Family concepts Study Guides

Chapter 3 KeyPoints

Considering a family as a unit (a single patient) helps in planning nursing care that not only meets QSEN competencies but also best meets the family's total needs. Because families exist within communities, assessment of the community and the family's place in the community yields further information on family functioning and abilities

Physical maintenance:

A healthy family provides food, shelter, clothing, and health care for its members. Being certain a family has enough resources to provide for a new or ill member is an important assessment

Type of family

How many family members live in the home? What are their ages and relationships?

Safety

Is the home safe from fire or unintentional injuries? (Are smoke alarms present and police and fire numbers posted?) If there are small children, are poisons put on high shelves or in locked cabinets? Are prescription medicines and alcohol in safe places?

Environment

Is there adequate space? Heat? Hot water? Adequate plumbing?

DEVELOPMENT OF SEXUAL ORIENTATION When is sexual orientation acknowledged ?

It is during adolescence, in seeking a sense of identity, that they realize the reason they feel "different" is because they are lesbian, gay, or bisexual (LGB). This can cause additional stress during adolescent development because revealing their sexual orientation to family and friends or "coming out" may be difficult.

There are high rates of homelessness (22% of homeless youth are LGB) and suicide (suicide attempts were present in up to 70% of surveyed LGB individuals) among

LGB adolescents Part of the reason these high rates occur may be because LGB teenagers don't know where to turn for help in a heterosexual-dominant culture

Families are more health conscious than ever before; the use of Internet sites to monitor their health or ask health questions is rapidly increasing.

Families are ripe for health education; providing evidence-based information can be a major nursing role.

Families are not as extended as in previous generations, so contain fewer members

Fewer family members are available as support people in a time of crisis. Nurses are called on to fulfi ll this role more than ever before.

Dual working parents may also require school-age children to spend some time alone after school before their parents return from work. What should the nurse help these parents do ?

Helping parents prevent loneliness in these "latchkey" or "self-care" children as well as helping children make good use of their time alone can be another important nursing responsibility

Health rehabilitation

Helping prevent complications from illness; helping a client with residual effects achieve an optimal state of wellness and independence; helping a client to accept inevitable death Ex: Encouraging a woman with gestational trophoblastic disease (abnormal placenta growth) to continue therapy or a child with a renal transplant to continue to take necessary medications

Infant mortality rate:

The number of deaths per 1,000 live births occurring at birth or in the first 12 months of life.

Maternal mortality rate:

The number of maternal deaths per 100,000 live births that occur as a direct result of the reproductive process.

Provider

Who brings in the bulk of the family's income?

Gatekeeper

Who determines what information will be released from the family, or what new information can be introduced?

Problem solver

Who does the family depend on to provide a solution to problems?

Environmentalist

Who is responsible for recycling and not wasting electricity or water?

Financial support

Who is responsible for the family's income? Are finances adequate? Is money divided evenly among family members?

Nurturer

Who is the primary caregiver to children or a physically or cognitively challenged member?

Culture bearer

Who maintains family and community customs so children can develop a sense of where they belong in history?

Decision maker

Who makes decisions, particularly in the area of lifestyle, and how leisure time is spent?

Health manager

Who makes healthcare decisions, ensures family members keep health appointments, immunizations are kept current, and preventive care such as a mammogram for the mother is scheduled?

Financial manager

Who supervises the family finances (pays the bills, provides savings for the future)?

The two main overarching 2020 national health goals are:

• Increase quality and years of healthy life. • Eliminate health disparities

pros and cons of gay and lesbian families

• Positive aspects: Provides the advantages of a nuclear family • Possible negative aspects: May suffer discrimination from neighbors who do not thoroughly approve or accept this family type

Pros and Cons of Polygamy families

• Positive aspects: Companionship; shared resources • Possible negative aspects: Not sanctioned by law; disapproval by community; decreased value of women

Pros and cons of extended families

• Positive aspects: Many people for child care and member support • Possible negative aspects : Resources may be stretched thin because of few wage earners

pros and cons of foster families

• Positive aspects: Prevents children from being raised in large orphanage settings • Possible negative aspects: Insecurity and inability to establish meaningful relationships because of frequent moves

pros and cons of Single-parent families

• Positive aspects: Ability to offer a unique and strong parent-child bond • Possible negative aspects: Resources may be limited

Pros and cons of adoptive families

• Positive aspects: Children grow up well cared for and experiencing a sense of love; a woman who relinquishes her child for adoption can feel a sense of relief her baby will have a lifestyle better than what she could provide. • Possible negative aspects: Divorce of the adopting parents can be devastating if the child views himself as the cause of the separation or as a child unable to find a secure family for a second time.

pros and cons of a dyad family

• Positive aspects: Companionship, possibly shared resources • Potential negative aspects: Often a short-term arrangement so can result in a sense of loss when the relationship ends

pros and cons of cohabitation family

• Positive aspects: Companionship, possibly fi nancial security; encourages a monogamous relationship • Potential negative aspects: As with dyad families, may result in a feeling of loss if only short term and the breakup isn't desired by both partners

pro and cons of blended family

• Positive aspects: Increased security and resources; exposure to different customs or culture may help children become more adaptable to new situations • Possible negative aspects: Rivalry or competition among children; difficulty adjusting to a stepparent

Nursing research

(the systematic investigation of problems that have implications for nursing practice and usually carried out by nurses) plays an important role in evidence-based practice as bodies of professional knowledge only grow and expand to the extent people in that profession are able to carry out research

HEALTHCARE BARRIERS BASED ON GENDER IDENTITY

-Transgender women face twice the victimization rates that cisgender women do -Transgender individuals have higher rates of negative experiences in healthcare settings than their LGB or heterosexual counterparts -FTM transgender individuals may seek pregnancy and find it difficult to obtain an understanding provider, one who they can trust and who can care for their specific needs related to pregnancy, gender dysphoria, and lactation -It is necessary to stop testosterone hormone therapy to successfully carry a pregnancy. The cessation of testosterone and the changes that occur with pregnancy (growing belly, increased mammary tissue if still present) can cause huge shifts in an individual's mental wellbeing and can lead to increased gender dysphoria -Listing of gender on birth certificates and legal protections for partners may be additional barriers to consider for transgender patients

RELIGION AND SPIRITUALITY Knowing which religion a family practices can help you locate the correct religious support person if one is needed. It helps in planning care if you know:

-a woman or adolescent wants a time or times set aside daily for private prayer or if they intend to fast, such as during Ramadan. -It guides implementation because many practices, such as whether the family eats meat, what and when holidays are celebrated, -whether ill newborns should be baptized, - and what clothing is proper to wear in public, are all dictated by religious beliefs.

The Joint Commission has recommendations for changes that can be made across organizations to increase effective communication with LGB patients , what are they ?

1.Rewriting policy to include LGB populations or incorporating new language into existing policy is an important step. 2.Adopting a nondiscrimination policy and having that policy posted clearly for employees and visitors can help ease the anxiety LGB families may feel. 3.Visiting policies should reflect changing families, and a patient should be able to name his or her support people, independent of his or her support person's legal status as a spouse or adoptive parent. 4.There should also be clear pathways to report any discrimination against LGB families

Assessing a Family for Home Care

1.interview with the patient and family; 2.a thorough health history and physical examination to document a woman's or child's current status; 3. an environmental, community, and social assessment. Family motivation and preparation are factors that contribute to successful home care.

To avoid exposure to excessive violence on television, the American Academy of Pediatrics (AAP) recommends children's television viewing time be limited until they reach

2 years of age (AAP, 2012). Many parents restrict this through school age so children have adequate time to spend with friends and on required homework. Caution parents that they need to monitor time spent on the Internet because of the misinformation posted and the risk from Internet predators

Client advocacy is necessary as it is easy for families to feel lost in the health care system.

Advocacy is safeguarding and advancing the interests of clients and their families. Familiarity with the health care services available in a community, establishing and maintaining a relationship with families, as well as helping them make informed choices about what course of action to take or what services would be best to use are important nursing roles.

ENVIRONMENTAL ASSESSMENT

An assessment of the family's environment ascertains whether the home's physical surroundings will be adequate for home care

Which of the following may occur in the blended type of family at a greater level than other types of families? A) Disagreement about childrearing practices B) Dislike by one of the children for doing homework C) Development of a food allergy by one of the children D) Formation of a strong relationship with a parent

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Page: 46 Feedback: Because blended families merge two families, traditions and family patterns may not merge smoothly.

A married couple has 3-year-old twins. They own a dog. The father's mother lives with them. The father is a professor; the mother has resigned from her position as a legal secretary to be the children's primary caregiver. Which type of family does this represent? A) extended B) cohabiting C) nuclear D) blended

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 44-45 Feedback: Families with more than two generations are extended families.

A 24-year-old woman is the mother of an 8-month-old baby. The woman's father lives nearby in a nursing home. Which type of family does this represent? A) Single parent B) Extended C) Blended D) Nuclear

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 45 Feedback: A lone parent of either gender with a child is defined as a single-parent family.

While assessing a family, the nurse constructs a genogram. The nurse uses this tool to achieve which result? A) A visual presentation of the relationships of family members. B) A diagram of an individual's genes. C) A map of the relationship of the family to the community. D) A teaching aid for showing how far family members live from each other.

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 51 Feedback: A genogram is an illustration of the relationship of family members.

A client family recently moved to the United States. They live with their relatives, who were already residing in the United States. This is an example of which family form? A) Extended B) Nuclear C) Communal D) Blended

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 30 Feedback: The extended family is a nuclear family with other family members in the same house.

A boy tells you that his family celebrates the Fourth of July by eating out at a local restaurant. He tells you this is a better way to celebrate the holiday than having a picnic like his neighbors. This statement is an example of: A) ethnocentrism. B) stereotyping. C) a taboo. D) cultural assimilation.

Ans: A Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 27 Feedback: Ethnocentrism is a belief that one's own culture or customs are superior to those of others.

A pregnant client from a nondominant culture arrives for a prenatal examination and is escorted to an examination room. When asked to remove clothing and wear an examination gown, the client hesitates. What should the nurse do to ensure cultural sensitivity in preparation for the examination? A) Leave the room. B) Stay in the room. C) Assist with clothing removal. D) Stand the distance of business space from the client.

Ans: A Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 28 Feedback: The client may be from a culture that values modesty. Because the client hesitated to remove clothing while the nurse was in attendance, the nurse should leave the room to permit the client to change into the examination gown. Staying in the room, assisting with clothing removal, or standing at the business distance from the client does not respect the client's modesty.

The nurse is visiting a family new to a community. The mother has a disability and the adolescent child is being treated for anorexia. What will the nurse do first when assessing this family? A) Construct an ecomap. B) Complete a genogram. C) Assess the home for safety. D) Discuss the daughter's anorexia.

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Feedback: An ecomap documents the "fit" of a family into their community by diagramming the family and community relationships. Because this family is new to the community, this would be the best thing for the nurse to do first. A mark of families who are new to a community is they have few community contacts because they have not formed these as yet. A family with few connecting lines between its members and the community may need increased nursing contact and support to remain a well family. A genogram is a diagram that details family structure and provides information about the family's health history and the roles of various family members across several generations. This might be appropriate for the nurse to complete at a later time. Assessing the home for safety and discussing the daughter's anorexia could also be done at a later time.

A pregnant client from a nondominant culture wants to deliver the baby "the American way" with epidural pain management. How should the nurse describe this client's statement about childbirth? A) Attempting assimilation B) Combating ethnocentrism C) Expression of acculturation D) Stereotyping American behavior

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 27 Feedback: Assimilation occurs when people from a nondominant culture adopt the values of the dominant culture. The client believes that epidural pain management is the American way of childbirth. Ethnocentrism is the belief one's own culture is superior to all others. The client is not demonstrating ethnocentrism. Acculturation is losing ethnic traditions because of disuse. There is not enough information to determine if the client is practicing acculturation. Stereotyping is expecting a person to act in a characteristic way without regard to individual traits. The client's desire to deliver the baby the American way is not stereotyping.

The term used to guide the cultural aspects of nursing care and respect individual differences is: A) diversity nursing. B) ethnicity nursing. C) family nursing. D) transcultural nursing.

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 27 Feedback: Transcultural nursing is the nursing care method that is guided by cultural aspects and respects individual differences.

When a woman is admitted to the labor-and-delivery unit, her husband says he is going to work and asks you to call when the baby is born. Your best response to this husband would be to A) ask him if he knows that he can stay with his wife during labor. B) tell him that all fathers now stay with their wives during labor. C) tell him he is missing out on the opportunity of a lifetime by leaving. D) insist he stay with his wife during labor because she will need his support.

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 24 Feedback: Respect for cultural values is important for developing effective nurse-client relationships.

You construct an ecomap for a family. An ecomap is a: A) visual presentation of the family's relationship to the community. B) map that shows the geographic location of the family. C) diagram that displays the occupations and educational level of the family. D) survey of how environmentally conscious family members are.

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 51-52 Feedback: A genogram details ways that a family relates to its community.

Suppose a patient has several large dogs that you are concerned have fleas. Where would you plan to sit to interview the patient during a home visit? A) A kitchen chair B) A couch in the parlor C) The bed in her bedroom D) A footstool in the family room

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Page: 62 Feedback: To avoid contracting fleas, avoid upholstered furniture and beds or a spot where it is likely the dog would sleep.

