Maternal & Child Health Nursing Chapter 3

A grandmother is the primary caretaker for her two grandsons due to financial reasons. The grandmother cooks primarily comfort foods consisting of fried foods with gravy. Her son recently went to the emergency department with chest pain where it was determined that he had no heart damage but his total cholesterol level was 395 mg/dL (10.23 mmol/L). The son was taught about ways to lower his cholesterol level. The grandmother has read the material. Which statement made by the grandmother demonstrates the most positive expected outcome for this scenario? A) "I will read labels and omit trans-fatty acids from cooking when possible." B) "I will limit the amount of eggs I serve each week." C) "I will try to limit the amount of bacon fat I use to make my gravy." D) "I will change from bacon fat to vegetable shortening when I fry green tomatoes."

A) "I will read labels and omit trans-fatty acids from cooking when possible." An evaluation should reveal not only that a goal has been achieved but also that the family feels more cohesive after working together toward the goal. Examples of expected outcomes that might be established include the grandmother stating she will omit trans-fatty acids from cooking to better safeguard the health of her family. Bacon fat is high in saturated fats and should be eliminated from a low-cholesterol diet. Eggs are acceptable sources of protein; however, the preparation is usually where saturated fat is added during the frying process.

After teaching students about different family structures, the instructor determines that the session was successful when the students identify which of the following as comprising a blended family. Select all that apply. A) Birth children B) Aunts C) Non-birth parent D) Grandparents E) Birth parent F) Step children

A) Birth children C) Non-birth parent E) Birth parent F) Step children A blended family is a stepfamily consisting of a birth parent and non-birth parent, birth children, as well as any offspring of the non-birth parent. Grandparents and aunts would be part of an extended family.

A nurse is working as part of a team to address the needs of single-parent families. Which consideration would be most important to address when developing programs for this group? Select all that apply. A) Changes in home and school environment B) Lower household income C) Lack of social support D) Emotional challenges for both parent and children E) Divorced mothers have great challenges than mothers who have never married.

A) Changes in home and school environment B) Lower household income C) Lack of social support D) Emotional challenges for both parent and children Families headed by single-parents face a multitude of challenges. Divorced mothers typically have a higher income and a higher educational level, and receive some support from their ex-spouse.

While assessing a family, the nurse notes indications of altered family functioning. Which of the following would the nurse most likely note? Select all that apply. A) Expression of guilt B) Significant difficulty with changes C) Noncompliance with treatment regimen D) Ease in expressing emotions E) Intense respect for other members

A) Expression of guilt B) Significant difficulty with changes C) Noncompliance with treatment regimen Altered family functioning may be noted by an inability to express or accept emotions, lack of respect or support for other family members, and an inability to adapt to change. In addition, members may verbalize feelings of inadequacy, guilt, anxiety, failure, helplessness, and powerlessness, Noncompliance with treatment may be manifestation of denial or refusal to acknowledge a problem's existence.

The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based? A) The family is the constant in the child's life and the primary source of strength. B) The child must be prepared to be his or her own source of strength during times of crisis. C) The care provider is the constant in the child's life and the primary source of strength. D) The wishes of the family should direct the nursing care plan for the child.

A) The family is the constant in the child's life and the primary source of strength. Family-centered care involves a partnership between the child, family, and health care providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own health care needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.

The nurse is assessing a family in which the parents are going through a divorce. There are three siblings in the family: a 4-year-old girl, a 10-year-old boy, and a 15-year-old girl. Which of the following is an important framework for the nurse to use when assessing the response of each child to the divorce? A) Crisis intervention B) Family systems C) Developmental stages D) Life cycle

C) Developmental stages Assessing each child individually from the perspective of his or her developmental stage allows for planning of interventions suitable to each child. Each of the other three frameworks addresses family dynamics rather than the specific needs of the children.

Assessment of an adult client reveals that he lives with his wife and three children. The client's father-in-law lives in an in-law suite attached to the client's home. The client's parents live about a block away and visit the family often. The nurse interprets this as which type of family? A) Nuclear B) Extended family C) Single-parent D) Blended

B) Extended family The client is describing an extended family which consists of the immediate family and grandparents, aunts, uncles and cousins who may or may not live under the same roof. A nuclear family traditionally includes a married adult man and woman and their children. A blended family includes children who live with one birth parent and one parent, as well as any offspring of the non-birth parent. A single-parent family is composed of one parent and one or more children.

