Peds Ch. 2 Social, Cultural, Religious, and Family Influences on Child Health Promotion (Test 1)

The nurse is caring for an adolescent hospitalized for asthma. The adolescent belongs to a large family. The nurse recognizes that the adolescent is likely to relate to which group? a. Peers b. Parents c. Siblings d. Teachers

A (Adolescents from a large family are more peer oriented than family oriented. Adolescents in small families identify more strongly with their parents and rely more on them for advice.)

When discussing discipline with the mother of a 4-year-old child, which should the nurse include? a. Parental control should be consistent. b. Withdrawal of love and approval is effective at this age. c. Children as young as 4 years rarely need to be disciplined. d. One should expect rules to be followed rigidly and unquestioningly.

A (For effective discipline, parents must be consistent and must follow through with agreed-on actions. Withdrawal of love and approval is never appropriate or effective. The 4-year-old child will test limits and may misbehave. Children of this age do not respond to verbal reasoning. Realistic goals should be set for this age group. Discipline is necessary to reinforce these goals. Discipline strategies should be appropriate to the childs age and temperament and the severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old child.)

Currently, the fastest-growing segment of the homeless population in the United States consists of which of the following? A. Families B. "Runaway" adolescents C. Migrant farm workers D. Individuals with mental disorders

A (Homeless individuals lack the resources and community ties necessary to provide for their own adequate shelter. One of the most pressing problems in the United States is the rapidly increasing number of homeless families, which currently account for 50% of the nation's homeless. "Runaway" or throwaway adolescents are often victims of physical and social abuse. Although it is a significant issue, these adolescents do not represent the fastest-growing segment of the homeless population. Migrant farm workers are some of the most severely disadvantaged in the United States. They have a mobile existence that is detrimental for children. They do not constitute the fastest-growing segment of the homeless population. Individuals with mental disorders may be homeless. They do not constitute the fastest-growing segment of the homeless population.)

The father of a hospitalized child tells the nurse, "He can't have meat. We are Buddhist and vegetarians." What is the nurse's best intervention? A. Order the child a meatless tray as requested. B. Ask a Buddhist priest to visit the family. C. Explain that hospital patients are exempt from dietary rules. D. Help the parent understand that meat provides protein needed for healing.

A (It is essential for the nurse to respect the religious practices of the child and family. The nurse should arrange a dietary consult to ensure that nutritionally complete vegetarian meals are prepared by the hospital kitchen. It is not necessary to ask a Buddhist priest to visit. The nurse should be able to arrange for a vegetarian tray. The nurse should not encourage the child and parent to go against their religious beliefs. Nutritionally complete, acceptable vegetarian meals should be provided.)

When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called which? a. Permissive b. Dictatorial c. Democratic d. Authoritarian

A (Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their childrens actions. Dictatorial or authoritarian parents attempt to control their childrens behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their childrens behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect their childrens individual natures.)

Which of the following statements is true concerning folk remedies? A. They may be used to reinforce the treatment plan. B. They are incompatible with modern medical regimens. C. They are a leading cause of death in some cultural groups. D. They are not a part of the culture in large, developed countries.

A (Whenever folk remedies are compatible, they should be used to reinforce the treatment plan. This will assist in establishing a caring environment. Depending on the folk remedy, it may not be incompatible with modern medical regimens. Occasionally, a folk remedy can lead to death, but this varies with the remedy and its use. The roles that folk remedies have in large, developed countries vary depending on the remedies and the country's cultures)

The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal? a. Adapt, as necessary, ethnic practices to health needs. b. Attempt, in a nonjudgmental way, to change ethnic beliefs. c. Encourage continuation of ethnic practices in the hospital setting. d. Strive to keep ethnic background from influencing health needs.

A (Whenever possible, nurses should facilitate the integration of ethnic practices into health care provision. The ethnic background is part of the individual; it should be difficult to eliminate the influence of ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting.)

Physical

A child's __________ characteristics and susceptibility to health problems can be related to ethnic and cultural variations of hereditary and socioeconomic forces.

Roles

A child's self-concept evolves from ideas about his or her social roles. _______ are cultural creations; therefore, the culture prescribes patterns of behavior for persons in a variety of social positions.

geographic, economic

A trend that has significantly influenced the American family is increasing ___________ and ___________ mobility. There is less reliance on tradition. Families are fragmented, with limited opportunity to transmit and acquire the traditional and accepted customs of a culture.

