Ch 2 - Maternal and Pediatric Nursing: Caring for Women and Children

16. A nurse is developing cultural competence. Which of the following indicates that the nurse is in the process of developing cultural knowledge? Select all that apply. A) Examining personal sociocultural heritage B) Reviewing personal biases and prejudices C) Seeking resources to further understanding of other cultures D) Becoming familiar with other culturally diverse lifestyles E) Performing a competent cultural assessment F) Advocating for social justice to eliminate disparities.

Seeking resources to further understanding of other cultures Becoming familiar with other culturally diverse lifestyles

1. The nurse is caring for a 2-week-old newborn girl with a metabolic disorder. Which of the following activities would deviate from the characteristics of family-centered care? A) Softening unpleasant information or prognoses B) Evaluating and changing the nursing plan of care C) Collaborating with the child and family as equals D) Showing respect for the family's beliefs and wishes

Softening unpleasant information or prognoses

24. A nurse is preparing a teaching plan for a woman who is pregnant for the first time. Which of the following would the nurse incorporate into the teaching plan to foster the client's learning? A) Teach "survival skills" first B) Use simple, non-medical language C) Refrain from using a hands-on approach D) Avoid repeating information E) Use visual materials such as photos and videos

Teach "survival skills" first Use simple, non-medical language Use visual materials such as photos and videos

14. Which of the following statements is accurate regarding women's health care in today's system? A) Women spend 95 cents of every dollar spent on health care. B) Women make almost 90% of all healthcare decisions. C) Women are still the minority in the United States. D) Men use more health services than women.

Women make almost 90% of all healthcare decisions.

4. A pregnant client tells her nurse that she is interested in arranging a home birth. After educating the client on the advantages and disadvantages, which statement would indicate that the client understood the information? A) "I like having the privacy, but it might be too expensive for me to set up in my home." B) "I want to have more control, but I am concerned if an emergency would arise." C) "It is safer because I will have a midwife." D) "The midwife is trained to resolve any emergency, and she can bring any pain meds."

"I want to have more control, but I am concerned if an emergency would arise."

20. During class, a nursing student asks, "I read an article that was talking about integrative medicine. What is that?" Which response by the instructor would be most appropriate? A) "It refers to the use of complementary and alternative medicine in place of traditional therapies for a condition." B) "It means that complementary and alternative medicine is used together with conventional therapies to reduce pain or discomfort." C) "It means that mainstream medical therapies and complementary and alternative therapies are combined based on scientific evidence for being effective." D) "It refers to situations when a client and his or her family prefer to use an unproven method of treatment over a proven one."

"It means that mainstream medical therapies and complementary and alternative therapies are combined based on scientific evidence for being effective."

15. A nurse is educating a client about a care plan. Which of the following statements would be appropriate to assess the client's learning ability? A) "Did you graduate from high school; how many years of schooling did you have?" B) "Do you have someone in your family who would understand this information?" C) "Many people have trouble remembering information; is this a problem for you?" D) "Would you prefer that the doctor give you more detailed medical information?"

"Many people have trouble remembering information; is this a problem for you?"

13. A nursing instructor is describing trends in maternal and newborn health care. The instructor addresses the length of stay for vaginal births during the past decade, citing that which of the following denotes the average stay? A) 24-48 hours or less B) 72-96 hours or less C) 48-72 hours or less D) 96-120 hours or less

24-48 hours or less

Using the family stress theory as an intervention approach for working with families experiencing parenting the nurse can help the family change which internal context factor? a. Success in coping with stressors b. Maturation of family members c. The family's perception of the event d. The prevailing cultural beliefs of society

ANS: C The family stress theory is concerned with the family's reaction to and perception of stressful events internal context factors include elements that a family can control such as psychological defences. It is not concerned with maturation of family members or with the prevailing cultural beliefs of society. The family's success in coping with stressors is an external rather than internal context.

Which should the nurse do when using an interpreter to communicate with a patient who speaks a different language? a. Respond promptly and positively to project authority. b. Never use a family member as an interpreter. c. Talk directly to the patient when communicating. d. Involve the family in all communication.

ANS: C The nurse should talk directly to the patient to create an atmosphere of respect. The nurse should not rush to judgement and should make sure that she or he understands the patient's message clearly. In crisis situations the nurse may need to use a family member or neighbour as a translator. The nurse should not assume involving the family in all communication as confidentiality may be breeched when doing so each situation needs to be assessed individually.

