Maternal and Newborn Nursing: Culture & Family Dynamics

Which concept characterizes transcultural nursing? A) Influencing culture by specific conditions related to an environment B) Planning care compatible with the client's health belief system C) Performing health-related activities and restoring wellness D) Acknowledging that clients with the same skin have similar social situations

B) Planning care compatible with the client's health belief system Planning care compatible with the client's health belief system is a characteristic of transcultural nursing. Acknowledging that clients with the same skin color have similar social situations leads to stereotyping. Stereotyping can be dangerous because it is dehumanizing and also interferes in accepting others as unique individuals. Culture is influenced by specific conditions related to environment. Performing health-related activities and restoring wellness is an important aspect of nursing and does not only pertain to transcultural nursing.

Which comment is an example of ethnocentrism? A) "It's so much better in the South. We know how to treat people nicely, not like they do in the North." B) "All Chinese women are bad drivers." C) "He's from France? He must hate Americans." D) "My parents speak Italian fluently, but I only know a few words."

A) "It's so much better in the South. We know how to treat people nicely, not like they do in the North." Ethnocentrism is the belief that one's culture is better than another's. Believing that the South is better than the North is an example of ethnocentrism.

A client who immigrated from China and has undergone labor induction with Pitocin has an elevated temperature and dry mucous membranes. She is refusing sips of water and ice. Which is the most appropriate nursing action at this time? A) Offer the client a hot beverage. B) Ask the client what she would like to drink. C) Increase the IV Pitocin to 125 mL/hr for hydration. D) Encourage the client to drink the ice and water.

B) Ask the client what she would like to drink. Although some Asian childbearing women drink only hot beverages, it would be appropriate first to find out what the client wants to drink and determine her preferences. There is a reason she has chosen to not drink the cold beverages, so it is best to ask her what she wants. The nurse should avoid generalizations. Increasing the Pitocin will likely increase her uterine contractions and is not appropriate practice for meeting hydration needs.

A couple had decided not to circumcise their newborn for nonreligious reasons. What is the appropriate response from the nurse? A) "That's very unusual, tell me what has led you to this decision." B) "What arrangements have you made outside the hospital?" C) "OK, great. I will let the physician know." D) "It's much better for the health of your newborn if you circumcise him."

C) "OK, great. I will let the physician know." The nurse should remain as nonjudgmental as possible when speaking with a client. There are many reasons why a couple may decide to leave their newborn uncircumcised. Both health benefits and risks are associated with circumcision. The nurse should respect the couple's decision.

A primigravida is admitted to the labor unit with contractions every 7-8 minutes. She is 3 cm dilated, 70% effaced, and at 0 station. She is very anxious, is having difficulty coping with contractions, and states that she did not attend prenatal classes. What is the most effective nursing intervention? 1. Instruct the patient in abdominal breathing and progressive relaxation. 2. Instruct the patient in patterned, paced breathing and touch relaxation. 3. Instruct the patient in pelvic tilt and pelvic rock exercises. 4. Call the physician and request a sedative

Correct Answer: 1 Rationale 1: Abdominal breathing and progressive relaxation assist the patient in relaxing, and allow the uterine muscles to work more efficiently. Rationale 2: Patterned, paced breathing and touch relaxation are exercises that are taught in childbirth preparation classes and involve the use of a partner. Rationale 3: Pelvic tilt and rock exercises are body-conditioning exercises. Rationale 4: Providing sedatives would not allow the patient to participate actively in the process.

A 7-year-old patient tells you that "Grandpa, Mommy, Daddy, and my brother live at my house." The nurse identifies this family type as: 1. Binuclear. 2. Extended. 3. Gay or lesbian. 4. Traditional. Correct Answer: 2

Rationale 1: A binuclear family includes divorced parents with joint custody of their biologic children, who alternate spending varying amounts of time in the home of each parent. Rationale 2: An extended family consists of a couple who share the house with their parents, siblings, or other relatives. Rationale 3: A gay or lesbian family is composed of two same-sex domestic partners; they might not have children. Rationale 4: The traditional nuclear family consists of a husband provider, a wife who stays home, and the biologic children of this union.

The nurse is working with the 5-day-old baby boy of a young Jewish couple. What comment is not culturally sensitive? A) "Oh, I see you have chosen not to have your baby circumcised." B) "What a beautiful little boy!" C) "I'll make sure he gets a blue blanket." D) "He seems hungry. Go ahead and nurse him."

A) "Oh, I see you have chosen not to have your baby circumcised." Ritual circumcision for Jewish babies takes place on the eighth day of life. All the other comments are acceptable.

A new patient is having a preconception physical exam. During the exam, the clinic nurse assesses the patient for: Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Pattern of exercise. 2. An acceptable birth plan. 3. Body mass index over 30. 4. Diarrhea. 5. Hemoglobin under 12 g/dl.

Correct Answer: 3,4,5 Rationale 1: The pattern of exercise is important, and would be part of the history, not of the physical exam. Rationale 2: An acceptable birth plan is important, but not until after conception has occurred. Rationale 3: The prenatal physical must include the body mass index measurement to assess for obesity, which is indicated by a body mass index over 30. Rationale 4: The prenatal physical must include data concerning diarrhea, which could indicate an intestinal infection. Rationale 5: The prenatal physical must include a hemoglobin test to ensure that anemia is not present. Hemoglobin under 12 g/dl indicates anemia.

A nurse is teaching a class of pregnant couples about the benefits of using a breathing technique for the latent phase of labor. Which benefit does the nurse include? 1. Aids visualization (imagery). 2. Increased physical and mental alertness 3. Increased response to soothing music 4. Helps the mother to focus attention.

Correct Answer: 4 Rationale 1: Breathing techniques do not promote visualization. Rationale 2: Breathing techniques can increase physical and mental relaxation. Rationale 3: Breathing techniques do not increase the mother's response to soothing music. Rationale 4: Breathing techniques help keep the mother and her unborn baby adequately oxygenated, and help the mother relax and focus her attention appropriately.

A laboring client, 2 cm dilated and 50% effaced, is screaming in pain. The nurse caring for this client recognizes this woman's response to pain should be documented using which label? A) inappropriate response to pain B) lack of pain control C) high pain tolerance D) low pain threshold

D) low pain threshold A person's response to pain is both individually and culturally determined. The pain threshold is the point at which the individual reports a stimulus is painful. Pain tolerance is the point at which an individual withdraws from a stimulus. Lack of pain control and inappropriate response to pain reflects the nurse's individual bias.

While interviewing a Chinese man about his son's health, the nurse notices that the man keeps his eyes focused on the floor. What is the best action by the nurse? A) Continue with the interview. B) Ask the man if anything is wrong. C) Ask the man if he would like to continue the interview at a different time. D) Stop and ask the man to elaborate about his anxiety regarding his son's care.

A) Continue with the interview. For some Chinese Americans, it is not culturally acceptable to make eye contact while conversing; this can be seen as a cultural norm for this man. Continuing with the interview is the best response so as not to make him feel uncomfortable.

The nurse caring for several patients and their families knows that roles in each family are determined by: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. Age. 2. Stressors. 3. Demographic trends. 4. Definition of family. 5. Ethnocentrism.

Correct Answer: 1,2,3 Rationale 1: Age can be a determinant of a role within the family-for example, a grandfather must be consulted for decision making. Rationale 2: Stressors upon the family and individuals can influence the roles assumed by a member of the family. Rationale 3: Demographic trends will influence roles in the family such as employment opportunities.

A patient having her fourth child is admitted to the labor unit and is accompanied by a doula. The intrapartum nurse expects the doula to assist with: 1. Fetal monitoring and relaxation techniques. 2. Physical and emotional comfort techniques. 3. Breathing techniques and labor assessment. 4. Massage and vaginal exams

Correct Answer: 2 Rationale 1: The doula will not be involved with fetal monitoring. Rationale 2: A doula is a trained lay birth companion, and focuses on helping the mother to relax and increase her comfort. Rationale 3: The doula does not do labor assessments. Rationale 4: A doula does not do vaginal exams.

The nurse is planning for an adolescent parenting class. Which topics would be priorities for the nurse to include in the adolescent class? Select all that apply. 1. Sexuality in pregnancy 2. Newborn care 3. Birth settings 4. Health dangers for the baby 5. How to be a good parent

Correct Answer: 2,4,5 Rationale 1: Sexuality in pregnancy would not be a priority. Rationale 2: Areas of concern for teens include how to care for the new baby. Rationale 3: Birth settings are not a priority. Rationale 4: Areas of concern for teens include health dangers to the baby. Rationale 5: Areas of concern for teens include how to be a good parent.

An expectant mother from a South Asian culture arrives 20 minutes late for her appointment. Which response by the nurse would be the best way for the nurse to address the client's tardiness? A) "I understand that Americans have a different understanding of time than other cultures; but it is important to be on time so that the provider can be available to see you." B) "You're late. Do you have any idea how rude that is here in the United States?" C) "The physician is no longer available. Please come back next week and be on time." D) "So glad to see you! Please come right in and we'll begin your examination."

