Ricci → Chapter 2: Family-Centered Community-Based Care PrepU

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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

The nurse is caring for several client's in the prenatal clinic. Which action by the nurse demonstrates cultural compentency?

The nurse asks each client about dietary restrictions and preferences during the postpartum period

The obstetrical nurse notes that a Muslim client has not been eating any of the meals supplied to her. Which actions performed by the nurse best demonstrate cultural competence?

The nurse becomes familiar with the Muslim client's meal practices.

A nurse working in a busy urban family clinic has noted a high percentage of single mothers. What should the nurses in this clinic be prepared to offer these single mothers?

support when a problem related to childrearing occurs

When caring for woman who speaks a different language than one's own, the nurse must ask for an interpreter before having the client sign which forms to ensure clarity can be confirmed? Select all that apply.

surgical permit end-of-life care consent to blood transfusions

The home care nurse visits a client who is 32 weeks' gestation on bed rest and reporting a severe headache. Which intervention should the nurse implement first?

Assess the client's vital signs and conduct a quick, focused assessment.

A nurse is visiting the home of a mother and her newborn. The woman's family members are present when the nurse arrives. What is the nurse's best approach to the situation?

Assess the family members' interactions with the newborn and one another.

The community health nurse is seeing a mother and newborn for the first home visit. Which information best indicates an understanding of visiting clients in their home?

The home visit is a way of monitoring the well-being of all family members.

A child is seen in the pediatric clinic for update of immunizations prior to starting middle school. During the intake process the nurse asks the parents if the family is involved in any neighborhood or community activities. The parents ask the nurse, "What does that have to do with immunizations?" What is an accurate response by the nurse?

"Based on research, our physician feels that better connection to community leads to better health in many ways."

When working with a woman and newborn being discharged with a prescription for an liquid antibiotic to be given 3 times a day, which directions are most appropriate?

"Give the medicine 3 times a day, spreading it out to work with your schedule."

During a hospital admission, an 8-year-old of Polish heritage tells you he is angry because so many people have asked him how to pronounce his name. What would be your best response?

"I will mark in your nursing care plan how to say it correctly."

While reviewing a woman's compliance with prenatal care, a nurse notes that which comment made by the woman may be a result of poverty rather than a cultural difference?

"I wish I could afford fresh fruits for vitamin C because I just don't remember to take those prenatal vitamins."

A pregnant woman experiencing morning sickness has asked her nurse about ways to reduce or alleviate it. After receiving education and information from the nurse, which statement would indicate that the client understood the information?

"I'll discuss with my primary care provider whether it is a good idea for me to use sea-bands."

A couple had decided not to circumcise their newborn for nonreligious reasons. What is the appropriate response from the nurse?

"OK, great. I will let the physician know."

A preterm newborn is to be discharged home on oxygen therapy and tube feedings. Which statement by the parents would indicate that they need additional teaching and preparation for this transition?

"Our insurance company will pay for all the equipment that we need for the treatments."

A nurse is uncomfortable caring for a pregnant client who is married to her female life partner. The best advice another nurse can give her would include which statement?

"Spend some time self-reflecting why this family difference might be bothering you."

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."

"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 reviewing the risk factors associated with having a child born with Down syndrome. Which situation(s) would the nurse idenfity as high risk for having a child born with Down syndrome? Select all that apply.

A 43-year-old woman pregnant with her third child, experiencing no complications A 42-year-old woman, pregnanct for the first time, having increased blood pressure readings

You evaluate a family to see if they are a good candidate for home care. Which of the following factors would be most important to see in their home or family?

A dedicated home-care provider Home care is only successful if there is a family member able to assume primary care of the child.

You evaluate a family to see if they are a good candidate for home care. Which of the following factors would be most important to see in their home or family? a) A one-floor building plan b) Nearby fire department c) An above-average income d) A dedicated home-care provider

A dedicated home-care provider Correct Explanation: Home care is only successful if there is a family member able to assume primary care of the child. p50

A client with hypertension tells her nurse that she would like to use a herbal substance (CAM) to lower her blood pressure instead of taking the antihypertensive medication. The nurse should:

Advise the client to speak with her physician about combining herbal substances with her medication. The nurse should ensure that the client speaks with her physician. Clients who are being treated with conventional medication therapy should be advised to avoid herbal substances because they may lead to unknown interaction effects.

The nurse is preparing to discuss birthing options with a 25-year-old female who is in a low-risk pregnancy with one older child. Which option will be best for the nurse to recommend for this client?

Any birthing settings

The nurse is preparing a prenatal seminar for young mothers. Which type of information should the nurse gather to ensure success of the program?

Approximate education level of the participants

A first-time mother is at home on the third day after delivery and has bleeding, painful nipples after breastfeeding. She calls the hospital to speak to her postpartum nurse. What is the best plan the nurse can implement for this patient? a) Tell the patient to have someone inspect her nipples to see if she is right. b) Advise the patient to nurse less frequently and pump between feedings. c) Arrange for a home visit from a lactation consultant. d) Suggest to the patient that she should change her brand of body wash.

Arrange for a home visit from a lactation consultant. Correct Explanation: This patient needs a skilled lactation consultant to personally assess this situation. Suggesting remedies without further assessment constitutes improper nursing care. An unskilled friend can miss signs of infection and does not have the evidence-based practice knowledge needed to best help this patient.

The nurse is caring for a childbearing family of a different cultural background. In order to provide culturally appropriate and competent care, the nurse should execute which nursing action? a) Ask the family for input into their care based on their cultural beliefs b) Expect the family to adopt the cultural beliefs of that facility c) Use your personal cultural experiences with the family d) Use a standard nursing care plan for the family

Ask the family for input into their care based on their cultural beliefs Correct Explanation: Cultural beliefs vary; care should be based on the individual beliefs of each family. The imposition of personal, institutional, or others beliefs should never be done to a patient. p42

The nurse is caring for a childbearing family of a different cultural background. In order to provide culturally appropriate and competent care, the nurse should execute which nursing action?

Ask the family for input into their care based on their cultural beliefs. Cultural beliefs vary; care should be based on the individual beliefs of each family. The imposition of personal, institutional, or others beliefs should never be done to a patient.

Planning and implementing home care involves many steps. Put the following steps in proper order: Park in a well-lit area Perform a physical examination Document all findings Obtain a copy of client's referral form Assess the suitability of the family Wash your hands

Assess the suitability of the family Obtain a copy of client's referral form Park in a well-lit area Wash your hands Perform a physical examination Document all findings Explanation: The correct order of steps when planning and implementing a home visit are as follows: 1) assess the suitability of the family; 2) obtain a copy of the client's referral form; 3) park in a well-lit area; 4) wash your hands; 5) perform a physical examination; 6) document all findings.

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

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

B) Broader assessment to include the environment

The home health nurse is meeting with a client for the initial assessment in the home. Which location should the nurse prioritize for this assessment?

Bedroom

What is a key element of providing family-centered care?

Communicate specific health information.

The nursing instructor is teaching students about the importance of active listening when communicating with patients. She informs them that which of the following might happen if the nurse does not listen? a) Trust will be established. b) Concerns will be discovered. c) Fears will be uncovered. d) Critical information may be missed.

Critical information may be missed. Correct Explanation: Active listening is critical to the communication process. Listening may uncover fears or concerns that the nurse may not have discovered through questioning. By not listening, critical information may be missed. p52

The nuring instructor is teaching students about the importance of active listening when communicating with patients. She informs them that which of the following might happen if the nurse does not listen?

Critical information may be missed. Active listening is critical to the communication process. Listening may uncover fears or concerns that the nurse may not have discovered through questioning. By not listening, critical information may be missed.

A clinical nurse specialist is conducting a review class for a group of nurses about cultural compentence and cultural diversity. The nurse determines that teh teaching was successful when the group identifies which term as reflecting the view of the world and set of traditions of a specific social group passed down through generations?

Culture

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

D) Helping the family obtain extra financial help for prescribed phototherapy

Decreased exposure to infection There may be an advantage of placing women with premature ruptured membranes on home care rather than hospital care because of the decreased exposure to infection in their own homes compared to hospitals. Although prevention of disruption to the family and lower cost for the health care delivery system may be advantages, they are not the most pertinent to the patient's condition. Home care would be more likely to cause social isolation than prevent it.

Encourage the client to learn a new skill while confined to bed. Most women can name activities they would like to do but have never had time to begin. One solution to help women cope with the stress of bed rest is for them to keep busy or use their time to learn a new skill.

A nursing instructor is teaching the class about community-based nursing. The instructor determines the session is successful when the students correctly choose which activity as an example of tertiary prevention?

Ensuring the client attends physical therapy after orthopedic surgery

A nurse is speaking to a young couple who have recently begun living together and are expecting a child in 3 months. The mother-to-be expresses both joy and fear at the prospect of beginning a new family. The nurse understands that, from the perspective of this young woman, the family referred to is of which type? a) Family of orientation b) Blended family c) Family of procreation d) Family of origin

Family of procreation Correct Explanation: For the purposes of assessing families, two basic family types can be described. The family of orientation is the family one is born into. The family of procreation is the family one establishes. Because the young woman is speaking about the family she is establishing, she is speaking about her family of procreation. Family of origin is the same as the family of orientation. A blended family is one in which a divorced or widowed person with children marries someone who also has children.