A 2-year-old child has been diagnosed recently with leukemia. She has been admitted to the hospital for initiation of treatment. The family is trying to cope with the new diagnosis, and family members describe themselves as being "in a state of shock." In working with the family, which of the following would be the priority nursing diagnosis? A) Altered family function related to shifting dynamics and roles of family system members B) Ineffective family coping related to new illness of the child C) Interrupted family processes related to hospitalization of the child D) Risk for financial strain related to the child's illness

B) Ineffective family coping related to new illness of the child We know that the family is not coping well with this new diagnosis and hospitalization. All the other choices imply situations that are potential consequences of this change in the family, but we do not have any specific information telling us that these alterations have actually taken place.

The nurse recognizes that which factors contribute to the increase in single-parent families? A) Increased birth rates in the United States B) Rising divorce rates C) Decrease in communal family units D) Increase in the number of gay and lesbian couples

B) Rising divorce rates Rising divorce rates, along with wider acceptance of babies born out of wedlock and changes in adoption laws, have caused an increase in single-parent-families. Birth rates in the U.S. have actually declined over the last decade, and thus have not increased the number of single-parent families. Additionally, the increase in gay and lesbian couples has actually decreased the single-parent-family numbers. The decrease in communal family units has not affected single-parent family numbers.

When reviewing the history of a pregnant client, the nurse identifies that the client has an extended family and that they all live together in a small home. Further assessment reveals that the family is not coping well because of the unexpected pregnancy, thus causing undue stress on the client. What would be a positive outcome for the nursing diagnosis of Ineffective family coping mechanisms related to an unplanned pregnancy? A) The client agrees to ask the extended members of her family to find another place to live so that they can prepare and make room for the new baby. B) The client agrees to take a second job to buy a bigger home for her extended family. C) Family members state that they have found ways to stretch their resources to adapt for a new family member in the home. D) The family agrees to counseling after the baby is born.

C) Family members state that they have found ways to stretch their resources to adapt for a new family member in the home. Extended families not only have the traditional members of a family but can also include grandparents, aunts, uncles, and/or cousins. Advantages of this kind of family are that there are numerous resources for members within the family who are ill or need support. However, because extended families live together, there can be a shortage of resources that could lead to stress when adding a member to that family. Asking the extended family to leave and/or taking a second job to buy a new home may not be a realistic or positive option for this client in her current state, and counseling after the baby is born does not eliminate the stress that the client feels currently. The positive outcome for this family would be for the extended family to come together to find ways to adapt to a new member.

A couple with infertility has decided to adopt an infant and receive a call several months later that an infant is available. The social worker gives them the history of the biological mom, a teenager who tried to conceal her pregnancy by dieting and taking laxatives. However, at 6 months' gestation, the teenager shared her pregnancy with the family and received prenatal care. Given this history, the couple should be counseled to observe the infant for which possible abnormality? A) risk for autism following immunizations B) excess swelling related to kidney problems C) abnormal neurologic development D) potential eating disorder as a teenager

C) abnormal neurologic development If the birth mother of an adopted child ate inadequately or received little prenatal care, for example, the adopted child is at a higher than normal risk for abnormal neurologic development. The risk for development of kidney problems or eating disorders would be the same as any other child. There is no proof that immunizations cause autism. The risk for autism would be the same as any other child.

An obese 16-year-old is about to be discharged. She tells the nurse that she does not like weighing so much and that all the kids at school make fun of her. What is the most important thing the nurse should encourage her to do to lose weight? A) get an after school job B) play more computer games C) exercise more D) ride the bus to school 3 to 4 days each week

C) exercise more More children are obese than ever before. A very important component to reducing obesity is encouraging children to exercise.

During a home visit from a "Parents as Teachers" leader, the leader notes the mom is enforcing "time out" when the preschool child breaks a rule. The mother is responsible for establishing rules and work assignments based on the child's age. When documenting the family assessment visit, the leader would identify the mother as fulfilling which family role? A) problem solver B) socialization of family members C) maintenance of order D) allocation of resources

C) maintenance of order Maintenance of order includes establishing family values, establishing rules about expected family responsibilities and roles, and enforcing common regulations for family members, such as using "time out" for toddlers. In healthy families, members know the family rules and respect and follow them; in dysfunctional families, the nurse may see a flagrant disregard of rules. Socialization of family members includes being certain that children feel part of the family and learning appropriate ways to interact with people outside the family, such as teachers, neighbors, or police. It means the family has an open communication system among family members and outward to the community. Allocation of resources involves determining which family needs will be met and their order of priority, including not only material goods but also affection and space. In healthy families, there is justification, consistency, and fairness in the distribution. In many families, resources are limited (e.g., no one has new shoes). The problem solver does just what the title implies, looking at problems and helping come to solutions.

