Family, Culture, and Spirituality

Question 21. The nurse is preparing to discharge an Orthodox Jewish client who was diagnosed with end-stage renal disease. As the nurse is setting up outpatient hemodialysis three times a week and planning dietary instructions, what is the most important aspect for the nurse to remember? 1. The client would need dialysis Mondays, Wednesdays, and Fridays. 2. The client would need to eliminate pork products from his or her diet. 3. The client would need to observe religious holidays and continue fasting on holidays. 4. The client would need to modify his or her diet and avoid kosher foods, which can worsen symptoms.

1 Rationales Option 1: As the client practices Orthodox Judaism, no work must be done on the Sabbath, which is Saturday. Therefore, the client cannot be scheduled for outpatient hemodialysis on a Tuesday, Thursday, Saturday schedule. Option 2: An Orthodox Jewish client would already refrain from consuming pork products. Option 3: Orthodox Jewish clients are not required to abstain from eating on fasting holidays if it will harm their health. Option 4: A kosher diet can be safe for this client; it is unnecessary to modify it. [Page reference: 324]

Question 18. People from which country are most likely to use Ayurveda for healthcare? 1. India 2. China 3. Japan 4. United States

1 Rationales Option 1: Ayurveda is a method of healthcare in India. Option 2: Traditional Chinese medicine like acupuncture is used in China, not Ayurveda. Option 3: Japan uses modern medicine and traditional methods like reiki, not Ayurveda. Option 4: Biofeedback is considered a complementary medicine used in the United States. [Page reference: 321]

Question 9. Which is an appropriate statement for the nurse to use when documenting a client's ethnicity? 1. The client is Bosnian. 2. The client is Caucasian. 3. The client is Buddhist. 4. The client practices Orthodox Judaism.

1 Rationales Option 1: Documenting the client is Bosnian describes his or her ethnicity. Option 2: When the nurse documents the client is Caucasian, this is describing the race of the client, not ethnicity. Option 3: Buddhism is a religion, not the ethnicity of a client. Option 4: Orthodox Judaism describes a client's religion, not his or her ethnicity. [Page reference: 313]

Question 11. Which would be considered a personal value? 1. Making honesty a priority 2. Believing that all men are liars 3. Claiming that praying before bed is vital 4. Stating that handwashing before meals is important

1 Rationales Option 1: Honesty is considered a personal value because it is a principle or standard that has specific meaning to someone. Option 2: A client who believes men are liars is exhibiting a belief, not a personal value. Option 3: Prayer before bed is a practice, or a set of behaviors that a client follows. Option 4: A client who states handwashing prior to meals is important is stating a belief, not a value, though he or she may value cleanliness. [Page reference: 315]

Question 45. A client is brought to the emergency room via ambulance after sustaining injuries in a motor vehicle accident and is critically ill. The nurse learns the client is a Jehovah's Witness. Which procedure would the nurse know the health-care team cannot perform? 1. Blood transfusion 2. Surgical procedures 3. Urinary catheterization 4. Dressing changes to wounds

1 Rationales Option 1: It is against the religion of Jehovah's Witnesses to accept blood, blood products, or organ transplants. The client would prefer to die than receive blood products. Option 2: Surgical procedures are not prohibited by Jehovah's Witnesses. Option 3: There are no restrictions for Jehovah's Witnesses regarding urinary catheters. Option 4: It is acceptable for a nurse to perform dressing changes to any wounds. This does not violate any beliefs of Jehovah's Witnesses. [Page reference: 317]

Question 10. The nurse is interviewing a client who has moved from Russia to the United States and has assimilated into American culture. Which statement is the best example of this process? 1. The client consumes a typical American diet. 2. The client celebrates both Russian and American holidays. 3. The client refuses to learn the language of the new country. 4. The client chooses to become a citizen of the United States.

1 Rationales Option 1: One example of assimilating would be giving up the dietary norms of Russia for those of the United States. Option 2: The client who celebrates holidays from both cultures shows acculturation. Option 3: A client who refuses to learn the language of the new country is not assimilating. Option 4: When the client chooses to become a citizen of the United States, this is more an example of socialization. [Page reference: 314]

Question 13. The nurse is preparing to interview a client who moved to the United States from Germany. What should the nurse remember when setting up the room for the interview? 1. The nurse should place the interview chair a good distance away from the nurse's chair. 2. The nurse should place the interview chair with 12 inches of space between the nurse and the client. 3. The nurse should place the interview chair with exactly 18 inches of space between the nurse and the client. 4. The nurse should place an extra interview chair in the room for the spouse to allow him or her to be present.

