NUR 243 PrepU Ch 2 Factors Influencing Child Health

The student nurse is shadowing a registered nurse on the pediatric inpatient care unit. They are caring for a teen who has openly shared that she was adopted at birth. Which statement by the student nurse indicates the need for intervention by the nurse?

"Are you in contact with your real mother?"

The nurse educator has completed a presentation on caring for babies born to mothers with a substance use disorder. Which statement by a participant would indicate the need for further education?

"Babies born to a mother with a substance use disorder don't have any difficulty eating." Explanation: Babies born to mothers with a substance use disorder tend to be small for gestational age. They may also suffer from withdrawal symptoms and are at a higher risk for both physical and mental abnormalities. They may also suffer from problems eating, such as a decreased ability to suck. Some of the problems of the baby may not be immediately apparent, because these problems can also encompass cognitive and skill-attainment delays.

The nurse is caring for a pediatric client who requires increased protein in the diet. The client's culture includes consuming very little meat. Which action will the nurse take first?

Determine which high-protein, non-meat foods the client currently eats

The nurse is assessing the risk potential for infection for children on a pediatric unit, based on their developmental level. Which group does the nurse determine is at the highest risk for respiratory infections?

infant

A 4-year-old boy is residing permanently with his grandparents. Which situation is unique to this type of family or living arrangement?

physical and financial stress on the caregivers

The nurse is collecting information from the mother of 3-year-old twins. The records show the mother is single. When planning care, what topic is of the highest priority for the nurse to investigate?

support network Explanation: Single-parent families have several concerns that can affect the health of the children. Life in a single-parent household can be stressful for both the adult and for the children. The single parent may feel overwhelmed with no one to share the day-to-day responsibilities. Financial resources, insurance, and living conditions are of concern but are not the highest priority

Parents have a 3-year-old boy with a difficult temperament. Which guidance will be most helpful for the nurse to provide?

"Provide a place for him to roughhouse."

A nurse is conducting a class for the staff at the clinic about sexual orientation. The nurse determines that additional teaching is needed when the class makes which statement?

"Sexual orientation is the same as gender identity."

The parent of a 15-year-old adolescent reports that the spouse is very strict with the adolescent. The parent voices concerns about the future impact of this style of parenting on the adolescent later in life. What response by the nurse is appropriate?

"Children who have parents who are authoritarians often are resentful later in life."

The nurse is caring for a child from a different culture. Which statement(s) by the nurse demonstrates an understanding of how culture impacts a client? Select all that apply.

"Culture can impact who a client chooses to see for health care needs." "Culture can impact the diet a client follows." "A client's cultural beliefs can impact spirituality and/or religion." "A client's cultural beliefs should be incorporated into the care a client receives.

A 14-year-old child shares with the nurse that she is adopted. She reports she was born in another country and now wishes she had more information about her ethnic and cultural background. She states her parents are not comfortable with this. What response by the nurse is most appropriate?

"Finding out about your culture may be enlightening for you." Explanation: The child of adoption will understandably have questions about their background. It is helpful for them to know about their culture and ethnicity. Open communication about this is helpful to them.

The father of a child mentions to the nurse that he is very worried about his 14-year-old son because he is associating with a group of kids that get into trouble frequently. What responses by the nurse would be appropriate? Select all that apply.

"Have you thought about encouraging your son to become involved in a sport? This could occupy his time in a constructive way." "Are there any activities that your son likes? There are often clubs offered at schools for a variety of interests."

The nurse is educating a group of caregivers of 3-year-old children on behavior. Which statement made by a caregiver concerns the nurse?

"I place my child in time-out for 10 minutes." Explanation: A useful method for dealing with a child who is not cooperating or who is out of control is to send the child to a "time-out" space. This should be a place where the child can be alone but may be observed without other distractions. The duration of the isolation should be limited—1 minute per year of age is usually adequate. Having a 3-year-old sit in time-out for 10 minutes is excessive and should be addressed. Having a child apologize when he/she is mean assists the child in learning appropriate actions. It is common for children to act out when they are told no or if their schedule is interrupted.

The parent of a school-age child asks the nurse how to handle telling the child about the parents getting divorced. Which response will the nurse make?

"If possible, both parents should tell the children together."

The parents of a 16-year-old child are meeting with the pediatrician to discuss the behavior problems of their adolescent. Which statements by the parents about their parenting style are consistent with an authoritarian style? Select all that apply.

"It is important that our daughter follow the rules of the household." "We tell our teen the rules of the household and the importance of her complying." "She will thank us one day for outlining clear expectations for her behavior."