The parents of a 5-year-old child ask the nurse how they can minimize misbehavior. Which responses should the nurse give? (Select all that apply.) a. Set clear and reasonable goals. b. Praise your child for desirable behavior. c. Dont call attention to unacceptable behavior. d. Teach desirable behavior through your own example. e. Dont provide an opportunity for your child to have any control.

A, B, D (To minimize misbehavior, parents should (1) set clear and reasonable rules and expect the same behavior regardless of the circumstances, (2) praise children for desirable behavior with attention and verbal approval, and (3) teach desirable behavior through their own example. Parents should call attention to unacceptable behavior as soon as it begins and provide children with opportunities for power and control.)

The nurse is teaching parents about the effects of media on childhood obesity. The nurse realizes the parents understand the teaching if they make which statements? (Select all that apply.) a. Advertising of unhealthy food can increase snacking. b. Increased screen time may be related to unhealthy sleep. c. There is a link between the amount of screen time and obesity. d. Increased screen time can lead to better knowledge of nutrition. e. Physical activity increases when children increase the amount of screen time.

A,B,C (A number of studies have demonstrated a link between the amount of screen time and obesity. Advertising of unhealthy food to children is a long-standing marketing practice, which may increase snacking in the face of decreased activity. In addition, both increased screen time and unhealthy eating may also be related to unhealthy sleep. Increased screen time does not lead to a better knowledge of nutrition or increased physical activity.)

Which describe the feelings and behaviors of adolescents related to divorce? (Select all that apply.) a. Disturbed concept of sexuality b. May withdraw from family and friends c. Worry about themselves, parents, or siblings d. Expression of anger, sadness, shame, or embarrassment e. Engage in fantasy to seek understanding of the divorce

A,B,C,D (Feelings and behaviors of adolescents related to divorce include a disturbed concept of sexuality; withdrawing from family and friends; worrying about themselves, parents, and siblings; and expressions of anger, sadness, shame, and embarrassment. Engaging in fantasy to seek understanding of the divorce is a reaction by a child who has preconceptual cognitive processes, not the formal thinking processes adolescents have.)

Which describe the feelings and behaviors of early preschool children related to divorce? (Select all that apply.) a. Regressive behavior b. Fear of abandonment c. Fear regarding the future d. Blame themselves for the divorce e. Intense desire for reconciliation of parents

A,B,D (Feelings and behaviors of early preschool children related to divorce include regressive behavior, fear of abandonment, and blaming themselves for the divorce. Fear regarding the future and intense desire for reconciliation of parents is a reaction later school-age children have to divorce.)

The nurse is presenting a staff development program about understanding culture in the health care encounter. Which components should the nurse include in the program? (Select all that apply.) a. Cultural humility b. Cultural research c. Cultural sensitivity d. Cultural competency

A,C,D (There are several different ways health care providers can best attend to all the different facets that make up an individuals culture. Cultural competence tends to promote building information about a specific culture. Cultural sensitivity, a second way of understanding culture in the context of the clinical encounter, may be understood as a way of using ones knowledge, consideration, understanding, respect, and tailoring after realizing awareness of self and others and encountering a diverse group or individual. Cultural humility, the third component, is a commitment and active engagement in a lifelong process that individuals enter into for an ongoing basis with patients, communities, colleagues, and themselves. Cultural research is not a component of understanding culture in the health care encounter.)

home

All cultures have some types of ________ remedies that they apply before seeking help from other persons. Avoid attacking traditional health cultural beliefs and practices as wrong or harmful or implying that biomedical measures are uniformly correct and effective and the only way to prevent illness or treat sickness. Such attacks usually result in rejection of biomedical health care practitioners and health teaching based on biomedicine or scientific facts.

Which type of family should the nurse recognize when a mother, her children, and a stepfather live together? a. Traditional nuclear b. Blended c. Extended d. Binuclear

B (A blended family contains at least one stepparent, stepsibling, or half-sibling. A traditional nuclear family consists of a married couple and their biologic children. No other relatives or nonrelatives are present in the household. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.)

The nurse is teaching a group of new nursing graduates about identifiable qualities of strong families that help them function effectively. Which quality should be included in the teaching? a. Lack of congruence among family members b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit

B (A clear set of family rules, values, and beliefs that establish expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Varied coping strategies are used by strong families. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.)

