Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing

The home care nurse is teaching home health assistants about home visit safety. Which statement by the home health assistant would require intervention by the nurse?

"I have become a member of the family, so I eat meals with them sometimes." The nurse should intervene regarding statements related to eating with the client. For personal safety, it is best to not consume any food or beverages at a client's home as one cannot be sure of the cleanliness of the dishes or the food.

A pregnant client tells her nurse that she is interested in arranging a home birth. After educating the client on the advantages and disadvantages of a home birth, which statement would indicate that the client understood the information?

"I want to have more control, but I am concerned if an emergency would arise." Home births have many advantages, such as having more control over the birth, being the least expensive option, creating a good relationship with a midwife, and having more flexibility in the comfort of your home. However, the limited availability of pain medication and danger to the mother and baby if an emergency arises are two of the main disadvantages.

The home care nurse has taught the pregnant home care client how to complete several self-assessment parameters. Which statement by the client indicates that teaching has been successful?

"I will sit or lie down for two hours and count how many times the baby kicks, looking for at least 10 per two hours." To assess for fetal movements, the client will need to sit or lie down to be able to feel fetal kicks, movements, or rolls during a 2-hour period. This should be done during the same time every day, in which the fetus is the most active. The nurse should instruct the client to keep a log of fetal movement and track the amount of time to reach 10 movements.

A pregnant woman reports she does not see the value in attending prepared childbirth classes because she plans to have an epidural to manage the discomfort from the contractions. What information should be included in responses by the nurse? Select all that apply.

"There are many different topics included in prepared childbirth classes aside from pain management." "Preparation for labor and birth can enhance your experience and coping abilities." "You can learn tools to assist you in the labor process both before and after your epidural." Prepared childbirth education courses provide information for prospective and expecting parents. The information in prepared childbirth education is not limited to pain management. Courses can include other topics such as potential procedures during the labor process, newborn care and postpartum care. Education and an accompanying understanding of the labor and birth experience can improve the coping skills of the mother and her partner. Advising the woman that she is limiting her options is argumentative and not appropriately stated.

As part of an education program for pregnant women and their partners, the nurse illustrates the various settings available for birth. The nurse determines that the program was successful when the group correctly chooses which statement about home births?

"Women giving birth at home have control over every part of labor." Home births permit the woman to maintain control over every aspect affecting the woman's labor, such as positioning, attire, and support persons present. A home birth involves the least amount of cost. Home births are recommended for pregnant women considered to be at low risk for complications. Some birthing centers may have very rigid screening criteria. The availability for pain medication is limited for home births.

The nurse is explaining to a school-age child the need to soak the hands twice a day to help with an infection. Which teaching should the nurse provide that would be appropriate for the client's cognitive level?

"Would you like to sit in the chair or stay in bed to soak your hand?" Before anyone can be cared for at home, teaching will be required so the family understands the illness and principles of care. Because the patient is a school-age child, the nurse should provide choices so that the patient has a sense of control over the situation. Soaking both hands may or may not be medically necessary. Telling the patient to stay in bed or soaking the hands now does not provide the patient with a sense of control and may lead to resistance or nonadherence to medical treatment.

The case manager is looking over the inpatient census on her floor to determine which client would be the best candidate for discharge with home health care follow-up. Which client would the case manager recommend to the physician for discharge?

10-year-old boy with an infected laceration on his leg who has been treated with IV antibiotics for 3 days. The child with the infected laceration is on IV antibiotics and can safely be discharged to complete the medication at home with home health care. The 6-year-old is too unstable for discharge. The infant's bilirubin is too high for doing home health phototherapy and may need additional hydration. The adolescent is on sickle cell crisis and is not ready for discharge 1 day after admission.

Which behavior suggests that a family is a well one?

A mother states that she has grown up since giving birth to her children. Growing with children is a mark of a healthy family. Lack of communication or time spent together leads to less than optimal families.

While assessing a family, the nurse constructs a genogram. The nurse uses this tool to achieve which result?

A visual presentation of the relationships of family members. A genogram is an illustration of the relationship of family members.

A child is hospitalized with complications related to hemophilia. The health care provider has discussed the child's plan of care with the parents, but they continue to ask questions. What action will the nurse take?