The nurse is planning outcomes of care for a family whose infant was born with a birth defect. Which outcome statement would be the most appropriate for this family? A) The parents will seek information regarding the birth defect. B) The parents will limit involvement with extended family members. C) The mother will return to work after 6 weeks as planned before the delivery. D) The father will learn to care for the infant so that the mother can return to work.

Ans: A Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Safety and Infection Control Cognitive Level: Analyze Feedback: The family has a new member who has a birth defect. The outcome statement that would be most appropriate for the family would be for the parents to seek out information about the birth defect. The parents limiting involvement with extended family members may indicate that the family will be isolated. The father learning to care for the infant so that the mother can return to work does not take into consideration if the father is employed. The mother planning to return to work after 6 weeks as planned before the delivery does not take into consideration the newborn's health care needs.

An adolescent tells the nurse that it is taboo in his family to use credit cards. The nurse would interpret this to mean thterm-109at: A) the adolescent's parents do not use credit cards. B) the adolescent's parents probably have few credit cards. C) the family is wealthy. D) the adolescent is too young to apply for a credit card.

Ans: A Client Needs: Psychosocial Integrity Cognitive Level: Analyze Feedback: A cultural taboo refers to an action that is disapproved.

The nurse is caring for a boy who states that his mother is a psychologist while his father is unemployed. His mother is the one who reminds him to take his medicine and also comforts his sister when she cries. Analyzing this description of his parents' roles, you would conclude that his: A) mother is the provider and nurturer. B) father is the health supervisor and nurturer. C) father is the peacemaker. D) mother is the decision maker.

Ans: A Client Needs: Psychosocial Integrity Cognitive Level: Analyze Page: 49 Feedback: The role of the family nurturer is to provide comfort; the provider is the one who furnishes the family income.

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: A) everyone could eat together. B) the family install an intercom system. C) her father buy a cell phone. D) the family buy her a television set.

Ans: A Client Needs: Psychosocial Integrity Cognitive Level: Analyze Page: 60 Feedback: Helping family members adjust to home care by arranging for times for family interaction is important.

A family with a 13-year-old child who has cystic fibrosis is having a stressful time since the father is currently unemployed while the mother works full-time. The ill child has been acting out at school. He is "sick of taking medications and doing chest expansion exercises" and "just wants to be like all the other kids." There are two stepbrothers living in the home creating problems of their own. At the moment, the ill child has a respiratory rate of 32 breaths/minute and has a productive cough with bilateral rales in both lung bases. The nurse assessing this family will document which priority NANDA related to the current family dynamics? A) Interrupted family processes B) Parental role conflict C) Caregiver role strain D) Impaired social interaction

Ans: A Client Needs: Psychosocial Integrity Cognitive Level: Apply Feedback: The most appropriate family NANDA would be Interrupted family processes related to the effect of child's illness and situational stressors limiting communication. The other NANDAs may be appropriate given more data, but they are not the priority for this family's current stressors.

The nurse is preparing to obtain a health history from a client with preeclampsia who is at home. In which area should the nurse conduct the assessment? A) Bedroom, where it is quiet and private B) Kitchen, so other family members can participate C) Porch, so the nurse does not have to enter the home D) Living room, so as to not interrupt television viewing

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 64 Feedback: The nurse should provide privacy and confidentiality when obtaining the health history and performing a physical examination. The nurse should identify a private location such as the bedroom. The kitchen, porch, and living room are not private areas for this assessment.

A client who is at 30 weeks' gestation is prescribed bed rest and home care. Which skills should the nurse anticipate providing when making the home care visits with the client? Select all that apply. A) Health teaching B) Monitoring vital signs C) Bathing and washing hair D) Monitoring fetal heart rate E) Administering medication

Ans: A, B, D, E Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 61 Feedback: Nursing care is considered skilled home nursing care if it includes primary health care provider-prescribed procedures such as dressing changes, administration of medication, health teaching, or observation of a woman through monitoring vital signs or fetal heart rate. Bathing and washing hair is not considered skilled nursing care

During an assessment, a pregnant client tells the nurse that "white foods" are not consumed in the client's culture. What should the nurse do first after learning this information? A) Ask the client to define "white foods." B) Document that "white foods" are not eaten. C) Explain that "white foods" have nutrients needed for pregnancy. D) Discuss reasons why "white foods" are avoided in the client's culture.

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 26 Feedback: The client is from a culture that avoids eating "white foods." The first thing that the nurse should do is assess what "white foods" are. From this information, the nurse could then determine appropriate diet teaching for the client. The nurse needs to do more than document that "white foods" are avoided. The nurse needs to know what "white foods" are before explaining their nutritional value. Discussing why "white foods" are avoided demonstrates cultural insensitivity.

While caring for a pregnant woman of Middle Eastern descent, a nurse attempts to mold the client's choices to fit what the nurse calls the "American way." When questioned, the nurse reports that it is best and easier to plan and deliver care term-112this way. This is cultural: A) destructiveness. B) blindness. C) awareness.term-114 D) sensitivity.

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Remember Page: 28 Feedback: Attempts to modify the culture and beliefs of others are a form of cultural destructiveness.

The nurse is completing an assessment of a family with a preschool-age child. Which areas should the nurse focus on when instructing the parents on tasks needed during this stage of family development? Select all that apply. A) Prevention of accidental injuries B) Importance of child's socialization C) Promoting health through immunizations D) Socialization through sporting events E) Need for dental care and health assessments

Ans: A, B Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Feedback: In the stage of family development with a preschool-age child, the parent's tasks are to prevent accidental injuries and begin the child's socialization. Socialization through sporting events, promoting health through immunizations, and the need for dental care and health assessments are family responsibilities for the family with a school-age child.

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. A) Never take medication in front of children. B) Use a reminder sheet and cross off when a medication has been taken. C) Drink a full glass of water with pills to ensure they reach the stomach. D) Keep all medication in a safe place above the height for a child to reach. E) Place medication doses in empty candy or mint containers to reduce waste.

Ans: A, B, C, D Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 70 Feedback: Instructions for medication safety in the home should include never taking medication in front of children, using a reminder sheet to keep track of medication doses, drinking a full glass of water with medication doses, and keeping all medication in a safe place above the height for a child to reach. Medications should not be placed in empty candy or mint containers because children might think that these items are candy and might accidentally ingest someone else's prescribed medication. This could lead to an accidental poisoning in the home.

The nurse is preparing to assess a pregnant client who is a member of a non-English-speaking culture. Which areas should the nurse assess to address cultural diversity? Select all that apply. A) pain B) time C) touch D) environment E) communication

Ans: A, B, C, E Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 25 Feedback: When conducting an assessment, areas to include that address cultural diversity include pain, time, touch, and communication. Environment is a global term that may or may not be appropriate for an assessment on cultural diversity.

. In providing culturally competent care to clients, the home care nurse should assess health care practices. What should be included in the home care nurse's assessment? Select all that apply. A) barriers to health care B) cultural practices C) health-promotion behaviors D) health care compliance E) education level

Ans: A, B, C, E Client Needs: Psychosocial Integrity Cognitive Level: Understand Page: 61 Feedback: The nurse should assess cultural practices that will often identify barriers to health care, health-promotion behaviors, and education level.

For which reasons would a nurse review infant mortality statistics in the United States? Select all that apply. A) Measures the quality of pregnancy care B) Reviews information on overall nutrition C) Compares health with those of other states D) Determines infant health and available care E) Provides an index of the country's general health

Ans: A, B, D, E Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 11 Feedback: Infant mortality statistics provide an index of a country's general health, measures the quality of pregnancy care, provides information on overall nutrition, and determines infant health and available care. Infant mortality statistics compares the health with those of other countries and not with those of other states.

During a family assessment, it is identified that the mother is unemployed but stays at home to prepare meals, monitor medication doses, and comfort the children with emotional issues. The father works outside of the home and pays the bills. Which terms should the nurse use to document the role of the father in this family? Select all that apply. A) Provider B) Nurturer C) Culture bearer D) Health manager E) Financial manager

Ans: A, E Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Feedback: The provider is considered the person who brings home the money, which would be the father because he works outside of the home. The person who pays the bills is considered the financial manager. The nurturer would be the one who makes the meals or the mother in this situation. The health manager is also the mother because she is the person who monitors medication doses. There is no evidence to support that either the mother or father function in the role as culture bearer.

Which of the following may be a strength of the single-parent type of family? A) Financial security B) Readily available support in a crisis C) Development of a special parent-child relationship D) Child wishing for no other siblings

Ans: C Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 45 Feedback: Because there is no competition for time from a spouse, single-parent families can promote special parent-child relationships.

A nurse is conducting a family assessment. Which behavior would suggest to the nurse that the family is well? A) A brother is so jealous of his new sister that he hides her clothes. B) A mother states she has grown up since giving birth to her children. C) A mother is angry that the father never helps with housework. D) A father wishes the family was able to spend more time together.

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Page: 51 Feedback: Growing with children is a mark of a healthy family. Lack of communication or time spent together leads to less than optimal families.

A family of dual-parent employment with two school-age children has moved into a community. During the home visit, the nurse overhears the children talking about something on the Internet being more interesting than school work. What type of information would be beneficial for the nurse to share with the parents at this time? A) School clubs that meet on the weekends B) Community activities planned specifically for after school C) Names of the Internet providers that service the community D) Local businesses seeking workers for part-time employment

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Feedback: The children of a dual-parent employment family might spend significant amounts of time on the Internet. The parents may not be aware of what Internet sites the children are frequenting. To reduce the amount of time spent alone on the Internet, the nurse should provide the parents with information about community activities planned specifically for after school. This could reduce the amount of time the children spend in the Internet while waiting for parents to return home from work. School clubs that meet on weekends will not help with the children spending time on the Internet during the week. Providing the names of Internet service providers does not address the issue. Local businesses seeking workers for part-time employment is inappropriate because the children are of school age.

A client is discussing her desires for childbirth with the nurse. She is from Russia originally, but in the discussion of her care plan she states she wants "to birth the American way, with an epidural." What term should the nurse use to describe the statement by the client? A) bias B) assimilation C) ethnicity D) prejudice

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 27 Feedback: Assimilation into a culture occurs when an individual or group of individuals adapts and adopts the values of the dominate culture. Birthing in Russia is very different, and the client is assimilated to the idea of birthing in the American culture.

The nurse is caring for a school-age child whose mother works two jobs, father is away from the home during the week truck driving, and older brother has a part-time after school job. The child will be hospitalized for several weeks for chemotherapy treatments. Which nursing diagnosis should the nurse identify as being appropriate for this family? A) Impaired parenting B) Parental role conflict C) Health-seeking behaviors D) Readiness for enhanced family coping

Ans: B Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Feedback: The diagnosis Parental Role Conflict would address the parents' work responsibilities and schedules and the relationship of work to the child's extended hospitalization. There is no evidence to suggest that there is impaired parenting, health-seeking behaviors, or readiness for enhanced family coping.

The nurse is visiting a client from a nondominant culture who was recently discharged from the hospital for complications of pregnancy. Which outcome of care would be appropriate for this client? A) The client will return to normal activities of daily living. B) The client will understand signs of the complication developing again. C) The client will consult with cultural healers to ensure the complication does not occur again. D) The client will follow medical advice and keep all scheduled appointments for continued care.

Ans: B Client Needs: Psychosocial Integrity Cognitive Level: Analyze Page: 26 Feedback: Because the client is from a nondominant culture, the best outcome of care would be for the client to understand the signs of the complication developing again so that medical treatment can be obtained as soon as possible. An outcome that the client will return to normal activities of daily living may not be appropriate because of the complication. The client may consult with cultural healers about the complication, but it is unclear if the complication can be treated by them. Expecting the client to follow medical advice and keep all scheduled appointments does not necessarily take the client's cultural needs into consideration.

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: A) advise her to be careful who she discusses this with as many will consider that a type of reportable child abuse. B) document her report but do nothing as this is a cultural belief that should be respected. C) encourage her to start the baby on formula after the first year as recommended by many physicians. D) discuss how painful this will be once the baby has teeth.

Ans: B Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 31 Feedback: Culturally specific decisions should be respected and incorporated into the plan of care.

A young client tells the nurse that it is taboo to date before the age of 18 years. How should the nurse interpret this client's statement? A) Everyone dates before the age of 18 years. B) Dating before the age of 18 years is not permitted. C) Dating before the age of 18 years can be done with permission. D) Dating before the age of 18 years is permitted in large groups only.

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 28 Feedback: A taboo is an action that is not acceptable to a culture. Dating before the age of 18 years being taboo means that it is not permitted. This does not mean that everyone dates before the age of 18 years or that dating is done with permission or in large groups only.

A preadolescent patient, a member of a single-parent family, has abdominal pain and the health care provider suspects that an appendectomy might need to be performed. The patient's father is asking for a second opinion, whereas the mother tells the nurse to do whatever needs to be done to help the patient. What does the nurse need to assess before moving forward with planning care for this patient? A) Permission to miss school B) Identify the custodial parent C) The type of health insurance D) Plans for help upon discharge

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Feedback: The nurse needs to identify who is the custodial parent. This is especially important when consent forms for care need to be signed. Once this information is obtained, the nurse needs to clearly document it in the patient's medical record. Permission to miss school, health insurance, and needs after discharge do not necessarily need to be assessed prior to planning care for the patient.