A) "I understand that Americans have a different understanding of time than other cultures; but it is important to be on time so that the provider can be available to see you." In some South Asian cultures, the use of time contrasts greatly and being late for appointments is a sign of respect (giving the person you are meeting time to organize and be prepared for your arrival). The best response is for the nurse to acknowledge cultural differences in a respectful manner but to inform the client of the need to be on time in the future. Explaining how lateness is rude in the U.S. shows some cultural awareness but is impatient and lacking in understanding. Not addressing the tardiness at all does not help the client become aware of the importance of showing up on time for future appointments. Telling the client to come back next week does not show cultural awareness.

A woman of Asian descent is in the second stage of labor, 8 cm dilated and 90% effaced. She keeps very quiet without expressing any outward signs of pain. Which intervention by the nurse would be most appropriate in this situation? A) Allow the woman to labor according to her cultural beliefs. B) Review the nursing goal to minimize the amount of pain with birth. C) Administer pain medication without asking the woman. D) Monitor the woman to attempt to predict when it is time to push.

A) Allow the woman to labor according to her cultural beliefs. The way people respond to pain is an example of a trait that is heavily influenced by culture. Some women and children scream with pain; others remain stoic and quiet. Both are "proper" responses, just culturally different. The best nursing intervention is to allow the woman to labor the way that is best for her. Administering pain medication without permission is unacceptable nursing practice. The nurse will have to assess the woman frequently, especially noting if any blood is coming from the vagina and performing frequent vaginal exams to know when it is time to push. "A close watch" could mean just looking into the room frequently. In the Asian culture, being stoic is expected behavior, so minimizing the pain may not be the goal of the woman.

What are examples of culturally sensitive care? Select all that apply. A) Providing a Middle Eastern woman an extra gown for covering up. B) Advocating for a postpartum client to stay in the hospital an extra day to rest. C) Nodding hello instead of shaking hands with an Orthodox Jewish male. D) Providing discharge instructions in Spanish to a Hispanic patient who speaks in broken English.

A) Providing a Middle Eastern woman an extra gown for covering up C) Nodding hello instead of shaking hands with an Orthodox Jewish male. D) Providing discharge instructions in Spanish to a Hispanic patient who speaks in broken English. Advocating for a client who needs rest and providing family-centered care are great nursing skills. However, these skills are not culturally specific and are relevant to all clients. Awareness of clients' cultural differences such as the preference of an Orthodox Jewish man who does not want to shake hands or of a Muslim American woman who desires extra modesty, and providing instructions in the language that is most comfortable for the client are examples of culturally sensitive care.

When caring for woman who speaks a different language than one's own, the nurse must ask for an interpreter before having the client sign which forms to ensure clarity can be confirmed? Select all that apply. A) end-of-life care B) consent to blood transfusions C) smoking cessation policy D) surgical permit E) dietary preferences

A) end-of-life care B) consent to blood transfusions D) surgical permit When caring for clients who speak a different dialect or language, the nurse should always ask them to repeat instruction to be certain it was interpreted correctly. The nurse should repeat what the client said so he or she can confirm understanding the nurse correctly. The nurse should not be reluctant to ask for an interpreter to help clarify forms, such as consent for blood transfusion, informed consent for surgery, or wishes regarding right-to-life care, as necessary. Dietary preferences and smoking cessation policy are not as important as the other forms that result in invasive procedures.

A 19-year-old pregnant adolescent who experienced a rape has arrive in the emergency department in active labor with no prenatal care. The nurse caring for the client should assess for which potential adverse health problem? A) sexually transmitted infections (STIs) B) hypertension caused by preeclampsia C) alcohol withdraw symptoms D) gestational diabetes

A) sexually transmitted infections (STIs) Any pregnant female who arrives in the emergency department without any prenatal care may be at increased risk for adverse health conditions, which may include STIs. It is rare for a younger client to develop gestational diabetes or preeclampsia. There is no indication that the client was intoxicated and at risk for alcohol withdraw.

A laboring woman has brought her partner as her support person who is dressed in feminine attire, but when she speaks, it is clear to the nurse that the support person has a male voice. When documenting about the client's support person, which term would be most appropriate? A) transgender B) male who likes to dress like a woman C) gender dysphoria D) drag queen

A) transgender A transgender person is an individual whose gender identity does not match the sex assigned at birth. Gender dysphoria is the realization one's physical sex and gender are mismatched, which can cause a lot of stress and anxiety. There is no data that supports the partner is experiencing anxiety. Drag queen is a slang, inappropriate term. The term "male who likes to dress like a woman" is making a judgment statement and not appropriate in a medical document.

Which is an example of culturally competent care? A) A nurse who explains to a Thai-American client the dangers of the additive MSG B) A nurse who arranges for a family's espiritualisto to visit a Hispanic pediatric client C) A nurse who arranges for a private room for a family friend D) A nurse who explains to an obese Polish American the importance of diet and exercise

B) A nurse who arranges for a family's espiritualisto to visit a Hispanic pediatric client An espiritualisto is typically a person in the Hispanic community who believes that he or she can treat illness supernaturally. As long as it does not interfere with care, having an espiritualisto visit a client in the hospital would be an example of providing culturally competent care.

The nurse caring for a woman in active labor notices a strange odor coming from some tea the family has brought. When questioned, the woman informs the nurse of herbs they have brewed in the tea to help lower the pain. Which intervention would be considered the most appropriate for the nurse to take? A) Suggest the woman rely solely on herbal prep rather than conventional medications. B) Research the herbs in the tea and report the findings to the provider. C) Inform the family that herbs and conventional drugs are not compatible. D) Ask the family to remove the tea from the L & D department.

B) Research the herbs in the tea and report the findings to the provider. The nurse should 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. Asking the family to remove the tea from the facility is nontherapeutic. Telling the woman that she will have to rely on their herbal prep solely is not true unless the herbs are contradicted with conventional medicines. Unless research is done, making a blank statement that herbs and medications are incompatible is untrue.

A nurse is uncomfortable caring for a pregnant client who is married to her female life partner. The best advice another nurse can give her would include which statement? A) "Maybe you should take another nursing course that focuses on cultural competencies; then you might have a better feeling caring for this family." B) "Maybe it would be best if you don't care for this group of families and focus on caring for the classic husband and wife team." C) "Spend some time self-reflecting why this family difference might be bothering you." D) "If you can just put on your happy face and focus on the baby rather than the parents, you will be able to care for all families."

C) "Spend some time self-reflecting why this family difference might be bothering you." There are some major barriers for health care providers when caring for individuals who are different from them. One of these barriers is the potential for personal bias. This barrier can only be addressed through self-reflection, trying to understand why these differences might be bothersome, and setting those feelings aside while taking care of clients. A cultural nursing course might be beneficial, but it will not help in the meantime. Pretending to be okay with the family differences will not deal with the problem. Ignoring feelings by working only with traditional family units will not solve the problem in the long term.

During a breastfeeding class, the nurse discusses ways to include the father in the breastfeeding process. The nurse knows further teaching is necessary when a prospective father states: 1. "I can feed the baby a bottle of formula." 2. "I can burp the baby between breasts." 3. "I can rock the baby to sleep after breastfeeding." 4. "When the baby wakes up, I can bring the baby to her mother."

Correct Answer: 1 Rationale 1: Feeding the baby a bottle is not an option. Breastfeeding has to be established. Rationale 2: Including the father in the breastfeeding process involves burping the baby between breasts and/or after feeding. Rationale 3: Including the father in the breastfeeding process involves rocking the baby back to sleep. Rationale 4: Including the father in the breastfeeding process involves bringing the baby to the mother for feedings.

The nurse is admitting a Mexican woman scheduled for a cholecystectomy. The nurse uses a cultural assessment tool during the admission. Which question would be most important for the nurse to ask? 1. "What other treatments have you used for your abdominal pain?" 2. "In what country were you were born?" 3. "When you talk to family members, how close do you stand?" 4. "How would you describe your role within your family?"

Correct Answer: 1 Rationale 1: Knowing what other treatments the patient has used for pain is most important because some traditional or folk remedies include the use of herbs, which can have medication interactions. Rationale 2: Although this information is helpful, it is not a physiological issue. Asking other questions is a higher priority. Rationale 3: Although understanding the client's perception of appropriate personal space is helpful, it is not a physiological issue. Asking other questions is a higher priority. Rationale 4: Although understanding the client's family roles is helpful, it is not a physiological issue. Asking other questions is a higher priority.

When planning care of childbearing families, the nurse encounters different spiritual and religious beliefs and practices. Which spiritual practice could impact the nurse's care of the childbearing family? 1. A strong belief in reincarnation, and thus refusal of an autopsy 2. The desire to light candles at home during a naming ceremony 3. Request by the family to speak to a Roman Catholic priest 4. Refusing consent for a blood transfusion by a Jehovah's Witness

Correct Answer: 1 Rationale 1: Spirituality relates to issues of the soul or spirit. Many people believe that the body will be reincarnated after death, and that procedures like autopsy and organ donation or transplantation will affect the form of the reincarnated body. Thus the nurse must assess the family's preferences and not assume that an autopsy will be performed. Rationale 2: Candles are often used in religious and spiritual ceremonies. Only if the family wished to light candles in the hospital would nursing care be affected. Rationale 3: Roman Catholicism is a formal religion, not a spiritual belief. If a patient desires to speak to a priest, there might be a hospital chaplain that is one, or their own parish can be called. Rationale 4: Jehovah's Witnesses comprise a formal religion, not a spiritual or religious belief. As part of their religion, they do not believe in blood transfusions.

