Ch. 2 Family Centered Community Based Care

A couple had decided not to circumcise their newborn for nonreligious reasons. What is the appropriate response from the nurse?

"OK, great. I will let the physician know."

A community health nurse is actively involved in various community projects. The nurse is providing a secondary prevention activity by organizing which event?

A skin cancer screening fair

A clinical nurse specialist is conducting a review class for a group of nurses about cultural compentence and cultural diversity. The nurse determines that teh teaching was successful when the group identifies which term as reflecting the view of the world and set of traditions of a specific social group passed down through generations?

Culture

The home health nurse enters the gated front yard of the client. A large aggressive dog appears on the front porch. What is the most appropriate action by the nurse?

Leave the yard and return to the car.

A nurse is visiting the home of a mother and her newborn. The woman's family members are present when the nurse arrives. What is the nurse's best approach to the situation?

Assess the family members' interactions with the newborn and one another.

The nurse notes that a 5-year-old boy is approaching obesity. Which is the priority intervention?

Assessing the diet of the child and family

The home care nurse is visiting a client and family for the first time. Which initial action can the nurse take to build trust with the client and family?

Communicate in an organized and professional manner.

What is a key element of providing family-centered care?

Communicate specific health information.

A home care nurse is visiting a pregnant client from the Arab culture. During the health history the husband frequently answers questions for the client. How should the nurse respond?

Continue with the health history.

A 40-year-old pregnant client tells her nurse that she would like to give birth in a birthing center because she wants several friends and family members to be there and will have more freedom at the center. What would be the most important factor for the nurse to point out when discussing this option with the client?

Birthing centers do not always have pediatricians on staff if the newborn has special needs.

A woman in active labor begins to recite a lullaby to "call the baby outside." Which action by the nurse caring for this woman is most appropriate at this time?

Allow the client to perform a ritual.

The nurse is preparing to discuss birthing options with a 25-year-old female who is in a low-risk pregnancy with one older child. Which option will be best for the nurse to recommend for this client?

Any birthing settings

A nurse is working with a culturally diverse patient population. Which strategy would the nurse most likely use to assist in recognizing cultural influences on pain perception? Select all that apply.

Appreciate that the meaning of pain varies among cultures. Appreciate that not all people communicate or express their level of pain in the same way. Recognize that communication of pain may not even be acceptable within a culture. Develop an awareness of personal values and beliefs. Use an assessment tool (e.g., rating scale from 1 to 10) to assist in measuring the pain.

A 4-year-old adopted child has begun to ask questions about when she was born. Which suggestions by the clinic nurse would be considered the most appropriate answer for this child related to her birth? Select all that apply.

Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them.

A nursing student is exploring community-based nursing as a career focus. The nurse is prepared to prioritize which activity as a primary focus?

Wellness

The nurse is providing an educational program for the staff working at a homeless shelter. The program is focused on the impact of homelessness on children. What information should be included in the presentation? Select all that apply.

Homeless children are at an increased risk for sexual abuse. Homeless children are at risk for developing chronic health problems. Acute health conditions are increased in homeless children.

During a home visit, the nurse begins teaching on medication safety in the home. What should the nurse include in these instructions? Select all that apply.

Never take medication in front of children. Use a reminder sheet and cross off when a medication has been taken. Drink a full glass of water with pills to ensure they reach the stomach. Keep all medication in a safe place above the height for a child to reach.

The nurse is concluding her initial visit with a client 28 weeks pregnant on bedrest for premature rupture of membranes. What information should the nurse consider when determining the timing of the next home visit?

amount of supervision and health education needed by the client

A child is seen in the pediatric clinic for update of immunizations prior to starting middle school. During the intake process the nurse asks the parents if the family is involved in any neighborhood or community activities. The parents ask the nurse, "What does that have to do with immunizations?" What is an accurate response by the nurse?

"Based on research, our physician feels that better connection to community leads to better health in many ways."

When working with a woman and newborn being discharged with a prescription for an liquid antibiotic to be given 3 times a day, which directions are most appropriate?

"Give the medicine 3 times a day, spreading it out to work with your schedule."

The home care nurse is teaching home health assistants about home visit safety. Which statement by the home health assistant would require intervention by the nurse?

"I have become a member of the family, so I eat meals with them sometimes."

A nurse is teaching an 18-year-old client about circumcision care for her second baby. Which statement made by the nurse would be most appropriate to assess the client's learning ability?

"I note you're having problems with reading the information. Will you tell me about this?"

During a hospital admission, an 8-year-old of Polish heritage tells you he is angry because so many people have asked him how to pronounce his name. What would be your best response?

"I will mark in your nursing care plan how to say it correctly."

While reviewing a woman's compliance with prenatal care, a nurse notes that which comment made by the woman may be a result of poverty rather than a cultural difference?