Answer the parents' questions as completely as possible. Explanation: Because the health care provider has discussed the child's care, the nurse should answer the parents' questions as completely as possible. Telling the parents that they have been fully briefed negates their concerns and is inappropriate. Encouraging the parents to focus on their child also negates their concerns. Unless the parents ask specifically for the health care provider, the nurse can answer the parents' questions.

A school-age child, a member of a family with a mother, father, and toddler, is hospitalized. The father is employed outside of the home, and the mother stays at home with the other child. The mother is challenged with supporting both children at this time. What should the nurse suggest to the mother?

Ask extended family members to help out during this time. In a time of crisis, the nuclear family is challenged because there are few family members to share the burden or look at a problem objectively. The nurse should suggest that the family locate and reach out to support people in their extended family during a crisis. Placing the toddler in day care and suggesting the father take time off to help might negatively impact the family's financial situation and would be inappropriate for the nurse to suggest these options. The option of visiting the school-age child after the father comes home from work may not support the child adequately during the hospitalization.

The nurse is performing a cultural assessment of a family that has a child hospitalized for leukemia. What is the best technique for providing culturally competent care for this family?

Ask the family about their culture and listen. Understanding and respecting the family's culture helps foster good communication and improves child and family education about health care. The best way to assess the family's cultural practices is to ask and then listen. Determine the language spoken at home and observe the use of eye contact and other physical contact. Demonstrate a caring, nonjudgmental attitude and sensitivity to the child's and family's cultural diversity. An interpreter should be hired for a family who does not speak the dominant language.

A nurse is providing care to a group of childbearing families from a different culture at the local family health clinic. Which action should the nurse prioritize?

Assess personal feelings about that culture. The first step is for the nurse to assess personal feelings about the culture. The nurse needs to develop cultural awareness, engage in self-exploration beyond one's own culture, see clients from different cultures, and examine personal biases and prejudices toward other cultures. Once this occurs, the nurse can learn a great deal about the culture to gain cultural knowledge and become familiar with similarities and differences between one's own culture and the family's culture. The nurse would adapt nursing care to address the practices of the family's culture to provide culturally competent care. The nurse could also ask the family about specifics that they follow in their family unit.

Advocacy for the client is an important aspect of community-based nursing. What is one way a nurse can advocate for a pediatric client?

Assist the family to apply for Medicaid or other forms of health care reimbursement. The nurse working in a community setting may often develop a long-standing relationship with families because of the continuous nature of client contact in an outpatient, school, or other setting. This type of relationship may allow the nurse to advocate for the client on a broader scale in health and welfare issues. Examples of interventions include helping the family apply for Medicaid or other forms of health care reimbursement. Reporting new cases of whooping cough is done to state authorities, not county authorities, and is not considered advocating for a client. Arranging educational events for the local hospital staff is not a community-based function. Assuring a mother that the bruises on her toddler will not be reported to social services—when it is mandated that any suspected case of child violence be reported—is not advocating for the child.

The nurse is preparing to obtain a health history from a client with preeclampsia who is at home. In which area should the nurse conduct the assessment?

Bedroom, where it is quiet and private The nurse should provide privacy and confidentiality when obtaining the health history and performing a physical examination. The nurse should identify a private location such as the bedroom. The kitchen, porch, and living room are not private areas for this assessment.

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.

Birth parent Non-birth parent Step children Birth 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.

The nurse in the pediatric clinic is working with families on a daily basis. Assessment of family structure has become an important part of the nursing assessment in the provision of quality care. A child who presents in the clinic has a mother, stepfather, sister, and stepbrother living within the family unit. The nurse correctly assesses this to be what type of family structure?

Blended The step-parent family does not bring in children from both previous marriages. Nuclear and extended families have children from one marriage who are either biologic or adopted. The blended family consists of two custodial parents who each bring in children from previous marriages.

Today, families come in a variety of structures. Two of these structures are the stepfamily and the blended family. What differentiates a blended family from a stepfamily?

Both adults are custodial parents and bring their children to the family structure. The stepfamily consists of a custodial parent and children and a new spouse. If both partners in the marriage bring children from a previous marriage into the household, the family is usually termed a blended family. If there are adult relatives living in the household along with the parents and their children, it is termed an extended family. When parents legally take a non-biologic child into their home and raise it as their biologic child it is an adoptive family. When one or both of the adults in the household are custodial and they live together, raising their children as one family, it is termed a cohabitation family.