1 Rationales Option 1: People of German ethnicity prefer a large amount of space between two people when they are talking. The nurse should provide ample space to promote comfort. Option 2: For a German client, 12 inches of space from the nurse is too close to promote comfort. Option 3: Americans and Canadians favor a distance of 18 inches between people when they are talking. Option 4: It is the client's choice to have his or her spouse present, but there is nothing to indicate this client would request this. [Page reference: 316]

Question 42. The nurse is caring for an 80-year-old patient who recently lost her husband. The client states "I no longer feel like I have a purpose in life. I desperately miss my husband. My prayers for his recovery did not work. I wonder if prayer does anything at all." Which of the following nursing diagnoses would the nurse consider? 1. Risk for Spiritual Distress 2. Moral Distress 3. Readiness for Enhanced Religiosity 4. Readiness for Enhanced Spiritual Well-Being

1 Rationales Option 1: Risk for Spiritual Distress is manifested as difficulty in finding purpose in life, loss of hope for relief, and a question about the usefulness of religious practices, such as prayer. Option 2: Moral Distress is experienced when a person makes a moral decision but is unable to carry out that decision. Option 3: Readiness for Enhanced Religiosity is the ability to increase reliance on religious beliefs or to participate in religious activities. The client is open and willing to enhance religious options. Option 4: Readiness for Enhanced Spiritual Well-Being occurs when the client see purpose in life and is integrating that as hope and connectedness throughout his or her life. [Page reference: 348-349]

Question 20. The nurse enters the room of a client who is tearful and holding a rosary. The client states he or she has been given a terminal diagnosis. In addition to sitting down with the client to talk, what is the best intervention for the nurse to implement first? 1. Ask the client if he or she would like the chaplain to visit. 2. Inform the client he or she will be kept in the nurse's prayers. 3. Provide the client some privacy and allow him or her to grieve alone. 4. Implement a care plan for the client related to grieving a terminal diagnosis.

1 Rationales Option 1: The client is holding a rosary, which denotes the client uses religious practices. It would be beneficial for the nurse to suggest a chaplain visit to tend to the client's spiritual needs. Option 2: Although it may provide a little comfort to pray for the client, this does not give the client support in coping with the diagnosis. Option 3: Before providing the client privacy, the nurse should ask the client if he or she wishes to be alone. Option 4: The nurse should implement a care plan of grieving related to the terminal diagnosis, but this can happen after the nurse addresses the client's immediate needs. [Page reference: 328]

Question 19. The nurse is preparing to administer NovoLog insulin to a client who is Muslim. The client refuses the medication, and the nurse documents the client is noncompliant. What error has the nurse made? 1. The nurse did not explain that insulins are no longer made from pork. 2. The nurse did not ask the client's spouse if it was acceptable to care for the client. 3. The nurse did not maintain an appropriate amount of space when speaking to the client. 4. The nurse did not provide for privacy when preparing to give the injection to the client.

1 Rationales Option 1: The use or consumption of any pork product is strictly prohibited by Muslim people. The nurse should explain that pork-based insulins are no longer used, and the client may have accepted the insulin. Option 2: In some cultures, a husband makes health-care decisions for his wife, but there is nothing to indicate this affected this client's decision. Option 3: There is nothing to indicate that personal space played a role in this client's refusal of insulin. Option 4: Although providing privacy for clients is important, this is likely unrelated to the client's culture and decision. [Page reference: 326]

Question 27. A nurse has started a new job working in family health and understands that the overall economic climate can be a major challenge. What family unit is most at risk for this challenge? 1. Single-parent families 2. A pregnant teenager who lives at home with her parents 3. Families who have adequate health insurance 4. A family member who is living with HIV

1 Rationales Option 1: These families are the hardest hit during economic downturns and have fewer resources. Option 2: The pregnant client living at home with her parents is not as high of a risk as a single-parent family. Option 3: Families who do not have adequate or affordable health insurance can be covered by the Affordable Care Act (ACA). Option 4: Although a devastating disease, there are medications and resources available to assist individuals with HIV and HIV-related complications. [Page reference: 299]

Question 12. Which statement made by the nurse indicates the use of a stereotype? 1. "People who are from China are good with computers." 2. "Some people of Irish descent have red hair and blue eyes." 3. "Many people of Mexican American heritage have brown eyes." 4. "Many people of African descent have a darker color to their skin."

