WEEK 11 ADN220 [THE CONCEPT OF FAMILY]
The nurse is planning care of a 10-year-old child with an asthma exacerbation whose parents are currently unemployed. Which interventions are the best for the nurse to pursue for this family? (Select all that apply.) A. Reassuring the family of the potential benefits of pursuing the nurse's collaborative interventions B. Identification of areas of knowledge deficiency in cultural competence C. Referral to community wellness clinics D. Avoidance of assumptions or judgments E. Referral to social services experts
***A. Reassuring the family of the potential benefits of pursuing the nurse's collaborative interventions B. Identification of areas of knowledge deficiency in cultural competence ***C. Referral to community wellness clinics D. Avoidance of assumptions or judgments ***E. Referral to social services experts Nurses often need to collaborate with other professionals to help clients regain or maintain health. The nurse's collaborators may include social services experts, community free wellness clinics, food banks, and other community organizations that can meet the family's needs. The nurse teaches the family the value of these resources to their child's and family's health and encourages them to follow through on securing support. Identification of areas of knowledge deficiency in cultural competence and avoiding assumptions or judgments about clients are part of the nurse's own professional development and practice, not a nursing intervention for a client.
Which are factors that shape family development? (Select all that apply.) A. Sibling relationships B. Parenting style C. Family-centered care D. Resiliency E. Boundaries
***A. Sibling relationships ***B. Parenting style C. Family-centered care ***D. Resiliency ***E. Boundaries Factors that shape family development are parent-child interaction, family size, sibling relationships, boundaries, family cohesion, resiliency, family coping mechanisms, emotional availability, family flexibility, family communication patterns, parenting style, and genetic considerations and nonmodifiable risk factors. Family-centered care is the partnership between nurses and families when planning care.
4 (complication of tonsillectomy is bleeding, and constant swallowing may indicate bleeding, 1 and 2 are expected. 3 is not usual for the procedure)
A 5 year old is admitted to the unit following a tonsillectomy. Which of the following would indicate a complication of the surgery? 1. decreased appetite 2. low grade fever 3. chest congestion 4. constant swallowing
2 (according to the Denver model a child of 4 should be ale to state his first and last name. Answer 1 & 3 are expected at 5 years old Answer 4 is expected of 5-6 year old)
A child with Downs syndrome has a developmental age of 4. According to the denver developmental assistance model the 4 year old should be able to: 1. draw a man in 6 parts 2. give his first and last name 3. dress without supervision 4. define a list of words
3 (2 and 4 are signs of FAS but not the priority at this time, Answer 1 would be of more recent use that 1 day ago.)
A client in labor admits to using alcohol during pregnancy. The most recent use was the day before. Based on the clients history, the nurse should give priority to assessing the newborn for: 1. respiratory depression 2. wide set eyes 3. jitteriness 4. low set ears
2 (Answer 1 = scarlet fever Answer 3= fifths disease Answer 4= FAS)
A newborn is diagnosed with congenital syphilis, Classic signs of congenital syphilis are 1. red papular rash, desquamation, white strawberry tongue 2. rhinitis, maculopapular rash, hepatosplenomegaly 3. red edeamatous cheeks, maculopapular rash on the trunk and extremities 4. epicanthal folds, low set ears, protruding tongue
a (Rationale: NWI proposed six dimensions of wellness: occupational, physical, social, intellectual, spiritual, and emotional wellness. These dimensions are all interconnected, contributing to an individual's overall well-being. Morality is not one of the proposed six dimensions of wellness.)
A nurse concerned with family wellness promotion understands that The National Wellness Institute (NWI) has proposed six dimensions of wellness including all except: a Moral b Occupational c Physical d Social
c (Rationale: The nurse will collaborate with the medical social worker (MSW) to aide in providing the family with financial resources. The nurse may collaborate with the physician, however, not for financial guidance. The nurse will not collaborate with the parent's employer or the home health agency.)
A nurse is caring for a family in a rural healthcare setting when the parents tell the nurse that they do not have enough money to pay for groceries. Who does the nurse collaborate with to help the family's financial problems? a The family physician b The parent's employer c The medical social worker (MSW) d The home health agency
The nurse is caring for a 10-year-old client with diabetes. The parents of the client do not speak English. How should the nurse best teach the client and family about home care? A. A sibling that speaks fluent English should translate. B. The client should translate. C. An agency translator should be used. D. The nurse should provide written instruction in the family's language.
A. A sibling that speaks fluent English should translate. B. The client should translate. ***C. An agency translator should be used. D. The nurse should provide written instruction in the family's language. Language barriers prevent therapeutic communication that is necessary to providing culturally competent care. It is not uncommon for children to be asked to interpret for the family; however, this exposes them to information they may not understand or know how to communicate. The preferred method for teaching home care is the hospital/agency translator. Information written in the family's language might be useful, after verbal instruction is given.
What does the open double quote"Aclose double quote" stand for in the LEARN model of cultural competence? A. Assert B. Acknowledge C. Affirm D. Accept
A. Assert ***B. Acknowledge C. Affirm D. Accept Acknowledge and discuss the differences and similarities between the perceptions of the client and that of the health care team. Assert, affirm, and accept are not steps in the LEARN model.
Which action by the nurse would indicate further education is necessary for the nursing care to be effective and culturally sensitive? A. Becomes knowledgeable about cultures served B. Becomes an effective communicator C. Puts own personal beliefs aside D. Acknowledges the numerous variations of family structures
A. Becomes knowledgeable about cultures served B. Becomes an effective communicator ***C. Puts own personal beliefs aside D. Acknowledges the numerous variations of family structures To become a culturally competent nurse, you must have the knowledge and skill to take care of families from different cultures. You should find out more about your clients' cultures, be a good communicator, acknowledge the numerous variations in family structure, and become aware of your own cultural beliefs so that you can anticipate possible misunderstandings. However, you do not have to put your own personal beliefs aside completely, but rather your beliefs should not affect the care that you provide.
Which interventions may be most appropriate when divorce alters a family structure? (Select all that apply.) A. Being alert to signs of intense grief reactions B. Considering the nature of the loss C. Providing information about counseling and support groups D. Educating about the importance of health maintenance and nutrition E. Advising about healthy coping mechanisms for stress
A. Being alert to signs of intense grief reactions B. Considering the nature of the loss ***C. Providing information about counseling and support groups ***D. Educating about the importance of health maintenance and nutrition ***E. Advising about healthy coping mechanisms for stress Family-focused interventions that are appropriate when divorce alters the family are providing information, advising about healthy coping mechanisms, and educating about the importance of health maintenance and nutrition. The nurse's being alert to signs of grief and considering what the loss means to the family are part of the nurse's assessment, not interventions.
A nurse is caring for a 5-year-old client from an intergenerational family with 75-year-old grandparents who have provided care since the parents went to prison. Which factor, affecting the families' ability to cope with a young child, should the nurse consider when planning care? A. Decision making that is dispersed throughout the family system B. Family concerns that focus on maintaining functioning C. Family roles that are assigned by age and gender D. Procedures that affect the client, but do not affect the functioning of the family
A. Decision making that is dispersed throughout the family system ***B. Family concerns that focus on maintaining functioning C. Family roles that are assigned by age and gender D. Procedures that affect the client, but do not affect the functioning of the family In order to plan care for the client, the nurse must understand the implications of care giving for the aging grandparents. As well as caring for a young child from a Stage II or IV family, the grandparents are in a Stage VIII family. Among the grandparents' concerns is maintaining function during the aging process, especially since they are caring for a young child. The plan of care must include interventions that comprehensively address family needs. Family role assignment, decision making, and procedures the child will undergo do not directly affect the family's ability to cope.
Seven-year-old Jermaine Cast has a serious, but not life-threatening, illness. He will need to be kept home from school for a 2-month course of treatment. His parents both work and neither parent has a lot of vacation time. What is the most important information the nurse can give the parents? A. Discuss free, or sliding fee, clinics available to families who are underinsured B. Discuss coping strategies for families facing the stress of caring for a sick child C. Assist family to find a good day care center D. Provide information regarding Family and Medical Leave Act
A. Discuss free, or sliding fee, clinics available to families who are underinsured B. Discuss coping strategies for families facing the stress of caring for a sick child C. Assist family to find a good day care center ***D. Provide information regarding Family and Medical Leave Act Nurses should educate the parents about the Family and Medical Leave Act of 1993, so each could take time without pay to be able to be home with the child after they have exhausted their vacation or sick time. It is always helpful to discuss coping strategies with parents under stress, but it is not the most important information the nurse could offer in this situation. Day care is an appropriate place for preschool-age children while their parents are at work, but is not usually equipped to take care of a child with a serious health issue. Free clinics, or sliding fee clinics are helpful for many uninsured people but would not resolve a need for months of care for a sick child, nor is there evidence that this is an issue for this family.
The nurse is doing an assessment addressing the interaction of members of the family. Which level of family cohesion describes a family where family members cannot develop a separate identity? A. Disengaged B. Separated C. Connected D. Enmeshed
A. Disengaged B. Separated C. Connected ***D. Enmeshed Members of an enmeshed family cannot develop a separate identity. Separated and connected family cohesion is thought to offer optimal family competency in Western developed societies. Disengaged families are like a group of strangers who happen to live together.
You are conducting an assessment to create a family plan of care for 8-year-old Timothy Lopez. Which question is least appropriate for the nurse to ask his grandmother to help with developing your plan? A. Does either parent have health conditions? B. What are the family's eating habits? C. What is your religion? D. What medical treatments are they interested in?
A. Does either parent have health conditions? B. What are the family's eating habits? C. What is your religion? ***D. What medical treatments are they interested in? Asking what medical treatments interest the family is not a question that would provide information that could be incorporated in a family plan of care. Health beliefs of clients may include folklore and practices from different cultures. A family plan of care requires in-depth assessment of the immediate and extended family, as well as review and consideration of the following factors: health history, socioeconomic status, religion, culture, nutrition, and social habits and practices.
The nurse is caring for a 3-year-old client. The client and the family are immigrants. When assessing the client, the nurse finds that the child has not had immunizations. Which is the best action of the nurse? A. Educate the family about the importance of immunizations B. Identify reasons and beliefs that may be preventing immunization C. Respect the parents' decision not to immunize their child D. Ensure that the client receives immunizations while hospitalized
A. Educate the family about the importance of immunizations ***B. Identify reasons and beliefs that may be preventing immunization C. Respect the parents' decision not to immunize their child D. Ensure that the client receives immunizations while hospitalized The nurse should first assess why the parents have not had the child immunized, which could include the family's cultural practices. The nurse must ensure that immigrant families or clients with views that differ from those of the mainstream culture are aware of the rules and laws governing the care and protection of children against preventable diseases. The first step is to identify why the child has not been immunized; then the family can be educated to promote immunization. Immunizations are given only when parents consent to vaccinations. The nurse cannot administer vaccinations without permission. By respecting the parents' decision without investigating the reasons they have chosen not to vaccinate their child is not appropriate to providing holistic care.
The nurse is caring for 6-year-old Justin Sennet, who has come to the clinic for a physical. His father is impatient and speaks sharply to the child, who is walking around the examination room. The father mentions that his wife died 6 months ago. What is important for the nurse to include during this interview? A. Encouraging the father to set limits with the child B. Assessing for signs of complicated grief C. Providing information about parenting styles D. Telling the father to demonstrate more parental warmth
A. Encouraging the father to set limits with the child ***B. Assessing for signs of complicated grief C. Providing information about parenting styles D. Telling the father to demonstrate more parental warmth The nurse's approach would be to assess how the family is coping with its loss in order to prevent abuse and trauma and promote family competence following this major family alteration. The nurse would assess for signs of complicated or traumatic grief and family violence. It could be appropriate to provide information about therapy and support groups, teach about healthy coping strategies, and facilitate referrals to counselors and other professional resources. Parenting style, emotional availability, family communication patterns, discipline, and limit setting are factors that impact family development; these are at play in this parent-child interaction, and would be noted in the nurse's assessment.