When a woman is asked how she feels about staying home with her children, she responds, "My husband and I have decided that he will work and I will manage the home." According to Duvall, this couple is fulfilling which family task? A) Allocation of resources B) Maintenance of order C) Division of labor D) Placement of family members in society

Ans: C Client Needs: Psychosocial Integrity Cognitive Level: Understand Page: 49 Feedback: Dividing family tasks into who will perform them is division of labor

A client from a nondominant culture is in the second stage of labor and is not demonstrating any manifestations of pain. What should the nurse do to support this client? A) Offer to provide a back rub. B) Measure the pain level with a pain rating scale. C) Discuss pain control measures with the physician. D) Nothing until the client asks for pain medication.

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 26 Feedback: The client may be from a culture where it is inappropriate to respond to pain. The nurse needs to objectively assess the client's level of pain before implementing nonpharmacologic or pharmacologic pain management measures. Offering to provide a back rub may or may not be desired by the client. Discussing pain control measures with the physician may be premature. Doing nothing unless the client asks for pain medication is inappropriate, considering the client is in the second stage of labor.

Two parents were both married once before. The father has two children from his previous marriage, and the mother has one child from her previous marriage. When they combine their families, they become which type of family? A) Double unit B) Blended C) Single unit D) Extended

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 46 Feedback: A blended family consists of the merging of two single-parent families.

The nurse visits a pediatric client at home for complications of sickle cell. Upon entering the home, the nurse notices a significant number of candles being burned, statues surrounding the client, and herbs around the room. What is the most appropriate response by the nurse? A) Call the social worker. B) Proceed with the visit. C) Call 9-1-1. D) Remove the items from the room.

Ans: B Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 62 Feedback: The nurse should procced with the visit as scheduled. Many clients will use complementary and alternative therapies which include spiritual and faith practices in the treatment of illness. The nurse should understand this to be the case.

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? A) Inform the client who will have access to the medical record. B) Communicate in an organized and professional manner. C) Assist the client in making informed health care decisions. D) Validate the client's feelings of frustration and anger.

Ans: B Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 64 Feedback: Communicating with the client in an organized and professional manner displays a level of competence by the nurse that promotes trust and respect. Next, the nurse will also want to inform the client who will have access to the medical record to build confidentiality and promote security.

The nurse is visiting a family with a toddler and school-age child. Which teaching should the nurse provide to the parents that would be appropriate for both children? A) Increased freedom B) Actions to ensure safety C) Encourage independent thinking D) Importance of school experiences

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Feedback: The teaching that would support both of the children's needs would be to focus on actions to ensure safety. Increased freedom would be appropriate for the adolescent. Encourage independent thinking would be appropriate for the young adult. Importance of school experiences would be appropriate for the school-age child but not for the toddler.

The nurse instructs a pregnant client who is at home on bed rest to drink at least eight glasses of fluid each day. What would be the best method to encourage the client to drink this amount? A) Get up every hour and get a drink from the refrigerator. B) Keep a pitcher of fluid readily available on a bedside table. C) Drink cool liquids and avoid hot liquids because they increase thirst. D) Drink the eight glasses before the spouse leaves for work in the morning.

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 70 Feedback: All women during pregnancy should drink six to eight full glasses of fluid a day to obtain adequate fluid for effective kidney function and placental exchange. The client on bed rest should have a supply of fluid close to the bed such as a water pitcher so this can be done easily. Getting up every hour does not support bed rest. Drinking eight glasses of fluid before the spouse leaves for work does not ensure adequate hydration during the day. The temperature of the liquids is inconsequential. Hot liquids do not necessarily increase thirst.

Which information is true of home care as a whole? A) It is decreasing because many new care measures are too technical for use in the home. B) It is increasing because new technology makes so many procedures available in the home. C) It is decreasing because the overall incidence of children's illnesses is decreasing in number. D) The amount of care remains even because only a limited number of nurses are available to give care.

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Remember Page: 69 Feedback: Home care is expanding because it can offer advantages to both caregivers and consumers. New technology makes it successful.

The nurse is assessing a patient for potential home care. Which patient statement indicates that the patient will be able to take a medication that is prescribed for three times a day? A) "I can take the three pills together at one time." B) "I will take one pill before breakfast, before lunch, and before dinner." C) "I can take one pill when I have symptoms and save the others for later." D) "I will take the pill when I get up in the morning and before I go to bed."

Ans: B Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 64 Feedback: The nurse is assessing if a patient is able to properly take a medication that is prescribed three doses per day. The statement that the patient will take one dose before breakfast, lunch, and dinner is evidence that the patient will be able to safely take the medication. Taking three pills together, taking a pill with symptoms, and taking a pill in the morning and at night indicates that the patient will not be able to adhere to the prescribed medication schedule.

A family consists of a mother, father, 3-year-old twins, and a new baby. According to Duvall's stages of family life, this family would be classified as being at which of the following? A) Stage VI family: launching center family B) Stage I family: marriage C) Stage VII family: family of middle years D) Stage III family: family with preschool children

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 50 Feedback: The age of the oldest child marks the family stage according to Duvall. Three-year-olds are preschoolers.

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. A) Keeping the car doors unlocked B) Keeping the gas tank of the car full C) Parking the car in a well-lighted area D) Using a map to avoid getting lost in a strange neighborhood E) Informing the agency of the estimated arrival time and expected return

Ans: B, C, D, E Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 63 Feedback: Safety tips for making home care visits include keeping the gas tank full, parking in a well-lighted area, using a map to avoid getting lost, and informing the agency of the estimated arrival time and expected return. The nurse should keep the car doors locked for safety.

A family of a mother, father, and a 6-year-old boy was recently enlarged to include a new baby sister. What type of family does this represent? A) Single unit B) Dysphasic C) Nuclear D) Extended

Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 44 Feedback: A nuclear family is defined as consisting of parents and children.

You see a 3-year-old girl in an ambulatory clinic because she has a bad cold. Her mother tells you the girl's problem was caused by her being affected by "mal ojo." What would be the best action? A) Tell her mother this is not a legitimate illness. B) Teach her mother that colds are caused by viruses. C) Ask her mother what symptoms her daughter is experiencing. D) Explain there is nothing to do for illnesses caused by evil spirits.

Ans: C Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Page: 25 Feedback: Respecting cultural values is important for effective nurse-client relationships.

A pregnant client from a nondominant culture arrives 2 hours late for a scheduled sonogram. What does this client's behavior indicate to the nurse? A) The client is confused. B) The client does not wear a wrist watch. C) Time orientation may be different for the client's culture. D) The client's culture may focus on the past and not the future.

Ans: C Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 30 Feedback: The client who is from a culture that has a different time orientation than the dominant culture will have difficulty adhering to time expectations. The client not arriving for the diagnostic test at the scheduled time does not mean that the client is confused. It is inconsequential if the client does or does not wear a wrist watch. There is no enough information to determine if the client is from a culture that focuses on the past and not the future.

A school-age child, a member of a family with a mother, father, and toddler, is hospitalized. The father is employed outside of the home, and the mother stays at home with the other child. The mother is challenged with supporting both children at this time. What should the nurse suggest to the mother? A) Place the toddler in day care. B) Suggest the father take time off to help. C) Ask extended family members to help out during this time. D) Visit with the patient after the father comes home from work.

Ans: C Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Feedback: In a time of crisis, the nuclear family is challenged because there are few family members to share the burden or look at a problem objectively. The nurse should suggest that the family locate and reach out to support people in their extended family during a crisis. Placing the toddler in day care and suggesting the father take time off to help might negatively impact the family's financial situation and would be inappropriate for the nurse to suggest these options. The option of visiting the school-age child after the father comes home from work may not support the child adequately during the hospitalization.

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? A) "Polish names are hard to pronounce." B) "No one ever says my name correctly either." C) "I will mark in your nursing care plan how to say it correctly." D) "I'll never use your name. Then, I can't say it wrong."

Ans: C Client Needs: Psychosocial Integrity Cognitive Level: Analyze Page: 36 Feedback: Respect for other cultures begins with personal respect.

A pregnant client from a nondominant culture explains that milk and dairy products cannot be consumed for 2 months during the pregnancy because of the need to fast for her religion. Which response should the nurse make after learning this information? A) "I'm sure that you don't need to follow this while you are pregnant." B) "Avoiding milk and dairy products for 2 months will harm the fetus." C) "There are other food sources where you can obtain the nutrients that are in milk." D) "You must have a great deal of will power to avoid milk and dairy products for 2 months."

Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 26 Feedback: The client is explaining a religious practice that influences the client's culture. The nurse needs to support this practice by offering other food sources for the client to consume that can provide the same or similar nutrients as the foods that are being abstained. Stating that religious practices do not need to be followed while pregnant is not taking the client's cultural needs into consideration. Stating that avoiding milk and dairy products will harm the fetus is an inappropriate scare tactic to persuade the client to follow the nurse's cultural expectations. Stating that the client has willpower has no value and stated.

An extended family is experiencing a crisis. Excessive work demands have caused the primary parents to work longer hours, but the grandmother who usually watches the children after school is recovering from hip replacement surgery. What can the nurse suggest to help this family through this period of time? A) One parent reduces work hours. B) Children go to the grandmother's house after school. C) Identify another extended family member to assist while the grandmother recovers. D) Recommend the children learn independence and stay at home alone until a parent arrives.

Ans: C Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Feedback: A positive aspect of the extended family is the availability of many people for child care and support. The family needs to call on this strength and ask another family member to help with the child support until the grandmother recovers. One negative aspect of the extended family is reduced resources because of fewer wage earners. This is not the case because both primary parents are working. Asking for one parent to reduce work hours would be a negative suggestion. Having the children go to the grandmother's home after school would negatively impact the grandmother's healing and is an inappropriate suggestion to make at this time. Recommending the children learn independence and stay at home alone could be a safety issue and would be an inappropriate suggestion at this time.

Which of the following may occur in nuclear families at a greater level than in some other types of families? A) Financial difficulties B) Problems with allocation of resources C) Formation of a poor parent-child relationship D) Lack of support people in a crisis Which of the following may occur in nuclear families at a greater level than in some other types of families? A) Financial difficulties B) Problems with allocation of resources C) Formation of a poor parent-child relationship D) Lack of support people in a crisis

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 44 Feedback: People in a nuclear family all may be so involved in a crisis that there is no objective support person.

The nurse is explaining to a school-age child the need to soak the hands twice a day to help with an infection. Which teaching should the nurse provide that would be appropriate for the client's cognitive level? A) "You should soak both hands to get them clean." B) "You need to stay in bed while your hand soaks." C) "Would you like to sit in the chair or stay in bed to soak your hand?" D) "I know your favorite show is on right now, but we need to soak your hand now."

Ans: C Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 59 Feedback: Before anyone can be cared for at home, teaching will be required so the family understands the illness and principles of care. Because the patient is a school-age child, the nurse should provide choices so that the patient has a sense of control over the situation. Soaking both hands may or may not be medically necessary. Telling the patient to stay in bed or soaking the hands now does not provide the patient with a sense of control and may lead to resistance or nonadherence to medical treatment.

During a family assessment, the nurse learns that the male parent smokes. What should the nurse do with this information to support the 2020 National Health Goals? A) Document the information in the medical record. B) Explain that smoking can cause long-term health problems. C) Ask if the male parent has made any efforts towards smoking cessation. D) Suggest that smoking be done away from other family members because of health concerns.

Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Feedback: One of the 2020 National Health Goals is to increase the percentage of adult smokers aged 18 years and older attempting to stop smoking from 48.3% to 80%. To support this goal, the nurse should ask the parent if any efforts toward smoking cessation have been taken.

The nurse is completing the health histories for twin toddlers. Which statement should the nurse make to the mother that focuses on the 2020 National Health Goals? A) Discuss adequate dental care. B) Explain the need for the toddlers to have socialization with other children. C) Remind the mother that the toddlers need regularly scheduled vaccinations. D) Stress the importance of home safety and prevention of accidental poisoning.

Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 59 Feedback: The 2020 National Health Goal applicable to this situation is to reduce or eliminate vaccine-preventable diseases such as measles, pertussis, and varicella. Dental care, socialization, and home safety are not 2020 National Health Goals.

The nurse evaluates a family to see if they are a good candidate for home care for a sick child. Which factor would be most important to see in their home or of the family? A) Nearby fire department B) A one-floor building plan C) A dedicated home-care provider D) An above-average income

Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 62 Feedback: Home care is only successful if there is a family member able to assume primary care of the child.

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? A) the location of the home B) client's type of health insurance C) amount of supervision and health education needed by the client D) the home visit schedule and needs of the agency to plan the visit

Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 65 Feedback: The nurse should complete an assessment on the client to include the amount of education and ability of the client to understand the health care provider's orders. The nurse should allow the agency to work with the insurance company, and the location of the home should not influence the decision of the nurse.

A pregnant patient experiencing exacerbation of asthma is prescribed home care. The nurse is planning to assess the patient's community for resources. On which areas will the nurse focus this assessment? Select all that apply. A) Religion B) Age span C) Health care D) Recreation E) Environment

Ans: C, E Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 62 Feedback: For a patient with asthma, the community areas that the nurse should assess include environment and access to health care. The environment could exacerbate the patient's symptoms and health care could influence the patient's ability to obtain help if necessary. Religion, age span, and recreation will not necessarily impact the maintenance of the patient's asthma.