The nurse is caring for a family in the community with a 2-month-old infant who is breastfed. The father helps by changing diapers and dressing and bathing the baby. The mother will return to work when the baby is 3 months old, and a child care provider has been arranged. Although the mother occasionally feels fatigued, the couple has resumed having sexual relations, although not as frequently as before the pregnancy. Which family model best describes this family? 1. Model of the Childbearing Family 2. Model Incorporating the Unattached Young Adult 3. Model of the Nuclear Family 4. Model Incorporating Divorce and Remarriage

Correct Answer: 1 Rationale 1: The Model of the Childbearing Family describes the transitions that the family undertakes in their home and their lives with the birth of the first child. The nurse's role is to assist the family in identifying possible safety issues, facilitating communication among family members, and identifying interventions that can assist in meeting the emotional and physical needs of caring for a newborn.

A laboring patient of Chinese descent has been very quiet during labor, and has made no noise during contractions during the past 4 hours. The nurse understands that this indicates that the client: 1. Believes pain should be endured and not expressed. 2. Is not in the active phase of labor yet. 3. Will not need pain medication during her hospitalization. 4. Has been abused by her husband, and is afraid to verbalize fear.

Correct Answer: 1 Rationale 1: The belief that pain should be endured and not expressed is a common traditional Chinese belief. Rationale 2: In this case, the nurse must assess for the progression of labor in other ways. Rationale 3: The nurse cannot make the assumption that no pain relief medication will be needed either during the labor and birth or the postpartum period. Rationale 4: This patient's silence does not necessarily indicate domestic abuse.

The nurse is teaching a class to prenatal patients about the benefits of a doula. Which statement by a patient demonstrates the need for further teaching? 1. "The doula will deliver the baby." 2. "The doula will assist with the birth." 3. "The doula will provide guidance and encouragement." 4. "The doula will attend to my comfort needs."

Correct Answer: 1 Rationale 1: The doula is trained to assist with births, but she does not deliver the baby. Rationale 2: The doula is trained to assist with births, but she does not deliver the baby. Rationale 3: The doula offers guidance and encouragement, and attends to the many comfort needs of the laboring mother and her family. Rationale 4: The doula offers guidance and encouragement, and attends to the many comfort needs of the laboring mother and her family.

The nurse is discussing with a childbirth class the different techniques of breathing exercises available. Regardless of the method of childbirth preparation, most childbirth classes: 1. Present ways of alleviating fear. 2. Teach imagery for relaxation. 3. Use patterned, paced breathing techniques. 4. Present the benefits of epidural anesthesia

Correct Answer: 1 Rationale 1: The overall goal of prenatal classes is to decrease fear through increasing knowledge and teaching participants skills to help cope with labor. These skills include various relaxation methods and breathing techniques. Rationale 2: Not all classes teach imagery. Rationale 3: Not all classes use patterned, paced breathing. Rationale 4: Many couples will be able to avoid an epidural by using the techniques they learned in classes.

The nurse in the obstetrical clinic is setting appointments for patients seeking preconceptual care. Which patient should be seen first? 1. 36-year-old, has never been pregnant, takes medication for a seizure disorder. 2. 15-year-old, smokes one pack per day, had a miscarriage 4 months ago. 3. 22-year-old, runs long distances, has been on the pill for 6 years. 4. 29-year-old, has had two abortions, takes a multiple-vitamin supplement

Correct Answer: 1 Rationale 1: This patient is the top priority because she has multiple risk factors: She is over the age of 35 and therefore is at risk for trisomies; she takes medication, and some medications are teratogenic and contraindicated during pregnancy; and pregnancy is not recommended for women with some conditions. This patient needs to see the specialist who prescribes her antiseizure medication, as well as an obstetric provider, to discuss the risks her age presents to a possible pregnancy. Rationale 2: Although this patient has the risks of being young and a smoker, she is not the highest-priority patient. Rationale 3: The only risk factor this patient has is a need to increase folic acid intake due to being on the pill for six years. She is not the highest-priority patient. Rationale 4: This patient has no risk factors for pregnancy. A history of more than three abortions increases the risks of preterm labor and infertility, but this patient has only had two abortions. She is not the highest-priority patient.

The nurse is completing an assessment for a prenatal visit. Which statement indicates that further teaching is necessary? 1. "Because I'm in my third trimester, I should return to the clinic in a month." 2. "Now that I've felt fetal movement, I should feel movement regularly." 3. "Before I take any over-the-counter medications, I should contact my doctor." 4. "Alcohol is possibly harmful to my baby, even at the end of my pregnancy."

Correct Answer: 1 Rationale 1: This statement is incorrect because prenatal visits during the third trimester are every 2 weeks from 26 to 36 weeks, and every week from 36 weeks to delivery. Rationale 2: This is a true statement. Once fetal movement is perceived, it should be felt regularly. Initially, this might not be every day, but in the third trimester, fetal movement should be noticeable several times per day. Rationale 3: This is a true statement. Regardless of the gestational age, over-the-counter medications can have deleterious effects on mom or baby; thus it is important for a pregnant woman to consult her provider prior to taking any over-the-counter medications throughout the pregnancy. Rationale 4: This is a true statement. Alcohol should be avoided throughout pregnancy and lactation.

A nurse conducts a class on relaxation exercises. Which couple are demonstrating the appropriate technique for touch relaxation? 1. The expectant mother relaxes her muscles in response to her partner's touch. 2. The expectant mother relaxes one muscle group at a time as her partner observes. 3. The expectant mother and her partner perform light abdominal stroking. 4. The expectant mother relaxes the rest of her body while tensing a specific muscle under the direction of her partner.

Correct Answer: 1 Rationale 1: Touch relaxation increases cooperation and teamwork between the woman and her coach during labor. Rationale 2: Progressive relaxation relaxes one muscle group at a time. Rationale 3: Effleurage involves performing light abdominal stroking. Rationale 4: Disassociation relaxation involves relaxing the rest of the body while tensing a specific muscle group.

The pregnant patient reports to the nurse that she is eating dirt on a weekly basis and was told to do this by her grandmother to have a healthy pregnancy. How should the nurse respond? 1. "The soil might contain contaminants that could harm your baby." 2. "This practice is completely unhealthy and should be stopped." 3. "Your grandmother gave you bad advice. Stop at once." 4. "There is no problem with this practice. Feel free to continue."

Correct Answer: 1 Rationale 1: It is a common practice for African Americans, especially those with familial roots in the South, to eat a specific type of clay dirt during pregnancy. However, the soil could have bacterial, viral, or chemical contaminants, and this practice should be discouraged to prevent maternal or fetal harm. Therapeutic communication requires explaining the rationale for not eating dirt, not just telling the client to stop. Rationale 2: Therapeutic communication must be used at all times with clients. The nurse should not just tell a client to stop but should provide more information. Rationale 3: Therapeutic communication must be used at all times with clients; thus the nurse should not simply tell a client that familial advice or practices are bad. Rationale 4: The soil could have bacterial, viral, or chemical contaminants, and this practice should be discouraged to prevent maternal or fetal harm.

Why is it important for the nurse to understand the type of family that a client comes from? Select all that apply. Standard Text: Select all that apply. 1. Family structure can influence finances and the ability to purchase nutritious foods. 2. Many types of families exist, and it is important to address the persons who hold power within the family. 3. The nurse can anticipate which problems a client will experience based on the type of family the client has. 4. Understanding if the client's family is nuclear or blended will help the nurse teach the client the appropriate information. 5. The values of the family will be predictable if the nurse knows what type of family the client is a part of.

Correct Answer: 1,2 Rationale 1: Dual-career/dual-earner families tend to have more stable finances, while single-parent families tend to have lower incomes. Nutrition impacts fetal growth and development, and nutritious foods tend to be more costly than nutrient-poor or junk food. Thus understanding the type of family can help the nurse determine the best education for the client. Rationale 2: Understanding the family power is important so that the nurse will address the appropriate person(s). This will facilitate effective communication, as the nurse will be perceived as respectful of the family. Rationale 3: Each client and family must be assessed as individuals, without making assumptions. Although generalities can be drawn based on the type of family that a client comes from or currently is part of, stereotypes must be avoided. Rationale 4: Each client and family must be assessed as individuals, without making assumptions. Although generalities can be drawn based on the type of family that a client comes from or currently is part of, stereotypes must be avoided. Rationale 5: Each client and family must be assessed as individuals, without making assumptions. Although generalities can be drawn based on the type of family that a client comes from or currently is part of, stereotypes must be avoided.

In assessing a family, the community nurse uses a family assessment tool, which provides an organized framework to collect data concerning: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. Access to laundry, and grocery facilities. 2. Access to health care. 3. Sharing of religious beliefs and values. 4. Acculturation to traditional lifestyles. 5. Ability to include a new spouse into the family unit.