The home care nurse is conducting an environmental assessment of an apartment home prior to the dismissal of a child with a wheelchair. Which finding on the environmental assessment would be the priority concern for the nurse?

Bunk beds in the client's room The child is in a wheelchair and has a bunk bed in his room. The client will not be able to get to the top bunk for sleeping. The nurse should address this with the parents to see if other sleeping arrangements need to be made prior to the client returning home.

A nurse is preparing an in-service presentation about homelessness and families. Which of the following would the nurse include in the discussion? Select all that apply.

Children of homeless families have special health needs. Children under 5 years of age make up almost half of the homeless children in the United States. Homeless school aged children experience more psychiatric symptoms. Children of homeless families have special health needs with children younger than 5 years of age making up 42% of the homeless children in the United States. Research has shown that homeless school aged children experience more psychiatric symptoms and have a greater fear of being stigmatized. Findings also support the need for programs to meet the physical, medical, developmental, emotional, and educational needs of these at-risk families to prevent negative outcomes for child development and socialization.

Families today tend to spend less time together than families did historically. What is one factor that could be used to explain this trend?

Children participate in many school activities Many factors contribute to the trend for families to spend less time together. Both parents may work, the children participate in many school activities, family members watch television rather than talking together at mealtime, family members may eat fast food or individual meals without sitting down together as a family, and there is an emphasis on the acquisition of material goods rather than the development of relationships. A family emphasis on relationships, eating meals together, and parents putting their careers on hold to raise their families are factors that would lead to families that spend more time together, not less.

A school nurse has discovered that one of the children has acquired a case of head lice. The school principal asks the nurse to write a letter that will be sent to parents explaining about head lice and measures to prevent infestation. What information is important for the nurse to include in the letter? Select all that apply.

Children should avoid sharing personal items such as combs and hats. Parents should inspect their child's head for nits with a fine tooth comb. A second treatment one week after the first is recommended. To prevent head lice infestation children should avoid sharing personal items such as barrettes, combs, and hats. Parents should also wash and dry clothes, bedding, and hats using high temperatures. Vacuuming soft surfaces that cannot be laundered (sofas and chairs) is also helpful. Parents should inspect their child's head daily with a fine tooth comb for nits (lice eggs) after treatment. A second treatment is often necessary 1 week to 10 days after the first. A head lice infestation can happen to any child and is not a reflection of poor hygiene or socioeconomic status. Shampoos with specific medications are necessary to treat head lice (permethrin).

What behaviors might the nurse expect to see in a 3-year-old child whose parents have been recently divorced?

Clinginess, bed-wetting, and thumb sucking Children in early childhood development may react to a divorce by regressing in their behavior. Children in middle childhood may fight with siblings, have tantrums, and/or act on best behavior in hopes of reuniting their family. Adolescents may act out in a negative way because of feeling a loss of being "in charge" as they are dealing with their own identity and sexuality.

The home care nurse is visiting a client and family for the first time. Which initial action can the nurse take to build trust with the client and family?

Communicate in an organized and professional manner. Communicating with the client in an organized and professional manner displays a level of competence by the nurse that promotes trust and respect. Next, the nurse will also want to inform the client who will have access to the medical record to build confidentiality and promote security.

A nurse is teaching a new mother from Latin America about breast-feeding before discharge. The proper language translation service is used, and the patient smiles to acknowledge her understanding. On the second day after discharge, a home health nurse visits the family and discovers that the mother is pumping her milk and discarding it. The hospital nurse did not take what aspect into her teaching of this new mother?

Cultural differences and beliefs regarding breast-feeding Cultural awareness is necessary to help the family coordinate its health care beliefs with those of the new community. Often cultural differences exist, and confusion can arise. It is important to determine whether harm is being done and to correct actions as needed.

The nurse is caring for a 4-year-old boy with Ewing sarcoma who is scheduled for a computed axial tomography (CAT) scan tomorrow. Which is the best example of therapeutic communication?

Describing what it is like to get a CAT scan using words he understands Describing what it is like to get a CAT scan using age-appropriate words is the best example of therapeutic communication. It is goal-directed, focused, and purposeful communication. Using family-familiar words and soft words is a good teaching technique. Telling him how cool he looks in his baseball cap and pajamas is not goal-directed communication. Telling the child he will get a shot when he wakes up could keep him awake all night.