The nurse is explaining different parenting styles to a group of parents. The nurse explains that an authoritative parenting style can lead to which child behavior? a. Shyness b. Self-reliance c. Submissiveness d. Self-consciousness

B (Children raised by parents with an authoritative parenting style tend to have high self-esteem and are self-reliant, assertive, inquisitive, content, and highly interactive with other children. Children raised by parents with an authoritarian parenting style tend to be sensitive, shy, self-conscious, retiring, and submissive.)

A foster parent is talking to the nurse about the health care needs for the child who has been placed in the parents care. Which statement best describes the health care needs of foster children? a. Foster children always come from abusive households and are emotionally fragile. b. Foster children tend to have a higher than normal incidence of acute and chronic health problems. c. Foster children are usually born prematurely and require technologically advanced health care. d. Foster children will not stay in the home for an extended period, so health care needs are not as important as emotional fulfillment.

B (Children who are placed in foster care have a higher incidence of acute and chronic health problems and may experience feelings of isolation and confusion; therefore, they should be monitored closely. Foster children do not always come from abusive households and may or may not be emotionally fragile; not all foster children are born prematurely or require technically advanced health care; and foster children may stay in the home for extended periods, so their health care needs require attention.)

The nurse is reviewing the importance of role learning for children. The nurse understands that childrens roles are primarily shaped by which members? a. Peers b. Parents c. Siblings d. Grandparents

B (Childrens roles are shaped primarily by the parents, who apply direct or indirect pressures to induce or force children into the desired patterns of behavior or direct their efforts toward modification of the role responses of the child on a mutually acceptable basis.)

Which of the following terms best describes a group of people who share a set of values, beliefs, practices, social relationships, laws, politics, economics, and norms of behavior? A. Race B. Culture C. Ethnicity D. Social group

B (Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames the outlook and decisions of a group of people. Race is defined as a division of humankind possessing traits that are genetically transmissible. Ethnicity is the affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A social group consists of a system of roles carried out in both primary and secondary groups. Socialization is the process by which individuals learn the roles that are expected of them)

The nurse is aware that if patients different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what? a. Acculturation b. Ethnocentrism c. Cultural shock d. Cultural sensitivity

B (Ethnocentrism is the belief that ones way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of ones ethnic group are superior to those of others. Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Cultural sensitivity, a component of culturally competent care, is an awareness of cultural similarities and differences.)

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Family stress theory c. Eriksons psychosocial theory d. Developmental systems theory

B (Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Eriksons theory applies to individual growth and development, not families. Developmental systems theory is an outgrowth of Duvalls theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others.)

Which family theory is described as a series of tasks for the family throughout its life span? a. Exchange theory b. Developmental theory c. Structural-functional theory d. Symbolic interactional theory

B (In developmental systems theory, the family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Exchange theory assumes that humans, families, and groups seek rewarding statuses so that rewards are maximized while costs are minimized. Structural-functional theory states that the family performs at least one societal function while also meeting family needs. Symbolic interactional theory describes the family as a unit of interacting persons with each occupying a position within the family.)

The nurse is discussing issues that are important with parents considering a cross-racial adoption. Which statement made by the parents indicates further teaching is needed? a. We will try to preserve the adopted childs racial heritage. b. We are glad we will be getting full medical information when we adopt our child. c. We will make sure to have everyone realize this is our child and a member of the family. d. We understand strangers may make thoughtless comments about our child being different from us.

B (In international adoptions, the medical information the parents receive may be incomplete or sketchy; weight, height, and head circumference are often the only objective information present in the childs medical record. Further teaching is needed if the parents expect full medical information. It is advised that parents who adopt children with different ethnic backgrounds do everything to preserve the adopted childrens racial heritage. Strangers may make thoughtless comments and talk about the children as though they were not members of the family. It is vital that family members declare to others that this is their child and a cherished member of the family.)

A parent of a school-age child tells the school nurse that the parents are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as what? a. Indicative of maladjustment b. A common reaction to divorce c. Suggestive of a lack of adequate parenting d. An unusual response that indicates a need for referral

B (Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. The childs responses are common reactions of school-age children to parental divorce.)