An adolescent believes that people from the Bronx are stupid. What does this type of belief represent? A) Group analysis B) Definitive analysis C) Ethnocentrism D) Stereotyping

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Feedback: Stereotyping is viewing people and things from preconceived notions.

A woman who is 7 weeks' pregnant is admitted with vaginal bleeding. She reports she never should have raised her arms above her head. Based upon your knowledge, what is your best response? A) Advise the client to keep her arms down to reduce the risk of bleeding. B) Explain to the client that this an unfounded myth. C) Ignore her comment. D) Recognize her cultural beliefs and explain in a nonjudgmental manner the potential causes of miscarriage.

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 26 Feedback: Lying to the client by agreeing she should have kept her arms down is inappropriate. Explaining the client's feelings as an unfounded myth does not handle the manner in an informative and sensitive manner. Ignoring the client's comment does nothing to help her.

The nurse has been working with a family on actions that strengthen loyalty between all members. Which healthy family behavior has been the focus of the nurse's interventions? A) Division of labor B) Physical maintenance C) Socialization of family members D) Maintenance of motivation and morale

Ans: D Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Feedback: In maintenance of motivation and morale, healthy families have pride in their family and allow them to support each other during a crisis. Assessing for loyalty is one way to measure this behavior. Division of labor focuses on family members dividing the workload among family members and adjusting workloads as necessary. Physical maintenance focuses on food, shelter, clothing, and health care. Socialization of family members focuses on every family member feeling as a part of the family and interacting with people outside of the family.

Which observation indicates to the nurse that a family is not functioning in a healthy way? A) The family pays cash for health care. B) The father comforts his crying daughter. C) The mother states, "This family couldn't function without me." D) The father does not share his concerns so his wife will not worry about them.

Ans: D Client Needs: Psychosocial Integrity Cognitive Level: Analyze Page: 51 Feedback: Healthy family functioning includes communication with each other and identifying and sharing feelings about the home situation. The family paying cash for health care does not support a family that is not functioning in a healthy way. The father comforting his crying daughter demonstrates healthy family functioning. The mother who believes the family could not function without could be a statement of frustration or evidence that the family needs her to maintain healthy functioning.

The nurse determines that a small nuclear family has achieved the family task of division of labor. What did the nurse assess in this family to come to this conclusion? A) Parents take the children out to meet the new neighbors. B) Parents and children attend religious services every week. C) Older children finish homework before watching television. D) Mother cares for children while father works outside of the home.

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Feedback: The task of division of labor is when the workload is divided evenly between family members. Parents taking children to meet the neighbors fulfill the task of family member socialization. The family attending religious services every week fulfills the task of member placement in society. Older children finishing homework before watching television fulfills the task of maintenance of order.

The nurse teaches a pregnant client from a nondominant culture that the health care provider wants the client to rest for several hours every afternoon. Which client statement indicates that teaching has been effective? A) "I need to go to sleep a few hours earlier every night." B) "I can stay in bed for a few more hours every morning." C) "I can lie down before lunch and then again right after dinner." D) "I need to lie down after lunch and not get up until it's time to prepare dinner."

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 30 Feedback: The nurse is evaluating the client's comprehension of teaching regarding obtaining rest for several hours every afternoon. The statement about lying down after lunch and not getting up until time to prepare dinner indicates the client understands the teaching. The other statements indicate that additional teaching is necessary because going to sleep earlier each evening, lying in bed longer each morning, and resting before lunch and after dinner do not demonstrate understanding of the health care provider's instructions.

The nurse is beginning an assessment with a pregnant client from a non-English-speaking culture. The interpreter is having difficulty understanding what the client is trying to say and the client is becoming frustrated. Which nursing diagnosis would be most appropriate for this situation? A) Fear B) Anxiety C) Powerlessness D) Impaired verbal communication

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 25 Feedback: For this client, impaired verbal communication is because of the frustration that is occurring between the client, interpreter, and the nurse. There is no evidence to support the diagnoses of fear, anxiety, or powerlessness with this client.

A woman in labor has brought a butcher knife with her and insists on putting it under her hospital mattress to "cut the labor pain." Your best response to this practice would be to: A) teach her to use chest breathing with contractions. B) educate her about the cause of labor pain. C) tell her that she cannot keep the knife because it is a lethal weapon. D) allow her to keep the knife under her mattress during labor.

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 26 Feedback: Respect for cultural values is important for developing effective nurse-client relationships.

During a home visit, the nurse determines that a family is functioning in a healthy manner. Which behavior did the nurse observe to make this determination? A) A mother is angry that the father never helps with housework. B) A brother is so jealous of his new sister that he hides her clothes. C) A father wishes the family was able to spend more time together. D) A mother states she has grown up since giving birth to her children.

Ans: D Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 65 Feedback: A family that is supportive of all family members and provides an environment conducive to each member's continued growth and development is more likely to be able to manage home care. The mother's statement about growing up after giving birth demonstrates growth. The mother that is angry because of no help with housework is demonstrating unrealistic expectations of family members. A brother that hides clothes is not successfully dealing with the stresses within the family. The father wishing the family had more time together might be overwhelmed with the home situation

During a home care visit, the nurse learns that a pregnant adolescent is concerned about being lonely at home. What should the nurse suggest to help with this problem? A) The family could buy her a television set. B) Her father could purchase her a cell phone. C) The family might install an intercom system. D) The family could have dinner together in the same room.

Ans: D Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 71 Feedback: To combat the feelings of loneliness and support the family structure, the family can plan to have one meal a day together, such as dinner, in the same room. A cell phone, intercom system, or television set may or may not help the adolescent with feelings of loneliness.

The home care nurse visits a Hispanic pregnant client who speaks very little English. At this visit her husband, who is fluent in English, is not present. Which intervention is most appropriate for the nurse to do? A) Continue with the visit and call the husband later. B) Cancel the visit and reschedule for another time. C) Just wait at the client's home for the husband to return. D) Call for a telephone interpreter and conduct the visit.

Ans: D Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 28 Feedback: The nurse should call for an interpreter to be used over the phone and continue with the visit. The nurse is not aware of a return time for the husband and could potentially delay other visits on the schedule.

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? A) The device is sitting on the kitchen table. B) The client cannot locate the device during a routine home visit. C) The client has two rhythm strips to share with the nurse during the home visit. D) The client has a log with the date, time, and number of fetal heart beats counted.

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 68 Feedback: Fetal heart rate monitoring can be taught to the client, including how to record the findings. The client that has a log with the date, time, and number of fetal heart beats counted indicates that teaching has been effective. Fetal heart monitoring should be conducted in the reclining position and the device should not be on the kitchen table. The client who is unable to locate the device is not performing the assessment as instructed. The client who has two rhythm strips to share with the nurse may or may not be performing the assessment as instructed.

One type of medicine a patient on home care receives could be given with any of the following schedules. Which of the following would be most effective in helping compliance? A) Two times a day at 12 noon and 12 midnight B) Every 4 hours around the clock C) Every 2 hours around the clock D) Three times a day at 10 am, 2 pm, and 10 pm

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 60 Feedback: Patients cannot be expected to get up during the night every night to take medicine. A schedule that lets people sleep is best.

A nurse is providing skilled home care to a pregnant woman. Which situation best describes this concept? A) The woman is concerned about her condition. B) The woman has developed a complication of pregnancy. C) The woman is more than 3 months pregnant. D) The woman needs daily fetal heart rate monitoring.

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 61 Feedback: Home care is considered to be skilled if it includes physician-prescribed procedures such as administration of medication or monitoring of FHR.

A preschooler, receiving home oxygen therapy, is excited about an upcoming birthday. Which statement by the patient's mother indicates that additional teaching on the safety of home oxygen therapy is needed for the occasion? A) "I'll be careful that no guest smokes." B) "I'll be certain he doesn't get too tired." C) "His brother can help him open presents." D) "I'm baking a cake and we'll have candles."

Ans: D Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 62 Feedback: During the home visit, the nurse should have instructed the mother on home safety with oxygen therapy. This includes knowing not to light candles near oxygen for a birthday. The statement about no guests smoking indicates that teaching has been effective. The statements about fatigue and having help with presents do not evaluate the effectiveness of teaching on home oxygen safety.

The nurse has completed teaching on total parenteral nutrition therapy for the parents of a 3-year-old client who will be receiving therapy at home. Which statement by the mother indicates that reteaching is necessary? A) "We will check the blood glucose levels 4 times a day." B) "I will flush the infusion line with saline before starting the TPN." C) "The TPN will warm on the counter for 2 hours before being started." D) "She can still take her bubble baths every day just like normal."

Ans: D Client Needs: Safe, Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Page: 71 Feedback: The nurse should address with the mother the importance of no baths if the water line will rise above the catheter insertion site; this can lead to infection.

A recently separated mother is overwhelmed with caring for three children under the age of 5 years. The oldest child has been recently diagnosed with muscular dystrophy. Which health care providers should the nurse consult to help the mother? Select all that apply. A) Dietician B) Physician C) Pharmacist D) Social worker E) Physical therapist

Ans: D, E Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Feedback: The mother is recently separated and is raising three children independently. The older child is diagnosed with a chronic illness. The nurse should consult a social worker to help identify resources that the mother and family need. The nurse should consult with a physical therapist to help the oldest child attain or maintain the maximum level of physical functioning. A dietician, physician, and pharmacist will not necessarily be of assistance to the family at this time.

The nurse is evaluating outcomes about a family's ability to care for an adolescent child who is recovering from a spinal cord injury. Which statements indicate that this family is transitioning in a healthy manner? Select all that apply. A) The patient states the injuries "messed up" the rest of his life. B) The mother states the need to have a break at least once per week. C) The patient states fewer episodes of nausea with changing position. D) The father states the child's accident has brought the family closer together. E) The mother states the ability to provide care for the child is becoming easier.

Ans: D, E Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Safety and Infection Control Cognitive Level: Analyze Feedback: The statements that indicate that the family is able to care for an adolescent child who is recovering from a spinal cord injury include the father's statement about the family being brought closer together and the mother's statement about the care being easier to provide. The patient's two statements do not address the family's ability to care for the patient. The mother's statement about needing a break does not measure if the family is able to care for the adolescent patient.

Cultural diversity

Are there specific customs or traditions that will affect health care? Can they obtain favorite foods locally? What holidays do they celebrate?

. A program designed to decrease the infant mortality rate in the United States would probably make the greatest impact if it focused on which aspect of care? A) offering increased WICC availability B) reducing the number of home births C) increasing the education level of parents D) increasing the number of women receiving prenatal care

D) increasing the number of women receiving prenatal care Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 11 Feedback: Receiving prenatal care has proven to be a major strategy for reducing infant mortality. The other interventions will not directly impact infant mortality rates to the degree that prenatal care will.

Emotional support within family

Do members eat together or spend an equal amount of time with each other daily? Do they band together to defend each other from outsiders?

Spirituality

Does the family have a religious affiliation? Do members attend religious services? Are there foods or activities restricted in relation to this that might influence care planning?

Health promotion

Educating parents and children to follow sound health practices through teaching and role modeling Ex: Teaching women the importance of rubella immunization before pregnancy; teaching adolescents the importance of safer sex practices

The Gay or Lesbian Family

Gay couples or lesbian couples live together as partners for companionship, financial security, and sexual fulfillment, or form the same structure as a nuclear family. As laws are being changed to legally sanction gay marriage, this type of family is increasing in number. Such a relationship offers support in times of crisis comparable to that offered by a nuclear or cohabitation family

The family of middle-aged parents (stage 7)

Goal • Adjust to "empty nest" syndrome by reawakening their relationship with their supportive partner. • Prepare for retirement so when they reach that stage they will not be unprepared socially or financially.

The launching stage family: the family with a late adolescent (stage 6)

Goal • Change their role from mother or father to onceremoved support persons or guideposts. • Encourage independent thinking and adult-level decision skills in their child.

Marriage (stage 1)

Goal • Establish a mutually satisfying relationship. • Learn to relate well to their families of orientation • Engage in reproductive life planning, if applicable.

The early childbearing family (stage 2)

Goal • Integrate the new member into the family. • Make whatever financial and social adjustments are necessary to meet the needs of the new member while continuing to meet the meets of the parents.

The family with an adolescent (oldest child is between 13 and 20 years of age) (stage 5)

Goal • Loosen ties enough to allow an adolescent more freedom while still remaining safe. • Begin to prepare adolescents for life on their own.

The family in retirement or older age (stage 8)

Goal • Maintain heath by preventive care in light of aging. • Participate in social, political, and neighborhood activities to keep active and enjoy this stage of life.

The family with a preschool child (stage 3)

Goal • Prevent unintentional injuries (accidents) such as poisoning or falls. • Begin socialization through play dates, child care, or nursery school settings.

The family with a school-age child (stage 4)

Goal • Promote children's health through immunizations, dental care, and routine health assessments. • Promote child safety related to home and automobiles. • Encourage socialization experiences outside the home such as sports participation, music lessons, or hobby activities. • Encourage a meaningful school experience to make learning a lifetime concern, not one of merely 12 years.