Students are reviewing information about family structures and functions. They demonstrate understanding of the information when they identify which of the following as true?

Despite changes in family structure, the nuclear family is still prominent. At the beginning of the 21st century, family structures are more varied than in the past. The small, traditional family unit known as the nuclear family remains prominent. The functions of each family differ but do exist to meet some common goals. From 1970 to 2007, married couples in families with children decreased from 93% to 71%. The traditional U.S. family structure is the nuclear family but other structures are common today.

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?

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.

Which of the following may occur in the blended type of family at a greater level than other types of families?

Disagreement about childrearing practices Because blended families merge two families, traditions and family patterns may not merge smoothly.

When a woman is asked how she feels about staying home with her children, she responds, "My husband and I have decided that he will work and I will manage the home." According to Duvall, this couple is fulfilling which family task?

Division of labor Dividing family tasks into who will perform them is division of labor.

The family functions as the oldest and most basic social unit in society. What is the primary purpose of the family?

Ensure survival The family's primary purpose is to ensure survival of the unit and its individual members and to continue society and its knowledge, customs, values, and beliefs. Other functions include physical sustenance, emotional support, intellectual stimulation, socialization, and spirituality. However, these are not the primary purpose of the family unit.

A 4-year-old adopted child has begun to ask questions about when she was born. Which suggestions by the clinic nurse would be considered the most appropriate answer for this child related to her birth? Select all that apply.

Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them. At least by 4 years, children are old enough to fully understand the story of their adoption: they grew inside the body of another woman who, because she could not care for them after they were born, gave them to the adopting parents to raise and love. It is important for parents not to criticize a birth mother as part of the explanation because children need to know, for their own self-esteem, that their birth parents were good people and they were capable of being loved by them, but things just did not work out that way. At age 4, children do not understand HIV status, not being able to provide for the needs of an infant, or prison terms.

A married couple has 3-year-old twins. They own a dog. The father's mother lives with them. The father is a professor; the mother has resigned from her position as a legal secretary to be the children's primary caregiver. Which type of family does this represent?

Extended Families with more than two generations are extended families.

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?

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.

The nurse is working with a same-sex couple, both of whom have children from previous relationships. Although the couple have no plans of marrying, they view their relationship as monogamous and long-term. Which family structure would apply to this family? Select all that apply.

Gay or lesbian family Cohabitation family Blended family As the members of the couple in this scenario are of the same sex, this is a gay or lesbian family. As the couple is not married, it is a cohabitation family. And as they each have children from previous relationships, it is a blended family. It is not an extended family, as it does not include extended family relations, such as grandmothers, grandfathers, aunts, uncles, cousins, or grandchildren. It is not a foster family, as the children are related biologically to at least one of the parents.

The functions of the family are important in preserving our society with its beliefs, norms, and values. There are five major functions of the family unit; what is one of them?

Giving and teaching emotional support For each family member, the family functions to provide sustenance and support in the five areas of wholeness: physical, emotional, intellectual, social, and spiritual. Protecting family members from violence in the media is not considered one of the five functions of a family, nor is giving meaning to a lifestyle. Cultural heritage of a family is important with its beliefs and traditions. Ignoring that cultural heritage for anything else is not a function of the family.

A nurse is providing care for a child diagnosed with beta-thalassemia who is receiving a blood transfusion. The child reports being bored and asks to go to the playroom. What is the best action for the nurse to take?

Have a child-life specialist find an appropriate activity to occupy the child during the transfusion. The best action the nurse can take is to have the child-life specialist work with child to find something interesting the child can do while in the room. There is a safety issue involved if the nurse tries to administer the transfusion in the playroom. The nurse can deny the request or explain the need for rest but if the child is feeling well it will likely not be enough to satisfy the child. Finding an appropriate activity for the child to engage in is the best option.

The biggest benefit of health care provided in the home is:

Inclusion of the entire family in health care planning and provision All patient care should focus on the patient and the family. The importance of side benefits of reduced cost and increased employment opportunities does not exceed the importance of benefits derived by including the family.

A client who is currently 30 weeks' gestation with three small children is placed on bed rest at home due to preeclampsia. Which is the priority nursing diagnosis for this client?