"I wish I could afford fresh fruits for vitamin C because I just don't remember to take those prenatal vitamins."

A pregnant woman experiencing morning sickness has asked her nurse about ways to reduce or alleviate it. After receiving education and information from the nurse, which statement would indicate that the client understood the information?

"I'll discuss with my primary care provider whether it is a good idea for me to use sea-bands."

The nurse educator has completed a presentation on caring for babies born to mothers with a substance use disorder. Which statement by a participant would indicate the need for further education?

"If a baby is born to a mother with a substance use disorder, the nurse needs to be aware that the baby will typically eat more than babies born to mothers with a substance use disorder.

A preterm newborn is to be discharged home on oxygen therapy and tube feedings. Which statement by the parents would indicate that they need additional teaching and preparation for this transition?

"Our insurance company will pay for all the equipment that we need for the treatments."

The nurse is reviewing the risk factors associated with having a child born with Down syndrome. Which situation(s) would the nurse idenfity as high risk for having a child born with Down syndrome? Select all that apply.

A 43-year-old woman pregnant with her third child, experiencing no complications A 42-year-old woman, pregnanct for the first time, having increased blood pressure readings

The nurse is preparing a prenatal seminar for young mothers. Which type of information should the nurse gather to ensure success of the program?

Approximate education level of the participants

The home care nurse visits a client who is 32 weeks' gestation on bed rest and reporting a severe headache. Which intervention should the nurse implement first?

Assess the client's vital signs and conduct a quick, focused assessment.

Advocacy for the client is an important aspect of community-based nursing. What is one way a nurse can advocate for a child client?

Assisting the family to apply for Medicaid or other forms of health care reimbursement

A community-based nurse has a different set of skills than those of counterparts who work in a hospital. Community-based nurses also face unique issues and challenges. What is one of the unique aspects of community-based nursing?

Autonomous

Which action should a nurse perform to avoid disrupting family routine when visiting to provide home care?

Avoid coming during mealtimes.

The home health nurse is meeting with a client for the initial assessment in the home. Which location should the nurse prioritize for this assessment?

Bedroom

A home care nurse has just completed a home assessment for a client and notes that there are no working smoke detectors in the upstairs of the home. The client states that her husband just lost his job and they cannot afford to purchase them. Which is the most appropriate referral for the nurse to initiate?

Call the local fire department.

A 13-year-old client who is newly diagnosed with type 1 diabetes is being discharged home with home care follow-up. What is the most appropriate goal for the nurse to select related to the nursing diagnosis of Health-Seeking Behaviors related to Skills Needed to Continue Home Care?

Client will self-administer insulin injections using appropriate technique.

The nurse is completing the social assessment of a client who reports the family members consist of herself, her boyfriend, their daughter, and his son. The nurse determines this family represents which family structure?

Cohabitation family

The nurse is caring for a 7-year-old boy and his family, who are immigrants. Which intervention will most significantly affect the success of the care provided?

Communicating with sensitivity using understandable terms

The nurse is caring for a child from a different culture. Which statement(s) by the nurse demonstrates an understanding of how culture impacts a client? Select all that apply.

Correct response: "Culture can impact who a client chooses to see for health care needs." "Culture can impact the diet a client follows." "A client's cultural beliefs can impact spirituality and/or religion." "A client's cultural beliefs should be incorporated into the care a client receives.

A 7-year-old client on a ventilator who is being cared for at home is admitted to the hospital for the fourth time in a 6-week period for respiratory complications. What might be the priority nursing diagnosis for this client?

Deficient knowledge

A nursing instructor is teaching the class about community-based nursing. The instructor determines the session is successful when the students correctly choose which activity as an example of tertiary prevention?

Ensuring the client attends physical therapy after orthopedic surgery

A community-based nurse is assessing the needs of a family of four, which includes a physically challenged 9-year-old. Which activity would the nurse prioritize to be an advocate for this family?

Establish eligibility for assistive devices for child.

The nurse is working with a same-sex couple, both of whom have children from previous relationships. Although the couple have no plans of marrying, they view their relationship as monogamous and long-term. Which family structure would apply to this family? Select all that apply.

Gay or lesbian family Cohabitation family Blended family

While performing a community assessment, a nurse notes a large increase in single-parent families. She performs some research and finds that the increasing numbers of single-parent families are related to which trends? Select all that apply.

Increasing divorce rate Changing attitudes toward children born out of wedlock Changing adoption laws

The nurse is preparing to make a home visit to admit a new client to services. Which actions should the nurse take to ensure personal safety? Select all that apply.

Keeping the gas tank of the car full Parking the car in a well-lighted area Using a map to avoid getting lost in a strange neighborhood Informing the agency of the estimated arrival time and expected return

A labor and birth nurse is admitting an adolescent client with her mother. The client appears to be upset, and the nurse wants to find out why. How should the nurse proceed? Select all that apply.