Men who have sex with men (MSM) may need counseling to help them avoid acquiring

HIV and other STIs because issues such as avoiding contact through anal intercourse or vaccination against hepatitis A and human papillomavirus (HPV) may not be routinely covered in sex education classes

There is a belief that women who have sex with women (WSW) are at much lower risk for contracting STIs. Although there may be a lower incidence of HIV in this population, there is still risk for

HPV and herpes simplex virus (HSV) as these are transmitted via skin-to-skin contact. Additionally, WSW may use sex toys that can transmit infection between partners. WSW are inadequately screened for STIs and pap smears because of this inaccurate belief

Division of labor:

Healthy families not only evenly divide the workload among members but are also flexible enough to interchange workloads as needed

Emotional support outside family

Is the family active in community organizations or activities? Do they visit (or are they visited by) friends and relatives? Can the family name at least one outside person they can always rely on for help in a time of crisis?

THE INTERVIEW Assessment begins with an interview to determine the current structure and function of the family such as

Identifying family roles, such as who are the -wage earner(s), -the decision maker(s), -the nurturer(s), - the problem solver(s), is an important component of the interview. Incorporating the current structure and function of the family to support the new activities of home care are addressed

Reproduction, recruitment, and release of family members:

Often, not a great deal of thought is given to who lives in a family; membership often happens more by changing circumstances than by true choice. Having to accept a new infant into an already crowded household may make a pregnancy a less-thanwelcome event; allowing a late adolescent to move to a college dorm may be viewed as abandonment by a close-knit family.

pros and cons nuclear family

Positive aspects: Support for family members; sense of security Possible negative aspects: May lack support people in a crisis situation

Allocation of resources:

This involves determining which family needs will be met and their order of priority, including not only material goods but also affection and space. In healthy families, there is justification, consistency, and fairness in the distribution. In many families, resources are limited, so for example, no one has new shoes. A danger sign would be a family in which one child is barefoot, whereas the others wear $100 sneakers

Socialization of family members:

This task includes being certain that children feel part of the family and learning appropriate ways to interact with people outside the family such as teachers, neighbors, or police. It means the family has an open communication system among family members and outward to the community

Maintenance of order

This task includes establishing family values, establishing rules about expected family responsibilities and roles, and enforcing common regulations for family members such as using "time out" for toddlers. In healthy families, members know the family rules and respect and follow them; in dysfunctional families, you may see a flagrant disregard of rules

PREPARING FOR A HOME VISIT

Typically, a first home visit is made within 24 hours of discharge or notice from an acute care or ambulatory care facility. A patient's referral form will inform the nurse of the patient's plan of care and treatment, and the nurse can generate a list of supplies needed for the visit. During a home visit, it is crucial to demonstrate respect for the patient's and family's privacy, beliefs, lifestyles, routines, culture, and requests. As a part of individualizing care, telephone a patient or family in advance to verify the address and arrange a mutually convenient time for a visit. Ethical and legal aspects of nursing care, such as confidentiality, informed consent, Health Insurance Portability and Accountability Act (HIPAA) requirements, decision making, and patient rights commonly associated with acute care nursing, are applicable to home care.

Health restoration

Using conscientious assessment to be certain that symptoms of illness are identified and interventions are begun to return client to wellness most rapidly Ex: Caring for a woman during a complication of pregnancy such as gestational diabetes or a child during an acute illness such as pneumonia

Health

What is a typical breakfast? Lunch? Dinner? Do members monitor the amount of saturated fat and trans-fatty acids in their diet? Do they receive adequate sleep? Do they have a primary care health provider? Are immunizations current? Is there a balance between work and recreation? Does the family feel it copes with problems adequately?

Teach Self-Monitoring by Serum or Urine Testing

Women who develop gestational diabetes will be required to self-monitor their serum glucose level using a glucometer at least once daily, some three or four times daily . Children with diabetes need to do these actions as well . Both women and children need support to be conscientious about continuing to do these actions when home care extends for a long time. A nurse can be instrumental in being the person to supply this support

OUTCOME IDENTIFICATION AND PLANNING - culture diversity -Planning needs to be very specific for individual families because cultural diversity preferences tend to be very personal-

You might want to begin care with an in-service education for team members who are unfamiliar with a particular cultural practice and its importance to a specific family involved. You also might want to ask if your agency could change a policy to accommodate a family's cultural preferences, such as the length of visiting hours, types of food served, or type of hospital clothing provided (e.g., women from the Middle East may only feel comfortable in longsleeved gowns and with head scarves). This type of planning can be beneficial not only because it makes health care more acceptable to families but also because it can motivate providers to examine policies, question the rationale behind them, and initiate more diverse care

QUALITY IMPROVEMENT Lisa has been on home care for a long time. Which of her following statements would worry the nurse most about whether her home is a safe place for home care? a. "My mother is trying to quit smoking; she usually goes outside to smoke." b. "If the lights go out, I know the circuit breaker is located in the garage." c. "A police report says there's never been a robbery in this neighborhood." d. "My father had the paint in the bathroom tested last year and it is lead-free."

a. "My mother is trying to quit smoking; she usually goes outside to smoke."

Maria Rodriques is a 12-year-old student. What advice should the nurse provide to an unlicensed care provider about communicating effectively with Maria? a. "Speak in a clear and natural tone when you're talking with Maria." b. "Maria is Hispanic, so avoid talking about current children's movies." c. "Maria's first language is Spanish, so avoid talking about difficult topics." d. "If possible, try to speak to Maria in an accent that's similar to hers."

a. "Speak in a clear and natural tone when you're talking with Maria."

Dual-parent employment has increased the number of children attending day care centers or after-school programs. This high attendance rate may have an impact on health care as well because children attending day care centers have an increased incidence of infections such as ?

acute diarrhea and upper respiratory infections. They may engage in less gross motor activities than children playing at home. Helping parents choose a quality day care center or afterschool program that takes the necessary precautions against infections and includes physical as well as academic activities can be a nursing responsibility

The first phase of family divorce

an antagonistic time as parents realize they are no longer compatible, marked by quarreling, hurt feelings, and whispered conversations. This phase can be particularly upsetting for children because they usually haven't been told what is happening as yet. They may assume the quarreling is their fault (i.e., if they had behaved better, this wouldn't be happening).

Maintenance of motivation and morale:

are able to maintain a sense of unity and pride in their family. When this is present, it helps members defend the family against threats as well as allows them to support each other during a crisis. It means parents are growing with and through the experience of their children the same as children grow through contact with their parents. Assessing whether a feeling of loyalty to other family members is present tells you a lot about the overall health of a family

The nursing process, a scientific form of problem solving, serves as the basis for

assessing, making a nursing diagnosis, planning, implementing, and evaluating care. It is a process broad enough to serve as the basis for modern nursing care because it is applicable to all health care settings, from the home to ambulatory clinics to intensive care unit

COMMUNICATION RELATED TO GENDER IDENTITY With transgender patients, just as with any other patient, it is important not to make

assumptions. A patient may be listed as a sex that they don't agree with on their medical chart. It is best to ask which pronouns (he, she, his, her) to use. A partner's gender should not be assumed either. It is crucial for a nurse to ask these questions to show sensitivity to this population's needs and to build trust with the patient.

TEAMWORK & COLLABORATION The nurse notices Mrs. Hanovan serves many roles in her family. If, while the nurse is talking to Charles, her 12-year-old son, she interrupts and says to him, "Don't tell our family secrets," the nurse would want the team members to appreciate she is fulfilling what family role? a. Decision maker b. Gatekeeper c. Problem solver d. Safety officer

b.

EVIDENCE-BASED PRACTICE Parenting by same-sex couples and child outcomes has often been questioned. A study looked at 43 female same-sex couples, 52 male same-sex couples, and 95 different-sex couples who were all parents. The couples were matched for demographic qualities. No differences were found in the children's well-being, the parent-child relationships, or use of professional or informal support by the parents . Sofia Garcia, who is a 28-year-old lesbian and Maria's aunt, presents for prenatal care with her mother. Her mother states that the baby will have problems because there is no man in the house. Based on this study, which statement helps the nurse address Sofia's mother's concerns? a. "The child will have male influence through his or her grandfathers." b. "Children raised in same-sex parent houses do just as well as children raised with different sex parents." c. "Every family faces challenges in raising their children. This will just be another challenge that they will encounter." d. "Do you feel Sofia will not do a good job raising her child?"

b. "Children raised in same-sex parent houses do just as well as children raised with different sex parents."

QUALITY IMPROVEMENT While she is in the hospital, Maria Rodriques, 12 years old, makes the following statements. The nurse determines which statement most clearly suggests she received culturally competent care? a. "My doctor is funny; he tells jokes and makes me laugh." b. "The nurses keep asking me who makes decisions in my family." c. "I'm sure my leg will heal quickly; the nurse said I'm an overall healthy person." d. "The nurse asked me what I like to eat and then brought me the taco I wanted."

b. "The nurses keep asking me who makes decisions in my family."

Suppose Mr. and Mrs. Hanovan divorce. Based on this study, what would be an important responsibility when the nurse is discharging James, an adolescent, from a hospital stay to his homecare setting? a. The nurse should suggest his mother, who will be his primary caregiver, to quit work so he will be able to have a stay-at-home mother for his care. b. The nurse should assess the parent's custodial pattern to be certain a responsible adult will be available no matter which home James returns to. c. The nurse should assure his parents that shared custody is a common pattern today and therefore does not pose a risk to teenagers; otherwise, no one would choose it. d. The nurse should assume the parents are responsible adults and will sensibly solve any problems that arise according to their custodial agreement.

b. The nurse should assess the parent's custodial pattern to be certain a responsible adult will be available no matter which home James returns to.

When children are first told they are adopted, they may exhibit "honeymoon behavior" or may try to behave perfectly for fear of

being given away again. After this honeymoon period, children may deliberately test their parents to see whether, despite bad behavior such as disobeying a house rule or even shoplifting, the parents will still keep them. It helps parents to put this behavior in perspective if they are aware it may happen

HEALTHCARE BARRIERS BASED ON SEXUAL ORIENTATION LGB patients may be hesitant to reveal their sexual orientation to healthcare providers because they are often the victims of

bullying, family rejection, and sexual assault. -In one study, 30% of LGB patients had a negative experience with a healthcare provider because of their sexual orientation

INFORMATICS The amount of technology and media that children are exposed to increases yearly. What is the youngest age the nurse would suggest the Hanovan family introduce their new baby to television viewing based on the recommendation of the AAP? a. 1 year b. 18 months c. 2 years d. 4 years

c. 2 years

EVIDENCE-BASED PRACTICE Adolescents may spend hours each day on social media websites or talking with friends. To determine if adolescents on home care experience depression from lack of social interaction, researchers conducted an online survey of 422 adolescents on home care. Findings from the survey revealed adolescents voiced positive aspects to 185 solitude, but they also strongly rejected wanting or liking spending time alone. They expressed feelings such as fear, boredom, and separation anxiety. Those who reported feeling lonely were significantly less likely to enjoy being home alone during the day than those who weren't experiencing loneliness . Lisa Puente is alone all day at home because both of her parents work. Based on the study, the nurse would make which recommendation to help Lisa prevent loneliness? a. She could arrange to go on brief outings with her friends. b. She could begin keeping a reflective diary of her thoughts and feelings. c. She and friends could all download a book to their e-readers and then discuss it by phone or online. d. She could keep up with her cheerleading squad by cheering along with them on Skype

c. She and friends could all download a book to their e-readers and then discuss it by phone or online.

PATIENT-CENTERED CARE The nurse needs to make a first home visit with Lisa, 16 years old, following a hospital stay. Which action by the nurse is best? a. Telephoning her home to establish a time both she and a parent will be present. b. Dropping in unannounced so the nurse can obtain a true picture of Lisa's home conditions. c. Visiting at a time Lisa will be there by herself so she can better express her feelings. d. E-mailing Lisa the 10 am arrival time; the nurse can expect a parent to also be home at that time.

c. Visiting at a time Lisa will be there by herself so she can better express her feelings.

Single-parent families play a large role in

childrearing. Unfortunately, low income is often a problem encountered by single-parent families, especially if a woman is the head of the household. Women's incomes for the same jobs are lower than men's by about 33% Single parents have difficulty working full time plus taking total care of young children. Trying to fulfi ll several central roles (mother and father) is not only time consuming but also mentally and physically exhausting and, in many instances, not rewarded

blended family (a remarriage or reconstituted family), a divorced or widowed person with children marries someone who also has

children. Although the arrangement is apt to be a positive one because it creates a nuclear family, childrearing problems can arise in this type of family from rivalry among the children for the attention of a parent. In addition, each spouse may encounter diffi culties in helping rear the other's children if their philosophy of childrearing differs from the biologic parent's, particularly in terms of discipline. Children may not welcome a stepparent because they have not yet r esolved their feelings about the separation of their biologic parents (through either divorce or death); they may believe the stepparent threatens their relationship with their biologic parent. They may become extremely distressed at seeing their other biologic parent move into another home and become a stepparent to other children.

cohabitation families are composed of

couples, perhaps with children, who live together but remain unmarried. A lthough such a relationship may be temporary, it may also be as long-lasting and as meaningful as a more traditional alliance

The Hanovan family consists of two parents plus James, 17 years old; Charles, 12 years old; and Brian, 2 years old. Mrs. Hanovan is 4 months pregnant. When examining how to improve the quality of the nurse's health teaching with the Hanovan family, which of Duvall's family life stages would the nurse consider the family currently experiencing? a. Pregnancy stage b. Preschool stage c. Launching stage d. Adolescent stage

d.