A family comes to the hospital for the father's preoperative visit. The nurse notes that the mother and children let the father answer all questions posed to family members. What should the nurse consider as she prepares the plan of care for this family? A. Family is showing self-disclosure B. Family has rigid flexibility C. Family is demonstrating diffuse boundaries D. Family is demonstrating resiliency
A. Family is showing self-disclosure ***B. Family has rigid flexibility C. Family is demonstrating diffuse boundaries D. Family is demonstrating resiliency The deferral of all family members to the father may indicate rigid family flexibility. A family with rigid flexibility demonstrates very low flexibility for change in the family's leadership, relationships, and rules. Low flexibility may impair the family's resiliency; its ability to respond productively to stress through adaptation and change during the father's illness and recovery. Family communication in high functioning families demonstrates self-disclosure in their communication patterns, where family members share personal feelings about themselves and others. Families with diffuse boundaries demonstrate very open contact with each other and outside systems. The nurse does not observe those behaviors in this family.
The nurse is caring for a 10-year-old client diagnosed with diabetes mellitus. Which assessment findings for this client and family members are teaching opportunities for the nurse? (Select all that apply.) A. Genogram B. Parental structuring C. Poverty-related stress D. Family members with BMI above 30 E. Family history of diabetes
A. Genogram B. Parental structuring ***C. Poverty-related stress ***D. Family members with BMI above 30 ***E. Family history of diabetes A family with a history of diabetes, body mass indices above 30 (indicates obesity), that is experiencing poverty-related stress needs education from the nurse about nutrition and its relationship to disease, as well as referrals to community resources that may be able to assist the family with needed food, medical care, and financial assistance. Parental structuring, an aspect of emotional availability, is the ability of parents to support the child's learning and inquiries without overwhelming the child's autonomy. A genogram is a map of gender, showing lines of descent through the generations of a family.
Which is a core belief about health in non-Western cultures? A. Health is an attribute of youth. B. Health is the absence of disease. C. Health is the strength to do anything you want. D. Health is a state of harmony that encompasses mind, body, and spirit.
A. Health is an attribute of youth. B. Health is the absence of disease. C. Health is the strength to do anything you want. ***D. Health is a state of harmony that encompasses mind, body, and spirit. Non-Western cultures view health as a harmonious state. Western society sees health as the absence of disease. Other views of health are more individual.
The nurse is caring for a 7-year-old child diagnosed with type 1 diabetes. The client is the only child in a two-parent nuclear family. The parents of this client would most likely be working on which developmental tasks in the family life cycle? (Select all that apply.) A. Learning to manage parental tasks B. Looking to retirement C. Managing external influences of friends D. Managing increased time commitments E. Being involved in child's sports, school, or clubs
A. Learning to manage parental tasks B. Looking to retirement ***C. Managing external influences of friends ***D. Managing increased time commitments ***E. Being involved in child's sports, school, or clubs The parents of a 7-year-old child would be working through Stage IV (family with school-age children). Developmental tasks at this stage of family development are facilitating peer relations, and maintaining family dynamics while adjusting to outside influences. At this stage of family development, parents are involved with school-related activities, sports, and clubs, and managing external influences of friends. Learning to manage parenting tasks and responsibilities occurs in Stage II (childbearing). Looking to retirement occurs in Stage VII (middle-aged parents).
During a health history interview with a family, the nurse is concerned that a 12-year-old client is experiencing signs of grief reaction. What information from the family would cause the nurse to suspect this condition? A. Nurse observes listening and self-disclosure. B. Nurse observes a family alteration. C. Nurse observes structured family flexibility. D. Nurse observes changes in physical health status.
A. Nurse observes listening and self-disclosure. ***B. Nurse observes a family alteration. C. Nurse observes structured family flexibility. D. Nurse observes changes in physical health status. An alteration in the family, loss of a family member because of death or divorce, could result in a grief reaction, which could manifest in the interview as depression, anger, or anxiety. Communication patterns that include family members listening, speaking, self-disclosing, and tracking, and family flexibility are characteristic of high functioning families. Grief may manifest in weight loss, headaches, sleeplessness and other symptoms, but the nurse would observe that after the health history interview, during the physical examination of family members that would follow.
Which group is diagnosed with AIDS at a rate that is more than ten times that of Caucasians? A. Pacific Islanders B. Asian Americans C. African Americans D. Hispanics
A. Pacific Islanders B. Asian Americans ***C. African Americans D. Hispanics African Americans have a rate of AIDS infection that is ten times that of Caucasians. Hispanics have a rate three times the Caucasian rate of AIDS infection. Asian Americans and Pacific Islanders do not have higher rates of AIDS.
Which description best depicts a binuclear family? A. Parents with biological children from a previous relationship or marriage B. Two parents with biological or adopted children living together C. Male and female parents, living together outside of marriage D. A family where there is co-parenting with children sharing time between families
A. Parents with biological children from a previous relationship or marriage B. Two parents with biological or adopted children living together C. Male and female parents, living together outside of marriage ***D. A family where there is co-parenting with children sharing time between families Binuclear describes a combination of parenting by two nuclear families, which can happen after a divorce has ended the original nuclear family. Children still spend time with each new family.A nuclear family consists of two parents with biological or adopted children, or children in the new family from a previous relationship or marriage. Male and female parents, living together outside of marriage, are referred to as heterosexual cohabiting.
The nurse is planning discharge care for a 10-year-old child with an asthma exacerbation. Which roles in the binuclear family unit of the child should the nurse identify before teaching can begin? (Select all that apply.) A. Primary caregiver for the child B. Financial decision maker for the child C. Legal guardian of the child D. Medical decision maker for the child E. Parent that is working outside home
A. Primary caregiver for the child ***B. Financial decision maker for the child ***C. Legal guardian of the child ***D. Medical decision maker for the child E. Parent that is working outside home Family members take on different roles within the family. The decision maker in the family may not be the primary provider or caregiver, or the working parent. The nurse must identify the legal, medical, and financial decision maker for each family when planning care for a child.
A supervisor has asked a nurse to train new nursing staff in culturally competent care. Which information would the nurse include in the training? (Select all that apply.) A. Promoting participation of fathers, as well as mothers, in healthcare visits B. Reasons nuclear families are superior C. Variations in family structure D. Communication skills E. Cultures served by the nursing staff
A. Promoting participation of fathers, as well as mothers, in healthcare visits B. Reasons nuclear families are superior ***C. Variations in family structure ***D. Communication skills ***E. Cultures served by the nursing staff The nurse would include information about the cultures served locally by the healthcare organization, variations in family structure that nurses may encounter, and communications skills. In the training, the nurse would teach avoidance of judgments and assumptions, such as why nuclear families are superior to other family structures. The topic of why fathers and mothers should both participate in healthcare visits would be more appropriate for an educational program about facilitating the transition to parenthood.
The nurse is providing an assessment of a family to determine a need for interventions. Which description is an indication of high functioning family communication? A. Resiliency B. Self-disclosure C. Flexibility D. Emotional availability
A. Resiliency ***B. Self-disclosure C. Flexibility D. Emotional availability In high-functioning families, each family member listens empathically and attentively, speaks for him or herself and not for others, self-discloses by sharing personal feelings about self and other family members, and tracks (stays on topic). Family flexibility is the amount of flexibility in a family's leadership, rules, and roles, and the family's ability to deal with stress. Emotional availability refers to the quality of parent-child interactions. Resiliency is a family's ability to adapt, evolve, and change with circumstances.
The nurse learns that a client with school-age children is also her mother's caregiver. The client tells the nurse, open double quote"I cannot meet everyone's demands anymore.close double quote" Which is the most appropriate diagnosis for this client? A. Sandwich generation syndrome B. Risk for situational low self-esteem C. Adjusting to outside influences D. Readjustment of marital relationship
A. Sandwich generation syndrome ***B. Risk for situational low self-esteem C. Adjusting to outside influences D. Readjustment of marital relationship A nurse who is assessing an adult family member who cares for both her own children and an aging parent may diagnose any one of several conditions including, but not limited to, ineffective self-health management, interrupted family processes, compromised family coping, or risk for situational low self-esteem. Adults in this group are known as open double quote"The Sandwich Generation,close double quote" which is not a nursing diagnosis. Families in Stage IV of the family life cycle must adjust to outside influences as children start school. Spouses in Stage VI of the family life cycle readjust their marital relationship as the family launches young adults.
The nurse is using an interpreter to discuss the care plan with a client of another culture. What form of communication is the nurse using to communicate with the client? A. Silence B. Touch C. Eye contact D. Verbal
A. Silence B. Touch C. Eye contact ***D. Verbal Verbal communication is an important tool to use when exchanging information about the plan of care. Using an interpreter is an example of using appropriate verbal communication to ensure that the client understands the information. Silence, touch, and eye contact are forms of nonverbal communication.
The nurse is taking care of a 10-year-old client receiving chemotherapy who is experiencing nausea that is distressing the client and parents. Which intervention would be most appropriate in implementing a family- centered plan of care? A. The nurse will provide small nutritious snacks to maintain body weight. B. The nurse will teach distraction techniques to decrease symptoms. C. The nurse will administer intravenous (IV) fluids to prevent dehydration. D. The nurse will administer pain medications as ordered to improve comfort.
A. The nurse will provide small nutritious snacks to maintain body weight. ***B. The nurse will teach distraction techniques to decrease symptoms. C. The nurse will administer intravenous (IV) fluids to prevent dehydration. D. The nurse will administer pain medications as ordered to improve comfort. Interventions are selected because they are related to a specific goal that is shared by the family and healthcare team. All of the interventions mentioned can be effectively used with the client receiving chemotherapy; however, only one intervention (teaching distraction) addresses the goal of decreasing symptoms of nausea.
Six-year-old Celine Toussaint has been diagnosed with sickle cell disease. She comes to the clinic with her grandparents and parents for follow-up care. In the assessment interview, the parents mention that they are both looking for work. Which nursing intervention would be appropriate for this family? A. Try to find a way to treat the child with less family involvement B. Facilitate connections with community resources C. Create an ecomap with the family D. Create a genogram with the family
A. Try to find a way to treat the child with less family involvement ***B. Facilitate connections with community resources C. Create an ecomap with the family D. Create a genogram with the family This family is at risk because of stressors related to serious illness and financial issues. The appropriate nursing intervention would be to facilitate connections with community resources that could address the family's immediate needs for employment. Intergenerational family support may be a major strength of this family, which the nurse would encourage. Family ecomaps and genograms are tools that nurses use in their assessments, not nursing interventions.