Make note of the client's and parent's nonverbal expressions. Maintain eye contact throughout the discussion. During the discussion maintain an open posture, with arms uncrossed.

A woman has presented to the clinic with her sick school-aged child. The child's mother reports she rarely has enough money to meet the health care needs of her chronically ill child. What information should be provided to the woman?

Medicaid may be available to low-income parents and their children.

The nurse is assessing an infant girl at its first well-baby visit. The nurse also observes the actions of the 6-year-old brother and parents who share that she was the best anniversary present they received this year. Which type of family will the nurse conclude these individuals represent?

Nuclear

The nursing instructor is teaching a session outlining the necessary skills of a community nurse. The instructor determines the session is successful when the students correctly choose which factor as the foundation of all nursing care?

Nursing process

A nursing instructor is teaching a group of nursing students about the various options available to provide nursing care in a community. The instructor determines the session is successsful when the students correctly choose which action as the primary focus of home care nursing?

Provide direct client care.

A home care client who is 30 weeks' gestation with triplets reports to the nurse that she is having increasing difficulty getting out of bed to perform hygiene or elimination. Which is the most appropriate intervention?

Request a hospital bed for the home

A nurse is developing a plan of care for a client of Muslim faith. Which action demonstrates an understanding of providing culturally competent care?

The client is asked if there are any meal preferences to be included in the care plan.

The nurse is caring for several client's in the prenatal clinic. Which action by the nurse demonstrates cultural compentency?

The nurse asks each client about dietary restrictions and preferences during the postpartum period

The obstetrical nurse notes that a Muslim client has not been eating any of the meals supplied to her. Which actions performed by the nurse best demonstrate cultural competence?

The nurse becomes familiar with the Muslim client's meal practices.

The emergency nurse is providing care for a pregnant woman admitted with a broken femur, blackened eye, and multiple contusions. She admits her partner is abusive. Which activity would be considered at the tertiary level of prevention?

The nurse contacts the crisis social worker for assistance.

A woman who is from the Philippines becomes upset when the nurse brings in an interpreter, rather than using her cousin as the translator. Which would be the best reason for using an official interpreter in this case?

There may be cultural limitations that change how the information is being interpreted by the family.

While interviewing a client, a nurse assesses the client's reaction to health care and determines that the reaction reflects the client's preferred ways of acting based on traditions. Which term would the nurse use to document this information?

cultural values

A pregnant woman with premature ruptured membranes is trying to decide whether home care might be the best option for her. Which advantage should the nurse mention to the client that is most pertinent to her condition?

decreased exposure to infection

When caring for a woman in her sixth month of pregnancy, the client reports her plans to nurse her baby for at least 2 to 3 years like the rest of the women in her family. Based upon the nurse's knowledge, the nurse should:

document her report but do nothing as this is a cultural belief that should be respected.

The term used to guide the cultural aspects of nursing care and respect individual differences is:

transcultural nursing.

A nurse is uncomfortable caring for a pregnant client who is married to her female life partner. The best advice another nurse can give her would include which statement?

"Spend some time self-reflecting why this family difference might be bothering you."

While taking a health history, the nurse finds out that the pregnant woman of Japanese descent comes from a culture that does not eat meat. Which foods will indicate sufficient protein intake? Select all that apply.

beans and rice eaten every day stir-fried carrots and beans regularly egg drop soup 2 to 3 times per week

A 19-year-old pregnant adolescent who experienced a rape has arrive in the emergency department in active labor with no prenatal care. The nurse caring for the client should assess for which potential adverse health problem?

sexually transmitted infections (STIs)

A nurse is caring for a Turkish American client. The nurse understands that there could be major cultural differences between the nurse and the client. The nurse contemplates assigning this client to a staff member who is of the same culture as the client. What is a potential consequence?

stereotyping of the client

The nurse is caring for a teen who has been hospitalized after a motor vehicle accident. The accident is believed to have been caused by alcohol and drug use. The teen states, "I fit in when I use marijuana and besides it is legal in some states." Which response by the nurse is most therapeutic?

"Telll me how you feel when you use marijuana."

At a prenatal class, the nurse is told by a client that her mother advises her not raise her hands above her head during pregnancy in order to avoid umbilical cord problems. What is the nurse's best response?

"This is a belief from your mother's culture about what to avoid during pregnancy."

As part of an education program for pregnant women and their partners, the nurse illustrates the various settings available for birth. The nurse determines that the program was successful when the group correctly chooses which statement about home births?

"Women giving birth at home have control over every part of labor."

The case manager is looking over the inpatient census on her floor to determine which client would be the best candidate for discharge with home health care follow-up. Which client would the case manager recommend to the physician for discharge?