SAFETY Because of smaller families, the supervision of children may be delegated to many different caregivers during a day's time. What age group has the most automobilerelated unintentional injuries if not supervised conscientiously? a. Infants, because child car seats are often installed incorrectly b. Toddlers, because they walk in front of cars in parking lots c. School-age children, because they ride school buses almost daily d. Adolescents, because of alcohol or distraction while driving

d. Adolescents, because of alcohol or distraction while driving

An important nursing role is to encourage parents to do

do as much for their child as they wish, such as feeding and bathing or administering oral medicine. Most of a parent's time, however, should be spent simply being close by to provide a comfortable, secure infl uence on their child

Before beginning nutrition counseling, try to learn what the dominant type of food that is stocked in stores in the community of your healthcare agency because women who cannot buy the foods you recommend in their own neighborhood may not

eat well because of the inconvenience (and increased cost) involved in shopping elsewhere

Another aspect of family assessment is to document the "fit" of a family into their community. This is done by means of an

ecomap, a diagram of family and community relationships Around the outside, draw circles that represent the family's community contacts such as church, school, neighbors, or other organizations. Families who "fit" well into their community usually have many outside circles or community contacts. A mark of families who are new to a community is that they have few community contacts because they have not formed these as of yet

Nurses can be instrumental in offering ______________ _____________ to members of a blended family until these adjustments for mutual living can be resolved

emotional support

Constructing such a ecomap helps you assess the

emotional support that will be available to a family in a time of crisis. A family whom you assess as having few connecting lines between its members and the community may need increased nursing contact and support to remain a well family.

Parents of transgender children often need support and guidance as they struggle with changes in their family. They may benefit from what ?

family therapy and support groups. Children who are transgender may do better with social pressure and bullying if they have a supportive family who affirms their gender. -Families can find support through organizations like PFLAG and the Human Rights Campaign

Home Enteral Nutrition Chronically ill children and women who have hyperemesis gravidarum may receive nutrition by a gastrostomy or nasogastric tube. The supplies necessary for enteral feedings, such as

feeding tubes and enteral pumps, are available for rent or purchase through pharmacies, medical supply houses, or the home care agency. -Such tubes are usually changed every 2 to 4 weeks. -Caution the family to monitor the amount of formula for the feedings they have on hand so they don't run out, especially over weekends or holidays when their supplier may be closed. -Patients on enteral feedings probably will need to weigh themselves periodically and record their weight.

Transgender people will often go through transition, where they begin to live as the gender they

feel they are. Many will seek a provider who can provide them with hormone replacement therapy to attain the characteristics of their gender Some may also choose to have gender affirmation surgery (previously termed sex change operations) so they appear cosmetically as the sex they feel they really are. They may have top and bottom surgery or just top surgery. Top surgery refers to having the breasts removed or breast implants placed. Bottom surgery refers to having a vagina or penis created.

Children whose parents can no longer care for them may be placed in a

foster or substitute home by a child protection agency Foster parents may have children of their own; they receive remuneration for care of the foster child.

Gender expression refers to the behavior a person exhibits, which may or may not be the same as the person's

gender identity or sex assigned at birth.

COMMUNICATION RELATED TO SEXUAL ORIENTATION Assuming anything about patients is a barrier to

good communication. When asking about a patient's needs, ask about the patient's partner or partners. -Once information is gathered about the gender of the patient's partner or partners, make sure to tailor education to the patient's specific needs. A nurse can build trust and ensure the individual will return for care as needed by using neutral terminology and asking what the patient needs -It is important to address mental and social healthcare needs in this population given the incidence of bullying, victimization, and mental health issues

An extended family includes not only a nuclear family but also other family members such as

grandmothers, grandfathers, aunts, uncles, cousins, and grandchildren. An advantage of such a family is it contains more people to serve as resources during crises and provides more role models for behavior or values . In a typical extended family, however, there is usually only one main income provider, a situation which can strain the family's resources, and to include all family members in shared decisions may be diffi cult. When assessing such families, remember that, because many members are present, a parent's strongest support person may not be their spouse, and a child's primary caregiver may not be his or her biologic parent

A family is defi ned by the U.S. Census Bureau as "a

group of people related by blood, marriage, or adoption living together

A genogram is a diagram that details family structure and provides information about the family's

health history and the roles of various family members across several generations. It can provide a basis for discussion and analysis of family interaction at healthcare visits

A transgender person is an individual whose gender identity does not match the

sex assigned at birth

The traditional nuclear family is composed of a

husband, wife, and children. In the past, it was the most common family structure seen worldwide. Today, however, in the United States, the number of nuclear families has declined to about 49% of families due to the increase in divorce, acceptance of single parenthood, remarriage, and a greater acceptance of same sex partnerships or marriage

An important way to increase open communication with children who are transitioning is to discuss what gender they

identify with and which pronouns they would like the nurse to use when addressing them. They also may choose a new name that feels more in line with their gender. Addressing them by their preferred name and preferred pronouns will build trust.

The third phase of family divorce

involves reshaping lives. The family becomes a single-parent,family or, if the custodial parent remarries, a blended one. Financial arrangements, whether higher or lower, stabilize. Children realize their lives are permanently changed, and they cannot go back to the time before the divorce and so must move forward

The second phase of family divorce

is the actual separation stage. Everyone in the family is forced to take on an unfamiliar role, perhaps move to a new home, and probably realize a marked difference in finances. Although it is comforting to be free from a house filled with tension and arguing, most children wish they had their old life back as they grieve for the missing parent

The biggest advantage of a nuclear family is

its ability to provide support to family members because, with its small size, people know each other well and can feel genuine affection and support for and from each other

Sex assigned at birth is usually based on a person's chromosomal sex:

male (XY) or female (XX). There have been cases of individuals born intersex, with ambiguous genitalia, where sex was assigned based on a provider's assessment of the genitalia alone

Gender identity is the inner sense a person has of being

male or female, which may be the same as or different from sex assigned at birth.

Concept mastery: Home nursing care is deemed "skilled" when a specific provider-prescribed procedure is indicated, such as

medication administration, monitoring, or dressing changes.

Gender dysphoria is the realization one's physical sex and gender are

mismatched, which can cause a lot of stress and anxiety.

Actions not acceptable to a culture are called taboos. Three universal taboos are

murder, incest, and cannibalism. Issues such as abortion, robbery, and lying are controversial taboos because these are taboos only to some people, not everyone. For instance, some cultures do not put emphasis on individual property ownership and therefore would not understand the concept of robbery. Other cultures will put social harmony, appeasing the other person, at a higher priority than the absolute truth

Counsel adopting parents that children tracing records to try to locate their birth parent is not a criticism of their care, but a

normal consequence of being adopted. Children seek their birth parents not because they do not love their adoptive parents, but because they need information to know where they fi t into the eternal scheme of life.

People who believe their own sins caused an illness may not be highly motivated to take medication or other measures to get well again since they do not believe

penicillin can cure them. -People with such beliefs may receive more comfort from a spiritualist or counselor than from their primary healthcare provider. -Another consequence may be reluctant to ask for pain medication if they believe the pain is necessary to be rid of the illness

The Polygamous Family

polygamy (a marriage with multiple wives or h usbands) has been illegal in the United States since 1978, such families are not an unusual arrangement worldwide, so new immigrants may report they have been raised in this type of family (or may still be living in this arrangement divided into polygyny (a family with one man and several wives) and polyandry (one wife with

Some lesbian and gay families include children from

previous heterosexual marriages or through the use of alternative insemination, adoption, or surrogate motherhood

Theoretically, foster home placement is temporary until children can be returned to their own parents. Unfortunately, if return does not become possible, children may be

raised to adulthood in a series of foster care families. Such children can experience a high level of insecurity, concerned that they will have to soon move again. In addition, they may have some emotional difficulties related to the reason they were removed from their original home

When assessing a family with a newly adopted child, be certain to determine the stage of parenting the parents have

reached. Nonadopting parents have 9 months to prepare physically and emotionally for a coming child. Adoptive parents may be asked to make the mental steps toward parenthood in as little as 24 hours

Although rare, there have been instances of doctors refusing to care for the children of

same-sex parents A meta-analysis of Nordic women's experience as same-sex couples seeking prenatal care found that they had anxiety about discussing their sexual orientation for fear of change in the quality of care they would receive from their provider

Because of expected or actual discrimination in the healthcare setting, LGB individuals may enter care late and may be at increased risk for adverse health conditions, including

sexually transmitted infections (STIs), unwanted pregnancy, and mental health issues They may also need help or suggestions for communicating with friends or family who are having difficulty accepting their sexual orientation. It is important for healthcare providers to be extremely sensitive to these needs.

When caring for children from foster homes, be certain to determine who has legal responsibility to

sign for health care for the child (a foster parent may or may not have this responsibility).

HEALTH HISTORY AND PHYSICAL EXAM women receiving home care are taught how to self-assess various health parameters such as blood pressure, temperature, pulse, protein in the urine, serum glucose (with the use of a glucometer), fundal height, fetal movement, fetal heart rate, and uterine contractions. Parents or other family members of ill children invariably need to assess vital signs, comfort level, oxygenation (by means of an oximeter), and side effects of medications. When teaching these assessments, be certain to :

spend enough time with the patient and/or family so they thoroughly understand both the reason for the assessment and the procedure for doing it

Female partners may use what to achieve pregnacny ?

sperm donation from a known or unknown partner to achieve pregnancy. They can use intrauterine insemination at home or with a fertility specialist. They may also achieve pregnancy through in vitro fertilization. Sometimes, only one partner carries the fetus; other times each partner has one or more pregnancies to complete their families

Same-sex couples may face what ?

stigma from healthcare professionals, their family, or the public as they try to grow their family, attend prenatal care, and deliver or attend the delivery of their babies.

hanks to the introduction of prenatal care and other community health measures such as efforts to encourage breastfeeding, require immunizations, initiate better unintentional injury prevention measures [e.g., requiring car seats], to reduce

sudden infant death syndrome [SIDS] or the sudden death of an infant less than 1 year of age

In all settings and types of care, keeping the family at the center of care or considering the family as the primary unit of care is important because

the level of a family's functioning is so important to the health status of its members

Male partners may use what to achieve pregnancy or grow their family?

their own sperm and an egg donor. Sometimes, that egg donor carries the pregnancy as well; other times, a third person is involved called a gestational carrier, or surrogate, who shares none of her genetic material with the baby but carries and delivers the baby Additionally, adoption is a common course of action couples use to grow their families.

dyad family is

two people living together without children. This category usually refers to single young adults who live together in shared apartments or dormitories for companionship and fi nancial security while completing school or beginning a career. Dyad families are generally viewed as temporary arrangements, but this could extend into a lifetime arrangement.

For the purposes of assessing families, two basic family types can be described:

• Family of orientation (the family one is born into; or oneself, mother, father, and siblings, if any) • Family of procreation (a family one establishes; or oneself, spouse or signifi cant other, and children, if any)

Health maintenance

Intervening to maintain health when risk of illness is present Ex: Encouraging women to be partners in prenatal care; teaching parents the importance of safeguarding their home by childproofing against poisoning

HEALTH BELIEFS Even health beliefs are not universal. For example, most people are familiar with the current controversy about whether male circumcision is necessary. More surprising to many people is the belief that, in some cultures, female genital cutting is what ?

(amputation of the clitoris and perhaps a portion of the vulva) is practiced. Although, as outsiders, this practice seems like a poor health decision, there is often acceptance of it and an expectation that it will be done for all females in the culture

Nursing Care Planning to Empower a Family WHEN A FAMILY HAS LIMITED ENGLISH PROFICIENCY

1. Many people can speak a second language better than they can read it. Assess each patient's reading level as well as speaking level and rewrite information at an easier level if necessary. 2. Ask an interpreter to translate and copy material into the family's primary language as necessary so it can be clearly understood. 3. Be certain rooms in your healthcare agency, such as bathrooms, are labeled with international symbols that do not require reading ability. 4. Learn a few phrases, such as "Good morning" or "This won't hurt," from other languages and use them in interactions with patients to show you're receptive to participating in solving language difficulties. 5. Use hand gestures or draw a figure, if need be, to help ensure productive communication. Imparting health information is what is important for safe care, not worrying how you look. 6. When using an interpreter, do not ignore the person seeking health care in preference to the interpreter. Observe facial expressions for confirmation that a person understands instructions. Use short sentences; avoid slang words that don't interpret accurately.

OUTCOME EVALUATION Assessing whether expected outcomes have been met should reveal that a family's diversity preferences have been considered and respected during care. If this was not achieved, procedures or policies may need to be modified until this can be realized. Examples of expected outcomes that might be established include:

1.Parents list three ways they are attempting to preserve cultural traditions in their children. 2.Child states she no longer feels socially isolated because of her family's differences. 3.Family members state they have learned to substitute easily purchased foods for traditional but unavailable foods to obtain adequate nutrition. 4.Child with severe hearing impairment writes that he feels communication with ambulatory care staff has been adequate. 5.Adolescent patient states he is ready to tell family about gender identity orsexual orientation.