Correct Answer: 1,2,3 Rationale 1: Access to laundry, grocery, and recreational facilities is a means of meeting the physical, emotional, and spiritual needs of members. Rationale 2: Access to health care is a means of meeting the physical, emotional, and spiritual needs of members. Rationale 3: Sharing of religious beliefs and values is a means of meeting the physical, emotional, and spiritual needs of members. Rationale 4: Acculturation to traditional lifestyles is not a part of the family assessment tool. Rationale 5: Ability to include a new spouse into the family unit is a developmental task/stage of those who are divorced, and is not a part of the family assessment tool.

During the assessment phase of a family, the community nurse recognizes that culture influences childrearing and childbearing in the: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. Beliefs about the importance of children. 2. Beliefs and attitudes about pregnancy. 3. Norms regarding infant feeding. 4. Acculturation is important in rearing children. 5. Time orientation to the future is very important.

Correct Answer: 1,2,3 Rationale 1: Culture influences beliefs about the importance of children. Rationale 2: Culture influences attitudes about pregnancy and the right vs. the obligation of women to bear children. Rationale 3: Culture influences infant feeding norms and practices. Rationale 4: Acculturation is not important in rearing children. Rationale 5: Time orientation is a cultural difference and can emphasize the past, present, or future. It does not influence childbearing and childrearing.

The OB-GYN nurse is evaluating patient satisfaction with her childbirth experience. The nurse looks at whether the nursing care included: Select all that apply. 1. Establishment of good rapport. 2. Involvement of the patient in decisions. 3. Provision of support to the patient. 4. Visitors' not being allowed in the labor room. 5. Keeping the patient bed-bound through labor.

Correct Answer: 1,2,3 Rationale 1: Establishing rapport with the patient and her support systems is important in providing a satisfying childbirth experience. Rationale 2: Involving the patient and her partner in the decision-making process is important in increasing satisfaction. Rationale 3: The patient requires support not only from the nurse, but also from family or a doula. Rationale 4: The patient needs to have family and/or friends with her during labor. The patient will limit visitors if needed. Rationale 5: The patient needs to be allowed to walk, use the rocking chair, sit in a hot tub, etc., if she desires.

The nurse will assess numerous health practices during patient pregnancies. Some practices include the: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. Prevalence of home remedies. 2. Importance of indigenous healers. 3. Influence of professional healthcare workers. 4. Addition of food to the formula at 2 weeks of age. 5. Wife's deferral to the spouse for decision making.

Correct Answer: 1,2,3 Rationale 1: Health practices during pregnancy are influenced by numerous factors, such as the prevalence of traditional home remedies and folk beliefs, the importance of indigenous healers, and the influence of professional healthcare workers. Rationale 2: Health practices during pregnancy are influenced by numerous factors, such as the prevalence of traditional home remedies and folk beliefs, the importance of indigenous healers, and the influence of professional healthcare workers. Rationale 3: Health practices during pregnancy are influenced by numerous factors, such as the prevalence of traditional home remedies and folk beliefs, the importance of indigenous healers, and the influence of professional healthcare workers. Rationale 4: The addition of food to formula at an early age is a cultural norm regarding infant feeding norms. Rationale 5: This applies to cultural diversity and not health practices during pregnancy.

In working with immigrants in an inner-city setting, the nurse recognizes that acculturation of immigrants often brings with it the benefit of: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. Improved socioeconomic status. 2. Use of preventive care services. 3. Increased job-related stressors. 4. Increase in substance abuse over time. 5. More physician visits due to language barriers.

Correct Answer: 1,2,3 Rationale 1: Improvement of socioeconomic status is a benefit of acculturation in the United States. Rationale 2: Acculturation of immigrants increases the likelihood that the family members will use preventive health services. Rationale 3: Job-related stressors increase as the immigrant acculturates, and this is detrimental to health. Rationale 4: Substance abuse tends to increase over time as immigrants acculturate, especially among Hispanics. Rationale 5: Language barriers with physicians tend to decrease the use of healthcare services.

The nurse is planning a prenatal class for adolescents. It is important that the class includes: Select all that apply. 1. Time to verbalize fears. 2. Only adolescent participants. 3. Provision of a support system. 4. Infant-stimulation concepts. 5. The Bradley philosophy of birthing.

Correct Answer: 1,2,3 Rationale 1: Prenatal education classes specifically designed for teens can provide a forum for verbalization of fears and concerns. Rationale 2: Many teenagers might feel that they might not receive privacy, respect, and acceptance in a standard adult-centered childbirth class. Rationale 3: Often, teenage mothers face pregnancy and childbirth without adequate support from a partner or parents. The teens-only class will provide this support. Rationale 4: Infant stimulation is not a goal of the prenatal education for teens. Rationale 5: All of the birthing methods should be presented to the adolescents during the prenatal education.

The public health nurse is working with a student nurse. The student nurse asks which of the six groups of people they have seen today are considered to be families. The nurse responds: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The married heterosexual couple without children." 2. "The gay couple with two adopted children." 3. "The unmarried heterosexual couple with two biological children." 4. "The lesbian couple not living together that have no children." 5. "The married heterosexual couple with three children, living with grandparents."

Correct Answer: 1,2,3,5 Rationale 1: Families take many forms in today's society. The basis for people to be considered a family is a commitment to one another and the sharing of responsibilities, chores, and expenses. A couple without children are still a family. Rationale 2: Families take many forms in today's society. The basis for people to be considered a family is a commitment to one another and the sharing of responsibilities, chores, and expenses. Gay and lesbian families are those in which two or more people who share a same-sex orientation live together, or in which a gay or lesbian single parent rears a child. Rationale 3: Families take many forms in today's society. The basis for people to be considered a family is a commitment to one another and the sharing of responsibilities, chores, and expenses. A family may be formed without a legal marriage. Rationale 4: A couple not living together and without children together are considered dating and not yet a family. Rationale 5: Families take many forms in today's society. The basis for people to be considered a family is a commitment to one another and the sharing of responsibilities, chores, and expenses. Extended family members, including parents or grandparents, will often live with their adult children or grandchildren, creating intergenerational families.

When working with families entering the childbearing years, the nurse knows that teaching will be needed regarding the challenges of: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. Meeting the emotional needs of a newborn. 2. Exploring the couple's feelings about role transition. 3. Accessing resources in the community. 4. Raising the infant in formal traditions of the grandparents. 5. Exploring ways of dealing with family conflict.

Correct Answer: 1,2,3,5 Rationale 1: The nurse can offer guidance to the couple as they transition into parenthood by identifying interventions that can assist in meeting the emotional and physical needs of caring for a newborn. Rationale 2: The nurse can provide support by actively listening as the couple express feelings related to current role transitions and changes in personal and family relationships.. Rationale 3: Resources can be provided to the new parents that will enable them to establish new relationships within their community. Rationale 4: Both sets of grandparents might have strong beliefs about childrearing, and might attempt to promote their own beliefs and rituals, but the couple might wish to develop new traditions and rituals within their own family unit. Rationale 5: Couples must effectively communicate with each other and other family members to avoid conflict

In counseling a pregnant patient about the main differences in birthing preparation methods, the nurse discusses: Select all that apply. 1. Theories as to why they work. 2. Relaxation techniques used. 3. Need for analgesia during labor. 4. Breathing patterns taught. 5. Importance of breastfeeding.

Correct Answer: 1,2,4 Rationale 1: One difference in the methods of birthing preparation lies in the theories of why they work. Rationale 2: One difference in the methods of birthing preparation lies in the relaxation techniques they teach. Rationale 3: The need for analgesia is not a difference between the different birthing preparation methods. Rationale 4: One difference in the methods of birthing preparation lies in the breathing patterns they teach.

In learning about Duvall's life-cycle stages ascribed to traditional families, the nursing student recognizes that developmental tasks of each stage include: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. Adjusting to new roles as mother and father. 2. Working out authority and socialization roles with the school. 3. Becoming a single parent with custodial responsibilities. 4. Becoming a couple and dating. 5. Adjusting to the loss of a spouse.

Correct Answer: 1,2,5 Rationale 1: Adjusting to new roles as mother and father occurs in Stage II, which describes childbearing families with infants. Rationale 2: Working out authority and socialization roles with schools occurs in Stage IV, which describes families with school-age children. Rationale 3: Traditional family life-cycle stages do not include those in which divorce occurs. Rationale 4: Becoming a couple and dating occurs before marriage, and is not a part of the traditional family life-cycle stages. Rationale 5: Stage VIII includes adjusting to the loss of a spouse.

In assessing a new family coming to the clinic, the nurse determines they are an extended kin family. Extended kin network family characteristics include: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. A sharing of a social support network. 2. The sharing of goods and services. 3. Elderly parents share housing. 4. Children are members of two nuclear families. 5. Living in a Latino community.

Correct Answer: 1,2,5 Rationale 1: Extended kin family networks share a social support network. Rationale 2: Extended kin family networks share goods and services. Rationale 3: Elderly parents sharing a household is a feature of the extended family system. Rationale 4: Children being members of two nuclear families applies to the binuclear family. Rationale 5: This type of family model is common in the Latino community.