2. The nurse is providing home care for a 6-year-old girl with multiple medical challenges. Which of the following activities would be considered the tertiary level of prevention? A) Arranging for a physical therapy session B) Teaching parents to administer albuterol C) Reminding parent to give a full course of antibiotics D) Giving a DTaP vaccination at the proper interval

Arranging for a physical therapy session

6. When caring for childbearing families from cultures different from one's own, which of the following must be accomplished first? A) Adapt to the practices of the family's culture B) Determine similarities between both cultures C) Assess personal feelings about that culture D) Learn as much as possible about that culture

Assess personal feelings about that culture

23. A nurse practicing in the community is preparing a presentation for a group of nursing students about this practice setting. Which of the following would the nurse include as characteristic of this role? A) Greater emphasis on direct physical care B) Broader assessment to include the environment C) Increased dependency on physician D) Limited decision-making and support

Broader assessment to include the environment

25. A group of nurses is reviewing the steps for developing cultural competence. The students demonstrate understanding when they identify which of the following is the final step? A) Cultural knowledge B) Cultural skills C) Cultural encounter D) Cultural awareness

Cultural encounter

11. When comparing community-based nursing with nursing in the acute care setting to a group of nursing students, the nurse describes the challenges associated with community-based nursing. Which of the following would the nurse include? A) Increased time available for education B) Improved access to resources C) Decision-making in isolation D) Greater environmental structure

Decision-making in isolation

10. When assuming the role of discharge planner for a woman requiring ventilator support at home, the nurse would do which of the following? A) Confer with the client's mother B) Teach new self-care skills to the client C) Determine if there is a need for backup power D) Discuss coverage with the insurance company

Determine if there is a need for backup power

8. The nurse would recommend the use of which supplement as a primary prevention strategy to prevent neural tube defects in pregnant women? A) Calcium B) Folic acid C) Vitamin C D) Iron

Folic acid

17. A nurse is engaged in providing family-centered care for a woman and her family. The nurse is providing instrumental support with which activity? A) Explaining to the woman and family what to expect during the birth process. B) Assisting the woman in breathing techniques to cope with labor contractions. C) Reinforcing the woman's role as a mother after birth D) Helping the family obtain extra financial help for prescribed phototherapy

Helping the family obtain extra financial help for prescribed phototherapy

7. After teaching a group of students about the changes in health care delivery and funding, which of the following, if identified by the group as a current trend seen in the maternal and child health care settings, would indicate that the teaching was successful? A) Increase in community settings for care B) Decrease in family poverty level C) Increase in hospitalization of children D) Decrease in managed care

Increase in community settings for care

19. A nursing instructor is presenting a class for a group of students about community-based nursing interventions. The instructor determines that additional teaching is needed when the students identify which of the following? A) Conducting childbirth education classes B) Counseling a pregnant teen with anemia C) Consulting with a parent of a child who is vomiting D) Performing epidemiologic investigations

Performing epidemiologic investigations

3. A nursing student is reviewing information about documenting client care and education in the medical record and the purposes that it serves. The student demonstrates a need for additional study when the nurse identifies which of the following as a reason? A) Serves as a communication tool for the interdisciplinary team. B) Demonstrates education the family has received if legal matters arise. C) Permits others access to allow refusal of medical insurance coverage. D) Verifies meeting client education standards set by the Joint Commission.

Permits others access to allow refusal of medical insurance coverage.

12. After teaching a group of students about the different levels of prevention, the instructor determines a need for additional teaching when the students identify which of the following is a secondary prevention level activity in community-based health care? A) Teaching women to take folic acid supplements to prevent neural tube defects B) Working with women who are victims of domestic violence C) Working with clients at an HIV clinic to provide nutritional and CAM therapies D) Teaching hypertensive clients to monitor blood pressure

Teaching women to take folic acid supplements to prevent neural tube defects

18. A nurse is considering a change in employment from the acute care setting to community-based nursing. The nurse is focusing her job search on ambulatory care settings. Which of the following would the nurse most likely find as a possible setting? Select all that apply. A) Urgent care center B) Hospice care C) Immunization clinic D) Physician's office E) Day surgery center F) Nursing home

Urgent care center Physician's office Day surgery center

21. While a nurse is obtaining a health history, the client tells the nurse that she practices aromatherapy. The nurse interprets this as which of the following? A) Use of essential oils to stimulate the sense of smell to balance the mind and body B) Application of pressure to specific points to allow self-healing C) Use of deep massage of areas on the foot or hand to rebalance body parts D) Participation in chanting and praying to promote healing.

Use of essential oils to stimulate the sense of smell to balance the mind and body

Which term describes the process by which people retain some of their own culture while adopting the practices of the dominant society? a. Acculturation b. Assimilation c. Ethnocentrism d. Cultural relativism

ANS: A Acculturation is the process by which people retain some of their own culture while adopting the practices of the dominant society. This process takes place over the course of generations. Assimilation is a loss of cultural identity. Ethnocentrism is the belief in the superiority of one's own culture over the cultures of others. Cultural relativism recognizes the roles of different cultures.

