know when he will be home.” ANS: D
According to group theory, a healthy family adjusts to changes in its structure by resetting roles and norms. In this family, a launched child has moved back in, disrupting the patterns established when he left. Agreeing to new rules and roles is a sign of adaptation. The other responses do not show adaptation to the new situation. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Evaluation Difficulty: Difficult PTS: 1 22. A student observes as an adult brother and sister lash out at the nurse caring for their
hospitalized parent. The parent lives at home but is dependent on the children for care and is obviously neglected. The nurse has informed the children that social work will be involved in their father‟s case. How does the nurse explain this interaction? A. “Don‟t worry; they will calm down eventually.” B. “Families often get emotional in these situations.” C. “They are focusing attention on me, not the problem.” D. “This family is obviously highly dysfunctional.” ANS: C
This family is dysfunctional, but that does not go far enough to explain the situation. This behavior is known as triangulation, and occurs when a dyad diverts attention away from their problems and chooses instead to focus on a third party, in this case the nurse. Reassuring the student they will calm down is neither helpful nor accurate as the family members may choose to continue to lash out. Families often do get emotional, but again, this information is not really helpful. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1
23. A nurse working with a married couple notes that both parties seem to try to be dominant in
their sessions. According to Bowen‟s family systems theory, which question asked by the nurse would yield the most useful information? A. “Are you each a first-born, middle child, or youngest sibling?” B. “How demonstrative were each of your parents when you were growing up?” C. “How many children were in each of your families?” D. “What socioeconomic classes did you both grow up in?” ANS: A
According to this family theory, birth order plays an important role in predicting certain patterns of behavior. Spouses who occupy the same birth order may have difficulty functioning together. In this case, both spouses probably are first-borns with a need for control. The other questions may yield helpful information as part of a thorough assessment, but are not related to this theory. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 24. A nurse working in a pediatric clinic is attempting to assess a school-age child who is
disrespectful of the nurse and parent and tears up a magazine when asked to sit down. What conclusion can the nurse make about this family? A. The child is not getting enough attention from the parents. B. The family is from an underserved community group. C. Financial stress has caused family strife and fighting. D. The parental disciplinary approach is inconsistent. ANS: D
Children whose parents have a laissez-faire disciplinary style tend to be disrespectful, aggressive, and disobedient. A laissez-faire disciplinary style includes inconsistent use of discipline, allowing children (rather than the parents) control over the environment, few rules, and children making their own decisions rather than being guided by parents. The other options may be true, but without further assessment, the nurse cannot make those conclusions. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Evaluation Difficulty: Difficult PTS: 1 25. A family with a loud, disobedient child has been working with a nurse. Which action observed
by the nurse indicates that goals for the diagnosis of impaired parenting have been met? A. The father delivers consequence to the child calmly. B. The father only asks the child twice not to do something. C. The mother doesn‟t cry when disciplining her child.
D. The mother states that the child is still testing the limits. ANS: A
Consistency in setting and enforcing rules is critical. Consequences should be delivered immediately, without anger, and consistently. The father‟s disciplining the child without getting mad is demonstrating that goals have been (or are being) met. The other options do not show consistent, calm, immediate consequences. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Evaluation Difficulty: Easy PTS: 1 26. A female patient from a refugee community is in the emergency department and needs urgent
surgery. The patient defers making a choice on the operation, preferring to wait for a cultural elder to arrive. What action by the nurse is most appropriate? A. Encourage the patient‟s family to talk her into having the operation. B. Explain kindly to the patient that her situation cannot wait. C. Respect the patient‟s choice and wait for the elder to arrive. D. Take the patient to surgery under the principle of implied consent. ANS: C
This is a difficult situation, but because the patient‟s wishes are known, the nurse has no choice other than to wait. In the emergency department, sometimes surgery is performed under the principle of implied consent (for instance, on an unconscious patient with no known family), but in this case, the patient has been clear as to her wishes, so doing that would be an ethics violation. The nurse must be careful to not be coercive. The nurse (and physician) would ensure that the patient understands the risks of waiting. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Difficulty: Difficult PTS: 1 27. A nurse wishes to assess how often members of a family consume alcohol or use drugs during
a typical week. What type of family assessment tool would this nurse choose? A. Ecomap B. Genogram C. Qualitative D. Quantitative ANS: D
A quantitative tool measures the frequency at which problems or behaviors occur. An ecomap is a tool that displays the outside systems used by the family. A genogram illustrates the family structures and compares generations within the same family. Qualitative tools measure the descriptions and depth of family experiences. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 28. A mother is worried about her three children developing an inherited medical condition
because many members of her family have died from this disease. To start an assessment of this family, which tool should the nurse choose? A. Ecomap B. Genogram C. Problem list D. Quantitative tool ANS: B
A genogram is a diagram of at least three generations that illustrates the present family structures and compares past generations with the present ones. To determine the prevalence of this inherited disorder in the family, the nurse would use a symbol to denote each family member with this disease. An ecomap displays the outside systems with which the family interacts. A problem list helps family members identify difficulties or negative characteristics. A quantitative tool assesses the frequency of a behavior or problem. A genogram has a quantitative influence, as it documents how many people in the family have the characteristic being studied, but a genogram is more specific. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 29. A nurse explains the benefits of a strengths-and-problems list to a student. Which is the best
explanation? A. Can use their strengths to work on identified priority problems B. Demonstrates that each family has both strengths and problems C. Forces people to be accountable and take responsibility for problems D. Lets families see which members have problems affecting them ANS: A
A strengths-and-problems list requires the family members to list their strengths as well as what each member brings to the group that is positive. The problems list helps the family prioritize problems to work on. By seeing this information in writing, the family members can capitalize on their strengths to work on the problems. It does demonstrate that each family has both strengths and problems, but that is not the main purpose. It does not force families to take responsibility, although it does encourage this. Its purpose is not to point out who has which problems. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 30. A nurse working with a pregnant woman who is a recent immigrant to the United States notes
that her husband rarely accompanies her to prenatal visits, and when he does, he sits in the waiting room. What action by the nurse is best? A. Ask the patient what role men in her culture play in pregnancy. B. Ask the woman why her husband doesn‟t seem involved. C. Encourage the man to participate in order to support his wife. D. Research the couple‟s cultural background and health beliefs. ANS: A
Culture affects the roles family members assume during times of illness, pregnancy and childbirth, and death. The best option is to ask the woman what role men in her culture play during pregnancy and childbirth. This can open a discussion of how the woman is coping and if she is getting enough support, either from her mate or friends and family. Asking why the man doesn‟t seem involved is judgmental. Encouraging the man to participate may not be desired by the woman and may be seen as an intrusion by the man. The nurse could research the culture but this would not lead to a discussion until the next visit. It is also important to be aware that there are variations in how people of the same culture behave and believe. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 31. A family has weekly game nights and monthly family together days. The nurse documents
these events as examples of which of the following? A. Family beliefs B. Family bonding C. Family building D. Family rituals ANS: C
Family-building activities are an extension of family rituals and center on recreation and leisure. They do contribute to family bonding, but the most specific answer is family building. Family activities are influenced by family beliefs. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Easy PTS: 1 32. A nurse is working with a family that has the nursing diagnosis of altered family processes.