The nurse teaching a group of students about trends that have affected the contemporary family includes: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. An increase in the median age at the time of marriage. 2. A higher percentage of marriages ending in divorce. 3. A decline in childless families. 4. Traditional nuclear families remaining the norm. 5. An increased acceptance of single women having children.

Correct Answer: 1,2,5 Rationale 1: Men are now a median age of 27.7 years and women are a median age of 26 when they first marry. These are increases over 1990 statistics. Rationale 2: There is a higher number of marriages that end in divorce, and this trend influences the makeup and function of the contemporary family. Rationale 3: The number of childless and child-free families has increased. Rationale 4: The traditional nuclear family is no longer the norm in the United States. Rationale 5: The traditional nuclear family is no longer the norm in the United States.

The prenatal nurse is teaching a group of women about preconception health measures. Topics the nurse includes are: Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Smoking. 2. Caffeine. 3. Limiting folic acid. 4. Increasing dietary fat. 5. Use of prescription drugs.

Correct Answer: 1,2,5 Rationale 1: Not smoking-or at least limiting cigarette intake-is an important aspect of prenatal counseling. Rationale 2: As a precaution, women are advised to avoid caffeine or limit the intake. Rationale 3: Folic acid is a necessary prenatal vitamin to decrease the risk of a baby with a neural tube defect. Rationale 4: A balanced diet is needed before, during, and after a pregnancy. Increasing dietary fat is not recommended. Rationale 5: Some prescription drugs can cause damage to the developing fetus. This needs to be discussed with the healthcare provider.

During a prenatal class, the nurse teaches patients about breathing techniques. The nurse explains the goals of breathing are Select all that apply. 1. Increase physical and mental relaxation. 2. Decrease the efficient use of muscles. 3. Provide a sense of control during labor. 4. Provide a means of focusing atttention. 5. Control adequate breathing patterns

Correct Answer: 1,3,4 Rationale 1: A goal of breathing techniques is to increase physical and mental relaxation. Rationale 2: A goal of breathing techniques is to increase the efficient use of muscles, not decrease it. Rationale 3: A goal of breathing techniques is to provide a sense of control for the mother. Rationale 4: A goal of breathing techniques is to provide a means of focusing attention. Rationale 5: A goal of breathing techniques is to provide control for inadequate breathing patterns during labor.

A couple is allowing electronic monitoring to be applied during labor. After the nurse applies the equipment, risks for which the nurse should assess include: Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Supine postural hypotension. 2. Cord prolapse with ruptured membranes. 3. Monitoring the machine, not the patient. 4. Intrauterine perforation. 5. Slowing of contractions in active labor.

Correct Answer: 1,3,4 Rationale 1: Supine postural hypotension is a risk of electronic fetal monitoring. Rationale 2: Use of electronic fetal monitoring does not cause cord prolapse with ruptured membranes. Rationale 3: Use of electronic fetal monitoring decreases personal interaction with mother because of attention paid to the machine. Rationale 4: Intrauterine perforation is a risk of electronic fetal monitoring when an internal uterine pressure device is used. Rationale 5: Use of electronic fetal monitoring does not cause the slowing of contractions in active labor.

The nurse manager in a hospital with a large immigrant population is planning an in-service. Aware of how ethnocentrism affects nursing care, the nurse manager includes the statement, "The belief that one's own values and beliefs are the only or the best values: 1. "Means that newcomers to the United States should adopt the norms and values of the country." 2. "Can create barriers to communication through misunderstanding." 3. "Leads to an expectation that all clients will exhibit pain the same way." 4. "Improves the quality of care provided to culturally diverse patient bases."

Correct Answer: 2 Rationale 1: Although acculturation involves adoption of some of the majority culture's practices and beliefs, each cultural group will continue to hold and express its own set of values and beliefs. Rationale 2: When the nurse assumes that a client has the same values and beliefs as the nurse, misunderstanding will frequently occur, which in turn can negatively impact nurse-client communication. Rationale 3: Expression of pain is one area that varies greatly from one culture to another. Rationale 4: The belief that one's own values and beliefs are the best will not improve the quality of care provided to culturally diverse patient bases.

The nurse is working with a patient whose religious beliefs differ from those of the general population. The best nursing intervention to use to meet the specific spiritual needs of this family is to: 1. Ask how important the patient's religious and spiritual beliefs are when making decisions about health care. 2. Show respect while allowing time and privacy for religious rituals. 3. Ask for the patient's opinion on what caused the illness. 4. Identify healthcare practices forbidden by religious or spiritual beliefs.

Correct Answer: 2 Rationale 1: Considering the impact of religious and spiritual beliefs might be part of the spiritual assessment process but is not an intervention. Rationale 2: Showing respect while allowing time and privacy for religious rituals is a culturally sensitive intervention. Rationale 3: Asking what caused the patient's illness is not an intervention, and does nothing to meet the spiritual needs specific to the family. Rationale 4: Identifying what health practices might be forbidden by the family's beliefs might be part of the spiritual assessment process but is not an intervention.

The nurse is discussing with a couple their concerns about delivering vaginally after having a cesarean birth. Parents planning on a vaginal birth after a cesarean birth (VBAC) should prepare: 1. Exclusively for a vaginal delivery. 2. Two birth plans: one for vaginal and one for cesarean. 3. For a long labor. 4. For a short labor.

Correct Answer: 2 Rationale 1: Preparing exclusively for a vaginal delivery will decrease a parent's sense of control over the birth experience if a cesarean needs to be performed. Rationale 2: In the care of vaginal birth after cesarean birth (VBAC), two birth plans should be prepared: one for vaginal delivery and one for cesarean birth. Rationale 3: The length of labor (short or long) cannot be determined for a VBAC delivery. Rationale 4: The length of labor (short or long) cannot be determined for a VBAC delivery.

A patient states that she is not interested in Lamaze classes because she is single and does not want to have natural childbirth. The nurse's best response would be: 1. "Lamaze classes promise painless childbirth. If you learn their methods, your pain is minimal." 2. "Lamaze classes can teach you relaxation methods and also the benefits and risks of pain-relief methods. This assists you in making the best decision for you." 3. "You are very nervous. I think these classes would be best for you." 4. "Lamaze classes are geared toward couples. You might want to find a different class."

Correct Answer: 2 Rationale 1: Stating that Lamaze classes promise painless childbirth is providing false information. Rationale 2: Lamaze teaches relaxation methods by utilizing patterned breathing. Those who are able to use the method require little if any anesthesia during delivery. Rationale 3: This is an inappropriate response. Rationale 4: This is an inappropriate response

A woman of Korean descent has just given birth to a son. Her partner wishes to give her sips of hot broth from a thermos he brought from home. The patient has refused the nurse's offer of ice chips or other cold drinks. The nurse should: 1. Explain to the client that she can have the broth if she will also drink cold water or juice. 2. Encourage the partner to feed the client sips of broth and ask whether the patient would like you to bring her some warm water to drink as well. 3. Explain to the couple that food cannot be brought from home, but that the nurse will make hot broth for the client. 4. Encourage the client to have the broth, but explain that it must be boiled first in the kitchen.

Correct Answer: 2 Rationale 1: Telling the client that she can have broth if she will drink cold water or juice first does not show cultural sensitivity and does not respect the client's beliefs. Rationale 2: Encouraging the partner to feed the client sips of broth and asking whether the client would like you to bring her some warm water to drink as well is an approach that shows cultural sensitivity. The equilibrium model of health, based on the concept of balance between light and dark, heat and cold, is the foundation for this belief and practice. Rationale 3: Telling the couple that the hospital does not allow food brought from home is inaccurate and insensitive to cultural beliefs. Rationale 4: Boiling the broth would make the broth too hot to drink, and is unnecessary.

A nurse is performing an assessment on a family with a father and mother who both work. What type of family does she record this family as being? 1. A traditional nuclear family 2. A dual-career/dual-earner family 3. An extended family 4. An extended kin family

Correct Answer: 2 Rationale 1: The traditional nuclear family is defined as a husband provider, a wife who stays home, and children. Rationale 2: A dual-career/dual-earner family is characterized by both parents working, by choice or necessity. Rationale 3: An extended family is defined as a couple who share household and childrearing responsibilities with parents, siblings, or other relatives. Rationale 4: An extended kin family is a specific form of an extended family in which two nuclear families of primary or unmarried kin live in close proximity to each other.

The nurse assesses her patient and finds her to have mild anxiety concerning the birth process. The patient states that she is not interested in attending classes because her husband does not want to participate. The nurse's best response would be: 1. "Your best choice is to be sedated and let the team do the work." 2. "Birthing classes of all types can help eliminate fear and teach coping techniques." 3. "You are very nervous. I think these classes would be best for you." 4. "Most classes are geared toward couples. Since your husband doesn't want to take them, these classes won't benefit you."

Correct Answer: 2 Rationale 1: This is an inappropriate statement, and does not inform the patient of choices available to her. Rationale 2: All programs in prepared childbirth have an educational component to help eliminate fear and teach coping mechanisms. The classes vary in coverage of subjects related to the maternity cycle, but all teach relaxation techniques and all prepare the participants for what to expect during labor and birth. Rationale 3: Being nervous is not a reason to take the class. It would be better to encourage the patient to take the class so she will be knowledgeable on the birth experience and because it could reduce any anxiety she might have about the experience. Rationale 4: Childbirth classes are geared toward teaching about relaxation techniques and preparing participants on what to expect. Single parents and non-couple participants often take the classes.