Ineffective role performance The client has three small children at home and is placed on bed rest, therefore limiting the amount of interaction and care she will be able to provide for the other children. This may interrupt the normal functioning of the family unit and the client's role within that unit.

The nurse is preparing to make a home visit to admit a new client to services. Which actions should the nurse take to ensure personal safety? Select all that apply.

Keeping the gas tank of the car full Parking the car in a well-lighted area Using a map to avoid getting lost in a strange neighborhood Informing the agency of the estimated arrival time and expected return Safety tips for making home care visits include keeping the gas tank full, parking in a well-lighted area, using a map to avoid getting lost, and informing the agency of the estimated arrival time and expected return. The nurse should keep the car doors locked for safety.

The nurse is asked to present an educational event to the local Junior League. While planning for the event, what is most important for the nurse to do?

Know the needs of the audience. To teach a group successfully, it is important to know the needs of the target population and to have the appropriate teaching skills, strategies, and resources. Asking questions about the histories of those who will be attending the event comes under the category of the targeted group's demographics. While it is important to have these facts, it is not most important for the nurse to know. Using posters that everyone can read is part of the presentation strategy of the nurse, but it is not most important. Telling those present at the event a brief synopsis of the nurse's background is usually done by whomever introduces the nurse as the speaker. It is not usually an activity the nurse does herself or himself.

The home health nurse enters the gated front yard of the client. A large aggressive dog appears on the front porch. What is the most appropriate action by the nurse?

Leave the yard and return to the car. The nurse should be most concerned with his or her personal safety and thus should leave the yard and return to the car. Once inside the car, the nurse can phone the client to request the dog be removed from the porch.

The nurse has been working with a family on actions that strengthen loyalty between all members. Which healthy family behavior has been the focus of the nurse's interventions?

Maintenance of motivation and morale In maintenance of motivation and morale, healthy families have pride in their family and allow them to support each other during a crisis. Assessing for loyalty is one way to measure this behavior. Division of labor focuses on family members dividing the workload among family members and adjusting workloads as necessary. Physical maintenance focuses on food, shelter, clothing, and health care. Socialization of family members focuses on every family member feeling as a part of the family and interacting with people outside of the family.

The nurse determines that a small nuclear family has achieved the family task of division of labor. What did the nurse assess in this family to come to this conclusion?

Mother cares for children while father works outside of the home. The task of division of labor is when the workload is divided evenly between family members. Parents taking children to meet the neighbors fulfill the task of family member socialization. The family attending religious services every week fulfills the task of member placement in society. Older children finishing homework before watching television fulfills the task of maintenance of order.

A family of a mother, father, and a 6-year-old boy was recently enlarged to include a new baby sister. What type of family does this represent?

Nuclear A nuclear family is defined as consisting of parents and children.

A nurse is assessing a family with a married couple and their immediate biological children. How would the nurse document the description of this family?

Nuclear A nuclear family is described in the question. In an extended family, other relatives also live in the residence. In a single-parent family there is only one parent in the house. In a blended family a couple is remarried with a child under 18 years old.

A nurse is providing home care to several families who live in a community with limited resources. Which action is an example of how the nurse can best "nurse the community"?

Organize a free flu vaccination in the community. Although all of these examples are effective means of professional self-improvement, only organizing a free flu vaccination directly benefits the community itself.

A high school nurse has noticed a trend in the reading ability of the freshman class. This high school is located in a poor, urban area where there is a high proportion of single mothers raising their children with minimal financial support. Young children many times do not have adult supervision with homework. The local school nurses discuss issues within the school area. Which suggestion by a high school nurse would be a realistic solution to the problem described in this scenario?

Organize a group of local high school students to begin a reading program in the grade school to increase interest in reading. It is easy to fall into the mindset that a single telephone call or an email about a problem will not make a difference. Organizing adolescents from a local high school to begin a reading program at a grade school so as to increase interest in reading and improve the literacy rate in their neighborhood is a sound example of primary prevention. It is doubtful that the school board will provide reading teachers for each school given financial restraints being placed on public education. Single parents working more than one job to provide necessities for their family will probably not attend a block party since they will be at work. Also, singling the parents out for not supervising homework is unprofessional and not appropriate. Even if the school nurses agree to help after hours with reading, the number of students receiving the private sessions would be very low. The best option is getting high school students involved in the project.