When formulating goals, whom does the nurse include? A. Entire family B. No one else C. Parents D. Physician ANS: A
The most effective goals are those that include the entire family. The entire family agrees upon the goals and commits to working on them. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Planning Difficulty: Easy PTS: 1 33. A 17-year-old high school senior is resentful about caring for younger siblings so the parents
can have a “date night” once every 2 weeks. The teen often “forgets” and schedules work or social activities that override the parents‟ plans. The parents are angry that the teen is so indifferent to their needs. What action by the family indicates that goals for the diagnosis of impaired family processes have been met? A. Parents and teen mutually plan date nights in advance. B. Parents consistently discipline teen for “forgetting.” C. Teen acknowledges “forgetting” date night on purpose. D. Teen expresses feelings about being made to babysit. ANS: A
All the outcomes show some positive resolution, but the most optimal response is the parents and teen jointly planning the parents' nights out. This shows collaboration, communication, and mutual respect. In the end, everyone‟s needs are taken into consideration, and the teen will be more willing to adapt the current role to include watching the siblings. Consistent consequences delivered without anger is a hallmark of healthy discipline. The teen is taking responsibility when he or she acknowledges that the forgetting occurs on purpose. The lines of communication are open when the teen is allowed to verbalize feelings. Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Evaluation Difficulty: Moderate PTS: 1 34. A nurse is working with a family with the diagnosis of impaired family processes. Although
both parties worked, one person worked part time and had the main responsibility for the household. The other spouse retired recently and has not taken on more of this role. Both people are angry and resentful. What goal would be best for this couple? A. Adapt to role changes positively within 2 months. B. Divide up household duties between spouses more evenly. C. Express feelings using “I” statements within 1 month. D. Learn to discuss anger and other negative emotions. ANS: C
A good goal or outcome is specific, measurable, and has a time element. The goal that best meets that description is expressing feelings using “I” statements within 1 month. Adapting to role changes is vague and not measurable. Dividing duties more evenly is not measurable and has no time element. Learning to discuss negative emotions does not mean using what is learned, so it is not as specific as the correct answer. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Planning Difficulty: Moderate PTS: 1 35. A patient is being discharged from a psychiatric facility after a suicide attempt. The family
consists of the patient, two parents, and two other teenage children. What action should the nurse teach the entire family as a priority? A. Assess for drugs or alcohol in the patient‟s room. B. Encourage the patient to take medications. C. Monitor the patient for signs of suicidal thoughts. D. Plan menus that contain nutritious food items. ANS: C
Safety is a priority concern in every family and all members should be made aware that the patient could have continued suicidal thoughts. If the siblings notice this, they should be taught to tell the parents immediately and could also be taught some effective communication to use. Looking for drugs or alcohol in the patient‟s room, encouraging medication use, and planning menus are all actions more appropriate for the parents. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Moderate
PTS: 1 36. A nurse is working with a family in which one member has schizophrenia. Using systems
theory, for which concern should the nurse specifically assess this family? A. Balance B. Boundaries C. Children‟s ages D. Subsystems ANS: B
Systems theory looks at boundaries, balance and homeostasis, and subsystems. An important concern in the family whose member is diagnosed with a mental illness is social isolation, which is related to boundaries. Some families view mental illness as shameful and try to keep the information secret. The nurse should work to ensure the family understands the importance of healthy interaction with outside systems. Children‟s ages would be assessed using developmental theories. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 37. A grade school nurse is conducting vision screening before school and notes the student is
accompanied by an older sister who has also brought a middle school child. The older child states that time is a problem because middle school starts in a few minutes and tells the younger child to go right to the classroom after the screening, then leaves. What question by the nurse would be most appropriate to ask the youngest child during the screening? A. “Do you feel safe at home or is someone hurting you there?” B. “Does your sister always bring you and your sibling to school?” C. “Have you ever seen your parents drinking a lot or using drugs?” D. “Why aren‟t your parents available to bring you to school?” ANS: B
In substance-abusing families, one child often takes the role as the responsible person, allowing the family to continue functioning. The fact that a sibling was bringing the children to school is a little unusual, and the nurse should assess the reason behind it. However, substance-abusing families often keep secrets for both social and legal reasons. The nurse should not ask directly about substance abuse, but rather open a line of discussion by introducing a nonthreatening question. There is no indication of abuse, so asking if the child is safe is not appropriate at this time. In a secret-keeping family, asking directly about drinking or drug use would most likely elicit a negative response. Asking “why” questions is confrontational. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment
Difficulty: Difficult PTS: 1 38. A patient has just been admitted to the hospital in critical condition. In caring for the entire
family, what action by the nurse is most important? A. Assessing who in the family will make decisions B. Determining if the family needs financial resources C. Ensuring each member understands the situation D. Orienting the family to visiting hours on the unit ANS: A
All options are important activities to keep the family engaged fully with the patient. However, for a patient who is critically ill, determining who makes medical decisions (and if there are advance directives) is crucial. The other actions can occur later. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 39. A hospice nurse is making the initial home visit to a patient who just returned home after a