In addition to breathing with contractions, what action will the nurse instruct a woman in labor to do during the first stage of labor? 1. Lie in the lithotomy position. 2. Perform effleurage. 3. Practice Kegel exercises. 4. Push with each contraction.

Correct Answer: 2 Rationale 1: This position is not supportive of labor and birth. Rationale 2: Effleurage is light massage that can soothe the mother during labor. Rationale 3: Kegel exercises will not help the mother work with her labor. Rationale 4: Pushing is not done during the first stage of labor.

While teaching a preconception class, the nurse should include which recommendation to decrease the risk of neural tube defects? 1. 500 mg vitamin C every day 2. 0.4 mg folate every day 3. 1500 mg calcium every day 4. 400 IUs vitamin A daily

Correct Answer: 2 Rationale 1: Vitamin C does not have anything to do with development of neural tube defects. Rationale 2: Folic acid supplementation prior to conception is recommended, since this decreases the risk of neural tube defects. Rationale 3: Calcium does nor decrease the risk of neural tube defects. Rationale 4: Vitamin A does not decrease the risk of neural tube defects.

A nurse is working in a clinic where people from several cultures are seen. As a first step toward the goal of personal cultural competence, the nurse will: 1. Enhance cultural skills. 2. Gain cultural awareness. 3. Seek cultural encounters. 4. Acquire cultural knowledge.

Correct Answer: 2 Rationale 1: Ways to enhance cultural skill include learning a prevalent language and learning how to recognize health-manifesting skin color variations in different races. Rationale 2: One begins by gaining cultural awareness or by gaining an effective and cognitive self-awareness of personal worldview biases, beliefs, etc. Rationale 3: During daily interactions with clients from diverse backgrounds, these cultural encounters allow the nurse to appreciate the uniqueness of individuals from varying backgrounds. Rationale 4: Another early step, although not the first step, is acquiring cultural knowledge, and includes studying information about the beliefs, biological variations, and favored treatments of specific cultural groups.

Which questions are appropriate for the nurse to ask during a cultural assessment of a patient new to the clinic? Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. What genetic and other biological differences affect caregiving? 2. Which family member must be consulted for decisions about care? 3. What type of health provider is the most appropriate? 4. Does the patient have beliefs or traditions that might impact the care plan? 5. Are communications patterns established?

Correct Answer: 2,3,4 Rationale 1: Genetic and biological differences are health concerns such as hypertension that the nurse must keep in mind, but not a question. Rationale 2: It is important the nurse recognize cultural differences in regard to which family member must be consulted for decisions about care. Rationale 3: Some cultures do not allow a person of the opposite gender to touch the patient. Cultural sensitivity will recognize and allow for this. Rationale 4: The nurse must be aware of traditions and beliefs that might impact the care plan. Rationale 5: Communication patterns will have been established. The nurse must be able to communicate with the patient, using the patterns of communication the patient uses.

The nurse is asked by a pregnant patient about the benefits of a breastfeeding class. The nurse's best response is that the programs offer: Select all that apply. 1. La Leche League's Web site. 2. Practical instruction. 3. Resources. 4. Encouragment. 5. Support for 1 month.

Correct Answer: 2,3,4 Rationale 1: La Leche is not the only group providing breastfeeding information and support. Rationale 2: Breastfeeding programs offer practical instruction for parents. Rationale 3: Breastfeeding programs offer resources for the parents. Rationale 4: Breastfeeding programs in the prenatal period offer encouragement to parents. Rationale 5: Mothers are encouraged to breastfeed for 1 year. Support will be given for longer than 1 month.

The prenatal nurse plans on teaching prenatal classes based on broad concepts. The nurse will include information about: Select all that apply. 1. Healthy prenatal lifestyles. 2. Relaxation techniques. 3. Breathing techniques. 4. Unique roles of grandparents. 5. Body-toning exercises.

Correct Answer: 2,3,5 Rationale 1: Healthy lifestyles should be discussed before the pregnancy, not after. Rationale 2: Most childbirth classes include information on relaxation techniques. Rationale 3: Most childbirth classes include information on breathing methods. Rationale 4: The unique roles of grandparents may be presented, but is not a broad concept of prenatal classes. Rationale 5: Most childbirth classes include information on body-toning exercises.

The nurse is working with a woman newly enrolled in an English-as-a-second-language class. The nurse wants to teach the woman about the importance of hand washing before meals. The best way to assimilate the nurse's cultural values about hygienic nutrition is to: 1. Have the nurse model proper hand washing before examining the woman. 2. Provide written materials in English about hygiene and diet for the patient to take home. 3. Have the woman repeat her interpretation of the information that was taught. 4. Schedule a medical interpreter to accompany the patient to her next visit.

Correct Answer: 3 Rationale 1: Assimilation is described as adopting and incorporating traits of the new culture within one's practices. Information must be understood before it is assimilated. The purpose of modeled behavior might be misunderstood if it is not accompanied by an explanation. Rationale 2: Written materials in English hold minimal value for patients with limited understanding. Rationale 3: When an interpreter is not available, asking patients to repeat their understanding of what was taught reveals how concepts were understood. Rationale 4: In working with families with limited English proficiency, it is optimal to have a medical interpreter present for the entire visit. When teaching has been done, the nurse has a responsibility to assess patient understanding; thus, an interpreter at the next visit will not help the nurse or the patient now.

The nurse has received a phone call from a 29-year-old married patient pregnant with her first child. The patient is at 10 weeks' gestation. Which class would be most appropriate for this patient to attend at this point in her pregnancy? 1. Breastfeeding class 2. Birthing classes 3. Early pregnancy class 4. Adolescent pregnancy class

Correct Answer: 3 Rationale 1: Breastfeeding class would be better late in the third trimester. Rationale 2: Birthing classes are best in the third trimester. Rationale 3: Patients learn most from prenatal classes when they are offered in chronologic order, so that the class content correlates with what they are experiencing. This patient is in her first trimester; early pregnancy classes discussing fetal development are the best option at this time. Rationale 4: This patient is not an adolescent; therefore, adolescent pregnancy classes are not appropriate for this patient.

The childbirth educator nurse states that the primary rationale for providing general information as well as breathing and relaxation exercises in childbirth education is: 1. So that mothers who are doing breathing exercises during labor will refrain from yelling. 2. Because breathing and relaxation exercises are less exhausting than crying and moaning. 3. Knowledge learned at childbirth education classes helps to break the fear-tension-pain cycle. 4. Childbirth education classes help to promote positive maternal-newborn bonding.

Correct Answer: 3 Rationale 1: Childbirth educators are not concerned with possible yelling. Rationale 2: Breathing and relaxation exercises and crying and moaning are all exhausting for the mother in labor. Rationale 3: The hope of the educators presenting the classes is that knowledge learned at childbirth education classes helps to break the fear-tension-pain cycle. Rationale 4: Even though bonding is discussed, it is not the primary goal of childbirth education classes.

An expectant couple desire to determine their compatibility with a care provider. They ask the nurse for assistance. Which question should be addressed first? 1. "Can my children attend the birth?" 2. "If I have a cesarean birth, can my husband attend?" 3. "What is your philosophy of birth?" 4. "What percentage of your patients have episiotomies?"

Correct Answer: 3 Rationale 1: Children's attendance is a component of the provider's philosophy. Rationale 2: A husband's presence for a cesarean birth is indicative of the provider's philosophy. Rationale 3: A thorough understanding of the provider's philosophy is essential to determining compatibility. Rationale 4: Episiotomy percentages are indicative of the provider's philosophy.

A nurse is teaching childbirth education classes to a group of pregnant teens. Which strategy would promote learning by the young women? 1. Avoiding the discussion of uncomfortable procedures like vaginal exams and blood tests 2. Focusing the discussion on baby care rather than labor and delivery 3. Providing more extensive teaching and a forum for verbalization of fears and concerns 4. Having the classes at a location other than high school to reduce their embarrassment

Correct Answer: 3 Rationale 1: It is important to include all information in childbirth classes, regardless of the age group. Rationale 2: Both baby care and labor and delivery are important in any childbirth class. Rationale 3: Adolescents often need more support and more extensive teaching during pregnancy. Prenatal education classes specifically designed for teens can provide a forum for verbalization of fears and concerns. Rationale 4: Conducting the classes at a school enables more teens to attend.

A couple would like their 5-year-old child to attend the birth of their baby. Which statement by the nurse would assist in the plan of care for the child? 1. "You should let your child stay home, because you will be focusing on the birth." 2. "Children under 12 are not allowed to be present at the birth." 3. "You should bring someone who can tend solely to any specific needs of your child." 4. "Bring some toys to keep your child occupied."

Correct Answer: 3 Rationale 1: Telling the parents their child should remain at home does not assist them with their wish to have their child present at the birth. Rationale 2: Children are allowed to be present at births. Rationale 3: A sibling should have his own support person whose primary responsibility is to take care of the child's needs. Rationale 4: Although the child might want to bring toys, this is not the best response by the nurse.