A nurse is concerned about a 14-year-old girl under her care because she has recently learned of an outbreak of sexually transmitted diseases at the girl's high school. The nurse asks the girl's parents whether they would be willing to let the nurse discuss it with their daughter in private, along with contraception options. The mother quickly interrupts the nurse and says, "Absolutely not. We will discuss that with her ourselves." Which role is the mother playing in this situation? a) Problem-solver b) Health manager c) Gatekeeper d) Financial manager

Gatekeeper Correct Explanation: The mother is playing the role of the gatekeeper, or the person who allows information into and out of the family. She is not solving a problem, managing her daughter's health, or managing the family's finances in this situation.

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.

While performing a community assessment, a nurse notes a large increase in single-parent families. She performs some research and finds that the increasing numbers of single-parent families are related to which trends? Select all that apply.

Increasing divorce rate Changing attitudes toward children born out of wedlock Changing adoption laws

As a community health nurse you are asked to present an educational event to the local Junior League. While planning for the event, what is most important for you, 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 asking about 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. Again it is not most important. Telling those present at the event a brief synopsis of the nurses' background is usually done by whomever introduces the nurse as the speaker. It is not usually an activity the nurse does himself or herself.

As a community health nurse you are asked to present an educational event to the local Junior League. While planning for the event, what is most important for you, the nurse, to do? a) Use posters that everyone in the group can read b) Tell the participants about the nurse's background c) Know the needs of the audience d) Ask questions about the histories of those present

Know the needs of the audience Correct Explanation: 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 asking about 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. Again it is not most important. Telling those present at the event a brief synopsis of the nurses' background is usually done by whomever introduces the nurse as the speaker. It is not usually an activity the nurse does himself or herself.

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.

A labor and birth nurse is admitting an adolescent client with her mother. The client appears to be upset, and the nurse wants to find out why. How should the nurse proceed? Select all that apply.

Make note of the client's and parent's nonverbal expressions. Maintain eye contact throughout the discussion. During the discussion maintain an open posture, with arms uncrossed.

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 nurse is preparing to teach a drug education class at a local elementary school. The nurse is focused on providing which type of care to the community?

Primary prevention

A nurse is assisting a young woman who has recently moved to the United States from Saudi Arabia. She is frustrated because she continually experiences conflict with her husband's older wife regarding childrearing. Which type of family is this woman a part of?

Polygamous family polygamous family is one that includes multiple wives or husbands or both, which describes this family. This family is not a dyad family (which would be only two members), extended family (which would include family beyond the nuclear family), or cohabitation family (which would involve unmarried partners).

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

As part of your role as a school nurse, you are conducting a drug education program in a fourth-grade class. This is an example of nursing in

Primary prevention Primary prevention is promotion of heath positive activities and includes teaching regarding safety, diet, rest, exercise, and disease prevention. Secondary prevention focuses on health screening activities that aid in early diagnosis and encourage prompt treatment. Tertiary prevention focuses on rehabilitation and instruction on ways to prevent further injury or illness. Home health care refers to practices done in the home by the patient.

A nursing instructor is teaching a group of nursing students about the various options available to provide nursing care in a community. The instructor determines the session is successsful when the students correctly choose which action as the primary focus of home care nursing?

Provide direct client care.

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

A nurse is assigned to perform a blood pressure evaluation on a pregnant patient. This type of care is referred to as a) Primary prevention b) Tertiary prevention c) Secondary prevention d) It is not prevention because the problem did occur.

Secondary prevention Correct Explanation: Secondary prevention refers to teaching and screening performed to assist early diagnosis and treatment of an existing or potential problem to avoid long-term negative effects. p41

Sleep deprivation due to working the night shift and caring for the child Although all of these could be valid reasons for the father to be fatigued and irritable, only the lack of sleep due to working the night shift and caring for the child pertain to the home care.

The father of a child who requires home care following open heart surgery has changed his work schedule to work the night shift so that he can take care of the child during the day. The father is obese, and his work requires strenuous manual labor. He takes insulin for his type 2 diabetes. He complains of being constantly fatigued and irritable, making it difficult to care for his child. Which of the following nursing diagnoses pertaining to home care would best explain the father's fatigue and irritability? a) Fatigue related to the physically demanding nature of his job b) Fatigue related to his obesity c) Impaired physical mobility due to obesity d) Sleep deprivation due to working the night shift and caring for the child

Sleep deprivation due to working the night shift and caring for the child Correct Explanation: Although all of these could be valid reasons for the father to be fatigued and irritable, only the lack of sleep due to working the night shift and caring for the child pertain to the home care.

A nurse in the community is working on primary prevention of illness by a) Teaching family members about administration of antibiotics b) Teaching a child how to manage his insulin dosage c) Teaching a patient how to assess the healing of a wound d) Teaching how to properly apply sunscreen

Teaching how to properly apply sunscreen Correct Explanation: Primary prevention consists of interventions taken to prevent an illness or promote a healthful behavior. It takes place before a problem exists.

A nurse in a woman's shelter is counseling a client who has been a victim of abuse. What type of prevention is this treatment? a) Tertiary b) Community-based c) Primary d) Secondary

Tertiary Correct Explanation: Working with victims of abuse or violence is tertiary prevention. Tertiary prevention is designed to reduce or limit the progression of a disease or condition. Primary, tertiary, and secondary are all examples of community-based care. Primary prevention involves preventing a disease or condition before it occurs. Secondary prevention is the early detection and treatment of adverse health conditions. p41

A nurse is assessing an adolescent in a clinic with both parents accompanying the child. The nurse questions whether the family is functioning in a healthy way after noting which action?

The father does not share his concerns with his wife.

A nurse has moved into a new community and will begin practicing at the local health department. Why is it important for this nurse to become familiar with the community where he or she will work?

The health of a community influences the health of its individuals. Because the health of a community influences the health of its individuals, it is important for the nurse to become acquainted with the community in which he or she practices. Community assessment can reveal aspects of a community that may have contributed to an illness and help determine whether a person will be able to return to the community without extra help and counseling after recovering from an illness.

All women during pregnancy should drink six to eight full glasses of fluid a day to obtain adequate fluid for effective kidney function and placental exchange. a) False b) True

True

Client and family education is a priority and is addressed in Healthy People 2010. This statement is which of the following?

True This is a true statement. "To cope effectively with illness, to understand and participate in decisions about treatment plans, and to maintain and improve health after treatment, clients and their families must have knowledge and skills relevant to their conditions" (JCAHO, 2008)

A nursing student is exploring community-based nursing as a career focus. The nurse is prepared to prioritize which activity as a primary focus?

Wellness

A nurse is addressing a group of women on the issue of women's health during their reproductive years. Which reason does the nurse provide regarding the need for comprehensive, community-centered care to women during this time period?

Women's health care needs change with their reproductive goals.

A pregnant woman who appears to be having contractions comes to the emergency room accompanied by her 10 year-old son. The mother speaks no English, but the son is fluent in both English and Spanish. The nurse knows she must use an interpreter to fully assess this patient? Which of the following would be the best interpreter?

a nurse on the medical-surgical floor who is fluent in both English and Spanish You should not use children as interpreters because by doing so you can affect family relationships, proper understanding, and compliance with health care issues. Also, just because someone speaks the language doesn't mean he will make a good interpreter, especially if they have no medical background. The nurse who speaks both languages would be a good choice. In this case an interpreter is definitely needed.

The nurse is concluding her initial visit with a client 28 weeks pregnant on bedrest for premature rupture of membranes. What information should the nurse consider when determining the timing of the next home visit?

amount of supervision and health education needed by the client

While taking a health history, the nurse finds out that the pregnant woman of Japanese descent comes from a culture that does not eat meat. Which foods will indicate sufficient protein intake? Select all that apply.

beans and rice eaten every day stir-fried carrots and beans regularly egg drop soup 2 to 3 times per week

While interviewing a client, a nurse assesses the client's reaction to health care and determines that the reaction reflects the client's preferred ways of acting based on traditions. Which term would the nurse use to document this information?

cultural values

A pregnant woman with premature ruptured membranes is trying to decide whether home care might be the best option for her. Which advantage should the nurse mention to the client that is most pertinent to her condition?

decreased exposure to infection

When giving family-centered care, the nurse recognizes that she needs to view which concept as the constant?

family Family-centered care recognizes the concept of the family as the constant. The health and functional abilities of the family affect the health of the patient and other members of the family.

When giving family-centered care, the nurse recognizes that she needs to view which concept as the constant? a) family b) patient c) individual d) none of the above

family Explanation: Family-centered care recognizes the concept of the family as the constant. The health and functional abilities of the family affect the health of the patient and other members of the family. p36

A physician orders a pregnant woman with slightly elevated blood pressure to return home on bed rest until her next scheduled check-up. This is an example of which type of care?

home care This is an example of home care, or care of persons in their own home. Hospice care relates to end-of-life care and care of those with chronic illnesses who are not expected to get any better. Skilled care requires treatments such as administering IV medications, enteral feedings, and dressing changes. Community care relates to care of individuals and/or groups of people living in a specific geographical area.

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."

A pregnant woman experiencing morning sickness has asked her nurse about ways to reduce or alleviate it. After receiving education and information from the nurse, which of the following statements would indicate that the client understood the information?

"I'll discuss with my doctor whether it is a good idea for me to use sea-bands." All therapies (complementary and alternative) should be discussed with the physician. Although some CAM therapies can help alleviate pain or sickness, all pregnant women should understand that these substances cross the placenta and can reach the growing embryo. In addition, many CAM therapies have not undergone scientific study and can place the woman at risk when mixed with traditional medicine.

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

A woman in active labor begins to recite a lullaby to "call the baby outside." Which action by the nurse caring for this woman is most appropriate at this time?

Allow the client to perform a ritual.

The nurse is completing the social assessment of a client who reports the family members consist of herself, her boyfriend, their daughter, and his son. The nurse determines this family represents which family structure?