lengthy hospitalization. What action by the nurse is most appropriate to help the family continue to function? A. Assess the degree of comfort in family caregiving. B. Ensure the family understands the hospice concept. C. Provide information about available hospice services. D. Refer the family to a community counseling center. ANS: A
In the at-home hospice setting, family members must find a balance between direct caregiving activities and their own needs for personal time. The nurse must assess this to help the family avoid caregiver strain and resentment and to maintain roles necessary for family functioning. Ensuring the family understands the hospice concept and providing information are also important, but are not directly related to family functioning. The family may or may not need counseling. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1
40. An immigrant family is working with a nurse on improving family dynamics. The nurse notes
that the teenage children do not subscribe to their parent‟s social and cultural mores and identify more with their native-born American friends. What description of the children is most accurate to record in the family‟s chart? A. Acculturated B. Assimilated C. Disconnected D. Lost children ANS: B
Assimilation is the process whereby a family or individual loses its unique cultural identity and identifies more with the dominant culture. The teens appear to be assimilated. Acculturation is the changes in cultural patterns within a group to match those of the host society. Connectedness relates to with whom the family identifies and relates as a family unit. Lost children are often seen in substance-abusing families. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 MULTIPLE RESPONSE 1. A nurse is explaining to a student why it is so important to consider the entire family as the
patient. What explanation for this is best? (Select all that apply.) A. Families are a rich source of information and support. B. Families will have to take over the caregiving role at home. C. If they are not included, families tend to interfere in care. D. The patient has to reintegrate into the family upon discharge. E. The patient‟s background context includes the family. ANS: A, D, E
The patient‟s family should be welcomed into nursing experiences. The family is a rich source of support and information about the patient. The patient will have to reintegrate into the family upon discharge. The patient‟s family represents the context from which he or she comes. Families may or may not have to assume the caregiving role. It is stereotypical to assume that families will interfere in patient care. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1
2. The nurse explains to the student that television and movies have often portrayed families in
certain ways, depending on the decade. Which of the following statements about this trend are correct? (Select all that apply.) A. 1950s–1960s: nuclear family, simple issues, father dominated B. 1960s–1970s: extended families, lower income, divorced parents C. 1980s–1990s: exploring social issues, stressed family closeness D. 1990s: single parents, social issues including poverty and abuse E. New millennium: alternative family structures, extended family ANS: A, C, D, E
In the 1950s and 1960s, families were father-dominated and nuclear in structure and shows focused on problems that were simple and easily solved. In the 1960s and 1970s, the trend was toward blended families (with widowhood being the reason for remarriage) that were mostly in an upper-income bracket. In the 1980s and 1990s, social issues such as class and politics became popular. The shows may not have shown resolution of the problem at hand, but emphasized the closeness of the family unit. In the 1990s, shows brought increased awareness of the challenges facing families dealing with a host of problems such as alcoholism, poverty, and abuse. In the new millennium, shows present alternative and extended family formats. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 3. A nurse working in the community understands that health is often affected by social
stressors. Which of the following are examples of societal pressures having a negative impact on the health of today‟s families? (Select all that apply.) A. Economic trends affecting access to health care B. Increased HIV/AIDS in women and children C. Loss of resources in public schools D. Restricted health-care access for adult males E. Violence and increased teen suicides ANS: A, B, C, E
Many social pressures have negative effects on the health of our families. Some of these trends include the economic situation, HIV and AIDS in women and children who are vulnerable due to barriers to health care, a loss of resources in schools, and an increase in all types of violence. As a group, adult males do not have restricted access to health care. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1
4. A nurse using family systems theory to work with patients and their families would do which
of the following? A. Assess how school, work, and church impact the family. B. Describe the developmental stage the family is in. C. Determine if there are any family secrets or taboos. D. Listen to how information is shared with providers. E. Observe how family members interact with each other. ANS: A, C, D, E
Family systems theory considers family boundaries (how the family interacts with the outside world) and looks at interaction among all the members, as the family unit itself is considered more important than the individuals within it. Boundaries can also be assessed in part by determining if there are family secrets or taboos (closed boundaries) or if information is shared too freely (open boundaries). Developmental stages of the family are not considered in family systems theory, but are part of Duvall‟s family developmental stages and theory. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 5. The nurse using developmental theory offers anticipatory guidance on preventing injuries to
the family of a preschooler. What concepts guide this information? A. Coordination lagging behind activity B. Development of personal values and ethics C. Impact of friends and peer group D. Poor judgment about safety risks E. Toddler‟s increasing physical abilities ANS: A, D, E
The toddler is in a stage where rapid physical development occurs but coordination and judgment are lagging behind. Thus the toddler is prone to accidents and injury. The nurse should offer anticipatory guidance so the parents can keep their child safe. Development of personal values and ethics occurs in the school-age and adolescent stage. Impact of peer group increases in this stage as well. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 6. The family nurse completes a genogram map when conducting a family assessment.