4 (Consistently responding to the infants needs fosters a sense of trust. Failure or inconsistency in meeting the infants needs results in a sense of mistrust. 1,2, and 3 are important to the development of the infant but do not necessarily foster a sense of trust)
According to Erikson, the developmental task of the infant is to establish trust. Parents and caregivers foster a sense of trust by: 1. holding the infant during feedings 2. speaking quietly to the infant 3. providing sensory stimulation 4. Consistently responding to needs
Barry Fitch is a 14-year-old boy with a right leg fracture. He plays football and his parents express concern about when he'll be able to return to the sport. Barry is found to be hypertensive and his BMI is 30.The provider starts Barry on an antihypertensive medication. Which action by the nurse will be beneficial to the family unit? Informing the parents that they will most likely need antianxiety medications to cope with their child's illness Counseling the parents that bariatric surgery is the best option for Barry Advising the parents to get a second opinion Answering any questions the parents may have about their child's illness
Answering any questions the parents may have about their child's illness
2 (because of their increased mobility and manual dexterity and curiosity, the 4 year old is at greater risk for accidental poisoning. Other accidental injuries in this age group include being struck by a car, falls, burns, and drowning. A 1 yr old lacks the development skill to be at risk, and an 8 yr old and 12 yr old are at less risk because they are aware of the dangers)
Assuming that all have achieved normal cognitive and emotional development, which of the following is at greatest risk for accidental poisoning? 1. 1 yr old 2. 4 yr old 3. 8 yr old 4. 12 yr old
a,b,e (Rationale For a family with middle-age adults who are in the process of planning for retirement, losing a job can be a major cause of stress. Moderate exercise, healthy eating, and relaxation techniques can help manage stress. Each individual who is making beneficial health changes is different and may need a form of care different from that of another family member. The client is already striving to quit smoking and has a job. There is no evidence the job is stressful.)
A 51-year-old client has recently found work after being laid off for 5 months. He and his wife had been making good progress with smoking cessation but he has regressed. He requests a referral to a smoking cessation clinic. Which other health promotion suggestion might the nurse make? (Select all that apply.) a Starting a plan of moderate exercise b Eating a healthier diet c Looking for work that does not cause so much stress d Following the partner's smoking reduction plan e Using relaxation techniques
c (Rationale Many diseases and negative health problems are preventable or minimized through lifestyle modifications. Use of fluoride has been shown to reduce dental decay, one of America's most prevalent health problems. Fluoride is used in the water supply, in toothpaste, as a supplement or it can be applied topically. There is a connection between oral health and heart health, but it probably would not be made with a normally well child client. Allergies are not prevented by the use of fluoride. Head lice are preventable by avoiding contact with someone or something already infected.)
A 6-year-old client comes to the clinic for a wellness visit and the nurse gives the child a coloring book about fluoride. Which preventable health problem is the nurse most concerned about for this client? a Head lice b Heart disease c Dental caries d Allergies
The nurse is caring for a school-age client diagnosed with leukemia. During subsequent visits, the nurse plans to assess the family unit for which possible responses? (Select all that apply.) Confusion and anger, with feelings of loss of control Financial difficulties resulting from medical bills or lack of employment Decreased job performance Anxiety, stress, or depression Manifestations of severe mental illness
Confusion and anger, with feelings of loss of control Financial difficulties resulting from medical bills or lack of employment Decreased job performance Anxiety, stress, or depression
Gemma Frank is a 30-year-old woman who has recently started hemodialysis treatments. Her boyfriend and their 6-year-old daughter are very supportive. She has been able to keep her job as a CPA because the office will work with her schedule. Which intervention will the nurse implement to help this family prevent impaired coping? Advising the family that things will be much easier now that she has begun treatment Connecting the family with appropriate supportive resources, including counselors and sources of financial assistance Counseling Ms. Frank that the renal diet cannot accommodate any of the foods enjoyed in her culture, but that she will become accustomed to it Communicating to the family that it is important to avoid talking about Ms. Frank's illness so as not to upset her
Connecting the family with appropriate supportive resources, including counselors and sources of financial assistance
Which is the most important clinical therapy for families coping with the stress of an individual's illness? Educating family about stress management, healthy eating, and community resources specific to their needs Advising families to spend as much time as possible with the ill individual to promote bonding Discouraging families from getting professional counseling because they need to work it out themselves Giving financial advice to clients and their families about how to manage their hospital bills
Educating family about stress management, healthy eating, and community resources specific to their needs
A client is diagnosed with diabetes mellitus. He has been in the hospital several times since the diagnosis 2 years ago. His wife tells the nurse that she is exhausted, and that they have both gained weight and withdrawn from social activities since his diagnosis. Which of the following are appropriate nursing actions? (Select all that apply.) Educating the client and family about healthy eating habits Apprising the client and family about a new diet center in town that has been successful for many individuals Providing resources for family counseling Teaching the client and family about healthy forms of stress management Discussing with the client and family the benefits of exercise for stress relief and health
Educating the client and family about healthy eating habits Providing resources for family counseling Teaching the client and family about healthy forms of stress management Discussing with the client and family the benefits of exercise for stress relief and health
Which factors place the family system at risk of alterations in function? (Select all that apply.) Family member quitting job Cohesive support system Medical bills Physical or mental illness in a family member Caregiver strain
Family member quitting job Medical bills Physical or mental illness in a family member Caregiver strain
The nurse is caring for a young school-age client diagnosed with sickle cell disease. When planning family-centered care, which factors must the nurse consider in the family's ability to cope? (Select all that apply.) Culture of the family Financial resources of the family Strength of the family structure Ability to seek services Number of dependents living at home
Financial resources of the family Strength of the family structure Ability to seek services
The nurse is caring for a preschool-age client and family who are immigrants. When assessing the client, the nurse finds that the child has not had immunizations. As the nurse is incorporating family-centered care into her practice, what is the initial action? Respecting the parents' decision not to immunize their child Ensuring that the client receives immunizations while hospitalized Identifying beliefs that are preventing the child from receiving immunizations Educating the family about the importance of immunizations
Identifying beliefs that are preventing the child from receiving immunizations
4 (According to Erikson the school age child needs the opportunity to be involved in tasks that he can complete so that he can develop a sense of industry. If he is not given these opportunities he is likely to develop feelings of inferiority. Answers 1,2,3 are not associated with the psychosocial development of the school age child.)
If the school aged child is not given the opportunity to engage in tasks and activities he can carry through to completion, he is likely to develop feelings of : 1. guilt 2. shame 3. stagnation 4. inferiority
2 (A 3 year old is expected to use magical thinking, such as believing a toy bear is a real bear. The other answers relate to an older child)
In terms of cognitive development, a 3 year old would be expected to: 1. think abstractly 2. use magical thinking 3. understand the conservation of matter 4. see things from the perspective of others
The nurse is caring for a client with an exacerbation of multiple sclerosis. Her husband confides that the stress of caring for her, in addition to their small children, has caused him to start smoking again after having quit many years ago. Knowing which information will alert the nurse to enhance the husband's coping skills? The cost of cigarette smoking can cause a serious financial burden for the family. The client's recovery will be impeded by the stress of discovering that her husband has started smoking. Smoking will most likely help the client's husband to deal with her illness in the short term. Inadequate coping function can lead to unhealthy choices and increase the risk of premature mortality in caregivers.
Inadequate coping function can lead to unhealthy choices and increase the risk of premature mortality in caregivers.
Which nursing practice recommendations incorporate the cultural diversity of families? (Select all that apply.) Integrate training in cultural diversity into staff development programs Adopt the family's cultural beliefs and practices in order to identify with them and be better able to relate Seek to understand the family's beliefs and practices related to race, culture, gender, and ethnicity Seek to understand and respect the family's religious/spiritual beliefs and incorporate them into the client's care Assist the family to navigate issues related to socioeconomic status, insurance status, geography, and access to health care
Integrate training in cultural diversity into staff development programs Seek to understand the family's beliefs and practices related to race, culture, gender, and ethnicity Seek to understand and respect the family's religious/spiritual beliefs and incorporate them into the client's care Assist the family to navigate issues related to socioeconomic status, insurance status, geography, and access to health care
For the family of a client with severe mental illness, family burden is the overall level of distress experienced. If a client is acting out by arguing excessively, displaying inappropriate sexual behavior, or causing damage to the property of others, this is an example of which type of distress? Stigma Subjective family burden Caregiver Objective family burden
Objective family burden
The father of an adolescent client diagnosed with severe mental illness confides in the nurse that he is stressed and frustrated. The father is having difficulty managing the consequences of his son's behavior as he has broken into neighbors' homes and stolen items, and recently wrecked the family car. The father also tells the nurse that he is ashamed of his son's behavior because the family's friends are not inviting them to visit and seem to be avoiding them. Based on the father's statements, which issues are being experienced by this family? (Select all that apply.) Objective family burden Family recovery Subjective family burden Friend support Stigmatization
Objective family burden Subjective family burden Stigmatization
A nurse works on a facility committee to develop policies and practice guidelines for implementing family-centered care. Which nursing practice guidelines will the nurse recommend to place the family at the center of care? (select all that apply) Performing a comprehensive family assessment with the family which identifies strengths and weakness Identifying extended family members who should receive information and education Using the family assessment to work through the nursing process for the client Initiating a training program for cultural diversity for the facility Establishing a therapeutic relationship with the family
Performing a comprehensive family assessment with the family which identifies strengths and weakness Identifying extended family members who should receive information and education Using the family assessment to work through the nursing process for the client Establishing a therapeutic relationship with the family
The nurse is caring for a man with polycystic kidney disease who will begin peritoneal dialysis the following week. The nurse will implement which of the following actions as part of the nursing care plan to prevent impaired family function? (Select all that apply.) Referring the client and his partner to an insurance specialist to discuss their plan and his coverage Scheduling a family conference to evaluate the client's home and readiness of his partner to help with dialysis Advising the client and his partner that they should handle these challenges on their own, without involving other family members to ensure their privacy Giving the client and his partner information about a local dialysis support group that meets every month Educating the client and his partner about the pros and cons of this modality of treatment and the potential challenges they will face
Referring the client and his partner to an insurance specialist to discuss their plan and his coverage Scheduling a family conference to evaluate the client's home and readiness of his partner to help with dialysis Giving the client and his partner information about a local dialysis support group that meets every month Educating the client and his partner about the pros and cons of this modality of treatment and the potential challenges they will face
The family of a client diagnosed with schizophrenia shows the nurse some information they have obtained from the Internet and asks whether there are any local support groups they can attend. They also have a list of questions to ask the provider about the client's diagnosis. The nurse realizes that this family is in which stage of family response (family recovery)? Stage 3—coping and competence Stage 1—discovery and denial Stage 2—recognition and acceptance Stage 4—personal and political advocacy
Stage 2—recognition and acceptance
The nurse is caring for a young client with severe mental illness. The mother of the client confides that she is overwhelmed with frustration and hopelessness. She states that her daughter was a straight-A student before she started 'acting out' prior to her diagnosis. She states, open double quote"She probably won't be able to finish medical school now. I don't know what she'll do.close double quote" The nurse realizes that the mother is exhibiting which type of distress? Objective family burden Family recovery Subjective family burden Stigma
Subjective family burden
Which actions help prevent family unit alterations in the presence of physical or mental illness? (Select all that apply.) Relying on the nurse for instructions Talking about the illness as a family Taking antianxiety medications Going to family counseling Accepting the illness
Talking about the illness as a family Going to family counseling Accepting the illness
The parents of a school-age child are informed that the child has type 1 diabetes mellitus. The nurse knows which interventions may help to prevent impaired family coping? (Select all that apply.) Teaching the family about challenges early in the process Talking about the illness together as a family Working with a family counselor Asking the provider early to prescribe antianxiety medications for the parents Learning about community resources and sources of financial assistance
Teaching the family about challenges early in the process Talking about the illness together as a family Working with a family counselor Learning about community resources and sources of financial assistance
3
The 2 month old has just receive the first injection of tetramune. The nurse should tell the mother that the immunization 1. will need to be repeated when the child is 4 years old 2. is given to determine whether the child is susceptible to pertussis 3. is one of a series of injections that protects against diphtheria, pertussis, tetanus, and H, influenzae b 4. Is a one time injection that protects against measles, mumps, rubella, and varicella
The nurse is caring for a client being treated for stage II breast cancer with chemotherapy and radiation. It is determined that the client's family is in stage 3 of family recovery. Which assessment finding supports stage 3 of family recovery? (Select all that apply). The extended family is running a 5K race in support of breast cancer clients. The client's family is angry that she has taken time off from work for her treatments. The client's family members accompany her to her chemotherapy treatments and stay with her during appointments. The family has arranged for the grandmother to care for the children after school every day. The client's husband arranges his business trips around her chemotherapy cycles.