Cohabitation family

A home care nurse is visiting a pregnant client from the Arab culture. During the health history the husband frequently answers questions for the client. How should the nurse respond?

Continue with the health history.

A community-based nurse is assessing the needs of a family of four, which includes a physically challenged 9-year-old. Which activity would the nurse prioritize to be an advocate for this family?

Establish eligibility for assistive devices for child.

An elderly woman brings her 10-year-old granddaughter to the doctor's office for a vaccination. The nurse learns that the elderly woman lives with her daughter, son-in-law, and three grandchildren. What type of family is this?

Extended family An extended, or multigenerational, family is one that includes not only a nuclear family but also other family members, such as grandmothers, grandfathers, aunts, uncles, cousins, and grandchildren. The family in the scenario fits this description. The family is not a blended family, as the children all have the same parents. It is not an adoptive family, as the children were born into the family, not adopted.

A nursing student states, "When communicating with an interpreter I should speak directly to the interpreter." This statement is which of the following?

False When using an interpreter, talk directly to the family, not to the interpreter.

The nurse is participating in a poisoning prevention program. This activity is an example of which type of community-based nursing intervention? a) Health system referral b) Nutritional counseling c) Health education program d) Health screening

Health education program Correct Explanation: Health screening interventions include activities such as mammograms, Pap smears, and well child hearing and vision checks. Health system referral interventions include activities such as referring a woman for a breast prosthesis after a mastectomy or arranging for home tutoring for a child with a long-term illness. Nutritional counseling interventions include activities such as Women, Infants, and Children (WIC) programs, counselor interview of a pregnant woman or child and parents with anemia, and eating disorders programs. Health education program interventions include activities such as poisoning prevention programs, childbirth education or breast self-examination classes, child safety programs, and youth drug awareness programs.

A female community health nurse is to be accompanied by a male student nurse for the day. The female nurse asks parents who are scheduled for an upcoming home visit if the student nurse can observe the breastfeeding assessment to be conducted for the new mother and baby. The couple decline. What is the nurse's most appropriate next action? a) Discuss acceptance and tolerance with the couple. b) Reassure the couple that the student nurse will be professional. c) Ask the couple about their concerns. d) Honor the couple's preference.

Honor the couple's preference. Correct Explanation: When providing services in the homes of clients, nurses need to respect the family's values and cultural preferences related to the provision of services. The other responses negate the couple's wishes and could be seen as confrontational and not client centered. p36

Which of the following is NOT an advantage of home care?

It can increase self-confidence because it allows sick people to rest while others take care of them. Home care can increase a woman's or child's self-confidence because it allows for more self-care and often more control of circumstances. The other statements are true.

The nurse is informing a young pregnant patient of the many different maternal community health services that are available. She tells the patient about the group that provides mother-to-mother support for breast-feeding, nutrition, and infant care problem-solving strategies. This group is known as which of the following?

La Leche League La Leche League provides mother-to-mother support for breast feeding, nutrition, and infant care. WIC is a federally funded program that provides food, nutrition, and other services for low income women, infants and children. AFDC stands for Aid to Families with Dependent Children. There are no groups known as the Breastfeeding Club.

What is the foundation for nursing care in the community? a) Nursing process b) Teaching c) Communication d) Case management

Nursing process Correct Explanation: The nursing process serves as the foundation of nursing care in the community, just as it does in a health care facility. Communication is an integral part of community-based nursing, as are teaching and case management, but they are not the foundation for the care provided. p38

Community care settings for the pediatric client are as varied in their settings as they are in their functions. Much of the care of the pediatric client has been shifted from the hospital setting to a community setting suitable for the care being provided. Which community care setting is appropriate for assessing vision and hearing in children? a) Vision and hearing centers b) Schools c) Pediatric rehabilitation centers d) Pediatric acute care clinics

Schools Correct Explanation: Assessing the vision and hearing of a child is a function of the school nurse who makes these assessments several times during the course of a child's school career. Vision and hearing centers, while in the community, are not settings to provide routine pediatric screenings for vision and hearing problems. Pediatric rehabilitation centers are not settings for vision and hearing screenings. Pediatric acute care clinics are for treating acute injuries and illnesses. They are not appropriate settings for routine screenings of a child. p46

A nurse is assigned to perform a blood pressure evaluation on a pregnant patient. This type of care is referred to as

Secondary prevention Secondary prevention refers to teaching and screening performed to assist early diagnosis and treatment of an existing or potential problem to avoid long-term negative effects.

Skilled home nursing care Home nursing care is considered skilled if it includes physician-prescribed procedures such as dressing changes, medication administration, health teaching, or observation of a woman or child's progress or status through such activities as monitoring vital signs or fetal heart rate.

A physician writes an order for home visits daily for a postpartum woman. The nurse is to perform dressing changes on an infected cesarean section incision and administer Rocephin 1 GM IV. What type of care will the nurse be providing in the home? a) Indirect home nursing care b) Skilled home nursing care c) Unskilled home nursing care d) Preventative care

Skilled home nursing care Correct Explanation: Home nursing care is considered skilled if it includes physician-prescribed procedures such as dressing changes, medication administration, health teaching, or observation of a woman or child's progress or status through such activities as monitoring vital signs or fetal heart rate. p 38

You are a nurse focused only on tertiary prevention. Which of the following most likely describes your actions in your current role? a) Caring for new mothers in a maternity clinic b) Identifying a child with pediculosis in an elementary school c) Taking case histories in an orthopedic clinic d) Providing care for an elderly patient in a home-care setting

Taking case histories in an orthopedic clinic Explanation: Orthopedic patients are typically recovering from injury or are in need of rehabilitation. Tertiary prevention focus is on rehabilitation activities and would be the focus of a nurse in an orthopedic clinic, aligning with the needs of the patients in the clinic. p41

A nurse in the community is working on primary prevention of illness by

Teaching how to properly apply sunscreen Primary prevention consists of interventions taken to prevent an illness or promote a healthful behavior. It takes place before a problem exists.

The nursing student demonstrates an understanding of what is included in postpartum home visits when she correctly lists which of the following? (Check all that apply.)

• monitoring the physical and emotional well-being of the family members • bridging the gap between discharge and ambulatory follow-up for mothers and their newborns • identifying potential or developing complications for the mother and newborn Home visits give the nurse an opportunity to assess the family's adaptation and dynamics and the home enviornment. Postpartum care includes monitoring the physical and emotional well-being of the family members, identifying potential or developing complications for the mother and newborn, and bridging the gap between discharge and ambulatory follow-up for mothers and their newborns. Administering all of the newborn vaccinations is not feassible as they are numerous and are scheduled at differnent intervals and are not given in the home but instead in a physician's office or clinic. The nurse does not perform any home cleaning for the family.

The community nurse who is working with women, children, and families knows the importance of using good communication, both verbal and nonverbal. Some examples of nonverbal communication include which of the following? (Check all that apply.) a) attending to others b) singing c) speaking d) nodding e) active listening

• nodding • attending to others • active listening Explanation: Verbal communication is the spoken word and it includes singing. Nodding, attending to others, and active listening are forms of nonverbal communication. p52

The nurse identifies which of the following to be techniques to use when teaching patients who have poor health literacy skills? (Check all that apply.)

• pictures • videos • audio tapes • color coding the patient has poor health literacy skills, learning can be fostered by the use of audio tapes, videos, pictures, and color coding (such as medication bottles or steps of a procedure). Written handouts would not be beneficial for someone who has a literacy problem.

A client receiving home care is on bed rest. She says to the nurse, "I feel so useless like this. I'm not used to being so inactive. What response from the nurse might help the client cope better with her situation? a) "Let me talk to the doctor to see if the restrictions can be eased back at all." b) "Are there hobbies you enjoy that you can do while resting that you never get a chance to do otherwise?" c) "Think about how much faster you'll recover by following directions." d) "I would love the opportunity to sit back and relax. Take advantage of this while you can."

"Are there hobbies you enjoy that you can do while resting that you never get a chance to do otherwise?" Correct Explanation: Women and children on bed rest react in several ways, but many report feeling "tied down," "like a prisoner," and "as if I'm missing out." One solution to help them cope with the stress of the experience is for them to keep busy or use their time to learn a new skill. Most women can name activities they would like to do but have never had time to begin to do. For example, if a woman likes to read but does not always have the time, bed rest at home may provide an ideal time for her to catch up on her reading. The other options are inappropriate responses. p56

A nurse is teaching an 18-year-old client about circumcision care for her second baby. Which statement made by the nurse would be most appropriate to assess the client's learning ability?

"I note you're having problems with reading the information. Will you tell me about this?"

"I'll discuss with my doctor whether it is a good idea for me to use sea-bands." Correct Explanation: All therapies (complementary and alternative) should be discussed with the physician. Although some CAM therapies can help alleviate pain or sickness, all pregnant women should understand that these substances cross the placenta and can reach the growing embryo. In addition, many CAM therapies have not undergone scientific study and can place the woman at risk when mixed with traditional medicine.

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?

"If a baby is born to a mother with a substance use disorder, the nurse needs to be aware that the baby will typically eat more than babies born to mothers with a substance use disorder.

A pre-term newborn is to be discharged home on oxygen therapy and tube feedings. Which statement by the parents would indicate that they need additional teaching and preparation for this transition? a) "We'll make sure that we have enough feeding solution to get through the weekend." b) "Our parents are going to take turns helping out at night so that we can get some sleep." c) "We know how to check to make sure the feeding tube isn't clogged." d) "Our insurance company will pay for all the equipment that we need for the treatments."