NURSING DIAGNOSIS Several nursing diagnoses speak to the consequences of ignoring cultural preferences in care, including:

1.Powerlessness related to expectations of care not being respected 2.Impaired verbal communication related to limited English proficiency 3.Imbalanced nutrition, less than daily requirements, related to unmet cultural food preferences 4.Anxiety related to a cultural preference for not wanting to bathe while ill 5.Fear related to possible ethnic discrimination

The number of single-parent families is increasing so rapidly it now equals the number of nuclear families in the United States.

A single parent may have fewer fi nancial resources than dual-employed parents. Nurses need to be aware of alternative care options and available to provide a backup opinion as needed.

Which trend is currently influencing maternal and child healthcare? A) An expansion of community based services B) Closure of regionalized healthcare centers C) The availability of additional family support D) A reduction in the number of latch key kids

A) An expansion of community based services Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 15-16 Feedback: The trend for community care is increasing because it has the potential to provide cost-effective health promotion/disease prevention patient care services to large numbers of children and families in an environment that is familiar to them. Regionalization of care is increasing because of the need for more specialized or advanced care. There is also an increase in the number of mothers who must work outside the home because they do not have extended family members to provide care for their children. This has resulted in an increase in the number of latchkey children left home alone after school while their mother works.

A client reports feeling increased levels of stress and anxiety before a routine ultrasound. What is an appropriate action by the nurse? A) Encourage the client to meditate for a few minutes. B) Cancel the ultrasound; the client is not conditionally stable. C) Contact the primary care provider to discuss the procedure with the client. D) Tell the client everything will be fine and continue with the ultrasound.

A) Encourage the client to meditate for a few minutes. Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 17 Feedback: By allowing the client a few minutes to mediate, she can relax and increase her overall well-being. Nurses should be aware of the use of complementary and alternative therapies and the benefits they can have on clients.

The nurse is reviewing the 2020 National Health Goals and notes that which is a focus of these goals? A) Health promotion and disease prevention B) Early diagnosis of chronic health problems C) Effective use of medication to treat disease D) Reduce the cost of health care and medications

A) Health promotion and disease prevention Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 5 Feedback: The 2020 National Health Goals are intended to help citizens more easily understand the importance of health promotion and disease prevention and to encourage wide participation in improving health in the next decade. These goals do not focus on the early diagnosis of chronic problems, use of medications to treat disease, or reduce the cost of health care and medications.

Which statement best describes the pattern of maternal mortality since World War II? A) It has steadily decreased. B) It has remained constant. C) It has steadily increased. D) After decreasing until the 1960s, it has increased steadily.

A) It has steadily decreased. Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 12 Feedback: Improved prenatal care and early ambulation after birth are factors that have decreased maternal death rates following birth over the past 70 years.

A nurse is doing a literature search on maternal mortality and finds that direct causes comprise the majority of maternal deaths. Direct causes are noted to be unpredictable reasons. Which action would be most appropriate to implement that would have the greatest impact on reducing these numbers? A) Practicing high standards of infection control. B) Monitoring maternal glucose levels in mothers with type 1 diabetes. C) Referring to a cardiologist for any arrhythmias. D) Administering oxytocic medications for increased postpartum bleeding. E) Beginning antibiotics prior to birth for a febrile mother.

A) Practicing high standards of infection control. Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 12 Feedback: Few women die giving birth in a developed countries, but it still happens. Health care providers can have the greatest impact on reducing these numbers by implementing good infection control measures, appropriate use of antibiotics during labor and postpartum periods, and use of oxytocics for maternal bleeding to prevent hemorrhage. Diabetes and cardiac arrhythmias are not considered direct causes, that is, they are known and predictable.

IMPLEMENTATION When implementing care, be certain not to force your cultural values on others. Appreciate that such values are ingrained and usually very difficult to change (in 110 yourself as well as in others)

An example of implementing care might be to make arrangements for a new Native American mother to take home the placenta after birth of her child if that is important to her, or planning home care for a Chinese American child whose family uses herbal medicine. It might be to establish a network of healthcare agency personnel or personnel from a nearby university or importing firm to serve as interpreters. It might be educating a child, family, or community about the reason for a hospital practice. Don't feel that you or your healthcare agency are always the ones who must adapt; however, a particular situation may call for both sides to adjust (cultural negotiation)

Which actions should the nurse perform when supporting the goals of maternal and child health care? Select all that apply. A) Advocates protecting the rights of the mother and fetus B) Teaches family members interventions to improve health C) Adheres to principles that focus on the needs of the mother D) Encourages maternal hospitalization to regain strength and stamina E) Assesses family members for strengths and specific needs or challenges

Ans: A, B, E Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 8 Feedback: Actions that the nurse should perform when supporting the goals of maternal and child health care include advocating the rights for the mother and fetus, teaching health promotion interventions, and assessing the family for strengths and specific needs or challenges. Adhering to principles that focus on the needs of the mother and encouraging maternal hospitalization to regain strength and stamina are not actions that support the goals of maternal and child health care.

The nurse has noticed a change in the type of care needed to support maternal and child health issues. What does the nurse realize as reasons for the changes in care? Select all that apply. A) Smaller families B) Less domestic violence C) More employed mothers D) Stable home environments E) More single-parent families

Ans: A, C, E Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 10 Feedback: Nursing care for maternal and child is changing because families are smaller, more mothers are employed out of the home, and there are more single-parent families. There is an increase in domestic violence, and families are less stable and more mobile, which influences homelessness.

The nurse suspects that an adolescent from the inner city stereotypes other people. Which statement did the client make that caused the nurse to come to this conclusion? A) "Kids who study are just nerds." B) "All people who live in the suburbs drive big cars." C) "City people are smarter than those who live in the suburbs." D) "I stay away from people who live downtown because they look funny."

Ans: B Client Needs: Psychosocial Integrity Cognitive Level: Analyze Page: 26 Feedback: Stereotyping is expecting a person to act in a characteristic way without regard to his or her individual traits. Ethnocentrism is the belief one's own culture is superior to all others as exemplified by the statement, "City people are smarter than those who live in the suburbs." Discrimination is treating people differently based on their physical or cultural traits, or by performing an act. The statements that exemplify discrimination are "kids who study are just nerds" and "I stay away from people who live downtown because they look funny."

A girl comes from a large family that you analyze as being extended. In planning hospital care for her, which factor would be most important for you consider? A) Restricting visitors to reduce the noise level B) Organizing nursing care at times other than visiting hours C) Asking the hospital's visitor program to call on her to prevent loneliness D) Spending increased time with her yourself to prevent loneliness

Ans: B Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 30 Feedback: Because extended families have many members, support people in time of an illness are usually available.

The nurse works in a maternal and child care area that supports health promotion. Which activities will the nurse perform to support this philosophy of health care? Select all that apply. A) Planning care B) Patient teaching C) Family counseling D) New mother advocacy E) Identifying nursing diagnoses

Ans: B, C, D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 7 Feedback: Extensive changes in the scope of maternal and child health nursing have occurred as health promotion has become a greater priority in care. The nursing activities for health promotion include teaching, counseling, and advocacy. Planning care and identifying nursing diagnoses are a part of the nursing process and not specific to health promotion.

The student nurse views a boy from a large extended family as poor because his father is unemployed. Considering his family structure, in what way might he view the student nurse as "poor"? A) You are planning to be a nurse. B) You own only one student nurse's uniform. C) You are unmarried and live alone. D) You stated you value honesty.

Ans: C Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 30 Feedback: An extended family is "rich" in that it can provide support to family members in times of family stress.

Which nursing action supports a 2020 National Health Goal that addresses cultural diversity? A) Focusing on actions to enhance disease prevention B) Reviewing actions to prevent accidents in the home environment C) Discussing breastfeeding with a pregnant client who is Hispanic D) Analyzing the client's compliance with health promotion activities

Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 24 Feedback: One 2020 National Health Goal for cultural diversity is to increase the proportion of mothers who breastfeed their babies in the early postpartum period from a baseline of 43.5% to a target of 60.6%. Actions to enhance disease prevention, prevent accidents, and comply with health promotion activities do not support the 2020 National Health Goals for cultural diversity.

To assess the sociocultural aspects of the family of an adolescent in an ambulatory clinic, what would you try to find out more about? A) His mother's occupation B) His mother's attitude toward citizenship C) The adolescent's education level D) His family structure

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Feedback: Family structure is a characteristic strongly influenced by culture and ethnicity.

Which question should the nurse ask when assessing the sociocultural aspects of a client's family? A) citizenship B) occupation C) education level D) family structure

Ans: D Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 30 Feedback: Family structure is a lifestyle area that is culturally determined. Citizenship, occupation, and education level are influenced by culture but on an individual basis.

A nursing student asks an experienced nurse to explain the role of evidence-based practice on the maternal child unit. Which statement by the experienced nurse is most appropriate? A) "We were trained to take a manual blood pressure, so I never use an automatic one." B) "Women have been able to be successful at having a natural birth after a cesarean birth." C) "Women should lay flat with their legs in the lithotomy position to give birth to a baby." D) "Only women need to experience bonding with the infant for the first 3 months of life."

B) "Women have been able to be successful at having a natural birth after a cesarean birth." Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 7-8 Feedback: Evidence-based practice brings together research, clinical expertise, and client preference to increase nursing outcomes. The research has increasingly indicated that it is safe for women to give birth vaginally following a cesarean birth (VBAC).

What makes the area of maternal-child health nursing a more extensive area for consideration of legal issues than other areas of nursing? A) Age of the clients B) Caring for a fetus, an unseen client C) Risk of labor and birth D) Lack of evidence-based information

B) Caring for a fetus, an unseen client Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Page: 19-20 Feedback: When providing care for the pregnant client, the fetus is unseen and unable to speak. Care for the maternal-child couplet, therefore, takes on a greater risk for legal and ethical issues as the fetus is not "born" nor of age to give consent for procedures.

While providing care to a child, the nurse informs the parents about the treatment plans and helps the parents make decisions about the child's care needs. What do this nurse's actions support? A) Autonomy B) Empowerment C) Accountability D) Informed consent

B) Empowerment Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 19 Feedback: Nurses promote empowerment of parents and children by respecting their views and concerns, regarding parents as important participants in their own or their child's health, keeping them informed, and helping/supporting them to make decisions about care. The nurse's actions are not being done to support autonomy, accountability, or informed consent

. The nurse is providing care to a new mother and infant according to the Quality & Safety Education for Nurses competency approach. Which action should the nurse perform to demonstrate the skill for the competency of safety? A) Assess the mother for preferences based on personal values. B) Ensure the mother and newborn have intact identification bands. C) Introduce all members of the care team to the mother and family. D) Document patient care using computerized spreadsheets and forms.

B) Ensure the mother and newborn have intact identification bands. Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 8 Feedback: Action to demonstrate the skill of the competency of safety is to ensure that the mother and newborn have intact identification bands. Assessing the mother for preferences based on personal values is the skill associated with patient-centered care. Introducing all members of the care team to the mother and family is the skill associated with teamwork and collaboration.

12. What makes the area of family nursing a difficult arena to provide care at times? A) The presence of family in the hospital rooms B) Family members who might not agree on treatments and a plan of care C) Family-centered care plans and use of community areas in acute care settings D) Nurses having different values from families

B) Family members who might not agree on treatments and a plan of care Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 5 Feedback: The family may not agree of the plan of care or treatment plans with each other or for their children. This is a difficult situation as the children do not have their rights to make their own decisions and the family needs to agree.

The nurse notes that statistics on maternal mortality had improved but are again becoming elevated. What does the nurse realize as a reason for this change in maternal mortality rates? A) Earlier prenatal care B) Gestational hypertension C) Increased vaginal deliveries D) Treatment for chronic diseases

B) Gestational hypertension Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Page: 12 Feedback: This increasing rate in maternal mortality is associated with more cesarean births, more gestational hypertension related to preexisting hypertensive disorders, and lack of health insurance for many Americans. This increase is not because of earlier prenatal care, increased vaginal deliveries, or treatment for chronic diseases.

. What is a current trend in child health care? A) Children are hospitalized for observation more than previously. B) Health promotion rather than health restoration is stressed. C) Child health care is moving out of regional centers. D) Nursing roles are decreasing because of the increasing role of families.

B) Health promotion rather than health restoration is stressed. Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Remember Page: 16 Feedback: It is recognized that keeping individuals well is more cost effective for a system than helping ill individuals return to wellness.

The nurse is caring for a mother who has just given birth to twins of 28 weeks' gestation, each weighing 2 kg. What is the health risk for the mother and the twins? A) Child mortality B) Neonatal death C) Infant mortality D) Maternal mortality

B) Neonatal death Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 11 Feedback: Neonatal death reflects the quality of care available to women during pregnancy and childbirth and the quality of care available to infants during the first month of life. The leading causes of death during this time are prematurity with associated low birth weight. Child mortality is the number of people who die during childhood years. Infant mortality is the number of infants who die before the age of 1 year. Maternal mortality is the number of women who die from activities related to childbirth.