A new patient to the clinic is 8 weeks pregnant with her second child. She asks the nurse about having a doula, since her husband is so nervous that he is no help. What will the nurse tell the patient about having a doula? 1. The doula will assist with pain medication. 2. The doula will be examining the patient periodically to see how labor is progressing. 3. The doula provides support and information, and is an advocate for the wishes of the patient and family. 4. The doula will be teaching breathing techniques and telling the patient when she can push.

Correct Answer: 3 Rationale 1: The doula is not involved with the administration of medications. Rationale 2: The doula does not examine the patient. Rationale 3: The doula is there for support and comfort, and to answer questions from the family. She is an advocate for patient and her family. Rationale 4: The doula does not teach breathing techniques or tell the patient when to push.

A couple discusses their childbirth preparation options with the nurse. They want the father to be actively involved, and for the expectant mother to avoid medications during the birthing process. The nurse's best response is: 1. "The hospital will follow your wishes." 2. "The Leboyer method will provide what you want." 3. "The Bradley method will provide for your needs." 4. "The Lamaze method will be easy to follow."

Correct Answer: 3 Rationale 1: The hospital method is not an option for preparation. Rationale 2: The Leboyer method emphasizes the provision of a gentle and peaceful environment for the birth process. Rationale 3: The Bradley method is referred to as partner- or husband-coached natural childbirth. Rationale 4: The Lamaze method involves the breathing technique that facilitates delivery by relaxing at the proper time.

The nurse in the community should use a family assessment tool to obtain what type of information? 1. How long the family has lived at its current address 2. What other health insurance the family has had in the past 3. How the family meets its nutritional needs and obtains food 4. What eye color the family desires in its unborn child

Correct Answer: 3 Rationale 1: The length of time at a residence is not included in the family assessment tool. Rationale 2: Past health insurance coverage is not included in the family assessment tool. Rationale 3: The family assessment tool is used by the community nurse to more fully understand a family through the tool's focus on meeting the needs of the family members; childrearing practices; communication; support and security; growth-producing relationships; community relationships; and hopes for children. Rationale 4: Desired eye color of a child is not included in the family assessment tool.

A home health nurse has set up a home visit with a Korean couple to follow up on their jaundiced 4-day-old baby, who was discharged home yesterday. Considering family power structure, what family members might the nurse expect to see in the home? 1. Just the parents 2. The grandmother 3. The grandfather and parents 4. The godparents

Correct Answer: 3 Rationale 1: The parents alone do not usually have the last word in decision making for a Korean family. Rationale 2: The grandmother would not usually have the last word in decision making for a Korean family. Rationale 3: In Korean families, the grandfather is usually the family member who plays a key role in decision making and who is likely to be present in this situation. Asians traditionally revere their elders and their wisdom. Rationale 4: The godparents would usually not have the last word in decision making for a Korean family. Global Rationale:

A nurse is comparing several different families' developmental stages, using Duvall's eight-stage family life cycle. Which person serves as a marker for a family's developmental stage in this theory? 1. The youngest child 2. The mother 3. The oldest child 4. The father

Correct Answer: 3 Rationale 1: The youngest child is not a marker, according to Duvall. Rationale 2: The mother is not a marker, according to Duvall. Rationale 3: The oldest child serves as a marker for the family's developmental stage, except in the last two stages, when children are no longer present. Rationale 4: The father is not a marker, according to Duvall.

The nurse is working with a prenatal patient. Which statement indicates that additional teaching is necessary? 1. "I will have Rh testing, even though this is my first pregnancy." 2. "My vagina will be cultured at 36 weeks for group B strep." 3. "Because I am married, I won't have the STI screening." 4. "My blood will be checked for hemoglobin level."

Correct Answer: 3 Rationale 1: This is a true statement. All patients are screened for blood type, Rh factor, and Rh antibodies, regardless of how many previous pregnancies (if any) they have had. Rationale 2: This is a true statement. Women are tested for group B strep to prevent neonatal infection. Rationale 3: All women should be screened for syphilis, gonorrhea, and hepatitis B. Rationale 4: This is a true statement. All women will have their hemoglobin assessed.

Following the birth of her infant, a patient states that her childbirth classes assisted her in dealing with labor and birth. The nurse understands that current research on childbirth education demonstrates which benefit? 1. Patients develop a strong attachment to the birth attendant. 2. Patients avoid the use of medication for labor. 3. Patients become dependent upon their partners. 4. Patients have a feeling of control over the birthing process.

Correct Answer: 4 Rationale 1: An increased attachment to the birth attendant is not necessarily a benefit of childbirth classes. Rationale 2: Childbirth education participants might use less medication during labor, but not all will avoid medication. Rationale 3: Childbirth classes do not increase the dependence on the partner. Rationale 4: Current research indicates that parents who participate in childbirth education have a greater sense of control over their labor and birth experience.

When teaching a culturally diverse group of childbearing families about hospital birthing options, the culturally competent nurse: 1. Understands that the families have the same values as the nurse. 2. Teaches the families how childbearing takes place in the United States. 3. Insists that the clients answer questions instead of their husbands. 4. Incorporates the specific beliefs of the cultural groups that are attending the class.

Correct Answer: 4 Rationale 1: Assuming that the families have the same values as the nurse is ethnocentrism. Rationale 2: Although it is important to explain health care during pregnancy and childbearing, this is not the top priority. Rationale 3: The husband's answering questions might be a cultural norm, and insisting that the client answer could decrease the family's trust in the healthcare system. Rationale 4: Cultural competence is the development of skills and knowledge necessary to appreciate, understand, and work with individuals from cultures other than the culture of the nurse. Through use of a cultural assessment tool, the nurse gains knowledge of the cultures that are likely to be encountered professionally, and in incorporating that knowledge into presentations, the nurse addresses the aspects of the client's culture that might impact how care can best be given to be accepted by the client.

The labor and delivery nurse is caring for a laboring patient who has asked for a priest to visit her during labor. The patient's mother died during childbirth, and although there are no complications during her pregnancy, the patient is fearful of her own death during labor. What is the best response by the nurse? 1. "Nothing is going to happen to you. We'll take very good care of you during your birth." 2. "Would you like to have an epidural so that you won't feel the pain of the contractions?" 3. "The priest won't be able to prevent complications, and might get in the way of your providers." 4. "Would you like me to contact your parish or our hospital chaplain to come see you?"

Correct Answer: 4 Rationale 1: Avoid statements of false reassurance, as there are no guarantees of the outcomes during health care. Using these statements shuts down effective communication, as the client's concern is downplayed. Rationale 2: The client's expressed concern is not about pain; it is a fear of death and a desire to see a priest. Address the client's concerns directly. Rationale 3: Although this statement is true, it is not therapeutic. It downplays the client's concerns, and will shut down effective communication. Address the concerns the client expresses. Rationale 4: When the client states she wants to see a priest, the nurse should attempt to make arrangements for this visit to occur in a timely manner. Most hospitals have a chaplaincy department that can provide assistance in obtaining the services of a wide variety of religious leaders.

The charge nurse is reviewing the care plans written by the unit's staff nurses. The charge nurse recognizes that the nursing diagnosis most likely to be construed as culturally biased and possibly offensive is: 1. Fear related to separation from support system during hospitalization. 2. Spiritual Distress related to discrepancy between beliefs and prescribed treatment. 3. Interrupted Family Processes related to a shift in family roles secondary to demands of illness. 4. Noncompliance related to impaired verbal communication secondary to recent immigration from non-English-speaking area.

Correct Answer: 4 Rationale 1: Fear related to separation from support system during hospitalization seeks to inform the culturally sensitive nurse on how to partner with the family more effectively. Rationale 2: Spiritual Distress related to discrepancy between beliefs and prescribed treatment seeks to inform the culturally sensitive nurse on how to partner with the family more effectively. Rationale 3: Interrupted Family Processes related to a shift in family roles secondary to demands of illness seeks to inform the culturally sensitive nurse on how to partner with the family more effectively. Rationale 4: The phrase "impaired verbal communication" might be offensive because speaking a different language is not equivalent to being impaired, and noncompliance does not necessarily stem from misunderstanding.

The patient who experienced an emergency cesarean birth with her first child expresses anxiety about her upcoming birth. How can the nurse teaching the patient's prenatal classes help decrease her anxiety? 1. Encourage muscle tightening with each contraction. 2. Explain that patterned breathing increases anxiety, and should be avoided. 3. Instruct the patient to hire a therapeutic massage therapist for labor. 4. Encourage the patient to practice progressive relaxation and use the technique in labor.

Correct Answer: 4 Rationale 1: Muscle tightening with each contraction will make the contraction more intense and painful and should be discouraged Rationale 2: Patterned breathing techniques decrease, not increase, anxiety. Practice of patterned breathing prior to the onset of labor facilitates its use during labor. Rationale 3: Not all patients enjoy massage, and not all patients have the resources to hire this type of professional for their labor. Rationale 4: Progressive relaxation (and all relaxation techniques), when practiced prior to labor, is a valuable tool to facilitate relaxation and therefore decrease anxiety during labor.