"Our insurance company will pay for all the equipment that we need for the treatments." Explanation: High-risk newborn home care involves all family members working together to provide 24-hour care. Managing supplies, trouble-shooting potential problems, and ensuring support are crucial to providing home care. Parents or caregivers must investigate and then negotiate with insurers for reimbursement of medical equipment and supplies. Insurers do not always cover all items necessary for care. p50

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?

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

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."

At a prenatal class, the nurse is told by a client that her mother advises her not raise her hands above her head during pregnancy in order to avoid umbilical cord problems. What is the nurse's best response?

"This is a belief from your mother's culture about what to avoid during pregnancy."

As part of an education program for pregnant women and their partners, the nurse describes the various settings available for childbirth. The nurse determines that the program was successful when the group relates which of the following about home births? a) "Women giving birth at home have control over every part of labor." b) "There are very rigid screening procedures that must be followed." c) "A home birth is probably the most expensive setting for childbirth." d) "A wide range of pain medications is readily available to the woman."

"Women giving birth at home have control over every part of labor." Correct Explanation: 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. p48

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.

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) 2448 hours or less B) 7296 hours or less C) 4872 hours or less D) 96120 hours or less

A) 2448 hours or less

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

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

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 clients learning? (Select all that apply.) A) Teach survival skills first B) Use simple, nonmedical language C) Refrain from using a hands-on approach D) Avoid repeating information E) Use visual materials such as photos and videos

A) Teach survival skills first B) Use simple, nonmedical language E) Avoid repeating information

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 as 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

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

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) Physicians office E) Day surgery center F) Nursing home

A) Urgent care center D) Physicians office E) Day surgery center

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.

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

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 health care decisions. C) Women are still the minority in the United States. D) Men use more health services than women.

A) Women spend 95 cents of every dollar spent on health care.

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

A)Arranging for a physical therapy session

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

A)Increase in community settings for care

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

A)Softening unpleasant information or prognoses

You are preparing an hour-long prenatal seminar for a group of 27 teenage mothers. Which type of information will you gather to help ensure the success of your program? a) Age, education levels, and language barriers of each of the participants b) Names of each of the participants c) Medical histories of each of the participants d) Incomes of each of the participants

Age, education levels, and language barriers of each of the participants Correct Explanation: When teaching a group of patients, the group leader should seek demographic information to help develop an appropriate teaching plan for all participants in the group. This is an impersonal group, and taking the medical histories or learning their names or incomes is not appropriate. p54

You are preparing an hour-long prenatal seminar for a group of 27 teenage mothers. Which type of information will you gather to help ensure the success of your program?

Age, education levels, and language barriers of each of the participants. When teaching a group of patients, the group leader should seek demographic information to help develop an appropriate teaching plan for all participants in the group. This is an impersonal group, and taking the medical histories or learning their names or incomes is not appropriate.

Amount of supervision and health education needed by the patient The nurse should complete an assessment on the patient to include the amount of education and ability of the patient to understand the health care provider's orders. The nurse should allow the agency to work with the insurance company, and the location of the home should not influence the decision of the nurse.

The nurse is concluding her initial visit with a patient 28 weeks pregnant on bedrest for premature rupture of membranes. What data should the nurse consider when determining the timing of the next home visit? a) Patient's type of health insurance b) Amount of supervision and health education needed by the patient c) The location of the home d) The home visit schedule and needs of the agency to plan the visit

Amount of supervision and health education needed by the patient Correct Explanation: The nurse should complete an assessment on the patient to include the amount of education and ability of the patient to understand the health care provider's orders. The nurse should allow the agency to work with the insurance company, and the location of the home should not influence the decision of the nurse.

A woman in her third trimester of pregnancy has difficulty travelling from her inner-city apartment to the doctor's office for ultrasound imaging. She has no car and is unfamiliar with the public transportation available in the area of the doctor's office. Which of the following interventions would most likely address this woman's challenges? a) An ecomap including information on public transportation b) Home care visits by the nurse c) Home care visits by a home care assistant d) Support from a lactation specialist after the birth of her child

An ecomap including information on public transportation Correct Explanation: Drawing an ecomap or a diagram of a family's relationship to its community can help identify what community resources are being used by a family or its "fit" into the community. Home care visits would not be appropriate in this situation, as the woman must receive ultrasound imaging at the doctor's office. Support from a lactation specialist would also not address this woman's immediate need.

A nurse is working with a culturally diverse patient population. Which strategy would the nurse most likely use to assist in recognizing cultural influences on pain perception? Select all that apply.

Appreciate that the meaning of pain varies among cultures. Appreciate that not all people communicate or express their level of pain in the same way. Recognize that communication of pain may not even be acceptable within a culture. Develop an awareness of personal values and beliefs. Use an assessment tool (e.g., rating scale from 1 to 10) to assist in measuring the pain.

Arrange for a home visit from a lactation consultant. This patient needs a skilled lactation consultant to personally assess this situation. Suggesting remedies without further assessment constitutes improper nursing care. An unskilled friend can miss signs of infection and does not have the evidence-based practice knowledge needed to best help this patient.

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

Assisting the family to apply for Medicaid or other forms of health care reimbursement

Advocacy for your client is an important aspect of community-based nursing. What is one way a community-based nurse can advocate for a child that is her client? a) Assisting the family to apply for Medicaid or other forms of health care reimbursement b) Assuring a young mother that you will not report the suspicious bruises on her toddler to social services c) Arranging for educational events for the local hospital staff d) Reporting a new case of whooping cough to the county health authorities

Assisting the family to apply for Medicaid or other forms of health care reimbursement Correct Explanation: The nurse working in a community setting may often develop a long-standing relationship with childbearing and child-rearing 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 her 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 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 abuse be reported is not advocating for the child.

Advocacy for your client is an important aspect of community-based nursing. What is one way a community-based nurse can advocate for a child that is her client? a) Arranging for educational events for the local hospital staff b) Reporting a new case of whooping cough to the county health authorities c) Assuring a young mother that you will not report the suspicious bruises on her toddler to social services d) Assisting the family to apply for Medicaid or other forms of health care reimbursement

Advocacy for your client is an important aspect of community-based nursing. What is one way a community-based nurse can advocate for a child that is her client?

Assisting 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 childbearing and child-rearing 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 her 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 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 abuse be reported is not advocating for the child.

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

Being a community-based nurse means that you have a different set of skills than those of your counterparts who work in a hospital. As a community-based nurse you 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 when you need to consult with them. Team work 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.

Autonomous Correct Explanation: 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 when you need to consult with them. Team work 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. p54

Which of the following should a nurse do to avoid disrupting a family routine when visiting to provide home care?

Avoid coming during mealtimes To avoid disrupting family routines, try not to visit at prayer times or mealtimes unless observing family interaction or what a client is eating for a typical meal is necessary for assessment. The other answers, although they are valid guidelines for home visits, would not help the nurse avoid disrupting a family routine

Which action should a nurse perform to avoid disrupting family routine when visiting to provide home care?

Avoid coming during mealtimes.

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

B)Folic acid

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.

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

A couple has recently been divorced. The couple has joint custody of their 15-year-old daughter. The nurse recognizes that the daughter is now at a 50% greater risk for which of the following?

Beginning smoking or drinking alcohol Findings have revealed that adolescents living in shared physical custody had higher rates of health risk behaviors such as beginning smoking or drinking alcohol compared with adolescents from two-parent families (60% and 50% higher). Children with parents who are both employed would be more likely to be exposed to violence on television if they are at home alone or to experience upper respiratory infections if in daycare. Although incidence of child maltreatment remains high, there is no correlation between joint custody and a 50% increase in risk for abuse.

A couple has recently been divorced. The couple has joint custody of their 15-year-old daughter. The nurse recognizes that the daughter is now at a 50% greater risk for which of the following? a) Being exposed to violence on television b) Experiencing upper respiratory infections c) Beginning smoking or drinking alcohol d) Being the victim of abuse

Beginning smoking or drinking alcohol Correct Explanation: Findings have revealed that adolescents living in shared physical custody had higher rates of health risk behaviors such as beginning smoking or drinking alcohol compared with adolescents from two-parent families (60% and 50% higher). Children with parents who are both employed would be more likely to be exposed to violence on television if they are at home alone or to experience upper respiratory infections if in daycare. Although incidence of child maltreatment remains high, there is no correlation between joint custody and a 50% increase in risk for abuse.

Birthing centers do not always have pediatricians on staff if the newborn has special needs.

Birthing centers do not always have pediatricians on staff if the newborn has special needs. With this particular client, the nurse should point out that many birthing centers do not have pediatricians on site. The nurse should include all information related to birthing centers, such as the freedom to eat, move around, and give birth in any position so that the client can make the best decision. Birthing centers do not limit the number of friends and family who can attend the birth.

A 40-year-old pregnant client tells her nurse that she would like to give birth in a birthing center because she wants several friends and family members to be there and will have more freedom at the center. What would be the most important factor for the nurse to point out when discussing this option with the client? a) Birthing centers do not always have pediatricians on staff if the newborn has special needs. b) Birthing centers limit the number of friends and family who can attend the birth. c) Birthing centers allow the client to eat and move around during labor. d) Birthing centers allow the client to give birth in any position.

Birthing centers do not always have pediatricians on staff if the newborn has special needs. Explanation: With this particular client, the nurse should point out that many birthing centers do not have pediatricians on site. The nurse should include all information related to birthing centers, such as the freedom to eat, move around, and give birth in any position so that the client can make the best decision. Birthing centers do not limit the number of friends and family who can attend the birth. p48

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

C) Cultural encounter

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

C) 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 clients mother B) Teach new self-care skills to the client C) Determine if there is a need for back-up power D) Discuss coverage with the insurance company

C) Determine if there is a need for back-up power

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.