10-year-old boy with an infected laceration on his leg who has been treated with IV antibiotics for 3 days.

The nursing instructor is teaching a session on the increase of health care costs associated with the advancement of modern technology. The instructor determines the session is successful when the students correctly choose which focus of community-based health care that has been implemented to combat the increased cost?

Preventing disease and its sequelae

The nurse is preparing to teach a drug education class at a local elementary school. The nurse is focused on providing which type of care to the community?

Primary prevention

Which intervention best demonstrates the L & D nurse is respectful of a client who is deaf and in early labor?

Seek assistance from another health care professional who can converse in sign language.

The camp nurse is reviewing the health information of the participants at a school-age diabetic summer camp. What topic would be most appropriate for this group of campers?

Self-administration of insulin

A homeless client diagnosed with human papillomavirus (HPV) is seen in the maternity clinic requesting a pregnancy test. Which nursing action would be the best example of the secondary level of prevention?

Suggest she have a Papanicolaou (Pap) smear.

A school-aged child from Japanese background expresses concern to the school nurse about feeling embarrassed over the parents' speaking broken English. After counseling the child, the nurse understands that which evaluation reflects a positive outcome for this child?

The child no longer feels isolated because of the family's differences.

A woman has presented to the clinic with her sick school-aged child. The child's mother reports she rarely has enough money to meet the health care needs of her chronically ill child. What information should be provided to the woman?

The client has a log with the date, time, and number of fetal heart beats counted.

The nurse instructs a client who is at 28 weeks' gestation on the correct use of the fetal heart monitor at home. Which observation indicates that teaching has been effective?

The client has a log with the date, time, and number of fetal heart beats counted.

A nurse is assessing an adolescent in a clinic with both parents accompanying the child. The nurse questions whether the family is functioning in a healthy way after noting which action?

The father does not share his concerns with his wife.

The community health nurse is seeing a mother and newborn for the first home visit. Which information best indicates an understanding of visiting clients in their home?

The home visit is a way of monitoring the well-being of all family members.

The home care nurse visited a newly assigned primagravida client with preeclampsia. When conducting the assessment and teaching, the client continued to cry and state she was in disbelief this was happening to her. When should the nurse schedule the second visit with the client?

The next day; the client is not coping well.

The nurse is caring for several families in the prenatal obstetrics office setting. Which is most important for the nurse?

Understanding and accepting the various types of family units, such as lesbian, gay and transgender

A nurse is addressing a group of women on the issue of women's health during their reproductive years. Which reason does the nurse provide regarding the need for comprehensive, community-centered care to women during this time period?

Women's health care needs change with their reproductive goals.

A nurse working in a busy urban family clinic has noted a high percentage of single mothers. What should the nurses in this clinic be prepared to offer these single mothers?

support when a problem related to childrearing occurs

When performing an initial home care assessment, the nurse evaluates material resources (e.g., hospital beds, oxygen, fetal home monitors) as well as which resource?

if the family can deal with the stress of home care

A nurse doing an admission assessment on a new Chinese American client notices that the client will not make eye contact. The most likely reason for this is that it:

is a sign of respect.

A laboring client, 2 cm dilated and 50% effaced, is screaming in pain. The nurse caring for this client recognizes this woman's response to pain should be documented using which label?

low pain threshold

A Native American mother has just arrived in the L & D department in active labor. Following the birth, which cultural practice may the nurse help arrange?

making arrangements for the mother to take home placenta after the birth

A nurse encourages both partners in a lesbian family to come into the examining room with the newborn during a well-baby check. What type of nursing is the nurse practicing?

transcultural nursing

A laboring woman has brought her partner as her support person who is dressed in feminine attire, but when she speaks, it is clear to the nurse that the support person has a male voice. When documenting about the client's support person, which term would be most appropriate?

transgender

A new mother tells the obstetrical nurse that her mother notices so much has changed in maternity care in recent years. One change she could likely be referring to is:

newborns stay at the mother's bedside with the family as long as it is well.

When caring for woman who speaks a different language than one's own, the nurse must ask for an interpreter before having the client sign which forms to ensure clarity can be confirmed? Select all that apply.

surgical permit end-of-life care consent to blood transfusions

A pregnant woman reports she does not see the value in attending prepared childbirth classes because she plans to have an epidural to manage the discomfort from the contractions. What information should be included in responses by the nurse? Select all that apply.

"There are many different topics included in prepared childbirth classes aside from pain management." "Preparation for labor and birth can enhance your experience and coping abilities." "You can learn tools to assist you in the labor process both before and after your epidural."

A pregnant teenager is not certain that she will like home care because she is afraid she will feel lonely. The nurse should suggest that:

everyone could eat together.