1 Rationales Option 1: This statement is a stereotype because it is generalizing the ability of an entire ethnic group. Option 2: This statement is documenting an observable commonality for people of Irish heritage. Option 3: This statement is an example of the nurse stating a commonality found in this ethnicity, and it is not derogatory. Option 4: This statement is not a stereotype, as it is stating a commonality among people within this ethnicity and is not a negative statement. [Page reference: 315-316]

Question 32. What is the family theory that focuses on outcomes rather than processes? 1. Structural-functional theory 2. General systems theory 3. Family interactional theory 4. Developmental theory

1 Rationales Option 1: Unlike the general systems theory, this theory focuses on the outcomes, not the processes. Option 2: This theory focuses on the interactions between systems and the changes that result from these interactions. Option 3: This theory focuses on family roles and less on the external influences on the family unit. Option 4: This theory focuses on the developmental stage of the family (i.e., childbearing to aging). [Page reference: 294]

Question 15. The nurse is examining a Native American client and notes a cough and crackles in the lungs. Which cultural practices might the client want to incorporate in the healing process? Select All That Apply. 1. Herbs 2. Chanting 3. Purification 4. Amulets 5. Acupuncture

1,2,3 Rationales Option 1: Herbs are frequently used in healing practices by clients of Native American descent. Option 2: People of Native American heritage practice chanting during healing ceremonies. Option 3: Purification is a process used by people of Native American descent. This is done to promote healing. Option 4: People of Asian heritage use amulets in healing practices. Option 5: People of Asian descent are more likely to use acupuncture than are Native Americans. [Page reference: 320]

Question 1. Which factors have led to a change in family living structures in the United States? Select All That Apply. 1. Aging population 2. Higher divorce rates 3. Socioeconomic factors 4. Lower life expectancies 5. Older age at first marriage 6. Decreased number of children

1,2,3,5 Option 1: An aging population has pushed more older adults to live with their middle aged children, changing the structure of family living in the United States. Option 2: Higher numbers of divorced men and women may remarry, leading to blended families with children from both previous marriages. Option 3: Income and an inability to afford to live alone may cause children to stay at home longer. Health-care expenses of older adults also impact their ability to live alone. Option 4: At this point, people are living longer and have longer life expectancies. Option 5: Many people are waiting until they get older to get married, which can result in children staying at home longer. Option 6: The number of children in a family has not had a significant impact on the structure of the family. [Page reference: 292]

Question 28. A nurse is conducting a family health assessment and wants to use a genogram. The genogram, constructed with a diagram that evaluates each family member's health risks, includes what information? Select all that apply. 1. Causes of death 2. Important health problems 3. Infections 4. Neighborhood lived in 5. Occupations 6. Finances

1,2,3,5 Rationales Option 1: This information is included in a genogram. Option 2: Health problems can be linked from generation to generation. Option 3: Infectious diseases are important to include on a genogram. Option 4: This is not an aspect of a genogram. Option 5: Individuals may have been exposed to occupational hazards (e.g., asbestos). Option 6: Finances are not pertinent to a genogram. [Page reference: 301]

Question 17. Why might a client use folk healers instead of traditional medicine? Select All That Apply. 1. Folk healers share the client's values and beliefs. 2. Folk healers visit the sick in the home. 3. Folk healers may charge more money. 4. Folk healers speak the same language. 5. Folk healers are harder to find when needed.

1,2,4 Rationales Option 1: Many clients prefer to use folk healers because they share common values and beliefs. Option 2: Folk healers make house calls, while traditional health-care providers usually do not. Option 3: Many clients believe that traditional health-care providers charge more money than do folk healers. Option 4: Folk healers tend to speak the same language as the clients who choose them. Option 5: Clients report that folk healers are more readily available for services than are traditional medicine practitioners. [Page reference: 319]

Question 7. An elderly client is brought into the clinic by his or her adult children for a check-up. The nurse weighs the client and notices a weight loss of 10 lb since the last visit 6 months ago. For which factors should the nurse assess the client? Select All That Apply. 1. Current appetite level 2. Poorly fitting dentures 3. Loss of companionship 4. Available transportation 5. Increased saliva production