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

A nurse is educating a client about a care plan. Which of the following statements would be appropriate to assess the clients 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?

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

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.

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

When caring for childbearing families from cultures different from ones 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

C)Assess personal feelings about that culture

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 in how to practice safe sex D)Offer testing for clients who practice unsafe sex

C)Educate clients in how to practice safe sex

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.

C)Permits others access to allow refusal of medical insurance coverage.

A home care nurse has just completed a home assessment for a client and notes that there are no working smoke detectors in the upstairs of the home. The client states that her husband just lost his job and they cannot afford to purchase them. Which is the most appropriate referral for the nurse to initiate?

Call the local fire department.

Working in a clinic, you are following up on the doctor's recommendation that your patient consult a nutritionist. By giving a list of referrals to this patient, you are fulfilling part of your role of a) Secondary prevention b) Client advocacy c) Community-based nursing d) Primary care

Client advocacy Explanation: Client advocacy is speaking or acting on behalf of clients to help them gain greater independence and to make the health care delivery system more responsive and relevant to their needs. Community-based nursing focuses on prevention and is directed toward persons and families within a community. Primary care is the direct action of the physician. Secondary prevention involves health screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects occur. p56

A woman with a high-risk pregnancy is on bed rest and is receiving home care from a nurse. The mother expresses anxiety over the possibility of losing the baby, as she has lost a previous pregnancy. She says that receiving visits from her friends and family while at home reduce her anxiety. Which of the following would be the most appropriate outcome criterion pertaining to the home care of this patient?

Client is able to receive frequent visits from friends and family The most appropriate outcome criterion for this patient pertaining to home care is that she is able to receive frequent visits from friends and family and thereby reduce her anxiety levels. Maintaining an appropriate weight could be an appropriate goal pertaining to home care, but it does not address the client's expressed need. Being able to manage pain effectively during labor at the hospital and traveling safely to the hospital do not primarily pertain to home care.

A 13-year-old client who is newly diagnosed with type 1 diabetes is being discharged home with home care follow-up. What is the most appropriate goal for the nurse to select related to the nursing diagnosis of Health-Seeking Behaviors related to Skills Needed to Continue Home Care?

Client will self-administer insulin injections using appropriate technique.

Which of the following is most critical to effective home care? a) A health problem that is mild to moderate in nature b) The client's ability to get along with home care assistants c) Commitment to home care from family and other essential people d) Provision of care by an experienced nurse

Commitment to home care from family and other essential people Correct Explanation: Home care works best when a family is strongly committed to home care and well prepared to cooperate with health care providers. p39

Which of the following is most critical to effective home care?

Commitment to home care from family and other essential people. Home care works best when a family is strongly committed to home care and well prepared to cooperate with health care providers.

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.

The nurse is caring for a pregnant woman and her family who are immigrants. Which intervention would be the priority for helping to achieve a successful outcome?

Communicating using understandable terms Communicating using understandable terms, whether that means using an interpreter or speaking slowly and using simple terms, will greatly affect the success of the care provided. Inquiring about their financial situation, assessing transportation issues, and helping them access aid programs are secondary to the need for effective communication.

The nurse is caring for a pregnant woman and her family who are immigrants. Which intervention would be the priority for helping to achieve a successful outcome? a) Referring them to state and local aid programs b) Communicating using understandable terms c) Asking how they got to the appointment d) Inquiring about the family's ability to buy medicine

Communicating using understandable terms Correct Explanation: Communicating using understandable terms, whether that means using an interpreter or speaking slowly and using simple terms, will greatly affect the success of the care provided. Inquiring about their financial situation, assessing transportation issues, and helping them access aid programs are secondary to the need for effective communication. p42

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 terms

The nurse is providing a secondary prevention activity when a) Conducting a skin cancer screening fair b) Teaching a group of adolescents about sexually transmitted diseases c) Showing a patient proper application of a colostomy device d) Instructing a group of senior citizens on use of the Internet

Conducting a skin cancer screening fair Correct Explanation: Secondary prevention measures are those taken to screen for diseases, delayed development according to criteria, or use of medication. p41

The nurse is providing a secondary prevention activity when

Conducting a skin cancer screening fair Secondary prevention measures are those taken to screen for diseases, delayed development according to criteria, or use of medication.

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.

Correct response: "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 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

D) Performing epidemiologic investigations

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 havent 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 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

D)Acute pain related to incision and cesarean birth

A pregnant woman with a premature ruptured membrane is trying to decide whether home care might be the best option for her. Which of the following is an advantage the nurse should mention to her that is most pertinent to her condition? a) Decreased exposure to infection b) Lower cost for the health care delivery system c) Prevention of social isolation d) Prevention of disruption of the family

Decreased exposure to infection Explanation: There may be an advantage of placing women with premature ruptured membranes on home care rather than hospital care because of the decreased exposure to infection in their own homes compared to hospitals. Although prevention of disruption to the family and lower cost for the health care delivery system may be advantages, they are not the most pertinent to the patient's condition. Home care would be more likely to cause social isolation than prevent it.

A 7-year-old client on a ventilator who is being cared for at home is admitted to the hospital for the fourth time in a 6-week period for respiratory complications. What might be the priority nursing diagnosis for this client?

Deficient knowledge

The role of a home care assistant includes not only recording a blood pressure reading but evaluating the reading and explaining its significance to the patient.

False When making assignments for home care assistants, be certain they understand that making an assessment (such as recording a blood pressure) is not the same as evaluating the meaning of the assessment. That requires professional expertise.

How can the home health nurse assist with achieving National Health Goals when caring for a woman with placental previa at 28 weeks' gestation who is on bed rest?

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

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

Educate the patient on the benefits of bed rest for the pregnancy and access community resources to assist her with compliance. Correct Explanation: National Health Goals are concerned with reducing complications of pregnancy, both by better monitoring and preventing complications during pregnancy. Nurses can help the nation achieve these goals by helping women better accept and adhere to home care if it is advised during pregnancy. p56

An ill child will be cared for at home by the parents. What resources will be most advantageous for this family? a) Financial assistance to buy medications b) Social service referral c) Visits from the nurse daily d) Effective support people from the family or community to offer help

Effective support people from the family or community to offer help Correct Explanation: Home care is most successful effective support people from the family or community offer help. Otherwise, parents and children can experience loneliness and low self-esteem that interfere with their ability to remain on continuous bed rest or continue with a medical regimen. p37-41

An ill child will be cared for at home by the parents. What resources will be most advantageous for this family?

Effective support people from the family or community to offer help. Home care is most successful effective support people from the family or community offer help. Otherwise, parents and children can experience loneliness and low self-esteem that interfere with their ability to remain on continuous bed rest or continue with a medical regimen.

A client at 28 weeks' gestation is required to maintain bed rest for the duration of the pregnancy because she has placenta previa. What suggestions can the nurse make for the client to help her cope with the experience? a) Allow the client to go on short walks and then right back to bed. b) Encourage the client to learn a new skill while confined to bed. c) Tell the client to watch television for distraction. d) Maintain quiet and no activity.

Encourage the client to learn a new skill while confined to bed. Correct Explanation: Most women can name activities they would like to do but have never had time to begin. One solution to help women cope with the stress of bed rest is for them to keep busy or use their time to learn a new skill. p56

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.

A genogram is a diagram of family and community relationships.

False An ecomap, not a genogram, is a diagram of family and community relationships and is used to document the fit of a family into their community. A genogram is a diagram that details family structure and provides information about the family's health history and the roles of various family members across several generations. It can provide a basis for discussion and analysis of family interaction at health care visits.

A nursing student states, "When communicating with an interpreter I should speak directly to the interpreter." This statement is which of the following? a) False b) True

False Correct Explanation: When using an interpreter, talk directly to the family, not to the interpreter. p52

A genogram is a diagram of family and community relationships. a) True b) False

False Explanation: An ecomap, not a genogram, is a diagram of family and community relationships and is used to document the fit of a family into their community. A genogram is a diagram that details family structure and provides information about the family's health history and the roles of various family members across several generations. It can provide a basis for discussion and analysis of family interaction at health care visits.

The role of a home care assistant includes not only recording a blood pressure reading but evaluating the reading and explaining its significance to the patient. a) True b) False

False Explanation: When making assignments for home care assistants, be certain they understand that making an assessment (such as recording a blood pressure) is not the same as evaluating the meaning of the assessment. That requires professional expertise

Which of the following is an advantage of home care over hospital care for the pregnant patient? a) Families can be better kept intact. b) Although it is more costly, it is more satisfying. c) It allows for stricter control of diet and exercise. d) Women can rest more efficiently.

Families can be better kept intact. Explanation: The main advantages of home care are cost-effectiveness and the ability to keep a family intact during extended therapy. p48

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

Have local carpenter build a ramp across the front steps to the house the client will use a wheelchair to ambulate, family members need to consider if adaptations of their home will be necessary. A local carpenter can build a ramp across the house steps or a split-level elevation to allow wheelchair access. Wheelchair lifts or elevators can be purchased and mounted alongside house steps, but they are more expensive. Placing furniture along the walls and providing tongs do not pertain to making the entrance to the house wheelchair accessible.