A nursing instructor is discussing ways to promote safe internet use in children with a group of nursing students. Which statement by a student would indicate a need for further education?

"It is okay for a parent to place a computer in a child's room if it is used for homework."

The nurse is providing a class to a group of parents about child rearing. One of the participants reports that she regularly uses spanking as a form of discipline for her 5-year-old son. What is the best response by the nurse?

"Many studies show that spanking can lead to aggression in children."

A parent is disciplining the 5-year-old daughter by putting her in time-out. How long should the child be in time-out?

5 minutes Explanation: The amount of time that a child spends in time-out is typically 1 minute per year of age; for example, a 3-year-old would spend 3 minutes in time-out.

The nurse is caring for a child. The nurse is trying to ensure that the family's cultural practices are supported. Which statement by the nurse indicates a lack of understanding regarding cultural competence?

"Since your child is only 8, I doubt that your child has any cultural practices we need to be aware of." Explanation: Typically, a child begins to understand his or her culture at approximately 5 years of age, so stating that the child does not have any cultural practices at the age of 8 is inaccurate. Diet, cultural practices, and religious practices related to culture are important for the nurse to know so that the nursing staff can support as many of these practices as possible

The nurse is caring for a teen who has been hospitalized after a motor vehicle accident. The accident is believed to have been caused by alcohol and drug use. The teen states, "I fit in when I use marijuana and, besides, it is legal in some states." Which response by the nurse is most therapeutic?

"Tell me how you feel when you use marijuana."

The father of a 6-year-old boy reports that his son is having difficulty adapting to the changes in the family structure since the father remarried a few months ago. The father asks the nurse for suggestions on what to do. What information can be provided by the nurse?

"The display of a united front between you, your wife, and your son's mother is important."

The nurse is doing an intake history on a 15-year-old client being admitted to a facility. Which statement(s) by the parents demonstrate effective means of discipline according to the American Academy of Pediatrics? Select all that apply.

"We always try to sit down and talk to our child when in trouble instead of scolding the child." "Taking away phone privileges from our child seems to work better than any other form of discipline."

The nurse in a community clinic is speaking with the parents of a child. The parents are planning to get a divorce and discuss with the nurse how they plan on handling talking with their child. Which statements by the parents demonstrate an effective approach to speaking with their child? Select all that apply.

"We plan on reminding our child that the divorce is not their fault in any way." "We both plan on communicating with our child every day, no matter whose house our child is staying at the time." "We plan on seeking the advice of a counselor during this difficult transition."

The nursing instructor is monitoring the discussion of a student nurse with an adoptive child and his adoptive parents. The child has always known he was adopted. Which statements by the student nurse require further teaching? Select all that apply.

"You are so fortunate that your natural parents gave you up for adoption. Your adoptive parents are wonderful." "Do your natural children and adopted child have similar interests?" "I am an adopted child as well. I have always wanted to know more about my real parents."

A client follows traditions of the Chinese culture. The client is 7 weeks' pregnant and admitted with vaginal bleeding. During admission, the client tells the nurse, "This is all my fault. I never should have raised my arms above my head." Which response by the nurse is most appropriate?

"You sound concerned. Let's talk about potential causes of miscarriage."

The public health nurse is assessing the risk potential for suicide among a group of adolescents. Which adolescent would the nurse determine is at highest risk of dying from suicide?

17-year-old Native American/First Nations male adolescent who has poor school attendance Explanation: Native American/First Nations and non-Hispanic White adolescents have the highest rate of suicide. Increased exposure to adverse events, such as intimate partner violence, childhood abuse or neglect, and coming from a low socioeconomic household lead to an increased risk of negative behaviors such as suicide attempts. Males are more likely than females to die from suicide; therefore, of these adolescents, the 17-year-old Native American/First Nations male adolescent is at the highest risk of death from suicide

To assess the sociocultural aspects of the family of an adolescent being seen in an ambulatory clinic, the nurse would try to find out more about:

Adolescent's family structure

Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact with a client who has a different cultural perspective on space and distance?

Allow the client to adopt a position that is comfortable for him or her.

You see a 3-year-old girl in an ambulatory clinic because she has a bad cold. Her mother tells you the girl's problem was caused by her being affected by "mal ojo." What would be the best action?

Ask her mother what symptoms her daughter is experiencing.

The nurse notes that a 5-year-old boy is approaching obesity. Which is the priority intervention?

Assessing the diet of the child and family

The nurse is caring for a 7-year-old child who is being treated for multiple fractures after being involved in an automobile accident. The nurse observes that the father frequently takes on the role of nurturer in the family. When planning care, which nursing intervention would most involve the father?