Which is a pictorial tool that can assist the nurse in assessing aspects of family life over generations? a. Genogram b. Family values construct c. Ecomap d. Human development wheel

ANS: A A genogram depicts the relationships of family members over generations. Family values construct does not depict the relationship of family members over generations. An ecomap depicts family social relationships. The human development wheel does not depict the relationship of family members over generations.

Which type of family is reflected when a mother's household consists of her husband his mother and another child? a. Extended b. Lone-parent c. Married-blended d. Trinuclear

ANS: A An extended family or multigenerational family includes blood relatives living with the nuclear family. Both parents and a grandparent are living in this extended family. Married-blended refers to families reconstructed after divorce. A lone-parent family only includes one parent. Both parents and a grandparent make up an extended family.

A married couple lives in a single-family house with their newborn son and the husband's daughter from a previous marriage. Which family form best describes this family? a. Blended family b. Extended family c. Nuclear family d. Same-sex family

ANS: A Blended families are formed as the result of divorce and remarriage. Unrelated family members join together to create a new household. Members of an extended family are kin or family members related by blood such as grandparents aunts and uncles. A nuclear family is a traditional family with a male and female partner along with the children resulting from that union. A same-sex family is a family with homosexual partners who cohabit with or without children.

Upon arriving for a follow-up postpartum and newborn home visit the woman's family members are present. What should the nurse do? a. Observe the family members' interactions with the newborn and with one another. b. Ask the woman to meet with her and the baby alone. c. Do a brief assessment of all family members present. d. Reschedule the visit for another time so that the mother and infant can be assessed privately.

ANS: A The nurse should introduce herself to the patient and the other family members present. Family members in the home may be providing care and assistance to the mother and infant. However this care may not be based on sound health practices. Nurses should take the opportunity to dispel myths while family members are present. The responsibility of the home care maternal-child nurse is to provide care to the new postpartum mother and her infant not to briefly assess all family members. The nurse can politely ask about the other people in the home and their relationships with the woman. Unless an indication is given that the woman would prefer privacy the visit may continue.

Which statement about family systems theory is inaccurate? a. A family system is part of a larger suprasystem. b. A family as a whole is equal to the sum of the individual members. c. A change in one family member affects all family members. d. Family members' behaviours are understood from a view of circular causality.

ANS: B A family as a whole is greater than the sum of its parts. A family system is a part of a larger suprasystem. A change in one family member affects all family members. Family members' behaviours are best understood from a view of circular rather than linear causality.

Which topic would be appropriate for the nurse to explore to gather information related to cultural expectations about childbirth? a. Marital status b. People present during labour c. Food intake during hospitalization d. Fears about being hospitalized

ANS: B An appropriate question to ask for the nurse to explore cultural expectations includes asking who they would like with them during their labour. Asking if she is married or has a partner is not a culturally acceptable question the nurse should ask how the woman defines her family. Asking about food preferences in the hospital assumes that she will have no choice rather the nurse should ask if she has any special dietary needs or requests. Asking what scares her about her hospitalization assumes that she is scared rather the nurse should ask if she has any concerns or fears about her upcoming hospitalization.

The nurse should be aware that the criteria used to make decisions and solve problems within families are based primarily on which factor(s)? a. Rituals and customs b. Values and beliefs c. Boundaries and channels d. Socialization processes

ANS: B Values and beliefs are the most prevalent factors in the decision-making and problem-solving techniques of families. Although culture may play a part in the decision-making process of a family ultimately values and beliefs dictate the course of action taken by family members. Boundaries and channels affect the relationship between the family members and the health care team not the decisions within the family. Socialization processes may help families interact with the community but they are not the criteria used for decision making within the family.

Which would be considered when viewing the family through a phenomenological lens? a. Professional relationships b. Experience of childbirth c. Cultural meanings and significance d. Health promotion within an environmental context

ANS: B The phenomenological lens cues the nurse to learn more about the woman's and family members' experiences of health and illness. Professional relationships would be considered when using the sociopolitical lens. The spiritual lens considers cultural meanings and significance. The socio-environmental perspective encourages an understanding of health and health promotion that focuses on the family in their environmental context.

The nurse demonstrates respect for the woman by carrying out which action when using an interpreter? a. Assigning an interpreter that the nurse has chosen b. Providing as much privacy as possible c. Attempting to have a family member act as the interpreter d. Respecting the woman's wishes when they violate standards of care

ANS: B To demonstrate respect and dignity for the woman the nurse should provide as much privacy as possible. It is important to involve the woman in the decision about who the interpreter will be. A family member is not a good choice for interpreter unless this is what the woman expresses that she wants. While it is important to respect the woman's wishes the nurse should not do this when they violate the standard of care.