1,2,4 Rationales Option 1: The nurse should assess the current appetite level to get more data about potential causes of the unexplained weight loss. Option 2: Poorly fitting dentures can lead to weight loss in elderly clients. Option 3: Loss of companionship occurs as a person ages, but it is only related to weight loss if the client becomes depressed. Option 4: An elderly client may not have transportation to get to the store to purchase healthy foods. Therefore, the nurse should assess the client's access to nutrition. Option 5: The elderly client usually experiences a decrease in saliva production, not an increase. [Page reference: 298]

Question 22. Which factors usually prevent nurses from providing spiritual care to clients? Select All That Apply. 1. Lack of time 2. Lack of privacy 3. Low-tech care 4. Economic constraints 5. Lack of nursing expertise

1,2,4,5 Rationales Option 1: Nurses may not have enough time to address a client's spiritual concerns due to physical care needs. Option 2: Some health-care facilities still place two clients in one room. This does not provide enough privacy for the nurse to help meet spiritual needs. Option 3: High-tech, not low-tech, nursing care can interfere with the nurse's ability to provide spiritual care to clients. Option 4: Hospitals may not have enough funding to allow nurses extra time to meet the spiritual needs of the client. Option 5: Nurses may feel uncomfortable with meeting clients' spiritual needs. Nurses may need to examine their own spiritual needs first and gain additional education to feel qualified to do this. [Page reference: 345]

Question 38. Lipson and Meleis suggest a minimal cultural assessment that includes what information? Select all that apply. 1. Native language spoken 2. Where client was raised 3. Where client is employed 4. Nonverbal communication style 5. Social supports in a new country 6. What transportation the client has

1,2,4,5 Rationales Option 1: The nurse needs to know if the client can speak English or if an interpreter is necessary. Option 2: There may need to be an additional assessment of communicable diseases. Option 3: This is not a necessary question for a cultural assessment. Option 4: The nurse needs to understand the cultural cues of the client and respond appropriately. Option 5: The nurse needs to know what support systems are available to the client and what resources may be necessary to refer the client to. Option 6: This assessment is not important to a focused cultural evaluation.

Question 8. What should the nurse keep in mind when learning about cultures? Select All That Apply. 1. Culture is universal and dynamic. 2. Cultural beliefs contribute to individuality. 3. Culture exists only in nonmaterial possessions. 4. Culture is passed down throughout generations. 5. Culture consists of common beliefs and practices. 6. Cultural assumptions and habits are unconscious.

1,2,4,5,6 Rationales Option 1: Culture is universal and dynamic. Everyone is part of a culture, and it constantly changes. Option 2: Cultural beliefs contribute to identity and a sense of belonging to a group of people with similar backgrounds and history. Option 3: Culture exists at many levels. It exists in material possessions such as art, writings, and dress. It also is found in nonmaterial possessions such as customs and traditions. Option 4: Culture is embedded in traditions and customs that are passed down through the generations. Option 5: People of the same culture often share the same beliefs, traditions, customs, and practices. Option 6: Cultural assumptions are difficult for people to explain among cultures, as they are embedded in daily life. [Page reference: 312]

Question 31. A community nurse is conducting a family assessment. The family assessment includes what data? Select all that apply. 1. Family composition 2. Family history with a genogram 3. Reviewing financial reports 4. Family weaknesses 5. Abuse and/or violence 6. Health beliefs, values, and behaviors

1,2,5,6 Rationales Option 1: The nurse needs to assess the age, relationship, date of birth, place of birth, occupation, and education for each family member. Option 2: The nurse can assist the family in understanding health risks for each member. Option 3: This aspect is not generally part of a family assessment. Option 4: A nurse should focus on the family's strengths, not weaknesses. Option 5: Nurses should assess this because of the prevalence, and family members may not provide that data without being asked. Option 6: This is a very important assessment in order for the nurse to identify how the family perceives health and illness, visiting health-care providers, and access to health-care services. [Page reference: 301]

Question 24. A new nurse is learning about the three perspectives of family nursing. What do these perspectives include? Select all that apply. 1. Family as the context of care 2. Family as an interactional unit 3. Family as the unit of care 4. Family as a system 5. Family as a developmental process 6. Family with maladaptive coping mechanisms