Bathing the child Explanation: The nurse would focus on the father for decisions about the course of treatment. Assuring medications are received on time is the family health manager's role. Staying with the child in the hospital will be handled by the family nurturer. All clinical input will be provided to the family gatekeeper for dissemination.

The nurse is caring for a 7-year-old boy and his family, who are immigrants. Which intervention will most significantly affect the success of the care provided?

Communicating with sensitivity using understandable term

The school nurse notes that a 10-year-old child has not had the required immunizations to attend classes. During discussion, the child states that his father lost his job and health insurance. What is the best action by the nurse?

Contact the parents to inform them of the situation and community resources that can be utilized to obtain immunizations.

The nurse is preparing to teach a class on cultural differences to a group of clients from the community. Which principle of culture will the nurse consider while planning the class information?

Each generation learns about culture from family and the community.

A 12-year-old child has low resiliency. The parent has asked for tips in working with the child to promote the improvement of this trait. What would be the most effective advice the nurse can provide to the parent?

Encourage the child's parent to assist the child to set short-term goals for identified projects.

The nurse is providing an educational program for the staff working at a homeless shelter. The program is focused on the impact of homelessness on children. What information should be included in the presentation? Select all that apply.

Homeless children are at an increased risk for sexual abuse. Homeless children are at risk for developing chronic health problems. Acute health conditions are increased in homeless children.

A woman has presented to the clinic with her sick school-aged child. The child's mother reports she rarely has enough money to meet the health care needs of her chronically ill child. What information should be provided to the woman?

Medicaid may be available to low-income parents and their children.

The mother of a 12-year-old boy is concerned about the dangers of the Internet. Which suggestion by the nurse best targets safety related to this?

Never share personal information online

The charge nurse overhears another nurse state, "I do not like caring for clients from a culture different from my own." Which action by the charge nurse is appropriate?

Privately discuss the comment with the nurse.

The nurse is taking a health history and examining a 3-year-old boy. Which action is most important for the parents to take?

Protect the child from all tobacco smoke

The mother of a child who has been termed to have a "difficult" temperament voices frustration in managing his care. What would be the best initial course of action by the nurse for this parent?

Review strategies that are beneficial in the care of a child with a difficult temperament.

A 7-year-old child tells the school nurse that he and his parents sleep in their car every night. What action should the nurse take?

Speak with the child's parents to offer to contact community agencies for support.

A nursing student asks the instructor why nurses focus on assessing sociocultural aspects of clients. Which response from the nurse is most accurate?

Such assessment can reveal why people take certain preventive or treatment measures related to their health.

The nurse is talking with an adopted child and the family. Which statement represents "positive" adoption language?

The birth mother was how old when your child was born? Explanation: Birth mother, not natural or real mother, is a positive term for the biological parent, as is simply parent for the adoptive mother or father. The adopted child is just a child and not someone given up or given away. Saying an adoption plan was followed makes a positive statement.

During an interview with a client, the nurse asks the client about their sexual orientation. The client tells the nurse, "I am queer." The nurse interprets this statement as indicating which situation?

The client is not exclusively heterosexual. Explanation: Queer is an adjective used by some people to indicate that their sexual orientation is not exclusively heterosexual. Sometimes, for those who identify as queer, the terms "lesbian," "gay," and "bisexual" are perceived to be too limiting and/or fraught with cultural connotations they feel do not apply to them. People are bisexual if they achieve sexual satisfaction from both same-sex and heterosexual relationships. Transgender is an umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth. Nonbinary is a gender identity term that refers to a person who does not identify as being solely male or solely female.

During the data collection in a well-child visit the parent reports divorcing the spouse about 6 months ago. The parent is concerned about the child's well-being and asks for input on the effects of divorce. Which statements by the parent demonstrates the need for further education? Select all that apply.

The largest number of problems noted in the child are most visible 3 to 5 years after the divorce. An estimated 50% of children of divorce may have problems with relationships in the future.

Over coffee following a worship service, parents ask the parish nurse for guidance in disciplining their children ages 4 years, 9 years, and 14 years. What concepts will guide the nurse's response? Select all that apply.

Use parental attention as positive reinforcement for desired behaviors. Maintain consistency in expectations at all ages. Role model appropriate behavior in word and deed.

The student nurse views a boy from a large extended family as poor because his father is unemployed. Considering his family structure, in what way might he view the student nurse as "poor"?

You are unmarried and live alone.

The hospice nurse observes the family of a child with a terminal illness interacting with the child. The siblings frequently play games with the child and the parents often read to the child. According to Friedman's structural functional theory, the nurse determines that the family is demonstrating which function?

affective function

A client family recently moved to the United States. They live with their relatives, who were already residing in the United States. This is an example of which family form?

extended Explanation: The extended family is a nuclear family with other family members in the same house.