Children may believe that they are responsible for their parents divorce and interpret the separation as punishment. At which age is this most likely to occur? a. 1 year b. 4 years c. 8 years d. 13 years

B (Preschool-age children are most likely to blame themselves for the divorce. A 4-year-old child will fear abandonment and express bewilderment regarding all human relationships. A 4-year-old child has magical thinking and believes his or her actions cause consequences, such as divorce. For infants, divorce may increase their irritability and interfere with the attachment process, but they are too young to feel responsibility. School-age children will have feelings of deprivation, including the loss of a parent, attention, money, and a secure future. Adolescents are able to disengage themselves from the parental conflict.)

After the family, which has the greatest influence on providing continuity between generations? a. Race b. School c. Social class d. Government

B (Schools convey a tremendous amount of culture from the older members to the younger members of society. They prepare children to carry out the traditional social roles that will be expected of them as adults. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize race as a distinct human type; although race may have an influence on childrearing practices, its role is not as significant as that of schools. Social class refers to the familys economic and educational levels. The social class of a family may change between generations. The government establishes parameters for children, including amount of schooling, but this is usually at a local level. The school culture has the most significant influence on continuity besides family.)

The nurse discovers welts on the back of a Vietnamese child during a home health visit. The childs mother says she has rubbed the edge of a coin on her childs oiled skin. The nurse should recognize this as what? a. Child abuse b. Cultural practice to rid the body of disease c. Cultural practice to treat enuresis or temper tantrums d. Child discipline measure common in the Vietnamese culture

B (This is descriptive of coining. The welts are created by repeatedly rubbing a coin on the childs oiled skin. The mother is attempting to rid the childs body of disease. Coining is a cultural healing practice. Coining is not specific for enuresis or temper tantrums. This is not child abuse or discipline.)

Communication

Because ______________, both verbal and nonverbal, is an important cultural consideration, nurses need to acknowledge and respect their patients' practices for productive interaction to occur. In working with families, it is essential for nurses to identify key members and decision makers; failure to include these significant individuals in teaching can seriously hinder adherence to the care plan.

Family

Because there is no universal agreement about the definition of _________, a _________ is what an individual considers it to be. The term family has been defined in many different ways according to the individual's own frame of reference, value judgment, or discipline. Earlier definitions of family emphasized that family members were related by legal ties or genetic relationships and lived in the same household with specific roles. Later definitions have been broadened to reflect both structural and functional changes.

Which type of family should the nurse recognize when the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Extended d. Binuclear

C (An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, stepsibling, or half-sibling. A nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.)

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, I want to go back to work, but I dont want Eric to suffer because Ill have less time with him. Which is the nurses most appropriate answer? a. Im sure hell be fine if you get a good babysitter. b. You will need to stay home until Eric starts school. c. Lets talk about the child care options that will be best for Eric. d. You should go back to work so Eric will get used to being with others.

C (Asking the mother about child care options is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. The other three answers are directive; they do not address the effect that her working will have on Eric.)

Maria is a Spanish-speaking 5-year-old girl who has started kindergarten in an English-speaking school. Crying most of the time, she appears helpless and unable to function in this new situation. What is the best explanation for this behavior? A. She lacks adequate maturity for attending school. B. She lacks the knowledge needed in school. C. She is experiencing cultural shock. D. She is experiencing minority group discrimination.

C (Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Maria's inability to speak English inhibits her ability to interact. This would explain Maria's inability to function in this new situation. There is no evidence that the child lacks the maturity or knowledge needed in school or is experiencing minority group discrimination.)

Which term best describes the sharing of common characteristics that differentiates one group from other groups in a society? a. Race b. Culture c. Ethnicity d. Superiority

C (Ethnicity is a classification aimed at grouping individuals who consider themselves, or are considered by others, to share common characteristics that differentiate them from the other collectivities in a society, and from which they develop their distinctive cultural behavior. Race is a term that groups together people by their outward physical appearance. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Superiority is the state or quality of being superior; it does not apply to ethnicity.)

The school nurse understands that children are impacted by divorce. Which has the most impact on the positive outcome of a divorce? a. Age of the child b. Gender of the child c. Family characteristics d. Ongoing family conflict

C (Family characteristics are more crucial to the childs well-being during a divorce than specific child characteristics, such as age or sex. High levels of ongoing family conflict are related to problems of social development, emotional stability, and cognitive skills for the child.)