A family with limited income must make the entrance to their house wheelchair accessible for their 11-year-old son, who is now receiving home care. Which of the following would be the most appropriate recommendation for the nurse to make? a) Have a wheelchair lift installed alongside the front steps b) Provide the boy with a pair of tongs so that he can reach items on high shelves c) Have local carpenter build a ramp across the front steps to the house d) Place furniture along the walls to increase safe turning space

Have local carpenter build a ramp across the front steps to the house Correct Explanation: If the client will use a wheelchair to ambulate, family members need to consider if adaptations of their home will be necessary. A local carpenter can build a ramp across the house steps or a split-level elevation to allow wheelchair access. Wheelchair lifts or elevators can be purchased and mounted alongside house steps, but they are more expensive. Placing furniture along the walls and providing tongs do not pertain to making the entrance to the house wheelchair accessible.

The nurse is participating in a poisoning prevention program. This activity is an example of which type of community-based nursing intervention?

Health education program Health screening interventions include activities such as mammograms, Pap smears, and well child hearing and vision checks. Health system referral interventions include activities such as referring a woman for a breast prosthesis after a mastectomy or arranging for home tutoring for a child with a long-term illness. Nutritional counseling interventions include activities such as Women, Infants, and Children (WIC) programs, counselor interview of a pregnant woman or child and parents with anemia, and eating disorders programs. Health education program interventions include activities such as poisoning prevention programs, childbirth education or breast self-examination classes, child safety programs, and youth drug awareness programs.

Honor the couple's preference. When providing services in the homes of clients, nurses need to respect the family's values and cultural preferences related to the provision of services. The other responses negate the couple's wishes and could be seen as confrontational and not client centered.

In what way does assessing a client's community most help the nurse provide better care? a) It allows the nurse to treat many people at once b) It can reveal if there are aspects about a community that contributed to an illness c) It can help the nurse find resources that the client may need during recuperation d) It facilitates the nurse's exposure to different cultures

It can reveal if there are aspects about a community that contributed to an illness Correct Explanation: Community assessment can reveal if there are aspects about a community that contributed to an illness (and therefore need to be corrected) and determine whether the person will be able to return to the community without extra help and counseling after recovering from an illness. p36

Communicating using understandable terms, whether that means using an interpreter or speaking slowly and using simple terms, will greatly affect the success of the care provided. Inquiring about their financial situation, assessing transportation issues, and helping them access aid programs are secondary to the need for effective communication.

It is increasing because new technology makes so many procedures available in the home. Home care is expanding because it can offer advantages to both caregivers and consumers. New technology makes it successful.

Which of the following is true of home care as a whole? a) It is decreasing because many new care measures are too technical for use in the home. b) It is decreasing because the overall incidence of children's illnesses is decreasing in number. c) It is increasing because new technology makes so many procedures available in the home. d) The amount of care remains even because only a limited number of nurses are available to give care.

It is increasing because new technology makes so many procedures available in the home. Explanation: Home care is expanding because it can offer advantages to both caregivers and consumers. New technology makes it successful. p50

During a home visit, the nurse begins teaching on medication safety in the home. What should the nurse include in these instructions? Select all that apply.

Never take medication in front of children. Use a reminder sheet and cross off when a medication has been taken. Drink a full glass of water with pills to ensure they reach the stomach. Keep all medication in a safe place above the height for a child to reach.

La Leche League Correct Explanation: La Leche League provides mother-to-mother support for breast feeding, nutrition, and infant care. WIC is a federally funded program that provides food, nutrition, and other services for low income women, infants and children. AFDC stands for Aid to Families with Dependent Children. There are no groups known as the Breastfeeding Club. p46

The nurse is assessing an infant girl at its first well-baby visit. The nurse also observes the actions of the 6-year-old brother and parents who share that she was the best anniversary present they received this year. Which type of family will the nurse conclude these individuals represent?

Nuclear

After talking at length with the single mother of a malnourished child, the nurse determines that the child's poor nutrition is a result of improper care of the child by an older sibling while the mother is working. This determination is an example of which step of the nursing process? a) Implementation b) Outcome identification and planning c) Assessment d) Nursing diagnosis

Nursing diagnosis Explanation: Nursing diagnosis is the step in the nursing process in which the nurse determines the cause of the problem the patient is facing. In this case, the cause of the child's nutrition is improper care of the child by his older sibling. Assessment would pertain to the questions posed and measures taken by the nurse to arrive at the diagnosis. Outcome identification and planning would pertain to what outcomes related to the child's nutrition and overall health are desired and what interventions are likely to bring about these outcomes. Implementation would involve putting the plan into action.

The nursing instructor is teaching a session outlining the necessary skills of a community nurse. The instructor determines the session is successful when the students correctly choose which factor as the foundation of all nursing care?

Nursing process

A nurse is providing home care to several families who live in a community with limited resources. Which of the following is an example of how the nurse can best "nurse the community"? a) Read a recent journal article on prevention of staph infections in hospitals b) Organize a free flu vaccination in the community c) Attend a leadership training workshop d) Obtain a Master's degree in a nursing field of interest

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

A nurse is providing home care to several families who live in a community with limited resources. Which of the following 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.

Modern health care has seen many technological advances. While improving many aspects of health care these advances have been a part of the reason for the increases in the cost of health care and the necessity of finding alternative health care approaches. These alternative approaches have different foci and goals than traditional health care. Community-based health care is one of these alternative approaches. What is the focus of community-based health care? a) Preventing disease and its sequelae b) Keeping clients with chronic illnesses in their homes c) Providing care for the client as an individual d) Tracking reportable diseases

Preventing disease and its sequelae Correct Explanation: 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. p37

As part of your role as a school nurse, you are conducting a drug education program in a fourth-grade class. This is an example of nursing in a) Primary prevention b) Secondary prevention c) Tertiary prevention d) Home health care

Primary prevention Correct Explanation: Primary prevention is promotion of heath positive activities and includes teaching regarding safety, diet, rest, exercise, and disease prevention. Secondary prevention focuses on health screening activities that aid in early diagnosis and encourage prompt treatment. Tertiary prevention focuses on rehabilitation and instruction on ways to prevent further injury or illness. Home health care refers to practices done in the home by the patient.

A nurse is reading about care of patients in the home. The role of the nurse in home care is a) Based only on the request of the patient b) Provider of direct patient care after receipt of health care provider orders c) Limited due to the lack of increase in home care costs d) As a visitor only, not to provide direct care in the home

Provider of direct patient care after receipt of health care provider orders Correct Explanation: Nurses are providers of home health care and follow the orders of the health care provider. Cost should not be an issue for the nurse. Patient requests can be listened to, but not at the detriment of care. The job of the nurse is direct care of the patient, the nurse is not a visitor in the home. p51

Schools Assessing the vision and hearing of a child is a function of the school nurse who makes these assessments several times during the course of a child's school career. Vision and hearing centers, while in the community, are not settings to provide routine pediatric screenings for vision and hearing problems. Pediatric rehabilitation centers are not settings for vision and hearing screenings. Pediatric acute care clinics are for treating acute injuries and illnesses. They are not appropriate settings for routine screenings of a child.

Community-based nursing focuses on prevention. As a school nurse in a community you send home information to let the parents know that during the following week you will be screening for lice infestations in all the first-grade classrooms. What type of prevention is this an example of?

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, occurs in special settings. Screening is a preventative measure, so the last answer is incorrect.

Secondary prevention Correct Explanation: 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, occurs in special settings. Screening is a preventative measure, so the last answer is incorrect. p41

Which intervention best demonstrates the L & D nurse is respectful of a client who is deaf and in early labor?

Seek assistance from another health care professional who can converse in sign language.

The camp nurse is reviewing the health information of the participants at a school-age diabetic summer camp. What topic would be most appropriate for this group of campers?

Self-administration of insulin

During pregnancy, women should drink at least eight glasses of fluid daily. For a woman on bed rest at home, which of the following would be the best method to encourage her to drink this amount? a) She drinks the eight glasses before her husband leaves for work in the morning. b) She drinks primarily cool liquids and avoids hot liquids, because they increase thirst. c) She keeps a pitcher of fluid readily available beside her on a table. d) She gets up every hour, stretches, and gets a drink from the refrigerator.

She keeps a pitcher of fluid readily available beside her on a table. Correct Explanation: Ready access to fluids is important to allow the patient to maintain bed rest. Getting out of bed would defeat the purpose of bed rest; drinking eight glasses at once would be uncomfortable. p56

A homeless client diagnosed with human papillomavirus (HPV) is seen in the maternity clinic requesting a pregnancy test. Which nursing action would be the best example of the secondary level of prevention?

Suggest she have a Papanicolaou (Pap) smear.

An example of an intervention taken on the tertiary prevention level of care is a) Teaching signs and symptoms of infection to a postoperative patient b) Showing a mother how to diaper her newborn c) Teaching a family about proper child restraint systems d) Teaching cardiopulmonary resuscitation to a group of lifeguards

Teaching signs and symptoms of infection to a postoperative patient Correct Explanation: A tertiary level intervention is one taken to prevent further illness or injury associated with an existing problem. p 41

An example of an intervention taken on the tertiary prevention level of care is

Teaching signs and symptoms of infection to a postoperative patient. A tertiary level intervention is one taken to prevent further illness or injury associated with an existing problem.

A school-aged child from Japanese background expresses concern to the school nurse about feeling embarrassed over the parents' speaking broken English. After counseling the child, the nurse understands that which evaluation reflects a positive outcome for this child?

The child no longer feels isolated because of the family's differences.

The client has a log with the date, time, and number of fetal heart beats counted.

The nurse instructs a client who is at 28 weeks' gestation on the correct use of the fetal heart monitor at home. Which observation indicates that teaching has been effective?

The client has a log with the date, time, and number of fetal heart beats counted.

A nurse is developing a plan of care for a client of Muslim faith. Which action demonstrates an understanding of providing culturally competent care?