1,3,4 Rationales Option 1: In this perspective, the nurse approaches the family unit of the ill individual. Option 2: This is a theory of families, not a perspective. Option 3: Nurses must provide family members with individual care. Option 4: Assessment and interventions are developed based on communications among family members. Option 5: This is a family developmental theory, not a family perspective. Option 6: This is a family experiencing health risk factors. [Page reference: 293]

Question 5. The home health nurse visits a client who is bedridden after a stroke and notices the client is quiet and withdrawn when the caregiver enters the room. What would the nurse assess for in the caregiver to support a nursing diagnosis of caregiver role strain? Select All That Apply. 1. Apathy 2. Neglect 3. Aggression 4. Depression 5. Physical injuries

1,3,4 Rationales Option 1: Supporting data for a nursing diagnosis of caregiver role strain includes apathy on the part of the caregiver. Option 2: Someone suffering from caregiver role strain may neglect the client, but the caregiver would not necessarily show signs of neglect. Option 3: The caregiver may be aggressive toward the client if experiencing caregiver role strain. Option 4: It is common for a caregiver to experience depression with caregiver role strain. Option 5: The client, not the caregiver, might have physical injuries if the caregiver is experiencing caregiver role strain. [Page reference: 304]

Question 14. A client who speaks limited English comes to the emergency room with abdominal pain. Which questions would be most appropriate to ask the client first? Select All That Apply. 1. "What languages do you speak?" 2. "Can you tell your family member where the pain is?" 3. "Are you comfortable speaking English?" 4. "Who should I speak with about decisions regarding your health-care needs?" 5. "Are you comfortable with using an interpreter?"

1,3,5 Rationales Option 1: The nurse should ask which languages the client is able to speak. This provides the nurse with information about proceeding to communicate with the client. Option 2: The nurse should not depend on a family member to be the interpreter for the client because this can introduce opportunities for errors. Option 3: It is appropriate for the nurse to ask the client if he or she feels comfortable speaking English; this helps give the client some control over the situation. Option 4: The nurse should ask this question, but it is not one of the first ones to ask. Option 5: A trained medical interpreter is the best way to communicate with the client if he or she does not feel comfortable speaking English. [Page reference: 324]

Question 47. A nurse utilizing the HOPE approach to spiritual assessment would ask which questions when addressing the "H" part of the method? Select All That Apply. 1. "What are your sources of internal support?" 2. "Do you belong to a religious or spiritual community? 3. "Do you believe in God?" 4. "What do you hold on to to get through your difficult times?" 5. "Has you illness affected your relationship with God?"

1,4 Rationales Option 1: The "H" portion of the HOPE spiritual assessment approach addresses sources of hope, meaning, comfort, strength, peace, love, and connection. Asking a client about his or her internal support system addresses this. Option 2: Asking a client about his/her spirituality touches on the "O" part of HOPE: organized religion. Option 3: Asking a client if he/she believes in God refers to the "O" part of HOPE: organized religion. Option 4: The "H" portion of the HOPE spiritual assessment approach addresses sources of hope, meaning, comfort, strength, peace, love, and connection. Asking a client about ways that he or she gets through tough times addresses this. Option 5: Asking a client about the impact his/her illness has had on a relationship with God references the "E" of HOPE: effects of medical care. [Page reference: 347]

Question 26. In caring for families with older adults, there are common health risk factors that a nurse must be aware of. What is the most important health risk for this family? 1. Social isolation and loneliness 2. Nutrition and hydration 3. Falls and safety 4. Forgetfulness and confusion

2 Rationales Option 1: According to Maslow, this is a lower-level need. Option 2: According to Maslow, this is the highest-level need (physiological). Option 3: Safety needs are lower in the hierarchy according to Maslow. Option 4: Safety needs come after physiological needs. [Page reference: 299]

Question 44. Using structural-functional theory, the nurse is working with a family going through a divorce. As the nurse plans the sessions, what will be the focus? 1. Ground rules created for each session 2. Children developing healthy coping patterns 3. Everyone's participation in each session 4. Identification of strengths and weaknesses

2 Rationales Option 1: Although ground rules are important, the focus of structural-functional theory is not the process of each session. Option 2: The focus of structural-functional theory is on outcomes. One outcome the nurse may focus on is the children in the family developing healthy coping patterns. Option 3: General systems theory would be focused on the process, which may include a focus on everyone participating in each session. Option 4: The nurse would identify strengths and weaknesses during the first few sessions, but this is not considered the focus. [Page reference: 294]