A couple is arguing and bickering all the time. This couple has not told the children yet that they are planning to get a divorce. When the couple discusses this with the school nurse, the nurse shares that at this early phase, children likely experience what type of feelings? A) act out their feelings by crying and screaming at their parents to "Stop!" B) tell their friends that their parents are always "mad" at them C) take blame for their parents quarreling and try to behave better D) make up false stories pretending they are, "one big happy family"

C) take blame for their parents quarreling and try to behave better The most appropriate answer is taking blame for their parents quarreling. The first phase is apt to be an antagonistic time as parents realize they are no longer compatible, marked by quarreling, hurt feelings, and whispered conversations. This phase can be particularly upsetting for children because they usually have not been told what is happening as yet. They may assume the quarreling is their fault (i.e., if they had behaved better, this would not be happening). They may act out (depending on age of child). Sometimes children share their feelings with the school nurse or teaching and they may use the word "mad" when describing the fighting in the home. Sensitive children may make up imaginary families that are happy.

How can the nurse assist with achieving National Health Goals when caring for a woman with placental previa at 28 weeks' gestation who is on bed rest? A) Educate the mother that she will need to be in the hospital for the duration of the pregnancy if she is not compliant with care at home. B) Inform the mother that she must have someone come into the home to live with her until after the baby is born. C) Inform the client that if she continues to get out of bed, she will lose the baby. D) Educate the client on the benefits of bed rest for the pregnancy and access community resources to assist her with compliance.

D) Educate the client on the benefits of bed rest for the pregnancy and access community resources to assist her with compliance. National Health Goals are concerned with reducing complications of pregnancy, both by better monitoring and preventing complications during pregnancy. Nurses can help the nation achieve these goals by helping women better accept and adhere to home care if it is advised during pregnancy.

A couple who has been married for 10 years chose to postpone having children until their professional careers were established. They now feel ready to start a family. After many months of trying, they are consulting with a fertility expert. The nurse should anticipate that this couple may be experiencing which NANDA due to the negative aspect of postponing pregnancy? A) Ineffective relationship B) Risk for impaired attachment C) Parental role conflict D) Ineffective childbearing process

D) Ineffective childbearing process Ineffective childbearing process is the only NANDA that relates to the process by which human beings are produced. The other NANDAs listed relate to role relationships. Risk for impaired attachment is associated with family relationships (i.e., people who are biologically related). Parental role conflict and Risk for impaired attachment are associated with role performance or the quality of functioning in socially expected behavior patterns.

Assessment of a client reveals that he is part of a nuclear family. The nurse interprets this as which of the following? A) Each family member exerts similar influence on the other person. B) Family members live together in one household. C) The family members share a common belief or bond. D) The family includes a married adult man, his wife, and their children.

D) The family includes a married adult man, his wife, and their children. A nuclear family includes a married adult man, his wife, and their children. A communal family is one in which members share a common belief or bond. Family members may not always live together in one household. However, they remain connected through their relationships. Each family member exerts varying, not similar, influence on the other persons.

An 5-year-old adoptive child has been injured on the playground and will require orthopedic surgery. The nurses encourage the parents to stay with the child as much as possible while the child is in the hospital based on which potential reason? A) They may become addicted to pain medications. B) They imagine that another family may want to take them home. C) They do not know how to entertain themselves when alone. D) They may be afraid they are going to be given back to the foster-care system.

D) They may be afraid they are going to be given back to the foster-care system. Preschoolers who have just been told they were adopted or were chosen by their adoptive parents "from all the babies in the hospital nursery," may be terribly afraid they are now being returned to the hospital to be given back. Parents of an adopted child may need additional help in preparing the child for the hospital experience and also should be encouraged to stay with the child in the hospital as much as possible to reduce this type of postadoption fear. It is unlikely the child will become addicted to pain medications. Any child 5 years of age needs supervision with entertainment. Usually, all children feel loved by their family but have been told to be leery of strangers. However, this is not the best answer.

Nursing students are learning about family structure and want to learn about their own families. Which of the following diagrams could they use that will show family structure? A) pie chart B) ecomap C) family APGAR D) genogram

D) genogram The genogram is a diagram that details family structure. An ecomap shows the "fit" of a family in the community. The family APGAR is a questionnaire. Pie chart is a distractor for this question.

While working with homeless families, the nurse learns that a single female parent heads the majority of homeless families. True False

True A single female parent heads the majority of homeless families. Among homeless women, 60% have children under age 18, but only 65% of them live with at least one of these children. Among homeless men, 41% have children under age 18, but only 7% of these fathers live with at least one of their own children (U.S. Department of Housing and Development, 1999).