The client is asked if there are any meal preferences to be included in the care plan.

A nurse has moved into a new community and will begin practicing at the local health department. Why is it important for this nurse to become familiar with the community where he or she will work? a) The workplace may implement alternate methods of treatment than the ones the nurse is used to employing. b) The nurse may not like it and choose to move before settling too deeply in the community. c) The health of a community influences the health of its individuals. d) It is not necessary for the nurse ti become familiar with the community prior to treating the individuals there.

The health of a community influences the health of its individuals. Correct Explanation: Because the health of a community influences the health of its individuals, it is important for the nurse to become acquainted with the community in which he or she practices. Community assessment can reveal aspects of a community that may have contributed to an illness and help determine whether a person will be able to return to the community without extra help and counseling after recovering from an illness. p37

The home care nurse visited a newly assigned primagravida 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 emergency nurse is providing care for a pregnant woman admitted with a broken femur, blackened eye, and multiple contusions. She admits her partner is abusive. Which activity would be considered at the tertiary level of prevention?

The nurse contacts the crisis social worker for assistance.

You are counseling a pregnant woman as to the best option for delivering her baby. She is 25 years old, has one other child, and is in a low-risk pregnancy. You advise her that the best option for delivery is a) A home setting b) A birthing center c) A hospital d) There is no evidence of any superiority among settings

There is no evidence of any superiority among settings Correct Explanation: When a women is low-risk and has no known medical needs, delivery location is the choice of the mother. Home births attended with certified nurse midwives are less likely to have complications and require interventions. Birthing centers are an option for an alternative birth setting, and hospitals are required delivery locations for women with potential needs or complications. p48

A woman who is from the Philippines becomes upset when the nurse brings in an interpreter, rather than using her cousin as the translator. Which would be the best reason for using an official interpreter in this case?

There may be cultural limitations that change how the information is being interpreted by the family.

To ensure that the woman is not engaging in activities that would disrupt her rest If bed rest is required, ask how the client occupies his or her time. A woman is not really resting if she is concerned about her family or finances, is caring for older children, or is so bored, she is frequently turning or sitting up. The other answers are legitimate reasons for asking the question but are not the best rationale for it.

A nurse is providing home care to a pregnant woman who is on bed rest. The woman has two other children. During her assessment, the nurse asks the woman how she occupies her time. What is the best rationale for asking this question? a) To build rapport with the patient b) To ensure that the woman is not engaging in activities that would disrupt her rest c) To pick up tips to pass on to other patients who are on bed rest d) To learn about the patient's hobbies

To ensure that the woman is not engaging in activities that would disrupt her rest Correct Explanation: If bed rest is required, ask how the client occupies his or her time. A woman is not really resting if she is concerned about her family or finances, is caring for older children, or is so bored, she is frequently turning or sitting up. The other answers are legitimate reasons for asking the question but are not the best rationale for it.

The first phase of divorce is marked by quarreling, hurt feelings, and whispered conversations, as the parents realize they are no longer compatible.

True The first phase is apt to be an antagonistic time as parents realize they are no longer compatible and is marked by quarreling, hurt feelings, and whispered conversations. This phase can be particularly upsetting for children because they usually haven't been told what is happening as yet. They may assume the quarreling is their fault (if they had behaved better, this wouldn't be happening). The second phase is the actual separation stage. The third phase involves reshaping lives.

Client and family education is a priority and is addressed in Healthy People 2010. This statement is which of the following? a) False b) True

True Correct Explanation: This is a true statement. "To cope effectively with illness, to understand and participate in decisions about treatment plans, and to maintain and improve health after treatment, clients and their families must have knowledge and skills relevant to their conditions" (JCAHO, 2008) p37

The nurse is caring for several families in the prenatal obstetrics office setting. Which is most important for the nurse?

Understanding and accepting the various types of family units, such as lesbian, gay and transgender

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.

A 19-year-old pregnant adolescent who experienced a rape has arrive in the emergency department in active labor with no prenatal care. The nurse caring for the client should assess for which potential adverse health problem?

sexually transmitted infections (STIs)

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.

A pregnant teenager is not certain that she will like home care because she is afraid she will feel lonely. You suggest that

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

A physician orders a pregnant woman with slightly elevated blood pressure to return home on bed rest until her next scheduled check-up. This is an example of which type of care? a) home care b) hospice care c) skilled home care d) community care

home care Correct Explanation: This is an example of home care, or care of persons in their own home. Hospice care relates to end-of-life care and care of those with chronic illnesses who are not expected to get any better. Skilled care requires treatments such as administering IV medications, enteral feedings, and dressing changes. Community care relates to care of individuals and/or groups of people living in a specific geographical area. p38

When performing an initial home care assessment, the nurse evaluates material resources (e.g., hospital beds, oxygen, fetal home monitors) as well as which resource?

if the family can deal with the stress of home care

When performing an initial home care assessment, the nurse evaluates material resources (eg, hospital beds, oxygen, fetal home monitors) as well as which of the following? a) number of people in the immediate family b) if the family can deal with the stress of home care c) type of dwelling the family lives in d) amount of money the household makes

if the family can deal with the stress of home care Correct Explanation: On the first home care visit, the nurse must perform a thorough history and physical examination of the patient as well as assess resources of the family and whether they will be able to care for the patient at home. Resources include not only material objects such as hospital beds, oxygen, and fetal monitors but also whether the family can deal with the chronic stress of home care. p 38

When performing an initial home care assessment, the nurse evaluates material resources (eg, hospital beds, oxygen, fetal home monitors) as well as which of the following?

if the family can deal with the stress of home care. On the first home care visit, the nurse must perform a thorough history and physical examination of the patient as well as assess resources of the family and whether they will be able to care for the patient at home. Resources include not only material objects such as hospital beds, oxygen, and fetal monitors but also whether the family can deal with the chronic stress of home care.

A nurse doing an admission assessment on a new Chinese American client notices that the client will not make eye contact. The most likely reason for this is that it:

is a sign of respect.

A laboring client, 2 cm dilated and 50% effaced, is screaming in pain. The nurse caring for this client recognizes this woman's response to pain should be documented using which label?

low pain threshold

A Native American mother has just arrived in the L & D department in active labor. Following the birth, which cultural practice may the nurse help arrange?

making arrangements for the mother to take home placenta after the birth

A new mother tells the obstetrical nurse that her mother notices so much has changed in maternity care in recent years. One change she could likely be referring to is:

newborns stay at the mother's bedside with the family as long as it is well.

The nurse is instructing a young woman who wants to get pregnant on the use of folic acid supplement three months before and three months after conception. This is an example of which level of prevention?

primary Taking folic acid is an example of primary prevention. Taking it three months before and at least three months after conception will help prevent neural tube defects such as anencephaly and spinal bifida.

primary Correct Explanation: Taking folic acid is an example of primary prevention. Taking it three months before and at least three months after conception will help prevent neural tube defects such as anencephaly and spinal bifida. p40

A young woman is seen in the physician's office for her yearly check-up and annual Pap smear. This is an example of which type of prevention?

secondary Secondary prevention is the early detection and treatment of adverse health conditions. A Pap smear is one example of this level. Such an intervention will not prevent a health problem, but is intended for early detection and prompt treatment to prevent complications.

A nurse is caring for a Turkish American client. The nurse understands that there could be major cultural differences between the nurse and the client. The nurse contemplates assigning this client to a staff member who is of the same culture as the client. What is a potential consequence?

stereotyping of the client

A home care nurse knows the importance of assessing a patient's community because: a) the health of a person is influenced by the health of the community b) a community has no influence on a patient, but it is good to know about it c) the community might hold festivals that the nurse would be interested in attending d) the particular community might offer the nurse things that another community does not

the health of a person is influenced by the health of the community Correct Explanation: Because the health of individuals is influenced by the health of their community, it is important for the nurse to become acquainted with the community in which she/he practices. Community assessments may reveal if there are aspects about a community that contributed to an illness and determine whether the person will be able to return to the community without extra help and counseling. p 37

The patient who gives birth at a hospital can expect a shorter hospital stay after a normal delivery. This is mainly due to which of the following? a) the father's desire to bring the baby home as soon as possible b) the recent reforms in health care financing c) the over-crowding of most nurseries d) the mother's desire to get home quickly

the recent reforms in health care financing Correct Explanation: Although it might be true that the mother wants to go home and the father wants the baby home as soon as possible, the reason for short hospital stays is due to changes in health care financing. Some nurseries may be more crowded than others, but it should not determine when a mother and baby is discharged. p50

The community health nurse understands that epidemiology plays a role in caring for and planning health services for patients in a community. She knows that epidemiology refers to which of the following?

the study of the causes, distribution, and control of disease in populations. Pathophysiology is the study of the changes of normal mechanical, physiological, and biochemical functions. Psychiatry is the study and treatment of mental disorders while epidemiology is the study of the causes, distribution, and control of disease in populations. Etymology is the study of the history of words and their meanings.

A nurse encourages both partners in a lesbian family to come into the examining room with the newborn during a well-baby check. What type of nursing is the nurse practicing?

transcultural nursing

The term used to guide the cultural aspects of nursing care and respect individual differences is:

transcultural nursing.