A nurse is determining if a referral for home care is appropriate for a patient. Which factor about the patient's condition would indicate the need for continued hospitalization?

Patient's condition is considered critical A critical condition of a patient is one that requires more constant assessment and could change quickly to threaten the person's life. This person's care should not be provided outside of a hospital. A self-limiting condition is one that will end regardless of care provided; a condition that has reached a plateau has not changed in a relatively long time; and a noninfectious condition may not be suitable for home care.

The nursing instructor is teaching a session on the increase of health care costs associated with the advancement of modern technology. The instructor determines the session is successful when the students correctly choose which focus of community-based health care that has been implemented to combat the increased cost?

Preventing disease and its sequelae Community-based nursing focuses on prevention and is directed toward persons and families within a community. Community-based nursing is holistic in nature and provides care for the client as part of a family and community, not just as an individual. It strives to keep clients with chronic illnesses in their homes, but that is not the focus of the care provided. A function of community-based nursing is reporting and tracking reportable diseases; again, that is not the focus of community-based nursing.

A nursing instructor is teaching a class about the basic functions of families. The instructor determines the class is successful when the students correctly choose which statement as a basic function of the family?

Reproduction remains an important function of all families. The family serves two functions in relation to society: to reproduce and to socialize offspring. Couples today are less, not more, concerned about unplanned pregnancies. This is because of the development of the various family planning methods. It is the responsibility of the older members to teach the younger ones how to function as adults; however, the younger members also teach the older members about the changing world. There are some families where some adults are not wage earners but may stay at home for a variety of reasons (by choice, disability, etc.), which can result in limited resources available for the family.

A home care client who is 30 weeks' gestation with triplets reports to the nurse that she is having increasing difficulty getting out of bed to perform hygiene or elimination. Which is the most appropriate intervention?

Request a hospital bed for the home The nurse can request a hospital bed for the home care client. This will allow the client to adjust the bed to various heights and positions that may make it easier to get out of bed when needed. The client's condition does not warrant direct care status.

A school nurse informs parents that a screening for lice will be conducted on all first graders the following week. Which type of prevention is this nurse conducting?

Secondary prevention Primary prevention is health-promoting activities that help prevent the development of illness or injury. Secondary prevention is health-screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects arise. Tertiary prevention is health-promoting activities that focus on rehabilitation and teaching to prevent further injury or illness and occurs in special settings. Screening is a preventive measure.

A 24-year-old woman is the mother of an 8-month-old baby. The woman's father lives nearby in a nursing home. Which type of family does this represent?

Single parent A lone parent of either gender with a child is defined as a single-parent family.

The nurse is incorporating nonverbal communication with verbal communication when explaining the treatment plan for a child with type 1 diabetes. What should the nurse do to communicate effectively with this family?

Sit opposite the family and lean forward slightly. Guidelines for appropriate nonverbal communication include the following: sit opposite the family and lean forward slightly; relax: maintain an open posture, with the arms uncrossed; maintain eye contact; and nod your head to demonstrate interest.

A family consists of a mother, father, 3-year-old twins, and a new baby. According to Duvall's stages of family life, this family would be classified as being at which of the following?

Stage III family: family with preschool children The age of the oldest child marks the family stage according to Duvall. Three-year-olds are preschoolers.

A nurse is completing a home visit for an ill child. The mother of the child appears physically exhausted, the house is in disarray, and the young sibling is misbehaving. Which outcome evaluation by the nurse is most appropriate?

The family has not adjusted appropriately to the home care of the client. The nurse would recognize that the family has not appropriately adjusted to providing home care for the ill child. The nurse should re-evaluate to see if additional resources are needed, such as a routine home health nurse or respite services for the client. The nurse should assess the family for levels of support and provide community resources.

The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based?

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.

Which observation indicates to the nurse that a family is not functioning in a healthy way?

The father does not share his concerns so his wife will not worry about them. Health family functioning includes communication with each other and identifying and sharing feelings about the home situation. The family paying cash for health care does not support a family that is not functioning in a healthy way. The father comforting his crying daughter demonstrates healthy family functioning. The mother who believes the family could not function without could be a statement of frustration or evidence that the family needs her to maintain healthy functioning.

The home care nurse visited a newly assigned primigravida client with preeclampsia. When conducting the assessment and teaching, the client continued to cry and state she was in disbelief this was happening to her. When should the nurse schedule the second visit with the client?