The nurse is planning to counsel family members as a group to assess the familys group dynamics. Which theoretic family model is the nurse using as a framework? a. Feminist theory b. Family stress theory c. Family systems theory d. Developmental theory

C (In family systems theory, the family is viewed as a system that continually interacts with its members and the environment. The emphasis is on the interaction between the members; a change in one family member creates a change in other members, which in turn results in a new change in the original member. Assessing the familys group dynamics is an example of using this theory as a framework. Family stress theory explains how families react to stressful events and suggests factors that promote adaptation to stress. Developmental theory addresses family change over time using Duvalls family life cycle stages based on the predictable changes in the familys structure, function, and roles, with the age of the oldest child as the marker for stage transition. Feminist theories assume that privilege and power are inequitably distributed based upon gender, race, and class.)

A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this? a. The parent is trying to feed the child only what the child likes most. b. Hispanics believe the evil eye enters when a person gets cold. c. The parent is trying to restore normal balance through appropriate hot remedies. d. Hispanics believe an innate energy called chi is strengthened by eating soup.

C (In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are cold conditions and are treated with hot foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy.)

Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined? a.Ethnicity b.Racial variation c.Status d.Geographic boundaries

C (Status is culturally determined and varies according to each culture. Some cultures ascribe higher status to age or socioeconomic position. Social roles also are influenced by the culture. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. It is one component of culture. Race and culture are two distinct attributes. Whereas racial grouping describes transmissible traits, culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries, but the boundaries are not culturally determined.)

The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include? a. Send the child to his or her room if the child has one. b. A general rule for length of time is 1 hour per year of age. c. Select an area that is safe and nonstimulating, such as a hallway. d. If the child cries, refuses, or is more disruptive, try another approach.

C (The area must be nonstimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The childs room may have toys and activities that negate the effect of being separated from the family. The general rule is 1 minute per year of age. An hour per year is excessive. When the child cries, refuses, or is more disruptive, the time-out does not start; the time-out begins when the child quiets.)

The nurse is discussing parenting in reconstituted families with a new stepparent. The nurse is aware that the new stepparent understands the teaching when which statement is made? a. I am glad there will be no disruption in my lifestyle. b. I dont think children really want to live in a two-parent home. c. I realize there may be power conflicts bringing two households together. d. I understand contact between grandparents should be kept to a minimum.

C (The entry of a stepparent into a ready-made family requires adjustments for all family members. Power conflicts are expected, and flexibility, mutual support, and open communication are critical in successful relationships. So the statement that power conflicts are possible means teaching was understood. Some obstacles to the role adjustments and family problem solving include disruption of previous lifestyles and interaction patterns, complexity in the formation of new ones, and lack of social supports. Most children from divorced families want to live in a two-parent home. There should be continued contact with grandparents.)

Which is an accurate description of homosexual (or gay-lesbian) families? a. A nurturing environment is lacking. b. The children become homosexual like their parents. c. The stability needed to raise healthy children is lacking. d. The quality of parenting is equivalent to that of nongay parents.

D (Although gay or lesbian families may be different from heterosexual families, the environment can be as healthy as any other. Lacking a nurturing environment and stability is reflective on the parents and family, not the type of family. There is little evidence to support that children become homosexual like their parents.)

How is family systems theory best described? a. The family is viewed as the sum of individual members. b. A change in one family member cannot create a change in other members. c. Individual family members are readily identified as the source of a problem. d. When the family system is disrupted, change can occur at any point in the system.

D (Family systems theory describes an interactional model. Any change in one member will create change in others. Although the family is the sum of the individual members, family systems theory focuses on the number of dyad interactions that can occur. The interactions, not the individual members, are considered to be the problem.)

A 3-year-old child was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guideline concerning adoption should the nurse use in planning a response? a. It is best to wait until the child asks about it. b. The best time to tell the child is between the ages of 7 and 10 years. c. It is not necessary to tell a child who was adopted so young. d. Telling the child is an important aspect of their parental responsibilities.

D (It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the childs identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to prevent third parties from telling the children before the parents have had the opportunity.)

Parents of a preschool child ask the nurse, Should we set rules for our child as part of a discipline plan? Which is an accurate response by the nurse? a. It is best to delay the punishment if a rule is broken. b. The child is too young for rules. At this age, unrestricted freedom is best. c. It is best to set the rules and reason with the child when the rules are broken. d. Set clear and reasonable rules and expect the same behavior regardless of the circumstances.