A laboring woman has brought her partner as her support person who is dressed in feminine attire, but when she speaks, it is clear to the nurse that the support person has a male voice. When documenting about the client's support person, which term would be most appropriate?

transgender

All women during pregnancy should drink six to eight full glasses of fluid a day to obtain adequate fluid for effective kidney function and placental exchange.

true

The nurse knows that patient education is a very important part of nursing care and that it begins when? a) after discharge b) with the first encounter of the patient c) when the patient asks for information d) prior to discharge

with the first encounter of the patient Correct Explanation: Patient education begins with the first patient encounter and proceeds through discharge and beyond. Reassessment after each step or change in the process is crucial to ensuring success. p55

The nurse is working with a same-sex couple, both of whom have children from previous relationships. Although the couple are not married and have no plans of marrying, they view their relationship as monogamous and long-term. Which of the following family types would apply to this family? (Select all that apply.) a) Dyad family b) Cohabitation family c) Foster family d) Gay or lesbian family e) Blended family f) Extended family

• Cohabitation family • Gay or lesbian family • Blended family Correct Explanation: 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 dyad family, as there are more than two members, and it is not a foster family, as the children are related biologically to at least one of the parents.

The nursing students are learning about using a family-centered approach to achieve positive outcomes. This family-centered care refers to which of the following?

• It refers to the collaborative partnership among the individual, family, and caregivers to determine goals, share information, offer support and formulate plans for health care. Family-centered care refers to the collaborative partnership among the individual, family, and caregivers to determine goals, share information, offer support and formulate plans for health care. Commnunity health nursing focuses on preventing illness and improving the health of populations and communities. In community-based care the community is the unit of service and the providers are concerned for the patients who seek service, but also with the larger population of potential or at-risk patients.

The nursing students are learning about using a family-centered approach to achieve positive outcomes. This family-centered care refers to which of the following? a) It refers to preventing illness and improving health of populations. b) It refers to the collaborative partnership among the individual, family, and caregivers to determine goals, share information, offer support and formulate plans for health care. c) It refers to providing care to a large population or potential or at-risk patients. d) none of the above

• It refers to the collaborative partnership among the individual, family, and caregivers to determine goals, share information, offer support and formulate plans for health care. Explanation: Family-centered care refers to the collaborative partnership among the individual, family, and caregivers to determine goals, share information, offer support and formulate plans for health care. Commnunity health nursing focuses on preventing illness and improving the health of populations and communities. In community-based care the community is the unit of service and the providers are concerned for the patients who seek service, but also with the larger population of potential or at-risk patients. p36

The nurse is assessing a pregnant woman's health literacy during a prenatal visit. Which of the following would the nurse identify as impacting the woman's health literacy? Select all that apply.

• Lack of familiarity with the information • Complexity of information • Woman's level of emotional distress Health literacy refers to the ability to read, understand, and use health care information. When new or unfamiliar information is presented or when emotional distress is present, reading ability and understanding are reduced. The last grade completed in school does not equate with reading ability. In addition, appearance, verbal ability, employment status, and educational level cannot reveal persons who do not read well.

• active listening • attending to others • nodding Verbal communication is the spoken word and it includes singing. Nodding, attending to others, and active listening are forms of nonverbal communication.

• allows for questions to be answered • promotes recognition of problem situations and their appropriate responses • allows for families and patients to make informed decisions • ensures the presence of basic health care skills Overall, patient and family education allows patients and families to make informed decisions, ensures the presence of basic health care skills, promotes recognition of problem situations, promotes appropriate responses to problems, and allows for questions to be answered. Through patient education patients can overcome feelings of helplessness and powerlessness and gain the confidence to be active members in their plan of care.

The nursing instructor is teaching students about the benefits of CAM. Which of the following are examples of CAM? (check all that apply)

• aromatherapy • guided imagery • therapeutic touch • acupressure CAM is the use of complementary and alternative medicine. It is used widely by people in all areas of the community and is used more often by women than men. Some examples include aromatherapy, homeopathy, acupressure, feng shui, guided imagery, reflexology, therapeutic touch, herbal medicine and spiritual healing.

The nurses who works in the community understands the importance of becoming culturally competent. Steps to gain cultural competence include which of the following? (Check all that apply.) a) cultural knowledge b) cultural encounters c) cultural skills d) cultural self-awareness e) replacing one's own cultural identity

• cultural knowledge • cultural encounters • cultural skills • cultural self-awareness Correct Explanation: Nurses working in the community need to develop cultural competence. Steps to gaining cultural competence include cultural self-awareness, cultural knowledge, cultural skills, and cultural encounters. Cultural competence does not mean replacing one's own cultural identity with another, ignoring the variability within cultural groups, or even appreciating the cultures being served. Instead, nurses skilled at cultural competence show a respect for difference, an eagerness to learn, and a willingness to accept multiple views of the world. 43

The nurses who works in the community understands the importance of becoming culturally competent. Steps to gain cultural competence include which of the following? (Check all that apply.)

• cultural self-awareness • cultural skills • cultural encounters • cultural knowledge Nurses working in the community need to develop cultural competence. Steps to gaining cultural competence include cultural self-awareness, cultural knowledge, cultural skills, and cultural encounters. Cultural competence does not mean replacing one's own cultural identity with another, ignoring the variability within cultural groups, or even appreciating the cultures being served. Instead, nurses skilled at cultural competence show a respect for difference, an eagerness to learn, and a willingness to accept multiple views of the world.

The nursing instructor is teaching a class on labor and delivery. She lists the advantages of a home birth and then lists which of the following to be disadvantages of home births? (Check all that apply.)

• danger to baby if emergency arises • danger to mother if emergency arises • limited availability of pain medication Home birth is advantageous for many different reasons, including permitting the woman to maintain control as well as allowing for labor to progress normally without any interferences and unnecessary interventions. Disadvatanges include the limited availability of pain medication and danger to the mother and baby if an emergency arises.

The nursing instructor is teaching students about the benefits of CAM. Which of the following are examples of CAM? (check all that apply) a) guided imagery b) therapeutic touch c) aromatherapy d) medication therapy e) acupressure

• guided imagery • therapeutic touch • aromatherapy • acupressure Correct Explanation: CAM is the use of complementary and alternative medicine. It is used widely by people in all areas of the community and is used more often by women than men. Some examples include aromatherapy, homeopathy, acupressure, feng shui, guided imagery, reflexology, therapeutic touch, herbal medicine and spiritual healing. p45

• health promotion • illness prevention Health care delivery has moved from the acute care settings out into the community. It now has a focus on health promotion and illness prevention. It wants to prevent acute and chronic illnesses so that they are not a focus of health care delivery but instead and outcomes if the goal of prevention is not achieved.

The experienced nurse has seen many changes in health care throughout the last few decades. One such change has been to move from acute care settings out into the community with an emphasis on which of the following? (Check all that apply.) a) health promotion b) acute illnesses c) chronic illnesses d) illness prevention e) none of the above

• health promotion • illness prevention Explanation: Health care delivery has moved from the acute care settings out into the community. It now has a focus on health promotion and illness prevention. It wants to prevent acute and chronic illnesses so that they are not a focus of health care delivery but instead and outcomes if the goal of prevention is not achieved. p52

• health promotion • medical and psychosocial interventions • early and continuing risk assessment • follow-up Early prenatal care can improve pregnancy outcomes. Basic components of prenatal care are early and continuing risk assessment, health promotion, medical and psychosocial interventions and follow-up. Not working while pregnant does not necessarily help. Keeping active usually provides a healthier lifestyle and in turn a better outcome.

The nurse reinforces to the patient that prenatal care is associated with improved pregnancy outcomes. She lists the basic components of good prenatal care to be which of the following? (Check all that apply.) a) medical and psychosocial interventions b) terminating employment while pregnant c) early and continuing risk assessment d) follow-up e) health promotion

• medical and psychosocial interventions • early and continuing risk assessment • follow-up • health promotion Correct Explanation: Early prenatal care can improve pregnancy outcomes. Basic components of prenatal care are early and continuing risk assessment, health promotion, medical and psychosocial interventions and follow-up. Not working while pregnant does not necessarily help. Keeping active usually provides a healthier lifestyle and in turn a better outcome. p46

The nursing student demonstrates an understanding of what is included in postpartum home visits when she correctly lists which of the following? (Check all that apply.) a) monitoring the physical and emotional well-being of the family members b) performing any home cleaning that the mother cannot perform c) administering all of the newborn vaccinations d) bridging the gap between discharge and ambulatory follow-up for mothers and their newborns e) identifying potential or developing complications for the mother and newborn

• monitoring the physical and emotional well-being of the family members • bridging the gap between discharge and ambulatory follow-up for mothers and their newborns • identifying potential or developing complications for the mother and newborn Correct Explanation: Home visits give the nurse an opportunity to assess the family's adaptation and dynamics and the home environment. Postpartum care includes monitoring the physical and emotional well-being of the family members, identifying potential or developing complications for the mother and newborn, and bridging the gap between discharge and ambulatory follow-up for mothers and their newborns. Administering all of the newborn vaccinations is not feasible as they are numerous and are scheduled at different intervals and are not given in the home but instead in a physician's office or clinic. The nurse does not perform any home cleaning for the family. p50

The nurse takes on many roles, especially in the community setting. One important role of the nurse in the community is educator. Patient and family education allows for which of the following? (Check all that apply.) a) promotes recognition of problem situations and their appropriate responses b) ensures the presence of basic health care skills c) helps families and patients to feel helpless and powerless d) allows for families and patients to make informed decisions e) allows for questions to be answered

• promotes recognition of problem situations and their appropriate responses • ensures the presence of basic health care skills • allows for families and patients to make informed decisions • allows for questions to be answered Correct Explanation: Overall, patient and family education allows patients and families to make informed decisions, ensures the presence of basic health care skills, promotes recognition of problem situations, promotes appropriate responses to problems, and allows for questions to be answered. Through patient education patients can overcome feelings of helplessness and powerlessness and gain the confidence to be active members in their plan of care. p54-55

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