Appropriate information the nurse should include in the genogram map includes which of the following? (Select all that apply.) A. Congenital diseases in the family
B. C. D. E.
Country of origin for family members Dates of birth for all family members Dates of divorce and deaths for family members Three or more generations
ANS: A, C, D, E
The genogram may be used to highlight generational influences of behaviors, illnesses, vocational information, or any other pertinent information that provides a larger picture of patterns that exert influence on the family‟s current situation. The genogram should include at least three family generations and should list dates of births, divorces, deaths, stillbirths, and other pertinent elements of family information. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 7. The nurse assesses the communication in a family that includes a single mother, a teenage son
and daughter, and a grandmother. During the family interview, the daughter answers many questions while the son and mother are quiet and the grandmother is absent. What conclusions can the nurse make about this family? (Select all that apply.) A. The communication patterns are healthy. B. The daughter may have a lot of power. C. The grandmother does not want to be involved. D. The grandmother may have little power. E. The mother and son may have a coalition. ANS: B, D, E
Communication theory asserts that patterns of communication within a family reveal much about the way the family functions, the structure of the family, the power base, decision making, affection, trust, and affiliation. Preliminary conclusions the nurse can make about this family are that the daughter may have a lot of power because she answers many questions without input from anyone else, the grandmother may not have much power because she is not even present, and the mother and son may have a coalition opposed to the daughter. The nurse will need to confirm these conclusions with further assessment. These communication patterns are not healthy. The nurse should not assume that the grandmother does not want to be involved but should assess the reason for her absence. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1
8. The clinic nurse keeps resource numbers and contacts for assistance with situations in which
family members may potentially require assistance to restore balance and function to the family. These developmental crises may include which of the following situations? (Select all that apply.) A. Home fire requiring a lengthy hotel stay B. Hospitalization of a family member C. Identification of domestic violence D. Postpartum depression in a young family E. The anticipated birth of a new baby ANS: A, B, C, D
Sometimes families are in special need of nursing intervention due to situational or developmental crises that go beyond the family‟s internal resources. Developmental crises occur as part of expected growth events that can take place during any developmental stage of the family or its individual members and include such situations as being displaced, hospitalization of a family member, domestic violence, and serious depression. Childbirth is a normal event that does not generally require special nursing intervention unless complications occur. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 9. A nurse assessing a family includes which components in the assessment? (Select all that
apply.) A. Dietary habits B. Family size and structure C. Parenting style D. Religious affiliation E. Socioeconomic status ANS: B, C, D, E
A family assessment includes family size and structure; parenting style; and religious, cultural, and socioeconomic orientation. Dietary habits are not specifically assessed, although this information may be part of a cultural assessment. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 10. A nurse is assessing a family whose patriarch died recently. Using Kübler-Ross‟s stages of
grieving, what stages should the nurse assess for? (Select all that apply.) A. Bargaining
B. C. D. E.
Dealing Denial Remorse Shock
ANS: A, C
Kübler-Ross‟s stages of grieving include denial, anger, bargaining, and acceptance. Dealing is one of Rodebaugh‟s stages. Remorse is one of Epperson‟s stages. Shock is one of Harvey‟s phases. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1
Chapter 4: Caring for Women, Families, and Children Across the Life Span MULTIPLE CHOICE 1. The clinic nurse knows that providing an influenza vaccination clinic for patients aged 65
years and older is best described as an example of what kind of health care? A. Disease prevention B. Health promotion C. Health screening D. Secondary prevention ANS: B
Health promotion refers to the advancement of health to the highest degree possible for an individual. One activity is providing vaccination clinics for older adults. Disease prevention focuses on the implementation of strategies to reduce the incidence of disease or the development of comorbid illnesses in individuals with existing diseases. Health screening (secondary prevention) aims to diagnose diseases early and begin effective treatment immediately. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Easy PTS: 1 2. The family clinic nurse encourages a patient to continue breastfeeding her 8-month-old infant
to facilitate maturation of the infant’s immune system. When does this occur? A. 12 months B. 16 months C. 18 months D. 24 months ANS: D
Because an infant’s immune system does not become fully mature until 2 years of age, the maternal transfer of antibodies and immune factors enhances development of the immune system and facilitates the neonate’s immune system response. The longer the time that an infant is breastfed, the stronger the protection again infection and the earlier the maturation of the infant’s immune system. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1
3. The clinic nurse is working with a mother who wants to know the best age for teaching
children about the names and functions of sexual organs. What should the nurse tell her? A. 5 to 6 years of age B. 6 to 7 years of age C. 8 to 9 years of age D. 9 to 11 years of age ANS: C
Between 8 and 11 years of age, children begin to focus on their own development and to contrast it with their friends’ development. At this time, parents should begin to educate their children about the names and functions of the male and female sexual organs, puberty, the menstrual cycle, sexual intercourse, pregnancy, pregnancy prevention, same-sex relationships, masturbation, and the spread of sexually transmitted infections, and encourage dialogue about personal expectations and values regarding sexual activity. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 4. The pediatric clinic nurse tells the parents that infants can roll over, presenting a safety
hazard, at what age? A. 1 month B. 2 months C. 3 months D. 4 months ANS: C
At 3 months, infants begin to roll over from the stomach to the back and to turn toward loud sounds. These activities can pose a safety hazard related to the changing tables used for changing diapers, and parents should be told to keep a hand on their infant at all times. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 5. The family clinic nurse reviews nutritional information with a 15-year-old patient. The
patient is concerned about being short and wonders if growth will continue. The nurse explains that the typical increase in height during adolescence is how much? A. 15% B. 25% C. 30% D. 35%
ANS: B