The extended family is running a 5K race in support of breast cancer clients. The client's family members accompany her to her chemotherapy treatments and stay with her during appointments. The family has arranged for the grandmother to care for the children after school every day. The client's husband arranges his business trips around her chemotherapy cycles.
The family of a client with a genetic disorder initiates an online support group for families of other individuals with this syndrome. They show the nurse their website and ask for feedback. Based on the family's behaviors, which conclusion by the nurse is the most appropriate? The family is being stigmatized. The family is exhibiting signs of subjective family burden. The family is in the final stage of family recovery. The family is in stage 1 of family recovery.
The family is in the final stage of family recovery.
The nurse is caring for a client with Guillain-Barré syndrome. She is on a ventilator; and though she is expected to make a full recovery, the provider has told the family that it will take some time. One evening, the client's husband comes to visit; he smells strongly of alcohol and he is slurring his words. Which conclusion by the nurse explains the husband's actions? The client's husband is not exhibiting signs of caregiver strain; he is an alcoholic. The client's medical bills have caused the family considerable stress and anxiety. The high stress and inadequate coping function of the husband may have led him to unhealthy choices. The client's husband is not supportive and should not be allowed to see the client.
The high stress and inadequate coping function of the husband may have led him to unhealthy choices.
1,2,6 (broccoli, green leafy veges, and milk are all good sources of folic acid)
The home nurse is preparing a teaching plan for a client with deficiencies in folic acid. Which foods increase the clients folic acid level? Select all that apply 1. broccoli 2. cabbage 3. chicken 4. dried fruit 5. white bread 6. milk
2 (Children 18-24 months typically have suffiecient sphincter control necessary for toilet training. Answer 1 : not developmentally capable Answer 3 &4: Should already be established)
The mother of a 1 year old wants to know when she should start toilet training her child. The nurse responds based on the knowledge that sufficient sphincter control for toilet training is present by 1. 12-15 months 2. 18-24 months 3. 26-30 months 4. 32-36 months
2 (The client with the appendectomy is the most stable of these clients and can be assigned to the NA, the others require skilled care)
The nurse is assigning staff for the day. Which client should be assigned to the NA? 1. 5 month old with bronchiolitis 2. 10 year old 2 days post appendectomy 3. 2 year old with periorbital cellulitis 4. 1 year old with fractured tibia
Which are clinical manifestations of impaired coping in the family system? (Select all that apply.) Unhealthy lifestyle choices, smoking or substance abuse Enhanced job performance Changes in weight, gain or loss Withdrawal from social activities Depression or anxiety
Unhealthy lifestyle choices, smoking or substance abuse Changes in weight, gain or loss Withdrawal from social activities Depression or anxiety
1,3,5 (skates and bicycles require greater motor development than that possessed by a 2-3 year old)
What toys are suited to the developmental skills of the 2-3 year old? Select all that apply 1. soap bubbles 2. skates 3. riding toys 4. bicycle 5. talking toys
The nurse is conducting the assessment phase of the nursing process to create a family plan of care for 6-year-old Timothy Rodriguez. Which question is inappropriate to ask the parents when developing the plan of care? Which medical treatments interest them Whether either parent has health conditions What the family's eating habits are The family's religious preference
Which medical treatments interest them
4
Why is phytonadione vit k administered to a newborn shortly after birth? 1. to stop hemorrhage 2. to treat infection 3. to replace electrolytes 4. to facilitate clotting
Developing provider-family relationships guided by the goals and expectations of both the family and the provider is a recommendation for which element of the family-centered care philosophy? Cultural diversity of families Family at the center Family-professional collaboration Coping differences and support Family-centered peer support
Family-professional collaboration
1
Before adminstering ear drops to a toddler the nurse should recognize that it is essential to consider which of the following? 1. age 2. weight 3. developmental level 4. ability to understand
4 (At 4 months of age the infant can roll over, which makes it vulnerable to falls from dressing tables or beds without rails. )
Which developmental milestone puts the 4 month old infant at greatest risk for injury? 1. switching objects from one hand to another 2. crawling 3. standing 4. rolling over
3 (the nurse should encourage the parents to stay)
Which nursing intervention would you expect when working with a hospitalized toddler? 1. ask the parent to leave the room when assessments are being performed 2. explain the items from home should not be brought into the hospital 3. tell the parents they may stay with the toddler 4. ask the toddler if he is ready to have his temp checked
2
Which of the following instructions should be included in the nurses teaching regarding oral contraceptive? 1. weight gain should be reported to the HCP 2. An alternate method of birth control is needed when taking antibiotics 3. if the client misses one or more pills two pills should be taken per day for one week 4. changes in the menstrual flow should be reported to the HCP
2
Which play activity is best suited for the gross motor skills of a toddler? 1. coloring book and crayons 2. ball 3. building cubes 4. swing set
Which are examples of nonverbal communication? (Select all that apply.) A. Sitting forward in a chair B. Crossed arms C. Yelling D. Blushing E. Lack of eye contact
***A. Sitting forward in a chair ***B. Crossed arms C. Yelling ***D. Blushing ***E. Lack of eye contact Blushing, lack of eye contact, crossed arms, and sitting forward in a chair are all forms of nonverbal communication. Yelling is verbal.
A nursing instructor is discussing the concept of cultural diversity with a group of nursing students. While discussing broad groups, the instructor realizes she needs to reinforce teaching this concept when her students give which example? A. An example of diversity is the customs of a community. B. A project discussing health care diversity in the inner city versus the suburbs of a major city. C. A subgroup of diversity could include education, or occupation. D. The sexual orientation of a group of college sophomores participating in a birth control study.
***A. An example of diversity is the customs of a community. B. A project discussing health care diversity in the inner city versus the suburbs of a major city. C. A subgroup of diversity could include education, or occupation. D. The sexual orientation of a group of college sophomores participating in a birth control study. The customs of a community are considered part of the culture. Diversity refers to the quality of being different. Characteristics that distinguish broad groups from one another. Examples include age, race, gender, sexual orientation, and religion. Subgroups of diversity include socioeconomic status, education, occupation, interests, marital status, or rural versus urban living situations.
A nurse is reviewing the medical records of a small urgent care clinic. The nurse has been asked to identify clients who may be considered vulnerable. Which clients will the nurse include as those who may be vulnerable? (Select all that apply.) A. An 82-year-old man living alone with no family nearby B. A 17-year-old in an afterschool boys' and girls' program C. A 32-year-old woman who lists the local shelter as her home address D. A 22-year-old woman who is crying and anxious because she is fighting with her roommate E. A 42-year-old man with a history of psychiatric illnesses who lives in his car in a nearby park
***A. An 82-year-old man living alone with no family nearby B. A 17-year-old in an afterschool boys' and girls' program ***C. A 32-year-old woman who lists the local shelter as her home address D. A 22-year-old woman who is crying and anxious because she is fighting with her roommate ***E. A 42-year-old man with a history of psychiatric illnesses who lives in his car in a nearby park Vulnerable populations include the elderly, children, people living in poverty, homeless people, and those who are in abusive relationships, are mentally ill, or chronically ill. An episode of anxiety or an altercation without a history of abuse is not considered evidence of belonging to a vulnerable population. A teenager in an afterschool program is not considered a member of a vulnerable population.
Chen Yong, a 23-year-old Chinese student, goes to the local Chinatown clinic when he hurts his leg playing soccer. He is told that the doctor is not available and he will have to return the following day for treatment. What health care disparity does this incident illustrate? A. Asians have reported problems with receiving timely health care. B. Asians are unlikely to have health insurance. C. Asians do not want to use Western medical services. D. Asians prefer to use acupuncture and herbs for treatment.
***A. Asians have reported problems with receiving timely health care. B. Asians are unlikely to have health insurance. C. Asians do not want to use Western medical services. D. Asians prefer to use acupuncture and herbs for treatment. Asians were 1.5 times as likely as Caucasians to report that they sometimes or never get care for illnesses or injury as soon as they wanted to. Although some Asians may select traditional Chinese medicine in certain situations, that is not a concern in this situation. Health care coverage is not the problem in Chen Yong's case.
The nurse is assessing the health status of an adult client. Which aspects of culture will the nurse consider when assessing this client? (Select all that apply.) A. Customs are part of the culture of a client. B. Culture is defined by nonphysical traits. C. A client's culture is determined by race. D. Values are a part of culture. E. Beliefs are a part of culture.
***A. Customs are part of the culture of a client. ***B. Culture is defined by nonphysical traits. C. A client's culture is determined by race. ***D. Values are a part of culture. ***E. Beliefs are a part of culture. The culture that encompasses a client's way of life is based on nonphysical traits. The values and beliefs a client holds are part of culture and can influence health care. Customs can influence a client's attitude toward health. Race refers to physical and genetic heritage and is directly related to such physical traits a client may have as skin color, but it is not related to a client's culture.
The nurse is caring for a 5-year-old client diagnosed with cancer. Which factors affecting a family's ability to cope should the nurse consider when planning care (Select all that apply.) A. Financial resources of the family B. Strength of the family structure C. Ability to seek services D. Number of dependents living at home E. Country of origin of the family
***A. Financial resources of the family ***B. Strength of the family structure ***C. Ability to seek services D. Number of dependents living at home E. Country of origin of the family A child's illness or hospitalization can create stressful events for the child and family. The family's ability to cope depends on the strength of the family structure, its ability to successfully seek services, its support system, and available resources. The country of origin of the family does not directly affect the ability to cope with a child's illness. The number of dependents living at home and family size do not directly affect the family's ability to cope with a child's illness.
The nurse is caring for a 32-year-old client, a partner in a gay marriage, who has just given birth. What does the nurse understand about this family that will affect the plan of care? A. Frustrations about infant care are normal. B. Children in lesbian families are at higher risk for poor health. C. Families have coping strategies. D. The home environment is less supportive and healthy.
***A. Frustrations about infant care are normal. B. Children in lesbian families are at higher risk for poor health. C. Families have coping strategies. D. The home environment is less supportive and healthy. As part of the nursing interventions, the nurse will facilitate the integration of the infant by helping these parents recognize that frustrations about infant care are normal, and encouraging bonding with and care for the infant by both parents. Homosexual adults form gay and lesbian families with goals of caring and commitment, the same as heterosexual couples do. Children in gay and lesbian families have been found to have the same advantages and expectations for development, adjustment and health as children in heterosexual families. Gay and lesbian parents can effectively provide supportive and healthy environments for their children. All families have coping strategies that help them deal with stress and change, which should be encouraged.
The nurse is to provide an assessment for a client of Asian descent and his family. What would the nurse need to understand related to the client and his family's worldview? (Select all that apply.) A. Health care beliefs B. Values C. Health care practices D. Language E. Educational level
***A. Health care beliefs ***B. Values ***C. Health care practices ***D. Language E. Educational level Health care beliefs, language, and values are part of a culture's worldview and can influence a client's acceptance of and cooperation with the treatment plan. If the client does not speak the same language as the nurse and the health care provider, an interpreter will be required. Health care practices may differ from what the nurse plans and can include alternative practices that may interfere with the treatment plan. Although not part of the worldview or culture, the client's level of education will be considered when planning teaching for the client.
Which are aspects of organizational governance that should reflect adherence to cultural competence standards? (Select all that apply.) A. Mission statement B. Staff training C. Organizational practice implementation D. Policies and procedures E. Translation services
***A. Mission statement B. Staff training ***C. Organizational practice implementation ***D. Policies and procedures E. Translation services Organizational mission, policies and procedures, and practice implementation should support cultural competence. Translation services and staff training are not part of organizational governance.