Question 37. A student nurse is learning about assessment techniques based on a client's skin color. How does the student nurse assess cyanosis in a dark-skinned client when he or she inspects the skin? 1. Skin temperature 2. Buccal mucosa 3. Sclera 4. Nail beds

2 Rationales Option 1: Skin temperature will not correctly assess for oxygenation status. Option 2: This is a preferred location to assess for cyanosis in a dark-skinned client. Option 3: This is more common to assess for jaundice. Option 4: It may be difficult to assess cyanosis in the nail beds of a dark-skinned client. [Page reference: 331]

Question 46. A nurse is working with families in a rural community. What nursing diagnosis would be the highest priority for a family in crisis? 1. Risk for Caregiver Role Strain 2. Interrupted Family Processes 3. Risk for Impaired Attachment 4. Social Isolation

2 Rationales Option 1: The potential or risk for diagnoses are not a priority about actual diagnoses. Option 2: This is a priority diagnosis for a family who is in crisis. Option 3: Risk for diagnoses would not be the priority at this time and would be prioritized after actual nursing diagnoses. Option 4: When a family is in crisis, social isolation is not the most important need until the family unit is stabilized. [Page reference: 303]

Question 33. Due to the growth of various populations, the United States is expected to become what type of nation by 2044? 1. Mostly non-Hispanic Whites 2. Majority-minority 3. Mostly Asians 4. Mostly from the MENA region

2 Rationales Option 1: This group will remain the largest single group from trend data between 2014 and 2060. Option 2: This is true due to the growth of various population groups. Option 3: Asians will be the second fastest growing population. Option 4: Immigrants from the Middle East and North Africa are predicted to increase over time. [Page reference: 311]

Question 34. What did Purnell define culture as? 1. A unique way we view the world by what luggage we carry around in life 2. The totality of socially transmitted behaviors, arts, beliefs, values, customs, and other characteristics of a population of people that guides their worldview and decision making 3. The learned, shared, and transmitted knowledge of values and beliefs of a specific group that are transmitted from generation to generation 4. The integrated pattern of thoughts, communications, actions, customs, beliefs, values, and institutions associated with racial, ethnic, religious, spiritual, biological, geographical, and sociological qualities

2 Rationales Option 1: This is the definition of culture by Spector. Option 2: This is the definition according to Purnell. Option 3: This is Leininger and McFarland's definition of culture. Option 4: This definition of culture is from the Office of Minority Health. [Page reference: 312]

Question 41. A nurse educator is planning a program for new graduate nurses regarding various religions. Which aspects of Judaism does the nurse educator include? Select all that apply. 1. Sacred writings of scripture are from the bible. 2. The Sabbath is celebrated from sunset on Friday to sunset on Saturday. 3. Passover is celebrated in either March or April. 4. A rabbi is consulted for spiritual or dietary questions. 5. Foods must be kosher for some Jews. 6. Blood transfusions are never allowed.

2,3,4,5 Rationales Option 1: Christianity is based on the Bible and Judaism is based on the Torah. Option 2: For Orthodox Jews, work is prohibited on the Sabbath and considered holy time without traveling or using appliances. Option 3: This is a specific holiday celebrated in the Jewish religion. Option 4: A rabbi role in Judaism is a similar role of a priest in Catholicism. Option 5: Some Jews consume only kosher foods, and there are strict guidelines for how food is prepared before consumption. Option 6: Jehovah's Witnesses believe that accepting blood transfusions is morally wrong. [Page reference: 341]

Question 6. The nurse is preparing to give a presentation to parents of adolescents about common risk-taking behaviors during the teenage years. What should the nurse include in the presentation? Select All That Apply. 1. Lying to parents 2. Accepting dares 3. Using illicit drugs 4. Cheating on tests 5. Being sexually promiscuous

2,3,5 Rationales Option 1: Children of all ages have times where they are dishonest and lie to their parents. This is not considered a risk-taking behavior specific to teenagers. Option 2: Teenagers often accept dares from others such as speeding in cars, smoking cigarettes, or breaking curfew. Option 3: The use of illicit drugs is a risky behavior to which teenagers are susceptible. Option 4: Cheating on tests is dishonest and may occur, but it is not a risk-taking behavior. Option 5: Sexual promiscuity is an example of risk-taking behaviors in which teenagers may engage. [Page reference: 297]