Diet and nutrition are especially important for facilitating optimal growth and development during adolescence. Adequate nutritional intake is essential to accommodate the growth spurt that occurs during this time. Adolescents gain approximately 25% of their adult height and 50% of their adult weight throughout this time period. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 6. A school nurse is interviewing a high school student sent to the office for frequent crying
episodes. The student admits to thinking of suicide and has made a previous attempt. The nurse determines that the teen has a suicide plan but does not yet have access to the materials needed to carry out the plan. How does the nurse interpret and act on this information? A. High risk: Call the school district counselor. B. High risk: Contact 911 immediately. C. Low risk: Send a referral home with the student. D. Moderate risk: Call the parents to come get the teen. ANS: B
Individuals who have suicidal thoughts should be assessed for a specific plan, the means to carry out the plan, and previous suicide attempts. This student has two of the three high-risk identifiers, so the teen should be seen by a mental health professional immediately. The safest way to ensure this occurs is to access the emergency medical system. The district counselor may not be prepared to deal with this situation and may not be available. The student is not low risk, so a referral should not be sent home. The student is not moderate risk, and the burden of ensuring immediate access to a health-care professional should not be placed on the parents, who also may be unavailable. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Implementation Difficulty: Difficult PTS: 1 7. The family clinic nurse initiates conversation with a 16-year-old adolescent male who is 5 feet
10 inches and weighs 250 pounds (113.6 kg). Which of the following is the most appropriate question for the nurse to ask the adolescent regarding his weight? A. “Are you willing to talk about your weight gain this year?” B. “Do you realize your weight puts you into an obese category?” C. “Do you participate in any activities or exercise?” D. “What do you think about your weight right now?” ANS: D
During adolescence, body weight has a dramatic effect on the development of self-image and self-esteem and can be a sensitive issue for discussion. An important strategy in discussions about weight and weight loss with adolescents is to begin the conversation with expressions of respect that are sensitive to cultural differences related to food choices and eating patterns. Regardless of whether the patient is ready to begin a weight control program, he may still benefit from talking openly about healthy eating and exercise. To open the conversation, the nurse can begin with a simple question to determine if the patient is willing to talk about the issue. The other questions may put the teen on the defensive and close communication. Answer choice 1 particularly is an example of poor communication, as it is a “yes-no” question. The teen could simply answer “no” and the nurse would have no recourse other than to end that line of discussion. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 8. A nurse is observing a mother and her 10-month-old infant. The mother is interacting happily
with the child while letting the baby eat pieces of hot dog. What action by the nurse is best? A. Compliment the mother on her parenting skills. B. Document that the baby is eating finger foods now. C. Stop the mother from feeding the hot dog to the baby. D. Teach the mother that hot dogs are poor nutrition. ANS: C
At this age, examples of appropriate finger foods include small pieces of lightly toasted bagel, small pieces of ripe bananas, well-cooked pasta, teething crackers, and low-sugar “O” shaped cereal. Protein sources such as meat should be pureed to avoid choking. The nurse should gently stop the mother from feeding the hot dog to the baby. Hot dogs are not the most nutritional food, but safety comes first, so this is not the best answer. Documentation is always important but can be done later. The nurse should find something to compliment the mother on to help establish a trusting relationship. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process: Implementation Difficulty: Easy PTS: 1 9. A nurse is teaching new parents about dental care for their baby. Which information should
the nurse provide? A. Brush the baby’s teeth with special baby toothpaste. B. The child should see a dentist before the age of 2. C. All teeth should be in by age 2. D. Wipe the baby’s gums with moist gauze.
ANS: D
Dental hygiene should be started early. Even before a child has teeth, the gums can be wiped with a damp cloth or gauze. Toothpaste cannot be used before age 2 (because of the risks associated with swallowing it). A dentist should examine a baby’s teeth within 6 months of the eruption of the first tooth, but no later than the first birthday. Children should have all 20 primary teeth by the third birthday. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 10. A public health nurse is visiting a family home where there is a newborn. Which assessment
finding by the nurse warrants immediate intervention? A. A cat is sitting on the kitchen counter by the stove. B. Roaches are evident in the kitchen and in the pantry. C. The baby is on a carpet that is stained and worn out. D. The crib has dirty bumper pads and a dirty comforter. ANS: D
To prevent sudden infant death syndrome (SIDS), the American Academy of Pediatrics recommends that all babies be put to sleep on their backs and that cribs be free of toys, comforters, and bumpers. Vaccinations and breastfeeding are also recommended. The other options show a house that is dirty but does not rise to the level of needing immediate intervention. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process: Intervention Difficulty: Moderate PTS: 1 11. A mother who has three older children now has a newborn. She complains to the physician
that sleeping on his back has caused her baby to have “a funny-shaped head” that the other kids didn’t have. She doesn’t want to continue having the baby sleep on his back. Which action by the nurse is best? A. Document the comments and alert the physician to the concern. B. Encourage her to put the baby on his stomach during the day. C. Explain that babies need to sleep on their sides at all times. D. Tell her that back-sleeping isn’t important after 5 months of age. ANS: B
The American Academy of Pediatrics recommends that all infants be placed on their backs when sleeping. This is probably new information the mother did not have for her older children. If the mother is concerned about plagiocephaly (misshapen head), she can be taught to place the baby on the stomach with a small rolled towel under the arms for support and comfort. Alternating positions in the crib and side-lying for short periods in the presence of an adult are also alternatives. Documentation should always occur, but is not the most important action. Telling the mother that babies need to sleep on their sides at all times is incorrect. Sleeping on the back is important for all infants. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 12. A clinic nurse is working with an extremely obese teen. Besides nutrition and related health
effects, what else should the nurse assess the patient for? A. Alcoholism B. Hepatitis C C. Lanugo D. Seat-belt use ANS: D
According to the results of a recent study, overweight teens tended to engage in high-risk behaviors such as smoking, chewing tobacco, and neglecting to wear a seat belt. The nurse should assess the teen for these behaviors. Alcoholism, presence of lanugo, and hepatitis C are not related. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 13. A school nurse is evaluating a teenager who is returning to school after breaking her fibula.