Which is the definition of the term multiculturalism? A. Multiculturalism describes a society in which many subcultures coexist. B. Multiculturalism describes shared values, beliefs, attitudes, and customs in a community of people. C. Multiculturalism is the process of adapting to local customs. D. Multiculturalism describes the quality of being unlike or different.
***A. Multiculturalism describes a society in which many subcultures coexist. B. Multiculturalism describes shared values, beliefs, attitudes, and customs in a community of people. C. Multiculturalism is the process of adapting to local customs. D. Multiculturalism describes the quality of being unlike or different. Multiculturalism refers to many cultures existing together. Culture describes shared values and customs. Diversity describes the quality of being unlike or different. Assimilation is the process of adapting to local customs.
The nurse observes the client in prayer with family members. Which cultural phenomenon would the nurse recognize is occurring? A. Social organization B. Personal space C. Time orientation D. Environmental control
***A. Social organization B. Personal space C. Time orientation D. Environmental control Religious beliefs are part of what may identify the social organization of the culture of a family unit. Although the family members might be close to each other, focus is not on personal space, which refers to the comfortable or appropriate distance for interaction with other people. Time orientation differs among cultures, with some putting more value on the past and present; Anglo-American culture places more emphasis on the future. However, the focus during this client's prayer is not on time. The family is displaying social organization and not controlling the environment around them.
When developing a family plan of care for a pediatric client with a chronic health condition, which areas require an in-depth assessment of all family members? (Select all that apply.) A. Socioeconomic status B. Religious preferences C. Medication schedules D. Culture and social practices E. Education level
***A. Socioeconomic status ***B. Religious preferences C. Medication schedules ***D. Culture and social practices E. Education level A family plan of care requires in-depth assessment of all family members, including their health history, socioeconomic status, religion, culture, nutrition, and social habits and practices. Medication schedules and education/intelligence levels do not need to be assessed unless the nurse becomes aware of a problem in this area.
The nurse is performing a cultural assessment on an adult client. What type of information would be used to complete the cultural assessment? (Select all that apply.) A. The language spoken in the home B. Whether the client has insurance C. The client's region or country of residence D. The kinds of food and drink the client prefers E. The cultural or religious influences in decision making
***A. The language spoken in the home B. Whether the client has insurance ***C. The client's region or country of residence ***D. The kinds of food and drink the client prefers ***E. The cultural or religious influences in decision making Subjective data would be gathered by asking questions about cultural beliefs. Objective data would be gathered through observation of the client and the interactions between significant family members who might be present. Discovering the region or country the client originates from and lives in would give clues about the client's culture. It is important to know what language is spoken in the home and whether the client understands English so that communication can be effective. Insurance is not necessarily a question that would come up during a cultural assessment, although socioeconomic status may affect health care delivery.
The nursing students are meeting for a post conference following their shift on a medical floor. One of the students is reviewing a client's cultural background. Which statement by the student illustrates the concept of cultural humility? A. The nurse's expression of sensitivity to the differences between her client's culture and her own. B. The nurse's discussion of her cultural superiority over her client's culture. C. The nurse's explanation to her client that his religious beliefs lack scientific validity when discussing his diagnosis D. The nurse's example of her authoritative stance when teaching her client which diet is best for his diagnosis.
***A. The nurse's expression of sensitivity to the differences between her client's culture and her own. B. The nurse's discussion of her cultural superiority over her client's culture. C. The nurse's explanation to her client that his religious beliefs lack scientific validity when discussing his diagnosis D. The nurse's example of her authoritative stance when teaching her client which diet is best for his diagnosis. Cultural humility is displayed when a nurse recognizes that his or her personal cultural values are not superior to the cultural values of another person. The nurse is not demonstrating cultural humility when he or she is claiming cultural superiority over another person. Taking an authoritative stance to influence a client against dietary choices does not reflect cultural humility. Abusing the power of the nurse's position against the client's religion is not using cultural humility. Cultural humility is demonstrated when the nurse is sensitive to the differences in his or her client's culture, even though the nurse's personal values are not the same as the client's.
The nurse is assessing a client of a different culture who has different religious beliefs. Which statements or questions by the nurse would demonstrate cultural competence when assessing the client? (Select all that apply.) A. "How do you feel about taking medications or blood products if they are prescribed?" B. "I understand that you may not believe in receiving human blood products; is that correct?" C. "I apologize for keeping you so long. Would you like some privacy for prayer before continuing the exam?" D. "May I ask what your partner might think about this plan of care?" E. "I cannot continue with this assessment if you are not willing to be compliant with my plan of care."
***A. "How do you feel about taking medications or blood products if they are prescribed?" ***B. "I understand that you may not believe in receiving human blood products; is that correct?" ***C. "I apologize for keeping you so long. Would you like some privacy for prayer before continuing the exam?" ***D. "May I ask what your partner might think about this plan of care?" E. "I cannot continue with this assessment if you are not willing to be compliant with my plan of care." The nurse can show knowledge of a client's culture by asking appropriate questions that are not demeaning or rude. Asking how the client feels about taking medications opens the conversation to what cultural or religious beliefs might interfere with the medical care of the client. Attitudes of acceptance and recognition would help to build rapport with the client. An accepting attitude does not mean the nurse agrees with the client but that the nurse is willing to accept what the client believes, and work it into the plan of care. Communication is an important skill for a nurse when assessing and caring for a client with a different culture to ensure proper care. Asking about family support opens the conversation so the client feels comfortable speaking about family objections. A nurse who does not demonstrate cultural competence would hinder the health care being provided to the client and may hinder the client's compliance. Refusing to work a plan of care around a client's cultural beliefs is unethical and not beneficial to the client.
a,b,d,e (Rationale Teaching families about stress management; giving resources for family counseling; and discussing healthy eating habits and the benefits of exercise are all appropriate interventions. It is not appropriate for the nurse to promote a specific product or service.)
A client is diagnosed with diabetes mellitus. He has been in the hospital several times since the diagnosis 2 years ago. His wife tells the nurse that she is exhausted, and that they have both gained weight and withdrawn from social activities since his diagnosis. Which of the following are appropriate nursing actions? (Select all that apply.) a Teaching the client and family about healthy forms of stress management b Providing resources for family counseling c Apprising the client and family about a new diet center in town that has been successful for many individuals d Discussing with the client and family the benefits of exercise for stress relief and health e Educating the client and family about healthy eating habits
3 (as the school age child develops concrete operational thinking, she becomes more selective and discriminating in her collections. Answer 1 refers to the cognitive development of infant Answer 2 refers to moral not cognitive development Answer 4 refers to the cognitive development of the toddler and preschool child)
A mother tells the nurse that her daughter has become quite a collector, filling her room with Beanie babies, dolls and stuffed animals. The nurse recognizes that the child is developing: 1. object permanence 2. post-conventional thinking 3. concrete operational thinking 4. pre-operational thinking
c (Rationale A 3-year-old child should already have received the MMR immunization; this is a prime time to assess the family's vaccination history and provide education on the benefits of vaccinations as a primary tool in preventing illness and maintaining health. Some adults in the family may also need immunizations, such as flu vaccines or vaccines that they did not receive when they were young. The nurse can provide information regarding physicians and criteria for a good daycare facility, but this isn't the priority. Young children dislike the discomfort of injections; therefore, their cooperation is usually minimal.)
A new client brings her 3-year-old son to the community clinic for a measles-mumps-rubella (MMR) vaccination because without it he will not be allowed to enroll in a local daycare facility. The nurse sees an opportunity to provide this client with which health-promoting education? a The importance of choosing a daycare facility that will enforce stringent guidelines b The importance of teaching preschoolers to cooperate with the nurse when they are receiving injections c The importance of having all family members up to date on their immunizations d The importance of establishing a relationship with a pediatrician as soon as you move to a new area
a (Rationale: Each family member being up to date with all vaccinations is an example of an achieved outcome while all other choices are planned nursing outcomes.)
A nurse has implemented a plan of care stressing health promotion for a family. Planned nursing outcomes that demonstrate health promotion include all except the following: a Each family member is up to date with all vaccinations. b Family will display or describe actions to manage stressors that tax family resources. c Family members will demonstrate actions to improve the overall health and social competence of the family unit. d Family will meet the needs of its members during developmental transitions.
a,b,c,d (Rationale Establishing a therapeutic relationship; performing a comprehensive assessment; using the assessment for the plan of care; and identifying family members who should be involved in the care are all parts of placing the family as the central element. Initiating a cultural diversity program, while important, is a separate element of the family-centered care model.)
A nurse works on a facility committee to develop policies and practice guidelines for implementing family-centered care. Which nursing practice guidelines will the nurse recommend to place the family at the center of care? (select all that apply) a Identifying extended family members who should receive information and education b Using the family assessment to work through the nursing process for the client c Performing a comprehensive family assessment with the family which identifies strengths and weakness d Establishing a therapeutic relationship with the family e Initiating a training program for cultural diversity for the facility
The nurse is teaching a 16-year-old unmarried client who has given birth. What is most important for the nurse to include when discussing care with the client and her extended family? A. "This infant is at risk for health and social problems." B. "It would be better for the child if the mother could marry the father." C. "Family members should become active in bonding with the infant." D. "This infant will strengthen your family ties."
A. "This infant is at risk for health and social problems." B. "It would be better for the child if the mother could marry the father." ***C. "Family members should become active in bonding with the infant." D. "This infant will strengthen your family ties." The nurse's instruction is that family members should become active in caring for, interacting with, and bonding with the infant. Children in adolescent families are at greater risk for health and social problems; however, this infant is currently a part of the mother's family. Parents in these families may be forced to stop their formal education and are more likely to be physically, developmentally, and financially unprepared to care for a child. The nurse understands this and encourages the extended family to provide support for the mother and infant in order to promote health. The nurse provides culturally competent care that includes promoting family competence and health, and being nonjudgmental, regardless of the type of family the client has. Integrating a new infant into any family comes with stressors. A family that is resilient can adapt and transform in response to stress.
The nurse educator is presenting an in-service to staff nurses regarding the spiritual health of clients admitted to the unit. Which role of the nurse will the educator include in the presentation? A. Asking the client's family for permission before disclosing the client's prognosis B. Declining to discuss spirituality directly out of respect for differing beliefs C. Assisting the client in recalling past experiences in which he or she drew upon hope while in crisis D. Introducing clients to the chaplain, who can assist them in finding religious belief
A. Asking the client's family for permission before disclosing the client's prognosis B. Declining to discuss spirituality directly out of respect for differing beliefs ***C. Assisting the client in recalling past experiences in which he or she drew upon hope while in crisis D. Introducing clients to the chaplain, who can assist them in finding religious belief Spiritual health is the state of wellness encompassing personal fulfillment as well as the fulfillment of life with others. The nurse can support the client's spirituality by assisting the client to recall times when he or she experienced hope. Spirituality is not the same as religious beliefs. The nurse can assist the client in developing spirituality without involving religious practices. The client should be the focus of care and information. It is important to include the family and any source of support, but the focus is the client. The role of the nurse is to support the client's experience of spirituality, not promote religious belief. The chaplain can provide support to the client in the development of his or her personal spiritual development.
A nursing student is doing an internship in an inner-city free clinic. As part of the curriculum the nursing student is expected to give a presentation on health care disparities in the United States. Which statistics are appropriate for the student to include in the presentation to classmates? (Select all that apply.) A. Caucasians populations have a worsening health disparity in colorectal cancer mortality than Hispanic or African American populations. B. Asian individuals are more likely not to seek care for an illness or injury. C. African Americans have a higher rate of new AIDS cases than Caucasians. D. Asian adults over the age of 65 are more likely than Caucasians not to be immunized against pneumonia. E. Caucasians were more likely to report poor health care communication than the Hispanic population.