A nurse is reviewing the statistical outcomes related to fetal deaths nationwide and notes that the numbers have changed over the last several decades. The best explanation would be: A) expectant mothers are seeking prenatal care later, resulting in decreases in the number. B) improved prenatal care has reduced the numbers of fetal deaths. C) increases are noted because of the growing number of pregnancies to teen mothers. D) increases are noted due the increasing number of older mothers becoming pregnant.

B) improved prenatal care has reduced the numbers of fetal deaths. Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Page: 11 Feedback: The number of fetal deaths in the United States has fallen. This has been attributed to the improvement in the delivery of prenatal care.

A 33-week gestation infant dies after 1 week of life in the neonatal intensive care unit. This infant's death rate would be classified under which statistical category? A) infant death under one month B) neonatal death C) preterm gestational death D) postneonatal death

B) neonatal death Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Page: 10 Feedback: The neonatal death rate is the number of deaths of an infant in the first 28 days of life. Gestational age is not a consideration when reporting deaths of infants. The other categories are not classifications for reporting infant deaths.

During a care conference, a nurse provides everyone with a copy of the latest research on improving the success of breast-feeding for first-time mothers. Which Quality & Safety Education for Nurses competency does this nurse's action support? A) Quality improvement B) Patient-centered care C) Evidence-based practice D) Teamwork and collaboration

C) Evidence-based practice Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 7 Feedback: Providing research material supports the Quality & Safety Education for Nurses competency of evidence-based practice because the nurse is integrating the best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Providing research evidence does not support the Quality & Safety Education for Nurses competencies of quality improvement, patient-centered care, or teamwork and collaboration.

A new mother asks the nurse if all of the new baby's injections can be given in one visit because the mother is losing income from missing work because of the office visits. What does this new mother's issue indicate to the nurse? A) The mother needs to find an alternative employer. B) The mother's income is more important that the baby's health. C) Missing work does not support the baby's health maintenance visits. D) The federal government needs to do more to support well-baby visits.

C) Missing work does not support the baby's health maintenance visits. Feedback: An area that needs additional research is finding effective stimuli to encourage women to bring children for health maintenance visits. The mother losing income because of missing work for well-baby visits will deter health maintenance visits for the baby going forward. This mother's issue does not indicate that the mother needs to find another job, that the mother's income is more important that the baby's health, or that the federal government needs to do more to support well-baby visits.

The nurse has been hired to provide care to patients on a maternal and child unit. What will the nurse use as a guide to legally provide care to this patient population? A) Code of ethics B) Nursing research C) Standards of practice D) Evidence-based guidelines

C) Standards of practice Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 19 Feedback: Understanding standards of care can help nurses practice within appropriate legal parameters. The Code of Ethics will help with ethical situations. Nursing research and evidence-based guidelines will help with providing care that is based upon best practices.

A nurse is providing teaching to a parenting class on childhood mortality prevention. Which topic would be the priority for the nurse to include? A) immunizations B) sex education C) seat belt safety D) obesity

C) seat belt safety Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 13-14 Feedback: The leading cause of death in children is unintentional injuries and is often preventable. Seatbelt safety would be a priority topic for the nurse to discuss as that is the one that could result in an injury.

Health care must respect cost containment by creating "health care homes" or "medical homes.

Comprehensive care is necessary in primary care settings because referral to specialists may not be an option depending on a family's type or lack of health insurance.

The nurse is planning an educational session for community members to address the issue of school-age child mortality. Which topic should the nurse identify as the highest priority for this population? A) Cancer B) Assault C) Suicide D) Accidents

D) Accidents Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 14 Feedback: For the school-age child between the ages of 5 and 14 years, the number one cause of mortality is from unintentional injuries or accidents. Other top five causes for child mortality include cancer, assault, and suicide.

14. The nurse is providing care in an organization that supports the maternal and child care continuum. Which type of patient care area is an example of this approach? A) Primary care B) Team nursing C) Case management D) Family-centered care

D) Family-centered care Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 4 Feedback: Keeping the family at the center of care is important because the level of a family's functioning is important to the health status of its members. A healthy family establishes an environment conducive to growth and health-promoting behaviors to sustain family members during crises. A family-centered approach enables nurses to better understand individuals and their effect on others and, in turn, to provide more holistic care. Primary nursing, team nursing, and case management do not necessary take into consideration the maternal and child care continuum.

Which statement correctly defines the term "perinatal death rate"? A) Number of deaths in utero of a fetus 500 g or more per 1000 live births B) Number of deaths per 1000 live births occurring in the first 28 days of life C) Number of deaths per 1000 live births occurring at birth or in the first 12 months of life D) Number of deaths per 1000 live births beginning when the fetus reaches 500 g and ending 28 days after birth

D) Number of deaths per 1000 live births beginning when the fetus reaches 500 g and ending 28 days after birth Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 10 Feedback: The term "perinatal" refers to the time of birth and that closely following it or the time "around birth."

CONCEPTS OF MALE AND FEMALE ROLES

In many cultures, the man is the dominant figure. In a strongly male-dominant culture, if approval for hospital admission or therapy is needed, the man would prefer to give this approval. A woman might be unable to offer an opinion of her own health or be too embarrassed to submit to a physical examination from a male healthcare provider unless a female nurse was also present. Some women insist on female-only providers for all aspects of care. A woman's pregnancy may have resulted not from a mutual decision but from sexual relations she felt she could not refuse

Families are more mobile than previously; there is an increase in the number of homeless women and children.

Good interviewing and health monitoring are necessary with mobile families so a health database can be established and there can be continuity of care

Ninety percent of women in the United States work outside their home at least part time; many women are the main wage earner for their family.

Health care must be scheduled at times a working parent can come for care for herself or can bring a child for care. Problems of latchkey (self-care) children and the number and safety of child care centers need to be addressed

Both child and intimate partner violence is increasing in incidence.

Screening for child or intimate partner violence should be included in all family assessments. Nurses must be aware of the legal responsibilities for reporting violence

Family-centered nursing care increases the number of clients a nurse cares for—that is, not four children, for example, but

four children plus four sets of parents; not just a single newborn, but his or her parents as well. Caring for families this way, rather than just an individual newborn or child, has an immeasurable effect on the health of children and parents as well as client satisfaction

Perinatal death rate:

The number of deaths during the perinatal time period (beginning when a fetus reaches 500 g, about week 20 of pregnancy, and ending about 4 to 6 weeks after birth); it is the sum of the fetal and neonatal rates.

Neonatal death rate:

The number of deaths per 1,000 live births occurring at birth or in the fi rst 28 days of life.

in some cultures, women are the dominant person in their family. The oldest woman in the home may be the one to

give consent for treatment or hospital admission If a woman is the family's dominant person and can no longer make her usual decisions because she is ill during pregnancy, for example, the entire family can be thrown into confusion. If the woman is a nondominant member, you may have to act as an advocate for her with a more dominant partner

INFORMATICS The nurse is including Maria's nursing care plan with her discharge instructions so a visiting community nurse can make her change from reduced activity to full sports participation as seamless as possible. Which aspect of her care planning could be regarded as an act of discrimination? a. Documenting the fact that Maria's mother is responsible for making most of the family's decisions. b. Cautioning against Maria's participation in the local soccer league because she is unlikely to fit in. c. Adding to her electronic health record a list of foods Maria does not eat because of her preference for Mexican American dishes. d. Documenting the fact that Maria's priest plays an important role in the family's spiritual life.

b. Cautioning against Maria's participation in the local soccer league because

Nursing theories are designed to offer helpful ways to view

clients so nursing activities can be created to best meet client needs

Evidence-based practice is the

conscientious, explicit, and judicious use of current best evidence in making decisions about the care of patients Evidence can be a combination of research, clinical expertise, and patient preferences or values

CULTURAL COMPETENCY FOR NURSES Transcultural nursing is care guided by

cultural aspects and respects individual differences

SAFETY Maria tells the nurse she rates the pain she has from bruising as 5 on a 10-point scale. The nurse offers to bring her a tablet of acetaminophen (Tylenol). Her grandmother produces a packet of herbs from her purse and says, "Good. I'll give her a family remedy along with that." The nurse recognizes which statement is the most culturally respectful response? a. "Wonderful. I'm sure herbs will complement what your doctor prescribed." b. "I wouldn't bother with that. Drugs are much more likely to be effective." c. "Good. I understand you people often use home cures for many things." d. "Let's check first to be certain the herbs won't cause an interaction."

d. "Let's check first to be certain the herbs won't cause an interaction."

PATIENT-CENTERED CARE Maria, 12 years old, tells the nurse she never eats peanut butter because her mother has warned her against it. Because peanut butter can be a good source of protein, how should the nurse best respond to her? a."Almost everyone in America eats peanut butter when they're young." b."Your mother's wrong; at 12, you should learn the truth about foods." c."I understand. I don't like the taste of peanut butter either." d."Let's look at your menu and pick out something you would like to eat."

d."Let's look at your menu and pick out something you would like to eat."

To assess patients for aspects of diversity, assess them as

individuals, not as one of a group. Note particularly any cultural characteristic that differs from the usual expectations of your care setting, so potential conflicts can be acknowledged and culturally competent care can be planned

Extensive changes in the scope of maternal and child health nursing have occurred as

health promotion (teaching, counseling, supporting, and advocacy, or keeping parents and children well) has become a greater priority in care

The 2020 National Health Goals are intended to help citizens more easily understand the importance of ?

health promotion and disease prevention and to encourage wide participation in improving health in the next decade

Numerous levels of cultural intolerance or acceptance persist because people hold different beliefs along a cultural competence continuum . When planning nursing care, try to not only respect these cultural differences but also

help people share their cultural beliefs with their entire care team so that their preferences will be considered and respected.

The type of therapy people choose to restore health is also dependent on culture. When a parent notices a child has an upper respiratory infection, for example, he or she may immediately call a healthcare provider for a formal prescription. Another parent will depend on an

herbal or "natural" self-help method. Be aware when taking health histories that many people today from all cultures rely on complementary or alternative therapies. Knowing about these is a way to be certain a medication that has been prescribed will not counteract or be synergistic with what herbs are being used

Most American women, for example, visit healthcare facilities early in pregnancy, follow prenatal directives, and at birth, allow a healthcare provider to supervise the birth. In other cultures, pregnancy and childbearing are considered such

natural processes that a healthcare provider is unnecessary. The woman knows the special rules and taboos she must follow to ensure a safe birth and depends on close friends rather than healthcare providers to guide her safely through labor and birth. She may plan to breastfeed until the next child is born or for as long as 5 years

NUTRITION PRACTICES When counseling a woman about nutrition during pregnancy, remember that respect for culturally preferred foods is important. People from other cultures, for example, tend to eat much less meat than those from the United States. Adequate protein is ingested, however, by mixing sources of incomplete protein such as beans and rice. Some women may omit various foods during pregnancy because they believe a

particular food will mark a baby (eating strawberries will cause birthmarks, eating raisins will cause brown spots) or they believe it is necessary to eat "hot" or "cold" foods to ensure optimal fetal growth. Pregnancy is usually considered a "hot" condition, so it may be difficult for a woman who is trying to eat only "cold" foods to agree to increase her intake of meat, usually considered a "hot" food. Asian women may believe in a similar pattern of required balances (yin and yang)

The overall goal through all phases of QSEN is to address the challenge of

preparing future nurses with the abilities necessary to continuously improve the quality and safety of the health care systems in which they work

The primary goal of both maternal and child health nursing can be stated simply as the

promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing.

The cause of illness is another area strongly culturally influenced. People in developed countries, for example, understand that illness is caused by documented factors such as bacteria, viruses, or trauma. In other cultures, illness may be viewed primarily as a

punishment from God, the effect of an evil spirit, or as the work of a person who wishes harm to the sick person.

the most important role of parents on a family-centered maternity unit is to

room-in and give total care to their newborn

PAIN RESPONSES These differences are so great, one woman in labor might report her contractions as "agonizing" each time she feels one, whereas a woman in the room next to her, experiencing the same degree of sensation, might barely change her facial expression and report her pain as tolerable. It is important to assess each person individually because there are so many possible responses to pain. Strategies to help recognize cultural influences on pain management or degree of pain include:

• Appreciate that the meaning of pain varies among people and cultures. • Appreciate that people do not all communicate or express their level of pain in the same way. • Recognize that the communication of pain may not be acceptable within a culture. • Develop an awareness of your personal values and beliefs as they may affect how you respond to people in pain. • Use an assessment tool, such as a 1-to-10 scale, to assist in measuring pain so you are certain you are being as objective as possible

Maternal and child health nursing can be visualized within a framework in which nurses use nursing process, nursing theory, and Quality & Safety Education for Nurses (QSEN) competencies to care for families during childbearing and childrearing years and through the four phases of health care:

• Health promotion • Health maintenance • Health restoration • Health rehabilitation

Use of Conversational Space People of different cultures use the space around them differently:

• Intimate space is the space closely surrounding a person. Physical examinations are conducted in this very tight space because palpation and auscultation are parts of the examination. • Conversational space is usually 18 in. to 4 ft away. • Beyond 4 ft is business space, as this amount of distance allows room for a desk between parties. • Public space is any distance beyond business space such as shouting across a parking lot. Use of the Internet or telephone can vary from private space ("I have a secret to tell you") to public space (conversation in a chat room).