The nurse notes the student has a blood pressure of 90/56 mm Hg, has a pulse of 58 beats/minute, and is wearing three layers of clothing. What action by the nurse is best? A. Ask the student if she had pain medication this morning. B. Document the findings and send the student to classes. C. Have the student lie down and call 911 immediately. D. Question the student about eating and exercising patterns. ANS: D
Signs of anorexia nervosa include weakness, dizziness, excessive weight loss, intolerance to cold, bradycardia, hypotension, bone loss with fractures, constipation, and the development of lanugo. The nurse should assess the student for the restricted eating and excessive exercise that is characteristic of this disorder. The lower blood pressure and pulse might be the result of pain medication, but the student should not have been allowed to return to school on these medications, and this does not explain why the student appears to feel cold. Documenting the findings is important, but the school nurse has an excellent opportunity to assess and intervene if needed. Calling 911 immediately is not warranted. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 14. A nurse is assessing a teen who has the nursing diagnosis of sleep pattern disturbance. What
statement by the teen indicates that goals for this diagnosis have been met? A. “I don’t want to cut out any more evening activities.” B. “I sleep until about noon on Saturdays to catch up.” C. “I take a long nap when I get home from school each day.” D. “I try to keep the same sleep and wake times all week.” ANS: D
Adolescents are commonly sleep deprived and often try to make up for their sleep deficit by sleeping more on weekends. This is actually detrimental, as the body has difficulty adapting to changing sleep routines. The teen who is keeping consistent sleep and wake times during the entire week has learned this fact and is probably getting better sleep than before. The other statements do not show understanding of sleep deprivation and ways to improve it. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Nursing Process: Evaluation Difficulty: Moderate PTS: 1 15. The school nurse wants to create a safe driving program for the high school students. In order
to have the greatest impact on safety, on which issue should the nurse focus? A. Female driving B. Late-night driving C. Seat-belt use D. Sleep deprivation ANS: C
The risk for motor vehicle accidents is greater among adolescents than for any other age group. Factors associated with this include the inability to assess hazardous situations while driving, speeding, driving under the influence of drugs and/or alcohol, and a low compliance with seat-belt use. Females are actually less likely to be in a motor vehicle crash than males. Late-night driving does not appear to increase risk. Although teens are often sleep deprived, this does not appear to be related. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 16. The parents of a 16-year-old boy are frustrated because the teen is always participating in
risky activities and getting hurt, and has a group of friends of whom the parents do not approve. What action by the nurse would be most helpful? A. Encourage an after-school program that includes rock climbing, rafting, and hiking. B. Reassure the parents that risk taking is just a normal part of adolescence. C. Show the teen statistics on preventable injuries and deaths among teenagers. D. Tell the teen his risky behavior can lead to injuries and worries his parents. ANS: A
Risk taking is a part of adolescence, but the teen needs healthy risk-taking activities. The nurse can encourage the teen to take part in a program that offers risk-taking under adult supervision. Rock climbing, hiking, and rafting are all healthy alternatives. Simply reassuring the parents that teens take risks does not give them information that helps the teen. Showing the teen statistics and explaining that he is worrying his parents are both unlikely to have much effect. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 17. A school nurse is preparing educational activities for all high school students on reproductive
health. The principal cautions that the program can only contain information about sexual abstinence. Which action by the nurse would be most appropriate? A. Argue that abstinence-only programs do not work and are not valuable. B. Discuss the need to have information appropriate to the teens’ experience. C. Plan the program but encourage questions not related to the prepared material. D. Prepare an abstinence-only program because teens should not have sex. ANS: B
Education on sexual health should take into consideration the age and sexual experience of the audience. For teens who have not yet had sexual intercourse, an abstinence-only program might make sense. However, if the teens have already engaged in sexual intercourse, they are likely to continue this behavior, and the program should focus on using condoms in order to avoid unprotected sex and its risks. Abstinence-only programs cannot be characterized as being of no value. Encouraging teens to ask questions off the prepared topic is a passive-aggressive action. It is not up to the nurse to decide if teens should have sex or not. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 18. A nurse is teaching conflict-resolution strategies to a group of teen mothers at risk for
violence. Which statement by a participant indicates understanding? A. “Friends of mine have said they would be willing to help in a crisis.” B. “If good communication doesn’t solve the problem, I will leave.” C. “If we can’t settle our differences, we will have to start talking all over again.” D. “My mother can help my boyfriend and me resolve a conflict.” ANS: B
Successful conflict resolution strategies enable the teen to remain calm and safe. If communication and respect do not work to resolve the conflict, the teen should remove herself from the situation. The other statements do not show that the teen has understood this message. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Evaluation Difficulty: Moderate PTS: 1 19. A young couple is in the clinic for a prenatal exam. The woman expresses concern that her
husband continues to binge drink and use drugs on weekends. What action by the nurse is best? A. Assess the father for reasons why he continues to abuse alcohol and illicit drugs at his age. B. Explain that if there are drugs in a house with a baby, the baby can be taken away. C. Help the husband see how his drug and alcohol use is inconsistent with the father role. D. Warn the husband that he will be putting the baby at risk unless he stops this activity. ANS: C
The most reliable theory on drug use focuses on role development. As young adults take on the roles of spouse and parent, illicit drug use can interfere with performing those roles. Also, when assuming adult roles is seen as incompatible with illicit drug use, substance use declines. The nurse’s best action is to help the husband see how binge drinking and drug use are not compatible with the father and role model roles. The nurse could assess the father for reasons he continues to abuse substances, but this will not help him diminish his use. Stating that the baby can be taken away may be seen as a threat and will probably cut off communication. Likewise, telling the father he will be putting his baby at risk may sound judgmental and threatening as well. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 20. The nurse is assessing a young woman who is overweight. Which action by the nurse is most
appropriate? A. Ask if she knows how overweight she is. B. Assess the woman for stress-related problems. C. Caution her about related chronic illnesses. D. Encourage the woman to exercise more. ANS: B