A. Caucasians populations have a worsening health disparity in colorectal cancer mortality than Hispanic or African American populations. ***B. Asian individuals are more likely not to seek care for an illness or injury. ***C. African Americans have a higher rate of new AIDS cases than Caucasians. ***D. Asian adults over the age of 65 are more likely than Caucasians not to be immunized against pneumonia. E. Caucasians were more likely to report poor health care communication than the Hispanic population. Health disparities among non-Caucasian populations are a concern in the United States. According to the 2010 National Health Disparities report, African Americans have a rate of AIDS that is ten times greater than Caucasians. Asian adults were 50% more likely than Caucasians not to be vaccinated for pneumonia. Asians were 1.5 times more likely not to get care for an illness or injury. African American populations have worsening colorectal cancer mortality from 2000dash-2006 than Caucasians. Hispanics are 1.7 times more likely to report poor communication with their health care provider than Caucasians.
A nurse makes the following statement, "Chinese people drink only hot tea, so don't put coffee on their trays. I know this because my last assignment was in San Francisco." The charge nurse identifies this remark as an example of which concept associated with culture? A. Ethnocentrism B. Prejudice C. Diversity D. Stereotyping
A. Ethnocentrism B. Prejudice C. Diversity ***D. Stereotyping Stereotyping is noted when a person assumes all members of a particular group have the same characteristics. This nurse is assuming all members of a group have the same eating habits. Ethnocentrism is the belief in the superiority of one's own culture and lifestyle. This nurse is making a generalization about a culture, not declaring the superiority of her own culture. Prejudice is a judgment about a person, place, or racial background that has no basis in knowledge. This nurse is making an assumption that all Chinese have the same traits. Diversity is a state of being different and occurs between and within cultural groups. It is not related to the statement this nurse made.
The nurse wants to provide culturally competent care to a client who lives on a long-term care unit. Which activities are appropriate for the nurse to implement? (Select all that apply.) A. Memorizing which foods members of each culture eat to restore health B. Educating the client about the U.S. health care system C. Asking the client where he or she thinks illness originates D. Seeking to understand one's own culture, its beliefs, and its assumptions E. Asking the client and his or her family how the illness affects them
A. Memorizing which foods members of each culture eat to restore health B. Educating the client about the U.S. health care system ***C. Asking the client where he or she thinks illness originates ***D. Seeking to understand one's own culture, its beliefs, and its assumptions ***E. Asking the client and his or her family how the illness affects them To provide culturally competent care, the nurse must first understand his or her own culture, its beliefs, and its assumptions. To assist in evaluating a client's culture, the nurse should ask certain questions to understand the client's beliefs. Asking where the client thinks his or her illness comes from will help the nurse understand illness from the client's perspective. Not all members of a culture eat the same thing. Memorizing stereotypes will not help the nurse to provide culturally competent care. Educating the client about the U.S. health care system does not help the nurse in providing culturally competent care.
Which cultural phenomenon that affects health care is classified as an environmental control? A. Skin color B. Emphasis on the past C. Faith healing D. Personal boundaries
A. Skin color B. Emphasis on the past ***C. Faith healing D. Personal boundaries Faith healing is an environmental control. Skin color is a biologic factor. Emphasis on the past is a time orientation. Personal boundaries are space factors.
The nurse is providing care to a client who is newly diagnosed with type 2 diabetes mellitus. The health care provider orders diabetic education, and notes that the client is noncompliant with his medication and diabetic diet. The client recently emigrated from Vietnam to live with his daughter and does not speak English. The client has expressed a desire to use traditional culturally based therapies to treat the diabetes. Repeat testing shows no improvement in glycemic control. Based on the client's culture, what are the barriers to the recommended diabetic care? (Select all that apply.) A. The lack of insurance B. Cultural belief that discussing the disease can influence the disease process C. The importance of the beliefs and cultural practices of the client's family and community D. The belief that illness is not related to pathophysiology E. Lack of trust in the health care system and providers
A. The lack of insurance ***B. Cultural belief that discussing the disease can influence the disease process ***C. The importance of the beliefs and cultural practices of the client's family and community ***D. The belief that illness is not related to pathophysiology ***E. Lack of trust in the health care system and providers Barriers to care that are influenced by cultural differences may include lack of trust in the health care system or the provider; the belief that illness is not related to pathophysiology; the influence of family and community as well as a cultural belief that discussing an illness can influence the disease process. Although a lack of insurance may influence the client's entry into care, it does not have cultural significance.
Sol, a 47-year-old man, wants to postpone his prostate surgery because his family will be gathering for Yom Kippur on that day. What is an appropriate nursing response? A. The nurse should insist that the client keep the surgery date. B. The nurse should ask the client whether his family will really mind if he doesn't join them for the holy day. C. The nurse should inform the surgeon of the scheduling problem and advocate for rescheduling the nonemergency procedure as soon as possible. D. The nurse should inform the client that his surgery may have to be postponed indefinitely.
A. The nurse should insist that the client keep the surgery date. B. The nurse should ask the client whether his family will really mind if he doesn't join them for the holy day. ***C. The nurse should inform the surgeon of the scheduling problem and advocate for rescheduling the nonemergency procedure as soon as possible. D. The nurse should inform the client that his surgery may have to be postponed indefinitely. Respecting the client's religious beliefs and practices is an important element in culturally competent nursing care. The nurse should not pressure clients about religious beliefs while informing them of medical concerns.
Angela Seitz, age 82, tells the nurse that the surgeon to whom she was referred told her that he does not do hip replacement surgery on someone as old as she. How would the nurse describe the surgeon's attitude? A. The surgeon is demonstrating homophobia. B. The surgeon is demonstrating ageism. C. The surgeon is demonstrating classism. D. The surgeon is demonstrating gender bias.
A. The surgeon is demonstrating homophobia. ***B. The surgeon is demonstrating ageism. C. The surgeon is demonstrating classism. D. The surgeon is demonstrating gender bias. Ageism is discrimination against older adults. Gender bias is demonstrating preferences towards one gender group over another. Classism involves oppressive practices based on socioeconomic status. Homophobia involves negative feelings or behaviors toward gays or lesbians.
Which is an accurate description of the term transsexual? A. Transsexuals are individuals born with anatomical characteristics that do not seem to fit the typical definitions of female or male B. Transsexuals demonstrate preferences toward one gender group over another. C. Transsexuals are individuals who perceive themselves to be in the "wrong body." D. Transsexuals have negative feelings or behaviors toward gays or lesbians.
A. Transsexuals are individuals born with anatomical characteristics that do not seem to fit the typical definitions of female or male B. Transsexuals demonstrate preferences toward one gender group over another. ***C. Transsexuals are individuals who perceive themselves to be in the "wrong body." D. Transsexuals have negative feelings or behaviors toward gays or lesbians. Transsexuals are individuals, of any anatomical gender who perceive themselves to be in the "wrong body." Intersex refers to individuals born with anatomical characteristics that do not seem to fit the typical definitions of female or male. Sexists demonstrate preferences toward one gender group over another. Homophobes have negative feelings or behaviors toward gays or lesbians.
An immigrant Hmong family (parents and two children) comes to a local outpatient clinic in an area where many Hmong have settled. The mother, age 42, has a hacking cough. How should the nurse address the language barrier? A. Use signs and gestures to communicate B. Ask the oldest child to act as translator C. Ask the local immigrant service organization to provide an interpreter D. Conduct a physical assessment with no explanations
A. Use signs and gestures to communicate B. Ask the oldest child to act as translator ***C. Ask the local immigrant service organization to provide an interpreter D. Conduct a physical assessment with no explanations Asking a family member to act as translator may create confidentiality issues. Signs and gestures are inadequate for clear communication. A representative of a local organization will understand the culture and may even have specific helpful knowledge of the family's background. Federal law requires provision of an interpreter.
A nurse administrator is asked to write guidelines for the staff nurses for the use of the hospital's interpreter services for non-English-speaking clients. Which recommendations will the administrator include in the guidelines? (Select all that apply). A. Use technical medical terminology related to the client's diagnosis and treatment B. Provide teaching sheets in the client's language C. Address questions to the client D. Use family members as the first line of interpretation E. Use verbal and nonverbal cues when addressing the client
A. Use technical medical terminology related to the client's diagnosis and treatment ***B. Provide teaching sheets in the client's language ***C. Address questions to the client D. Use family members as the first line of interpretation ***E. Use verbal and nonverbal cues when addressing the client Effective communication with interpreter services includes using nonverbal and verbal communication, including eye contact; speaking in simple, not complex terms; and providing the client with teaching sheets in their language. Family members should not be used as interpreters for confidentiality reasons. Questions should be addressed to the client.
d (Rationale: Presenting to the clinic indicates the family is probably ready to face the health challenges caused by previous activities. There is no evidence that the adult child or parent is experiencing disabling coping. Impaired parenting applies when the parent is unable to care for the child rather than the reverse. Although some strain may be experienced by the caregiver, there is no evidence that role strain is the most important aspect of this situation.)
An older client, brought to an agency by an adult child, is demonstrating signs and symptoms of fluid retention related to excessive sodium intake. Further nursing assessment indicates inadequate food storage and preparation techniques in the home. Which of the following nursing diagnoses is the most appropriate for this family? a Disabled Family Coping b Caregiver Role Strain c Impaired Parenting d Readiness for Enhanced Family Coping
d (Single-parent families with young children are at risk for health alterations because these families often live in poverty. The nurse can support and encourage the strength evidenced by the desire to be financially self-sufficient, while keeping in mind the goal of family wellness. The nurse helps the family head to explore additional resources available to her, using questions to direct her thinking rather than providing answers to difficult problems. Some social services resources, as well as community support groups, may be available. The nurse may encourage discussion about the possibility of the family supplying nighttime child care, which would ensure that her child is in a safe environment while the parent is at work.)
Callie Washington is a newly divorced mother who relocated to the town where her parents live. She was able to find a job working the night shift. At a wellness visit for her 4-year-old daughter, Callie asks the nurse about daycare providers in the area who provide services at night. Which is the best intervention for the nurse to offer to this family? a Give the client a directory with names and addresses of licensed child care providers in the area. b Commend the client for being willing to make hard sacrifices in order to be financially independent. c Suggest that the client find employment that will not require her to leave her child with strangers overnight. d Help the client identify resources available to her that will not risk her child's safety or her own psychological well-being.
c (Rationale Objective family burden is related to symptomatic behaviors of the client; providing care for the client; and dealing with the social stigma of mental illness. Subjective family burden is defined as the psychological distress of the family members in relation to the objective burden. Stigma involves the negative attitudes and belief that lead people to fear, reject, avoid, and discriminate against people with mental illness. Being a caregiver is a role that the family may have to assume when caring for a client with severe mental illness. This is not a type of distress.)
For the family of a client with severe mental illness, family burden is the overall level of distress experienced. If a client is acting out by arguing excessively, displaying inappropriate sexual behavior, or causing damage to the property of others, this is an example of which type of distress? a Subjective family burden b Caregiver c Objective family burden d Stigma
2 (Children at 18 months like push pull toys. Children at approx 3 years old begin to dress themselves and build a tower of 8 blocks. At age 4 children can copy a horizontal or vertical line)
Which finding is expected in an 18 month old with normal growth and development? 1. she dresses herself 2. she pulls a toy behind her 3. she can build a tower of 8 blocks 4. she can copy a horizontal or vertical line
4 (The nurse who has had the chickenpox has immunity to the illness and will not transmit chickenpox to the client, even if the virus has formed scabs there is still a risk.)