The next day; the client is not coping well. The client is in a state of disbelief regarding the diagnosis. The nurse will need to assess to see if the teaching that was conducted was retained and to evaluate whether this client is an appropriate client for home care.

A family is getting divorced and is asking about what is best for the children. How should the nurse approach this question?

The nurse should encourage the father to be involved in the care of the children. Research has shown that a father's continued involvement with his children is associated with a positive outcome. It is not appropriate for the nurse to give personal contact information. The nurse can make a follow-up call, but that may not necessarily affect a positive outcome in the children.

One type of medicine a patient on home care receives could be given with any of the following schedules. Which of the following would be most effective in helping compliance?

Three times a day at 10 am, 2 pm, and 10 pm Patients cannot be expected to get up during the night every night to take medicine. A schedule that lets people sleep is best.

Children in foster care have a disproportionately higher incidence of pediatric acute and chronic conditions.

True Children in foster care have a disproportionately higher incidence of pediatric acute and chronic conditions. Careful evaluation is needed to determine if the child has been receiving regular and ongoing treatment for these conditions.

A community health nurse is actively involved in various community projects. The nurse is providing a secondary prevention activity by organizing which event?

a skin cancer screening fair Secondary prevention measures are those taken to screen for diseases (such as skin cancer screening), delayed development according to criteria, or use of medication. Primary prevention involves health promotion activities to prevent the development of illness or injury. This level of prevention includes giving information which could include teaching older adults how to use the internet to find reliable information concerning various diseases, or providing STI education to prevent the spread of the disease. Tertiary prevention includes health promotion activities that focus on rehabilitation and that provide information to prevent further injury or illness, such as teaching a client how to properly apply a colostomy device.

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 26 weeks' 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?

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.

A school nurse visiting with a 10-year-old child asks what they do as a family on weekends. The child responds, "Our dad just doesn't want outside people stopping by to visit, so we mainly stay to ourselves." The nurse finds this statement a little odd and makes a mental note to start observing the children in this family for possible signs of what potential problem?

abusive or dysfunctional family trying to hide their family abuse from outsiders A mark of families who are new to a community is they have few community contacts because they have not formed these as yet. This pattern is also the mark of an abusive or dysfunctional family if such a family deliberately keeps outside people separate from them. Families with a hoarding problem or doomsday-prepping families also shield themselves from others but are not very common possibilities. Close-knit families usually have lots of other family members stopping by throughout the week.

The nurse is providing home care for a 6-year-old girl with multiple medical challenges. Which activity would be considered the tertiary level of prevention?

arranging for a physical therapy session The tertiary level of prevention involves restorative, rehabilitative, or quality-of-life care such as arranging for a physical therapy session. Teaching parents to administer albuterol and reminding a parent to give the full course of antibiotics as prescribed are part of the secondary level of prevention, which focuses on diagnosis and treatment of illness. Giving a DTaP vaccination at the proper interval is an example of the primary level of prevention, which centers on health promotion and illness prevention.

A community-based nurse has a different set of skills than those of counterparts who work in a hospital. Community-based nurses also face unique issues and challenges. What is one of the unique aspects of community-based nursing?

autonomous Community-based nursing practice is autonomous. There are often no other members of the health care team to consult, or no members within the area to consult with. Teamwork is important in community-based nursing, but it is not a unique aspect of this type of nursing. Disease orientation is the medical model of health care. Community-based nursing takes in all aspects of the client, including community aspects such as education—not just the disease process. Therefore, it is more holistic rather than less holistic.

The nurse interviews a family that consists of a husband and wife who have both previously been in a marital relationship and who are living with two children. The children are the biological children of the mother and were born before the remarriage. This family situation is termed a(n): You Selected:

blended family. The blended family or stepfamily is a remarried family with a child under 18 years of age who is the biological child of one of the parents and was born before the remarriage. The nuclear family consists of a married couple and their immediate biological children. The binuclear family refers to the familial structure of joint custody families. The extended family consists of several generations of the family, including the immediate nuclear family, grandparents, and other relatives such as aunts, uncles, and cousins.

Home care is most successful when:

each member of the family can share the household tasks of the patient When the family, both nuclear and extended, contributes to fulfill the roles of the patient, the patient's stress is reduced and the function of the family is maintained. Separating children from parents can add to the family's stress. It is better if the partner can share the duties of the patient, which may require stepping outside the cultural role.