In young adulthood, women especially begin to manifest stress-related disorders, including comfort eating. The nurse’s best action is to assess the woman for this problem. The nurse can encourage her to exercise and can caution her about the relationship between poor nutrition and chronic illness, but if stress is causing the woman to overeat, she probably will not be able to make significant changes without addressing the cause. Asking the woman if she knows how heavy she is right now is disrespectful and will likely end the therapeutic relationship. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 21. A nurse is teaching a 24-year-old male about reproductive health. Which information should
the nurse provide this patient about testicular cancer? A. Annual screening is recommended for testicular cancer. B. If the epididymis is tender to the touch, that is concerning. C. Perform a testicular self examination after a warm shower. D. Because testicular cancer is rare at this age, no action is needed. ANS: C
Although cancer of the epididymis is considered rare, it is still the most common cancer found in men aged 20–34. Men should be taught the technique of testicular self-examination, which is best performed after a warm shower when the scrotum is more relaxed. Annual screening is not recommended other than during a clinical exam. The epididymis is normally slightly tender to pressure. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 22. A woman presents to the family practice clinic complaining of abdominal pain, pain during
ovulation, and heavy periods. What action by the nurse is best? A. Facilitate a vaginal ultrasound. B. Obtain consent for a laparoscopy. C. Prepare the woman for a pelvic exam. D. Provide education on ibuprofen (Motrin). ANS: C
This woman has manifestations of endometriosis. Diagnosis can be made via a pelvic exam, although it is often difficult to do so. Some physicians will order ultrasounds or laparoscopy with biopsy. The first step, however, is the pelvic exam, so the nurse should prepare the woman for this to occur. After making a diagnosis of endometriosis, the nurse can educate the woman on medical management, which includes using ibuprofen for pain. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Easy PTS: 1 23. A patient is in the clinic for an annual exam. Her past medical history includes endometriosis
for which she takes medroxyprogesterone (Depo-Provera). What assessment finding would the nurse relate to the medical condition or medication? A. 20-lb weight gain B. Cold intolerance C. Facial acne D. Facial hair growth ANS: A
Depo-Provera is used to treat endometriosis, but one undesirable side effect is weight gain. Danazol (Danocrine) is also used to treat this condition, but side effects of acne and facial hair growth cause this medication to be prescribed less often. Cold intolerance is not a common side effect of medications used to treat endometriosis. Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 24. A nurse reads in a patient’s chart that the Bethesda system terminology used to describe her
cervical cytology and histology is AIS. What can the nurse conclude about this woman’s treatment? A. Follow-up in 1 month B. Possible chemotherapy C. Repeat test in 3 months D. Use of luprolide (Lupron) ANS: B
The Bethesda System terminology describes categories of epithelial cell abnormalities. The categories are ASC (atypical squamous cells), LSIL (low-grade squamous intraepithelial lesions), HSIL (high-grade squamous intraepithelial lesions), AGC (atypical glandular cells), and AIS (adenocarcinoma in situ). Treatment for cancer of the cervix includes surgery, chemotherapy, radiation, or a combination of these. The other options are not appropriate for this situation. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 25. A 21-year-old woman who has not been sexually active is in the clinic and requests a Gardasil
vaccination. After giving the shot, what instruction does the nurse provide to her? A. Return in 1 month for the next shot. B. Return in 2 months for the next shot. C. Return in 6 months for the next shot. D. Return in 1 year for the next shot. ANS: B
Gardasil is given in a series of three injections. The second shot is 2 months after the first. The third shot is 6 months after the first. The other options are incorrect. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching-Learning Difficulty: Moderate PTS: 1
26. A young woman has had three urinary tract infections (UTIs) in the last year. What teaching
should the nurse plan for this patient? A. Avoid sexual intercourse during your period. B. Take prophylactic antibiotics daily. C. Void every 4 hours while awake. D. Wipe from front to back after using the bathroom. ANS: D
Preventative measures for UTIs include drinking plenty of water, voiding when the urge is felt, wiping from front to back, taking showers instead of baths, not using perfumes or bath oil if baths are taken, wearing cotton underwear, and avoiding feminine hygiene sprays and scented douches. The other options are not related. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 27. The nurse prepares to offer health screening and promotion activities for women aged 40–60.
Which activity does the nurse plan to include as a priority for this group? A. Alzheimer’s disease screening B. Breast cancer screening C. Gardasil vaccinations D. Influenza vaccinations ANS: B
Breast cancer is the second leading cause of cancer death in women in the United States and is the leading cause of death in women aged 40–55. The priority screening activity is for breast cancer. Alzheimer’s disease screening is typically done in the older patient. Gardasil is recommended for females aged 9–26. Influenza vaccinations are important for all ages. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Easy PTS: 1 28. A nurse is volunteering for the local chapter of the cancer society and is planning breast
cancer screening and educational activities in the community. In order to have the most impact on this disease, which women should the nurse target? A. African Americans B. Asian Americans C. Caucasian Americans D. Native Americans ANS: A
African American women are more likely to die from breast cancer because of late diagnosis, and in women under 45 in this group, breast cancer is more common. To have the greatest impact, the nurse should target this group of women. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer. Caucasian women tend to develop breast cancer more frequently than African American women, but they die less often. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 29. A postmenopausal woman asks the nurse about reducing her breast cancer risk. The woman is
overweight, consumes one alcoholic drink daily, does not smoke, and works at a desk. What response by the nurse is best? A. Exercise regularly. B. Lose weight. C. Stop drinking. D. Take aspirin daily. ANS: B
Alcohol intake, smoking, and weight maintenance all affect breast health. However, this woman’s highest risk factor is being overweight. After menopause, estrogen is produced in body fat cells. The combination of estrogen and dietary fat significantly increases the chance of breast cancer development. Exercise can be part of a weight-loss regimen, but this is not the most comprehensive answer. Drinking one drink a day is not linked to increased breast cancer risk, although drinking two to five drinks a day is associated with an increased risk. Taking an aspirin daily is for promotion of heart health. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 30. A preoperative nurse is caring for a patient who will undergo an open breast biopsy. What
action by the nurse takes priority? A. Ensure that an informed consent is signed and witnessed. B. Inventory and label all of the patient’s belongings. C. Orient the patient’s significant others to the waiting room. D. Premedicate the patient on arrival to the pre-op holding area. ANS: A