The charge nurse is making assignments for the day. After accepting the assignment to care for a client with leukemia the nurse tells the charge nurse that her child has chicken pox. Which initial action should the charge nurse take? 1. change the nurses assignment to another client 2. explain to the nurse there is no risk to the client 3. askk the nurse if the chicken pox have crusted 4. ask the nurse if she has ever had chickenpox
c (Rationale Stage 1 is when family members may notice the individual's erratic behavior and often deny that anything is wrong. In Stage 2, families begin searching for information and accept the diagnosis. Stage 3 describes how families learn coping strategies and become competent in providing care for the client. The final stage is one of personal and political advocacy.)
The family of a client diagnosed with schizophrenia shows the nurse some information they have obtained from the Internet and asks whether there are any local support groups they can attend. They also have a list of questions to ask the provider about the client's diagnosis. The nurse realizes that this family is in which stage of family response (family recovery)? a Stage 3—coping and competence b Stage 4—personal and political advocacy c Stage 2 —recognition and acceptance d Stage 1 —discovery and denial
2 (The preschool aged child is described as associative. At this stage children are more interested in playing with other children than they are with toys. The child may talk to other children and exhange toys or play games without any rules. Answer 1 describes the play of a school aged child. Answer 3 describes the play of a toddler. Answer 4 describes the play of an infant)
Which term describes the play activity of the preschool age child? 1. cooperative 2. associative 3. parallel 4. solitary
c (Families with older adults are at the developmental stage at which the death of a spouse is common. They often need assistance to deal with their grief, which can lead to depression. Poor nutrition and lack of exercise can result from the underlying problem of depression; the client is not motivated to do what they may already know. The family consisting of older adults needs coping mechanisms to adjust to aging, living alone, and the chronic illness that aging often brings. Even when physical ailments are treated, a family's wellness is at risk if the client's emotional, social, spiritual, and intellectual health is not addressed.)
The home health nurse makes a visit to the apartment of 66-year-old Carla Morris, a client with rheumatoid arthritis who is recently widowed. Carla remarks that since her husband died, she is not motivated to cook nutritious meals that only she will eat. The nurse would ask Carla whether she is keeping her appointments with which healthcare provider? a Nutritionist b Rheumatologist c Grief counselor d Physical therapist
d (Rationale: For the nurse to be able to promote family health and treat the family during illness, the nurse must establish a trusting relationship with the family to allow for effective communication and to confirm that goals are mutual. Even though confirming that the family's health insurance coverage covers all members is important, it is not the priority. A detailed history of each member is important, but the family needs to trust the nurse first for the histories to be valid. Meetings with the family as a group should be done after the relationship is established and the nurse can explore goals for the group. )
The nurse firsts performs which task prior to initiating interventions of a family-centered care plan? a Complete a thorough history and assessment of each member of the family. b Confirm that the family health insurance covers all members. c Meet with all family members simultaneously. d Establish a trusting relationship with each family member.
a,b,c,d (Rationale The HOME Inventory assesses the home environment of families with children of all ages. The nurse observes parental responsiveness and acceptance, home learning environment, and physical environment of the home. The atmosphere must be relaxed and informal so that family members can act in their normal way. Since the objective is to observe interaction of parent and child, the parent is not separated from the child for an interview.)
The nurse has arranged a HOME Inventory with a client's family that includes small children. How should the nurse administer the HOME Inventory? (Select all that apply.) a The Inventory should take about 45 -90 minutes. b Family members are encouraged to act normally during the interview and observation. c The atmosphere should be relaxed and informal. d Responsiveness of the parent to the child is observed. e The parent should be interviewed in a quiet place free from distractions.
b (Rationale Family health and wellness is a collaborative effort, and this family is in need of assistance, which is a priority. The nurse can call on support from social workers, counselors, specialists, and whatever potential resources meet the client's needs. A therapeutic relationship with the family is one characterized by empathy and trust, and will develop as the nurse interviews and provides appropriate referrals for the young family. The nurse always offers wellness-promoting options without judgment. The Friedman Family Assessment Tool would be used in the home at a later date.)
The nurse has been assessing a family that includes young parents and their three children. The mother has dark circles around her eyes, looks disheveled, and appears tired. Which intervention by the nurse would be appropriate for this family? a Establishing a therapeutic relationship b Giving a referral to appropriate community resources and/or counseling c Utilizing the Friedman Family Assessment Tool d Suggesting that the family may not be diligent in following through with behavioral goals
c (Rationale The nurse educates clients about how to increase healthy behaviors and make appropriate lifestyle changes where they are needed. This empowers the client to make decisions to improve personal health and the health of the family unit. Client goals are unique and personal and are determined by the client, not the nurse. Although the nurse educates the client about available healthcare resources, it is the client's decision whether or not to take those suggestions. Identifying problem areas is one step in promoting wellness in a family, but it is not the goal.)
The nurse has been assessing the parents and small children of a family who are all moderately overweight. Which is the nurse's goal when promoting wellness in this client family? a Identify the problem behaviors and unhealthy lifestyle habits of individuals in the family. b Monitor the goals of the family to ensure that they are reasonable and attainable. c Empower the client to improve the health of the family now and reduce the risk of disease later. d Promote the use of all available community healthcare resources.
d,e (Rationale: The surviving spouse needs to recognize that dying is a part of adjusting to aging and that bodily changes occur as a result of aging. Coping with loss is a part of grieving that the widow or widower must endure as a result of the death of the spouse. Although coping with lack of privacy may occur if the older adult moves in with family members, that is not what is being addressed here. Planning for retirement may be a part of what is happening, but it is not what is occurring in this setting. Relating to kin may also be occurring, but it is not pertinent to this situation.)
When the spouse of an older person dies, which tasks need to be accomplished? (Select all that apply.) a Relating to kin b Planning for retirement c Coping with lack of privacy d Coping with loss e Adjusting to the aging client
d (Rationale The high stress associated with a family member's illness can lead to health problems and early mortality for the caregiver, especially if he chooses unhealthy habits. Though the cost of cigarettes is not inconsiderable and the client may be distressed by his smoking, these are not the most important considerations for this family. The nurse, while compassionate in regard to the family's stress, should not encourage smoking as a stress reliever.)
The nurse is caring for a client with an exacerbation of multiple sclerosis. Her husband confides that the stress of caring for her, in addition to their small children, has caused him to start smoking again after having quit many years ago. Knowing which information will alert the nurse to enhance the husband's coping skills? a Smoking will most likely help the client's husband to deal with her illness in the short term. b The cost of cigarette smoking can cause a serious financial burden for the family. c The client's recovery will be impeded by the stress of discovering that her husband has started smoking. d Inadequate coping function can lead to unhealthy choices and increase the risk of premature mortality in caregivers.
b,c,d,e (Rationale The nurse can enhance family coping by advising family members of upcoming challenges; educating them about treatments and resources; and apprising them of community and financial sources of help. Encouraging them to enlist family support is beneficial.)
The nurse is caring for a man with polycystic kidney disease who will begin peritoneal dialysis the following week. The nurse will implement which of the following actions as part of the nursing care plan to prevent impaired family function? (Select all that apply.) a Advising the client and his partner that they should handle these challenges on their own, without involving other family members to ensure their privacy b Educating the client and his partner about the pros and cons of this modality of treatment and the potential challenges they will face c Scheduling a family conference to evaluate the client's home and readiness of his partner to help with dialysis d Giving the client and his partner information about a local dialysis support group that meets every month e Referring the client and his partner to an insurance specialist to discuss their plan and his coverage
d (Rationale Cultural practices detrimental to a child's growth and development, safety, or basic needs must be addressed first. The nurse must ensure that immigrant families or clients with views that differ from those of the mainstream culture are aware of the rules and laws governing the care and protection of children in the United States. The first step is to identify the reason the child has not been immunized. Doing so will assist the nurse in planning and delivering further education to promote immunization. Immunizations are given only when parents consent to vaccinations. The nurse cannot administer vaccinations without permission. By respecting the parents' decision without investigating the reasons they have chosen not to vaccinate their child, the nurse is not providing holistic care.)
The nurse is caring for a preschool-age client and family who are immigrants. When assessing the client, the nurse finds that the child has not had immunizations. As the nurse is incorporating family-centered care into her practice, what is the initial action? a Respecting the parents' decision not to immunize their child b Educating the family about the importance of immunizations c Ensuring that the client receives immunizations while hospitalized d Identifying beliefs that are preventing the child from receiving immunizations
b,c,d,e ( Rationale In coping with the illness of a child, family systems may exhibit anxiety, stress, depression, decreased job performance, job loss, and financial difficulties. Family members may also feel confusion and anger because of their inability to control the effects of illness on the child. The nurse would not expect severe mental illness to be a clinical manifestation of ineffective coping.)
The nurse is caring for a school-age client diagnosed with leukemia. During subsequent visits, the nurse plans to assess the family unit for which possible responses? (Select all that apply.) a Manifestations of severe mental illness b Decreased job performance or job loss c Confusion and anger, with feelings of loss of control d Financial difficulties resulting from medical bills or lack of employment e Anxiety, stress, or depression
d (Rationale The HOME Inventory is designed to measure quality and quantity of stimulation and support in the home environment for ages birth to 15 years. It would not be used for a family of adults with no children. The Family Ecomap diagrams family interactions with each other and with the community. The Family APGAR assesses adaptability, partnership, growth, affection, and resolve within the family. The Friedman Family Assessment Tool examines the family in the larger context of the community in which the family lives.)
The nurse is choosing multifaceted family assessment tools to use with a family composed of a newly married couple. Which assessment tool does the nurse discard as not applicable to this family? a Family Ecomap b Friedman Family Assessment c Family APGAR d HOME Inventory
b,c,d,e (Rationale Aside from a client's physical health, family health depends on individual and family home environment, work environment, lifestyle choices, emotional health, and personal social relationships. Some work and living conditions create stress that the nurse can help the family address. Good health behaviors are encouraged, while the client is given education to eliminate or minimize risk from damaging health behaviors. The lack of family friends would be explored, but is not an essential part of the initial assessment for family health issues.)
The nurse is doing a focused assessment on a client with family health needs. Which is the most important assessment for the nurse to include in this initial visit? (Select all that apply.) a Reasons for a lack of family friends b Work history c Work function d Positive lifestyle behaviors e Choices that pose a risk to disease prevention
a,c,d,e (Rationale Assessment of a family's wellness considers the physical, social, emotional, spiritual, occupational, and intellectual well-being of family members individually and the unit as a whole. How children are developing intellectually, where the family lives, which family members are at risk for poor health outcomes, and the support the family members show for one another all impact on the well-being of the unit. The nurse empowers the family to set its own goals for family health.)
The nurse is performing a wellness assessment for a family with school-age children. Which assessment is important to identify the factors that contribute to the health of the family? (Select all that apply.) a Family members who are in good health b Goals the nurse needs to set for the family c How well the children are doing in school d How family members interact with one another e Neighborhood in which the family lives
b,c,d,e (Client-specific interventions are targeted to each client's unique, actual or potential health alteration. A client who has recently lost a job may need information on reducing and relieving stress, while the single parent would find it helpful to learn how the children in the family can be entertained on a budget. A longtime smoker may decide it is time to quit. Learning how to eat healthy on a limited budget could incorporate a referral to a nutritionist. Each intervention is aimed at the client's goal. Being respectful and professional is not client-specific.)
The nurse is planning for a client and family's health promotion. Which is the best example of client-specific nursing interventions? (Select all that apply.) a Treating the client in a professional and nonjudgmental manner b Referring the client to a smoking-cessation clinic c Showing parents how to use available items to make safe and inexpensive toys d Educating the client on reducing and relieving stress e Referring the client to a nutritionist
2 (While the infant is quiet the nurse should begin the exam by listening to the heart and lung sounds. If the nurse elicits the Babinski reflex, palpates the abdomen, or checks the tympanic membranes, the infant may cry and it will be difficult to adequately listen to the heart and lungs.)