Canada's official multiculturalism policy (1971) confirmed which statement? a. The rights of African-Canadian people b. The value and dignity of lesbian and gay people c. Canada's two official languages: French and English d. Preservation of dignity among lone-parent families

ANS: C Canada's official multiculturalism policy (1971) confirmed Canada's two official languages: French and English. The rights of people identified included Indigenous people. The value and dignity of all Canadians was confirmed with no one group singled out. There was no mention of lone-parent families in this policy.

Which characteristic is reflective of cultural safety? a. Maximizing respectful relationships with diverse populations b. Examining one's own values and beliefs of various cultures c. Process and outcome to promote greater health equity d. Valuing diversity and inclusivity

ANS: C Cultural safety is both a process and an outcome whose goal is to promote greater health equity. Maximizing respectful relationships with diverse populations is part of cultural competence. Examining one's own values and beliefs is related to personal reflections and is not part of cultural safety. Diversity and inclusivity are values that underpin cultural competence.

Which type of family represents a traditional family structure in which male and female partners and their children live as an independent unit? a. Extended family b. Binuclear family c. Nuclear family d. Blended family

ANS: C In contemporary society the traditional nuclear-family structure actually represents a relatively small number of families. Extended families have additional blood relatives other than the parents. A binuclear family involves two households. A blended family is reconstructed after divorce and involves the merger of two families.

What is the focus of relational nursing? a. Primarily disease prevention b. Provision of health services c. Recognition of determinants of health d. Resiliency of the woman and her family

ANS: C Relational nursing focuses primarily on the recognition of the determinants of health. It is more congruent with health promotion than disease prevention. The focus of perinatal nursing has moved away from the provision of health service in order to focus on the determinants of health. The resiliency of the woman and her family is not the focus of relational nursing.

Why is the patient's family important to the maternity perinatal and pediatric nurse? a. They provide financial support for the mother. b. The nurse will know which family member makes the decisions. c. They will provide care for the new mother when the nurse is unable to make a home visit. d. The family culture will influence nursing care decisions.

ANS: D Family culture influences a family's feelings and attitudes toward health their children and health care delivery systems and is thus important to the nurse. Providing financial support for the mother is not related to why the family is important to the nurse. The nurse will not necessarily know which family member(s) makes the decisions. Family care is not a substitute for a nursing home visit.

In what form do families tend to be most socially vulnerable? a. Blended family b. Extended family c. Nuclear family d. Lone-parent family

ANS: D The lone-parent family particularly the female lone-parent family is more likely to have a lower income and to experience poverty which in turn can affect the health status of family members. The married-blended family the extended family and the nuclear family are not most socially vulnerable.

When planning interventions for diverse families you realize that acceptance of the interventions will be most influenced by which factor? a. Educational achievement b. Income level c. Subcultural group d. Individual beliefs

ANS: D The patient's culture beliefs and values are ultimately the key to acceptance of health care interventions. However these beliefs may be influenced by factors such as educational level income level and ethnic background. Educational achievement income level and subcultural group are all important factors. However the nurse must understand that a woman's concerns from her own point of view will have the most influence on her adherence to interventions.

5. The nurse is making a home visit to a client who had a cesarean birth 3 days ago. Assessment reveals that the client is complaining of intermittent pain, rating it as 8 on a scale of 1 to 10. She states, "I'm pretty tired. And with this pain, I haven't been drinking and eating like I should. The medication helps a bit but not much. My mom has been helping with the baby." Her incision is clean, dry, and intact. Which nursing diagnosis would the nurse identify as the priority for this client? A) Impaired skin integrity related to cesarean birth incision B) Fatigue related to the effects of surgery and caretaking activities C) Imbalanced nutrition, less than body requirements related to poor fluid and food intake D) Acute pain related to incision and cesarean birth

Acute pain related to incision and cesarean birth

22. A pregnant woman asks the nurse about giving birth in a birthing center. She says, "I'm thinking about using one but I'm not sure." Which of the following would the nurse need to integrate into the explanation about this birth setting? Select all that apply. A) An alternative for women who are uncomfortable with a home birth. B) The longer length of stay needed when compared to hospital births C) Focus on supporting women through labor instead of managing labor D) View of labor and birth as a normal process requiring no intervention E) Care provided primarily by obstetricians with midwives as backup care

An alternative for women who are uncomfortable with a home birth. Focus on supporting women through labor instead of managing labor View of labor and birth as a normal process requiring no intervention

9. Which action would the nurse include in a primary prevention program in the community to help reduce the incidence of HIV infection? A) Provide treatment for clients who test positive for HIV B) Monitor viral load counts periodically C) Educate clients on how to practice safe sex D) Offer testing for clients who practice unsafe sex

Educate clients on how to practice safe sex