A pregnant teenager is not certain that she will like home care because she is afraid she will feel lonely. The nurse should suggest that:

everyone could eat together. Helping family members adjust to home care by arranging for times for family interaction is important.

A family that regularly takes in foster children is visiting the junior high school nurse to inform the staff that there will be a new 8th grade foster child beginning school the following week. The school nurse should monitor this new student for which psychosocial response to being moved to the foster care system?

high level of insecurity Theoretically, foster home placement is temporary until children can be returned to their own parents. Unfortunately, if return does not become possible, children may be raised to adulthood in a series of foster care families. Such children can experience a high level of insecurity, concerned that they will have to soon move again. Aggressiveness and eating disorders should be assessed, but these responses are not the priority for most foster children. Immunization completion is not a psychosocial response to being a foster child.

A pregnant client is being discharged. The nurse is educating the client about the advantages of continuing her treatment at home. Which advantages would the nurse include? Select all that apply.

increased individual teaching lifestyle assessments increased self-care The home care setting allows the nurse to spend time with the individual and the family in a private environment in which teaching can occur. This also allows for a lifestyle assessment to better understand ways in which to promote healthy behaviors, not simply those related to pregnancy. Home care also increases the ability of the client to perform self-care that may have otherwise been done by others (for the client) in the acute care setting. The home care setting decreases health care costs and allows the nurse to better asses the values and priority of the client and family.

The nurse is caring for a young pregnant couple who are members of an extended family. The nurse anticipates the greatest challenge for this family will involve which factor?

limited amount of available resources Extended families usually consist of the nuclear family of the parents and children and then relatives such as grandparents, aunts, uncles, cousins, etc. living together. This can result in limited resources due to many family members and often few providers. One of the advantages of the extended family is the increased support which is available. The amount of education or a child developing a chronic illness would not be factors to consider nor have any influence in this case.

A high school nurse has noted several of the incoming freshmen are "only children" (they have no siblings). The nurse plans some "brown bag lunch discussions" for this group of students. Which topics should be addressed in these sessions? Select all that apply.

managing stress getting a "failing" grade at school when a favorite sports team loses As children have fewer older sibling role models than in past generations (families are having fewer children), they may need more counseling in behaviors such as how to manage stress, how to survive a failing grade at school, or how to deal with a sports team's loss. Healthy eating and adequate sleep amounts pertain to all students, especially teens.

Two previously divorced people are getting married and becoming a blended family. They each have two children from prior marriages. They have met with a family counselor to discuss potential problems of blended families and ways to deal with the problems. Which potential problem will likely occur at some early point in the marriage?

rivalry for attention of a parent In a blended family (a remarriage or reconstituted family), a divorced or widowed person with children marries someone who also has children. Although the arrangement is apt to be a positive one because it creates a nuclear family, childrearing problems can arise in this type of family from rivalry among the children for the attention of a parent. The other situations (sleeping arrangements, financial changes in the household, and privacy issues) may develop, but rivalry for attention is the one most likely to occur, according to literature.

During a visit with a new family, the nurse assesses one of their children. The nurse asks about current immunization status and how often the child visits the family health care provider. The nurse also asks the child about experiences with activities outside the home. The nurse reviews the importance of safety like wearing helmets. Given this data, what age group of child would one anticipate this nurse is assessing?

school-age When working with the family of a school-age child, the nurse should focus the assessment on: promoting children's health through immunizations, dental care, and routine health assessments; promoting child safety related to home and automobiles; encouraging socialization experiences outside the home such as sports participation, music lessons, or hobbies; and encouraging a meaningful school experience to make learning a lifetime concern.

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?

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.

A nurse working in the community is involved in providing primary prevention. Which intervention would be most appropriate to implement?

teaching parents of toddlers about ways to prevent poisoning Primary prevention involves preventing a disease or condition before it occurs, such as teaching parents of toddlers about poisoning prevention. Working with women who are victims of domestic violence, clients at an HIV clinic, or hypertensive clients are all examples of tertiary prevention, which is designed to reduce or limit the progression of a disease or condition.

You construct an ecomap for a family. An ecomap is a:

visual presentation of the family's relationship to the community. A genogram details ways that a family relates to its community.