The nurse is ready to begin an exam on a 9 month infant who is sitting quietly on his mothers lap. Which should the nurse do first? 1. check the babinski reflex 2. listen to the heart and lung sounds 3. palpate the abdomen 4. check the tympanic membranes
c (Rationale Some families have a history of certain diseases, and members of that family may be at risk because of gender and/or race. Taydash-Sachs is a disease that occurs primarily in persons with an eastern European heritage. Sickle cell disease occurs primarily in persons with an African, South American, or Caribbean heritage. Osteoporosis occurs most frequently in women. Males are at risk for developing cardiovascular disease earlier than women, but the disease is not race-specific.)
The nurse is taking a family health history from a 24-year-old eastern European male client. The nurse will be alert to a health history that includes which race-specific genetically transmitted disorder? a Cardiovascular disease b Osteoporosis c Tay-Sachs disease d Sickle cell disease
b (Rationale: The nurse working with a family to develop a care plan identifies potential resources in the community that match the child's and the family's needs for support. The nurse will collaborate with the family to discuss those resources and to select the ones that are acceptable to the family, to increase the likelihood that the family will follow through with the plan. In some cases it may be necessary to collaborate with a multidisciplinary team, including social workers, to help the family obtain assistance to overcome, for example, financial struggles. All other choices are independent interventions, not collaborative.)
The nurse is working with a family to develop a care plan to identify potential resources in the community that match the family's needs for support. The nurse uses a collaborative approach which includes: a Assessing the family for readiness to learn. b Working with a medical social worker (MSW) to provide the family with needed financial resources. c Educating the family about health concerns related to genetic disorders. d Establishing an appropriate nursing diagnosis for the family.
2 (Parallel play, the form of play used by toddlers, involves playing beside one another with like toys but without interaction. Answer 1 describes associative play typical of a preschooler Answer 3 describes cooperative play typical of the school aged child Answer 4 describes solitary play, typical of the infant)
The nurse observes a group of toddlers at daycare. Which of the following play situations exhibits the characteristics of parallel play? 1. lindie and laura sharing clay to make cookies 2. nick and matt playing beside each other with trucks 3. adrienne working a puzzle with meridith and ryan 4. Ashley playing with a busy box while sitting in her crib
a (The Family APGAR helps to measure family adaptability, partnership, growth, affection, and resolve. It can identify where the family needs help and also where the family is strong. Widely varying answers among family members could indicate a lack of cohesiveness in the family that warrants more help to deal with the demands of everyday life. Lack of family function affects the health of individuals in the family and the family unit as a whole. The family members complete the questionnaire independently without discussion. The form is simple and careful instructions are provided. The family should have some commonality in their answers if functioning appropriately.)
Three generations of the Cho family live together. When they complete their Family APGAR questionnaires, the nurse notes that the response of each individual is very different from those of the other family members. How may this information be interpreted by the nurse? a The family may need more support to cope with the demands of daily life, family function, and their health maintenance needs. b The family should have discussed their answers with each other first in order to present a unanimous response to the questions. c The family members each exhibit an independent spirit that is a desirable quality. d The family did not understand the instructions on how the questionnaires were to be completed.
2,3,5 (The 18 month old can be expected to remove their clothes, point to at least one named body part, and kick a ball forward. Answer 1 is expected at 2-3 years old Answer 4 is expected of a 3 year old)
Which behaviors are expected to be observed in the 18 month old? Select all that apply 1. has a vocabulary of 900 words 2. removes clothes 3. points to at least one named body part 4. asks many questions 5. can kick a ball forward
3 (A soft book is the best toy for a one year olds level. The other answers are more suited to a toddler)
Which toy is best suited to the developmental skills of a one year old? 1. pounding board 2. pull toy 3. soft books 4. puzzle with larger pieces
d (The individual and family psychosocial history along with physical examination is the initial step in assessing individual and family health. It may include, among other things, data on work history, family health history, history of emotional or mental imbalance, positive and negative lifestyle choices that impact health and disease prevention, current vital signs, and current physical symptoms or disorders. The other assessment tools are supplementary and may be used over time as a trusting relationship is built with the family.)
Which initial assessment data does the nurse collect to help identify a client's actual and potential health alterations? a HOME Inventory b Family APGAR questionnaire c Friedman Family Assessment Tool d Psychosocial history with a physical examination
1 (The school age child (8-9) engages in cooperative play. These children enjoy competitive games in which there are rules and guidance for winning. Answers 2 and 4 describe peer group relationships of the preschool child and Answer 3 describes peer group relationships of the preteen.)
Which of the following characterizes peer group relationships in 8 and 9 year olds? 1. activities organized around competitive games 2. loyalty and strong same sex friendships 3. informal socialization between boys and girls 4. shared activities with one best friend
3 (the 2 year old can conmbine 3-4 words. A 2 year old understands yes or no, but not the meaning of all words. Asking why and seeking information is typical of a 3 year old)
Which of the following describes language development of an 2 year old child? 1. doesnt understand yes or no 2. understands the meanings of all words 3. can combine three or four words 4. repeatedly asks "why?"
1 (infants can discriminate speech and the human voice from other patterns of sound. The other answers are inaccurate statements)
Which of the following statement is true regarding language development of young children? 1. infants can discriminate speech from other patterns of sound 2. boys are more advanced in language development than girls of the same age 3. second born children develop language earlier than first born or only children 4. using single words for an entire sentence suggests delayed speech development
4 (according to Kohlberg, in the pre conventional stage of development, the behavior of a preschool age child is determined by the consequences of the behavior.)
Which of the following statements reflects Kohlberg's theory of the moral development of the preschool age child? 1. obeying adults is seen as correct behavior 2. showing respect for parents is seen as important 3. pleasing others is viewed as good behavior 4. behavior is determined by consequences
1 (Maturational crisis are normal expected changes that face the family. Entering nursery school is a maturational crisis because the child begins to move away from the family and spend more time in the care of others. It is a time of adjustment for both the child and the parents. The other answers represent situational crisis.)
Which one of the following situations represents a maturational crisis for the family? 1. a 4 year old entering nursery school 2. development of preeclampsia during pregnancy 3. loss of employment and health benefits 4. hospitalization of grandfather with stroke
a (Rationale Family health promotion enlists the support of all family members. The lifestyle choices of one family member affect the health and function of the family unit. Family noncooperation even in small things, such as agreed-upon chores of the children not being completed, will affect the emotional bond. Doing things together, such as preparing meals at home, selecting a family pet, and completing a Lamaze class, relieves stress and demonstrates cooperation so that the family can cope with larger issues successfully.)
Which outcome indicates that a client family may need additional assistance to achieve and maintain their health goals? a The adolescent children have completed the agreed-upon chores once in a 4-week time period. b The parents cooked dinner for the family an average of four nights a week for two consecutive weeks. c The teenaged daughter has finished Lamaze classes with her mother as her birth coach. d The family has gone to pick out a pet from the local animal shelter.
a,b,c,d (The nurse can draw on the nutritionist to teach healthy eating habits. Mental health workers can provide coping and stress reduction techniques. Physicians may refer a client or be involved in educating a client about healthy lifestyles. Educational programs can provide a structured environment for learning lifestyle changes. Ministers of faith may be important, but they are not part of healthy lifestyle behaviors.)
Which resources can be most helpful to the nurse who is providing education to a group of clients about healthy lifestyle behaviors? (Select all that apply.) a Nutritionists b Mental health specialists c Physicians d Educational programs e Ministers of faith
b,c,d,e (A client's family history could put the client at increased risk for developing health problems, such as genetically transmitted disorders. Living in poverty is a major risk factor and is increasing because of the rise in the number of single-parent families. Working a stressful job and living in a dangerous neighborhood amount to occupational and environmental hazards, which put the client at risk for developing health problems. Regular exercise is a health promotion behavior that reduces the risk for disease. A client's family history could put the client at increased risk for developing health problems, such as genetically transmitted disorders. Living in poverty is a major risk factor and is increasing because of the rise in the number of single-parent families. Working a stressful job and living in a dangerous neighborhood amount to occupational and environmental hazards, which put the client at risk for developing health problems. Regular exercise is a health promotion behavior that reduces the risk for disease. A client's family history could put the client at increased risk for developing health problems, such as genetically transmitted disorders. Living in poverty is a major risk factor and is increasing because of the rise in the number of single-parent families. Working a stressful job and living in a dangerous neighborhood amount to occupational and environmental hazards, which put the client at risk for developing health problems. Regular exercise is a health promotion behavior that reduces the risk for disease. A client's family history could put the client at increased risk for developing health problems, such as genetically transmitted disorders. Living in poverty is a major risk factor and is increasing because of the rise in the number of single-parent families. Working a stressful job and living in a dangerous neighborhood amount to occupational and environmental hazards, which put the client at risk for developing health problems. Regular exercise is a health promotion behavior that reduces the risk for disease.)
Which risk factor for developing health problems may be experienced by an individual or a family? (Select all that apply.) a Regular exercise b Poverty c Stressful job d Family history of disease e Dangerous neighborhood
a (Family health promotion principles are designed for a family regardless of its developmental stage. Each new stage brings attendant health risks and requires adaptations to achieve and maintain wellness.)
Which statement about family health promotion is an incorrect description? a Family health promotion principles are designed primarily to guide families who are raising young children. b Family health promotion is applicable at the various developmental stages experienced by a family. c Family health promotion is a process that enables individuals to control and improve their own health condition, thereby improving the whole family unit. d Family health promotion is community-based because it considers the client's political, social, and physical surroundings.
3 (FHT can be detected at 8 weeks gestation using vaginal ultrasound, 1,2 & 4 are untrue)
Which statement is true regarding FHT? 1. the normal range for FHT is 100-180 bpm 2. A doppler ultrasound can detect FHT at 18-20 weeks gestation 3. FHT can be detected at 8 weeks gestation using vaginal ultrasound 4. A TOCO monitor is an invasive means of measuring FHT
d (Rationale The family ecomap reveals the individual family member's perceptions about their relationships with the family unit and other significant individuals and groups in their lives. The family members must give that information.)
he nurse is explaining how a family ecomap diagrams the family's relationships and interactions with the social networks in the community. Which statement by a family member indicates that further teaching is required? a "Family members must participate in preparing the ecomap. " b "The nurse and other healthcare providers can use the ecomap to visualize our family's social network. c "The ecomap can show areas in which our family and individual relationships are strong. d "The nurse will prepare the ecomap by observing our family in a social setting.
The nurse is assessing the cultural needs of an adult male client who states that he believes in the hot-cold theory. Which response by the nurse indicates understanding of the basis of this cultural belief? A. "What does this belief have to do with your health care?" B. "I am not familiar with this theory. Would you be willing to share more information about it with me?" C. "That is ridiculous and we cannot agree with this theory." D. "Is this the practice of voodoo?"
A. "What does this belief have to do with your health care?" ***B. "I am not familiar with this theory. Would you be willing to share more information about it with me?" C. "That is ridiculous and we cannot agree with this theory." D. "Is this the practice of voodoo?" Asking the client about his belief ensures that the nurse understands it. The nurse would not be judgmental or enforce beliefs onto the client, and using words like "ridiculous" is unacceptable and shows no cultural knowledge. Asking the client if the practice of the hot-cold theory is voodoo would indicate that the nurse does not have a cultural knowledge or understanding and would not make the client feel comfortable. Asking this client what his belief has to do with his health care would indicate that the nurse does not have an interest in incorporating the cultural beliefs of the client into a health care plan and would be inappropriate.