Question 2. According to general systems theory, which element is part of the suprasystem? 1. Mother 2. Daughter 3. Community 4. Decision maker

3 Option 1: The mother would be part of the subsystem, not the suprasystem. Option 2: Children are parts of the subsystem. Option 3: The community is a broader system that surrounds the family unit, making it part of the subsystem. Option 4: One person in a subsystem may be the primary decision maker. [Page reference: 294]

Question 3. Which theory used by the nurse caring for a family would focus on the roles of each family member? 1. Developmental theory 2. General systems theory 3. Family interactional theory 4. Structural-functional theory

3 Rationales Option 1: Developmental theory focuses on the stage of family development, not the roles of each family member. Option 2: General systems theory focuses on how systems interact with each other, not the roles of each family member. Option 3: Family interactional theory focuses on the role each member plays within the family. Option 4: Structural-functional theory focuses on the outcomes instead of the process. It does not focus on the roles of each family member. [Page reference: 294]

Question 25. Parents with young children are concerned with safety, development, education, and nutrition. What is the most important risk to family health? 1. Childcare services 2. Marital relationships 3. Communicable diseases 4. Chronic illnesses

3 Rationales Option 1: Safe and affordable child care is necessary when parents work outside the home. Option 2: Marital discord can be detrimental to the family unit. Option 3: Parents should be educated on the importance of annual vaccinations and myths associated with them. Option 4: Families can experience high levels of stress if a child has a chronic disease such as autism or diabetes. [Page reference: 296]

Question 35. The nurse is applying cultural concepts to community outreach work. Which statement by the nurse demonstrates correct understanding of cultural concepts? 1. "Assimilation is the process of learning to become a member of a society or group." 2. "I will provide care based on my cultural beliefs because they are more acceptable." 3. "I believe new members in the community from Thailand are experiencing the acculturation process." 4. "I can care for minority groups the same if they live in the same neighborhood."

3 Rationales Option 1: This is not the definition of assimilation; it is the definition of socialization. Option 2: This statement refers to ethnocentrism, which is not a culturally acceptable concept when working with various groups. Option 3: Acculturation is a learning process that can take years through which immigrants begin to accept elements of the new culture and maintain their own culture. Option 4: Minority groups may or may not share the same values, beliefs, or physical attributes. Therefore, the nurse should not assume that the same care will be appropriate or culturally competent. [Page reference: 314]

Question 23. A nurse is learning about family structures. What does the nurse understand that a holistic definition of a family is? 1. Two or more related people living in the same household 2. A group of people consisting of a wife, husband, and children 3. Two or more individuals who provide physical, emotional, economic, or spiritual support to each other and may or may not be related by blood 4. A group of grandparents, aunts, uncles, and cousins living in a single dwelling

3 Rationales Option 1: This is the formal definition of a family. Option 2: This is a traditional definition of a family. Option 3: This is the holistic definition of a family, according to Lofquist, Lugaila, O'Connell, et al., 2012. Option 4: This is an example of an extended family. [Page reference: 292]

Question 4. The nurse is caring for a client who is married with two children ages 3 and 5. The client has sustained a work-related injury that is likely to impact the family unit. According to family developmental theory, which tasks will this family need to master? Select All That Apply. 1. Being involved in the community 2. Supporting school-related activities 3. Setting up play dates for the children 4. Coping with decreased parental energy 5. Exploring options for career development

3,4 Rationales Option 1: Community involvement happens in the "no longer newlyweds" stage without children. Option 2: This couple would not be supporting school-related activities because the children are younger. Option 3: According to family developmental theory, the family with preschool children will focus on socializing the children with others. Option 4: Parents with preschool children may report decreased energy, especially under the strain of one parent recovering from an injury. Option 5: A client in the beginning family stage will explore options for career development. [Page reference: 294-295]

Question 16. The family asks the student nurse if the client can have a piece of cake. The student nurse states, "No, unfortunately the client is NPO." Which type of communication is the student nurse using? 1. Slang 2. Street talk 3. Unprofessional 4. Health-care jargon

4 Rationales Option 1: Slang consists of informal words, for instance, "grass" instead of "marijuana." "NPO" is not an example of slang. Option 2: Street talk includes informal words like slang to communicate thoughts. Option 3: The student nurse is not being unprofessional, although the family may not understand "NPO." Option 4: The student nurse is using health-care jargon when communicating with the family. The family may not understand that "NPO" means the client may not have anything by mouth. [Page reference: 324]