All actions are appropriate, but the priority action is in ensuring that an informed consent form has been signed and properly witnessed.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Difficulty: Easy PTS: 1 31. A nurse in a family practice clinic sees several generations of the same family. For which
family members should the nurse arrange routine screening colonoscopies? A. Daughter, age 52 B. Grandfather, age 80, no history of polyps or cancer C. Grandmother, age 72, history of polyps D. Grandson, age 30, no gastrointestinal symptoms ANS: A
Individuals aged 50 and older should have screening colonoscopies, so the daughter should be scheduled for this procedure. The CDC does not recommend routine screening for patients aged 75–85 and recommends no screening after age 85, so the grandparents do not need to be screened. For patients with family history of colon polyps or cancer, screening should begin in their 40s, so the grandson does not yet need screening. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 32. A nurse is reviewing the results of several patients’ cholesterol and lipid screenings. For
which patient is the action appropriate? A. HDL cholesterol 66 mg/dL: Evaluate patient for cardiovascular risk. B. LDL cholesterol 98 mg/dL: Instruct patient to take fish oil 3 gm daily. C. Total cholesterol 240 mg/dL: Teach heart-healthy lifestyle changes. D. Triglycerides 132 mg/dL: Refer to dietician for comprehensive diet education. ANS: C
A cholesterol below 200 mg/dL is desirable, so this patient’s level is high. The nurse should plan to teach this patient about heart-healthy lifestyle changes. The other laboratory values are in the desirable range, so no action is necessary. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process: Implementation Difficulty: Difficult PTS: 1
33. A 53-year-old woman is having her annual physical and tells the nurse she has not had a
period for 7 months. She wants to know if she has undergone menopause. What response by the nurse is best? A. “No, at your age, fluctuations in your menstrual cycle are normal findings.” B. “No, menopause only begins in women after the age of 55.” C. “Yes, not having a period for more than 6 months is diagnostic of menopause.” D. “You have to go 1 year without a menstrual period to be sure that menopause has occurred.” ANS: D
Menopause can only be diagnosed with certainty after 1 year without menstrual periods. Although fluctuations in a woman’s cycle are normal during the perimenopausal years, this answer is not correct, as it appears to signify that there is no relationship between the lack of periods and menopause, and so is misleading. The average age of menopause in the United States is 51.4 years, with a range of 35–60 years. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 34. A nurse is evaluating several patients for possible hormone therapy to reduce severe
symptoms of menopause. For which patient would hormone therapy be recommended? A. 53 years old, smoker, estrogen-progestin therapy B. 54 years old, history of endometrial cancer 10 years ago, estrogen only C. 55 years old, history of hysterectomy 4 years ago, estrogen only D. 76 years old, went through menopause 16 years ago, estrogen-progestin ANS: C
Estrogen therapy for women who have had a hysterectomy or estrogen-progestin therapy offers the greatest benefit and smallest risk to those who are within 10 years of menopause. The patient who is 55 and has had a hysterectomy would be the best candidate. The 53-year-old smoker has a double risk for venous thromboembolism (VTE) because smoking increases the risk along with the combination hormone therapy. Estrogen-only therapy increases the risk of endometrial cancer, so it is not used in patients who have a history of endometrial cancer. The smallest risk is seen in women within 10 years of menopause, so the 76-year-old woman is too far removed from menopause to receive hormone therapy. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1
35. A woman suffering from severe vasomotor menopausal symptoms wants to use
complementary or alternative therapies instead of hormone therapy. What advice by the nurse is best? A. “Acupuncture has been shown to work better than other body therapies.” B. “Herbs are a great option as they do not typically have side effects.” C. “Mind–body, manipulative, or traditional Chinese medicine are safer than herbs.” D. “Research shows that black cohosh significantly reduces hot flashes.” ANS: C
There is no evidence that either herbal preparations or complementary approaches such as acupuncture, mind–body therapies, or manipulative therapies significantly reduce the symptoms of menopause. However, body-related therapies are considered safer because they do not have the side effects of herbal preparations. The nurse’s best answer is to explain this to the patient. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 36. A nulliparous 53-year-old woman is in the clinic complaining of lower abdominal fullness,
heavy menses, and severe menstrual cramping. What treatment does the nurse anticipate for this woman? A. Administration of leuprolide (Lupron) B. Hysterectomy and bilateral salpingo-oophorectomy C. None; issue will resolve spontaneously D. Surgical removal of the ovaries ANS: A
These are symptoms of a uterine leiomyoma (fibroid). The medical treatment includes nonsteroidal anti-inflammatory drugs, oral contraceptives, and Lupron. Ovarian cysts often resolve spontaneously. For ovarian cancer, a complete hysterectomy with bilateral salpingo-oopherectomy is the procedure of choice. Because some of these symptoms are also seen in ovarian cancer, the nurse should be sure to assess the patient further. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process: Planning Difficulty: Moderate PTS: 1 37. A nurse notes that a woman’s chart lists “dyspareunia” as a diagnosis. In planning education
for the patient, which topics would the nurse include? A. Black cohosh and soy nuts B. Kegel exercises and use of a pessary C. Nonsteroidal anti-inflammatory medications
D. Water-based vaginal lubricants ANS: D
Dyspareunia is painful intercourse, often seen in postmenopausal women. Prolonged foreplay and the use of water-based vaginal lubricants are helpful suggestions to ease this symptom. Black cohosh and soy nuts are often used to relieve menopausal symptoms. Kegel exercises and pessaries are used for urinary incontinence. Nonsteroidal anti-inflammatory medications are used for mild pain and swelling. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 38. A nurse is working with an older adult who has never exercised despite understanding the
health benefits. What can the nurse do to improve the chances that this adult will begin an exercise regimen? A. Ask the patient if dancing sounds like fun. B. Encourage the patient to join a fitness club. C. Explain how exercise increases independence. D. Have the family talk with the patient about it. ANS: C
Maintaining physical fitness in later years contributes to health, well-being, and independence. If the patient already understands the health benefits of exercising, asking about dancing and joining fitness clubs is not likely to get the desired response. However, if the nurse can show the patient how being physically fit may mean more years of independent living, the patient might be willing to make some small changes. Asking the family to talk with the patient is not showing the nurse in action. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Easy PTS: 1 39. An older patient has never exercised, but wants to begin now. What response by the nurse is
best? A. “At your age, exercise will not benefit you.” B. “Good for you! I am so proud of you!” C. “Remember to stretch before exercising.” D. “Start with exercising for only 5 minutes a day.” ANS: D