D (Nurses can help parents establish realistic and concrete rules. The clearer the limits that are set and the more consistently they are enforced, the less need there is for disciplinary action. Delaying punishment weakens its intent. Children want and need limits. Unrestricted freedom is a threat to their security and safety. Reasoning involves explaining why an act is wrong and is usually appropriate for older children, especially when moral issues are involved. However, young children cannot be expected to see the other side because of their egocentrism.)

Which is a consequence of the physical punishment of children, such as spanking? a. The psychologic impact is usually minimal. b. The childs development of reasoning increases. c. Children rarely become accustomed to spanking. d. Misbehavior is likely to occur when parents are not present.

D (Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake but rather out of fear of punishment. Spanking can cause severe physical and psychologic injury and interfere with effective parentchild interaction. The use of corporal punishment may interfere with the childs development of moral reasoning. Children do become accustomed to spanking, requiring more severe corporal punishment each time.)

positioning

Family size and ___________within the family structure have a strong impact on a child's development. Parenting practices differ between small and large families. Age differences between siblings affect the childhood environment but to a lesser extent than does the sex of the sibling.

poverty, immigrants

Groups of children with greater physical and mental health problems are those living in ________, those who are homeless, those in migrant farm families, and those who are recent __________ to the United States. A high correlation between poverty and illness has long been observed. Impoverished families experience poor nutrition; without medical insurance, they have little if any preventive health care, inadequate health maintenance, and limited access to health services. One of the most significant health problems related to poverty is a high infant mortality rate. Homeless children have physical and mental disorders more often than do poor children who have a permanent residence. Homeless children lack basic health care, including routine immunization and screening for routine problems, and they have high rates of acute and chronic illnesses.

subcultural influences

Important ____________ ______________ on children include ethnicity, socioeconomic class, poverty, homelessness, immigration, religion, school, community, and peers. Children's membership in a cultural subgroup is, for the most part, involuntary.

Minority

Membership in a ___________ group presents special challenges for children, although changes in societal attitudes are slowly taking place. The United States has more racial, ethnic, and religious minority groups than any other country. Because American cultures and subcultures can be so diverse, it is essential that nurses be knowledgeable about the predominant groups in their work community and apply this knowledge in their practice.

cultural competence

Nurses have a responsibility to continually develop _____________ _______________. This includes understanding and respecting the influence of culture, race, and ethnicity on the development of social and emotional relationships, childrearing practices, and attitudes toward health.

structure

The family __________ or family composition, consists of individuals, each with a socially recognized status and position, who interact with one another on a regular, recurring basis in socially sanctioned ways. Although the traditional family structure has been nuclear or extended, in recent years other forms, such as the single-parent family, have emerged.

Peer

_________ relationships become increasingly important and influential as children proceed through school. In school, children have what can be regarded as a culture of their own. This is even more apparent in an unsupervised playgroup because in school, the culture is partly produced by adults.

Religion

____________ influences the lifestyles of most cultures. Among many groups, illness, injury, or death is believed to be sent by God as a punishment for sin. Nurses promote holistic nursing care through an integration of spiritual and psychosocial care. The care focuses on activities that support a person's system of beliefs and worship, such as praying, reading religious materials, and performing religious rituals. Meeting the spiritual needs of the child and family can provide strength.

Ethnicity

____________ is the classification of or affiliation with any of the basic groups or divisions of humankind or any heterogeneous population differentiated by customs, characteristics, language, or similar distinguishing factors.

Health beliefs

____________ related to the cause of illness and the maintenance of health are an integral part of a family's cultural heritage. Often inseparable from religious beliefs, they influence the way families cope with health problems and respond to health care providers. Predominant among most cultures are beliefs related to natural forces, supernatural forces, and an imbalance between forces.

Culture

_____________ is the sum total of mores, traditions, and beliefs about how people function. It encompasses other products of human works and thoughts specific to members of an intergenerational group, community, or population. It is an ingrained orientation to life that serves as a frame of reference for one's own perception and judgment. Culture is the way of life of a group of people that incorporates experiences of the past, influences thought and action in the present, and conveys these traditions to future group members.

Cultural shock

______________ is characterized by the inability to respond to or function within a new or strange situation. This can happen to a patient in a hospital or to a nurse caring for patients with different cultural backgrounds. Immigrants to a new country and persons from a subcultural group experience the same cultural shock when they must adjust to the ways of an unfamiliar subgroup or setting.