The nurse is performing a cultural assessment using the Transcultural Assessment Model. What aspect of communication should the nurse keep in mind when planning the assessment? 1. Personal space does not vary from one culture to another. 2. Cultural groups living in the United States are future-oriented. 3. Nonverbal communication is consistent across cultures. 4. The use of silence can differ among different groups.

Correct Answer: 4 Rationale 1: The Transcultural Assessment Model views each client as a culturally unique individual. Personal space varies from one culture to another. Rationale 2: The Transcultural Assessment Model views each client as a culturally unique individual. Although the United States norm is a future orientation, not all cultural groups living in the United States adhere to this norm. Rationale 3: The Transcultural Assessment Model views each client as a culturally unique individual. Nonverbal communication varies from one culture to another. Rationale 4: The Transcultural Assessment Model views each client as a culturally unique individual. In planning an assessment using this model, the nurse must remember that the use of silence differs among groups.

The nurse is assisting an expectant couple in developing a birth plan. Which instruction would the nurse include in the teaching plan? 1. The birth plan includes only patient choices, and does not take into account standard choices of the healthcare provider. 2. The birth plan allows the patient to make choices about the birth process; however, these choices cannot be altered. 3. The birth plan is a legally binding contract between the patient and the healthcare provider. 4. The birth plan is a communication tool between the patient and the healthcare provider.

Correct Answer: 4 Rationale 1: The birth plan does not include only the patient's choices. Rationale 2: The written plan identifies options that are available, and can be altered. Rationale 3: The birth plan is not a legal document. Rationale 4: The birth plan is used as a tool for communication among the expectant parents, the healthcare provider, and the healthcare professionals at the birth setting.

During the assessment, the nurse notices that an African American baby has a darker, slightly bluish-hued patch about 5 cm 7 cm on the buttocks and lower back. What is the nurse's next action? 1. Call the Department of Social Services (DSS) to report this sign of abuse. 2. Confer with the physician about the possibility of a bleeding tendency. 3. Ask the mother about the cause of the bruise. 4. Chart the presence of a Mongolian spot.

Correct Answer: 4 Rationale 1: The nurse who calls the DSS to report the patch as a sign of abuse will reveal ignorance of biologic differences and possibly provoke the family to file charges of harassment. Rationale 2: The nurse who confers with the physician about the patch will reveal ignorance of biologic differences in culturally competent assessments. Rationale 3: Asking the mother about the cause of the bruise reveals the nurse's ignorance of biologic differences and cultural insensitivity. Rationale 4: The nurse will chart the presence of a Mongolian spot, which is observed in races with dark skin tones.

The nurse works in a facility that cares for patients from a broad range of racial, ethnic, cultural, and religious backgrounds. Which statement should the nurse include in a presentation to recently hired nurses on the patient population of the facility? 1. "Our patients come from a broad range of backgrounds, but we have a good interpreter service." 2. "Many of our patients come from backgrounds different from your own, but it doesn't cause problems for the nurses." 3. "Because most of the doctors are bilingual, we don't have to deal with the differences in cultural backgrounds of our patients." 4. "Understanding the common values and health practices of our diverse patients will facilitate better care and health outcomes."

Correct Answer: 4 Rationale 1: The role of a foreign language interpreter is to facilitate communication. The interpreter might not be able to interpret the cultural practices of patients. An example is a Spanish interpreter: The interpreter might be from Spain, but interprets language for clients from Guatemala and Nicaragua, countries about which the interpreter might know virtually nothing. Rationale 2: Racial, ethnic, cultural, and religious backgrounds of patients have significant implications for how the patients perceive health, illness, and health care. It is important for nurses to understand the backgrounds of the client population that attends that facility. Rationale 3: Bilingual physicians, like all physicians, have very busy schedules, and often do not understand nursing care. It is the responsibility of the nurse to become familiar with the backgrounds of the patient population. Rationale 4: Because of the implications for care based on cultural background, it is important for nurses to understand the backgrounds of the patient population that attends the facility.

An Islamic woman is in active labor and informs the nurses that she is fasting during the day since it is Ramadan. What would the nurses be assessing for in this woman related to her cultural ritual? A) Fasting will be able to continue since laboring women are not allowed to eat at this time. B) Call the health care provider for a prescription for IV fluids to keep her hydrated as she labors. C) Ask the the family to bring in traditional foods during the evening hours so the woman can receive some nourishment. D) Respect this woman's faith, but also assess for dehydration and hypoglycemia.

D) Respect this woman's faith, but also assess for dehydration and hypoglycemia. Knowing which religion a family practices can help the nurse locate the correct religious support person if one is needed. It helps in planning care if the nurse know a woman wants a time or times set aside daily for private prayer or if they intend to fast, such as during Ramadan. The nurse should respect the woman's faith; however, the nurse should also assess hydration status and for hypoglycemia since she is fasting yet working hard to give birth to the infant. Most women in labor can drink fluids throughout the labor process. Asking the family to supply foods may be appropriate but also may be inappropriate if the woman is the one that cooks for the family. Hydration in the form of IV fluids may be considered inappropriate since the culture is for fasting of fluids and food.

A boy from the Zulu people of South Africa has recently immigrated to the United States with his mother and is visiting the doctor's office for a physical. The nurse recognizes that this most accurately describes this boy's ethnicity: A) Black B) African C) South African D) Zulu

D) Zulu Ethnicity refers to the cultural group in which a person was born, although the term is sometimes used in a narrower context to mean only race. In this case, Zulu best describes the boy's ethnicity, as this was the cultural group into which he was born. Black and, to a certain extent, African refer to his race. South African refers to his nationality.

A nurse doing an admission assessment on a new Chinese American client notices that the client will not make eye contact. The most likely reason for this is that it: A) is a sign of disrespect. B) implies the client is not interested. C) implies the client wants to avoid the nurse. D) is a sign of respect.

D) is a sign of respect. Whether people look at one another when talking is culturally determined. Chinese Americans, for example, may not make eye contact during a conversation. This social custom shows respect for the position of the health care provider and is a compliment and not an avoidance issue.

A couple who came to the United States two years ago with their two children are seeing the nurse in the community clinic. The nurse knows their family is acculturating when the mother makes which statement? 1. "The children are much less well-behaved than they used to be." 2. "Our diet now includes hamburgers and French fries." 3. "We celebrate the same holidays that we used to at home." 4. "When the children leave the house, I worry about them."

Rationale 2: Inclusion of fast food in the diet is an indication of acculturation, as it shows a belief in the nutritional value of these foods and an acceptance of purchasing fast food as equivalent in value to home-cooked meals.

A nursing student says, "I don't think people have any differences. I think we are all alike, and so I plan to treat all of my clients alike." This is an example of cultural: A) sensitivity. B) blindness. C) destructiveness. D) awareness.

B) blindness People commit cultural blindness when they do not see or believe there are cultural differences among people. Cultural destructiveness is making everyone fit the same cultural pattern, and excluding those who don't fit. Cultural awareness is recognizing that we all live and function within a culture of our own and that our identity is shaped by it. Cultural sensitivity is understanding and accepting different cultural values, attitudes, and behaviors.

The nurse is caring for a postpartal patient of Hmong descent who immigrated to the United States 5 years ago. The patient asks for the regular hospital menu because American food tastes best. The nurse assesses this response to be related to which of the following cultural concepts? 1. Acculturation 2. Ethnocentrism 3. Enculturation 4. Stereotyping

Correct Answer: 1 Rationale 1: Acculturation (assimilation) is the correct assessment because the patient adapted to a new cultural norm in terms of food choices. Rationale 2: Ethnocentrism refers to a social identity that is associated with shared behaviors and patterns. Rationale 3: Enculturation occurs when culture is learned and passed on from generation to generation, and often happens when a group is isolated. Rationale 4: Stereotyping is the assumption that all members of a group have the same characteristics.

The nurse is preparing to assess the development of a family new to the clinic. The nurse understands that the primary use of a family assessment tool is to: 1. Obtain a comprehensive medical history of family members. 2. Determine to which clinic the client should be referred. 3. Predict how a family will likely change with the addition of children. 4. Understand the physical, emotional, and spiritual needs of members.

Correct Answer: 4 Rationale 1: The medical history is one area that is explored using a family assessment tool, but it is not the primary use of the family assessment. Rationale 2: Although referrals might take place as a result of the family assessment findings, this is not the primary purpose of the assessment. Rationale 3: Family development models help predict how a family will likely change with the addition of children. Rationale 4: Understanding the physical, emotional, and spiritual needs of members is the main reason for using a family assessment tool.

The nurse is preparing a community presentation on family development. Which statement should the nurse include? 1. The youngest child determines the family's current stage. 2. A family does not experience overlapping of stages. 3. Family development ends when the youngest child leaves home. 4. The stages describe the family's progression over time.

Correct Answer: 4 Rationale 1: The youngest child is not a marker for which stage the family is in. Rationale 2: Families with more than one child can experience multiple stages simultaneously. Rationale 3: Families' development continues after the youngest child leaves home. Rationale 4: Family development stages describe the changes and adaptations that a family goes through over time as children are added to the family.