Question 39. The nurse is learning about the differences between spirituality, religion, and spiritual care. Which definition demonstrates that the nurse has a correct understanding of spirituality? 1. A map that tells you what to believe and what values are important in life 2. Discussions and theories related to God and God's relation to the world 3. Doctrines about the human soul as it relates to death, judgment, and eternal life 4. Core issues involving divine experiences on a daily basis that include faith, hope, and love

4 Rationales Option 1: This is a definition of religion and not spirituality. Religion may include a specific denomination of practice and is a lens for reading the world. Option 2: This is theology where there are notions of sin, sacred writings, evil, and suffering. Option 3: In the Western world, this is the concept of eschatology. Option 4: This is a definition of spirituality that is a personal experience for healing. [Page reference: 338]

Question 30. Which is a developmental task for the childbearing family? 1. Deciding whether to have children 2. Being involved in the community 3. Aging family 4. Adjusting to life changes after birth and the infant's needs

4 Rationales Option 1: This is the beginning family stage where there is a sense of autonomy and independence from the family of origin. Option 2: This is the "no longer newlyweds" (with no children yet) stage. Option 3: Adjusting to retirement and possibly the loss of a spouse. Option 4: This is a task within the childbearing family when children range from being a newborn to 2 years. [Page reference: 295]

Question 36. There are multiple types of healing systems throughout the world. What does the nurse understand that the biomedical system focuses on? 1. The belief that supernatural forces influence health and illness 2. The need for balance and harmony of the human with nature 3. The use of non-traditional therapies such as massage, aromatherapy, and herbal supplements for healing 4. A combination of Western medicine and values of individualism to create healing

4 Rationales Option 1: This is the magico-religious system of healing. Option 2: This is the holistic belief of healing. Option 3: Complementary and alternative therapies are undergoing more research and practiced for healing. Option 4: The traditional health-care system is created by professionally trained providers for particular roles and responsibilities. [Page reference: 317]

Question 40. A new school health nurse is working in a diverse school district. The nurse is interested in learning how to become a more culturally competent nurse for spiritual care needs of students and staff. What is one of the most important actions the nurse can do? 1. Learn about all the religions and cultures in the school by taking a college course. 2. Make sure all students and staff follow the school lunch policy, 3. Treat all students and staff the same, regardless of various cultures or religions. 4. Self-reflect on spiritual needs of self and be sensitive in communicating about spiritual issues of others.

4 Rationales Option 1: This may not be feasible or realistic depending on the size of the school. An assessment of the students and staff would be appropriate for this setting. Option 2: This action would not be culturally or spiritually competent, as staff and students may have dietary restrictions that should be respected during school hours. Option 3: Treating all cultures the same would not demonstrate cultural competence, as there are nuances within certain cultures that should not be overlooked; care must be individualized. Option 4: The culturally competent nurse must know thyself before understanding others who are culturally or spiritually different. [Page reference: 344-345]

Question 43. The nurse is teaching a client with newly diagnosed type 2 diabetes mellitus about self-management. What can the nurse do to focus on the family as the context for care? 1. Check the spouse's blood glucose level. 2. Determine who will be the primary caregiver. 3. Inquire how this illness has impacted the family. 4. Ask the client if the family will be helping with injections.

4 Rationales Option 1: When the family is the unit of care, not context of care, the nurse may check the spouse's blood glucose level. Option 2: Before doing any teaching, the nurse would determine who will be providing care, but this is not the focus of the family as the context for care during client education. Option 3: The nurse would ask how the illness has impacted the family if focusing on the family as a system. This would likely occur during assessment, not implementation of client education. Option 4: If the nurse is focusing on the family as the context for care, the nurse would ask if family members will be participating in care. [Page reference: 293]

Question 29. The nurse is meeting with a family whose father/husband will be discharged from alcohol rehabilitation. The nurse wants to use the PICOT method to explain the treatment process. Arrange the order of PICOT components from first to last. 1 No family support 2 Over 6 to 12 months 3 Alcoholic adults 4 Decreased relapse 5 Family support

Your Response - 3,5,1,4,2 Correct Correct Feedback PICOT represents Population/client, Intervention/indicator, Comparator/control, Outcome, and Time. Therefore, the correct order of components is alcoholic adults, family support, no family support, decreased relapse, and over 6 to 12 months. [Page reference: 303]