The nurse is assessing a woman who is pregnant. Her health history reveals she has three young adult children. Which nursing intervention would be most appropriate according to Duvall's developmental theory?

assessing the parent's coping abilities

While caring for a hospitalized child, the nurse notes the parent does not take into consideration the wishes or opinions of the child. During a period of discussion, the parent states "My child needs clear rules and knows I expect my child to do as I say." This is consistent with which style of parenting?

authoritarian Explanation: Authoritarian parenting style consists of the parents making the rules for the child to follow. There is little to no flexibility or decision making by the child. Authoritative parenting is also referred to as democratic parenting. In this style of parenting, there are rules and expectations of behavior but the parents embrace the individuality of the child and do allow some input by the child. Permissive parents have little control over the behavior of their children. Rules are often inconsistent, unclear or nonexistent. Uninvolved parents are indifferent. They do not provide rules or standards.

The nurse is discussing the impact of smoking with the mother of a toddler. Which statement by the mother indicates an adequate understanding of the impact of her smoking?

ct response: "Even the clothing I wear when smoking can pose a danger to my son." Explanation: Secondhand smoke and other pollutants are a health hazard for children. A recent study found that residual tobacco smoke and carcinogens remain after a cigarette is extinguished (referred to as third-hand smoke). These toxins cling to the smoker's hair and clothes and can be present on any surface in the house, such as carpet and cushions. Children are particularly susceptible to third-hand smoke since they breathe near, crawl, touch and mouth contaminated surfaces.

A nurse is caring for a client who has recently moved from her native Mexico. The nurse senses that the client misses her native country and asks her if she would like some burritos for lunch and perhaps watch the Mexican channel on television. The nurse is practicing:

cultural competence. Explanation: Cultural competence is the capacity to work effectively and with people, integrating elements of their culture (e.g., vocabulary, values, attitudes, rules, norms, customs, etc.). Cultural blindness is when one does not see or believe there are cultural differences among people. Cultural awareness is being aware that we all live and function within a culture of our own and that our identity is shaped by it. Cultural destructiveness is making everyone fit the same cultural pattern.

A nurse is reviewing a journal article that describes a view of the world and a set of traditions that a specific social group uses and transmits to the next generation. The nurse is reading an article about which concept?

culture

During a well-child care visit, the mother of a 4-year-old child reports her son is extremely active at home and cries easily if frustrated. This is consistent with which level of the classic temperament theory?

difficult temperament

First-time parents are discussing temperament with the nurse. They describe their child as easily frustrated by his toys and withdrawing from anything new. Overall, he is quite physically active and can become irritated easily. The nurse believes this child could be categorized as:

difficult. Explanation: The parents described the difficult child. The easy child is even-tempered, predictable, and positive. The slow-to-warm-up child can be moody and moderately active and may need time to adjust to something new while doing so with mild resistance. Intolerant is not a category of temperament

When caring for a woman in her sixth month of pregnancy, the client reports her plans to nurse her baby for at least 2 to 3 years like the rest of the women in her family. Based upon the nurse's knowledge, the nurse should:

document her report but do nothing as this is a cultural belief that should be respected.

Native Americans who are wearing their tribal dress are demonstrating their native dance to a community group. This is an example of:

ethnicity

A boy tells you that his family celebrates the Fourth of July by eating out at a local restaurant. He tells you this is a better way to celebrate the holiday than having a picnic like his neighbors. This statement is an example of:

ethnocentrism. Explanation: Ethnocentrism is a belief that one's own culture or customs are superior to those of others.

The nurse is teaching techniques for effective discipline to the parents of a 9-year-old girl. The girl is misbehaving, and the parents wish to use the extinction method. Which action is an example of extinction?

going home early from shopping Explanation: Going home early from shopping if the child misbehaves is an example of extinction discipline. Positive reinforcement is eliminated for inappropriate behavior. Going out for ice cream, praising her for polite behavior, and letting her go to a friend's house are all types of positive reinforcement

During a parenting class, the nurse gives examples of extinction as a form of discipline. What would be an example of this technique?

ignoring a temper tantrum Explanation: The goal of extinction is to reduce parental attention (reinforcement). Ignoring a temper tantrum does that. Loss of privileges and time-out also are extinction techniques. Praising is positive reinforcement. Spanking is corporal punishment, while verbal reprimand is verbal punishment.

The parents of a 10-year-old child are discussing with their physician their plans to divorce. Which factor will have the greatest influence on the initial response of the child?

the child's age