Chapter 4: Health of the individual, family, and community.
A family that consists of two homosexual parents and three children living in the same house is an example of which type of family?
Nuclear Explanation: The nuclear family is also known as the traditional family and is composed of two parents and their children. The parents might be heterosexual or homosexual, are often married or in a committed relationship. An extended family includes aunts, uncles, and grandparents. A blended family is also a traditional family formed when parents bring unrelated children from previous relationships together to form a new family. A single-parent family involves one parent and may be the result of marital separation or divorce, the death of a spouse, or the parent never having been married.
A family assessment of a father, mother, and four children has suggested the presence of several risk factors. Which aspect of the family's structure and function would be considered a psychosocial risk factor?
The parents have a tumultuous relationship, with frequent separations in the past. Explanation: Conflict is an example of a psychosocial risk factor. Chemical dependency is considered a lifestyle risk factor, whereas a lack of adequate housing is an environmental risk factor. Lack of electricity is an economic risk factor.
A 44-year-old client is being treated for dehydration in an acute care hospital. The nurse determines that the rehydration treatment is working by assessing which values?
Urine output of 1500 mL in 24 hours Explanation: A balance between intake and elimination of fluids is an essential physiological need. Disruption in the water balance in the body results in either dehydration or edema. Measuring the fluid intake and output can determine the client's hydration status. A 24-hour urine output of 1500 mL is normal (range 1000 to 3000 mL/day) and indicates sufficient fluid intake to produce a normal urine output. An elevated hematocrit and urine specific gravity indicate that the client is dehydrated. An oral intake alone is not an indicator of adequate hydration.
An adolescent confides in the school nurse that the adolescent is arguing daily with her mother and often wonders whether her mother loves her. The school nurse recognizes that the student faces which of the following risk factors for altered family health?
A psychosocial risk factor Explanation: Conflicts between family members are considered psychosocial risk factors. Lifestyle risk factors are habits or behaviors people choose to engage in such as smoking and exercise. Developmental risk factors are characterized by vulnerability to negative social and environmental influences, such as peers and underage drinking. Biological risk factors are related to genetics, the brain, health habits, and medical issues.
The nurse is explaining the expected developmental tasks of a typical family with adolescents. Which of the following would be incorrect for the nurse to include?
Adjustment to retirement Explanation: Developmental tasks for families with adolescents and young adults include balancing teenagers' freedom with responsibility, maintaining supportive home base, and strengthening marital relationships. Adjusting to retirement is a developmental task for families with older adults.
The parents of a blended family have a baby boy age six months who is due for immunizations. The clinic closest to their home has recently closed, and they feel intimidated by the prospect of going to the large, university hospital near their home. Which type of factor is the primary influence on this aspect of the family's health?
Community health care structure Explanation: The size, location, and services of health care offerings in a geographical area are components of the community health care structure and its influence on health. Family functioning, lifestyle, and economic considerations are not primary influences on the family's actions.
The nurse is providing discharge information to the mother of a 4-year-old who was just diagnosed with influenza A. Which comments, made by the mother, indicate a potential problem in this child's future care? Select all that apply.
"How much does this antibiotic cost?" "I have already missed two day's work because I was sick." Explanation: Asking about the cost of an antibiotic may indicate an issue with finances. The statement about missing work may indicate that the mother has a childcare issue. Staying with grandma indicates a plan for the child's care. The nurse would educate the mother about flu immunizations, but the statement does not indicate a problem. The statement about missing the movies indicates the mother has knowledge of the need for rest and avoiding the spread of the virus to others.
A young couple who have been married less than a year are having difficulty with adjusting to parenting. What is a contributing factor to this level of maladjustment?
Limited time in learning to be a marital partner Explanation: Tasks that the family does not complete at any one developmental stage can produce chronic difficulties as the family struggles to master tasks at the next stage. The couple is struggling due to them only being together married for less than a year and the difficulty of a having a child in this short time frame. Nothing in the stem alludes to the couple having issues with the stress of education, job, and parenting nor economic difficulties or involvement with significant others.
A new graduate nurse asks a nurse manager working at the community health center, "I've heard people talk about community health nursing and community-based nursing. Is there a difference?" Which response by the nurse manager would be appropriate?
Community health nursing involves care for entire populations whereas community-based nursing focuses on individuals and families in that population." Explanation: In contrast to community health nursing, which focuses on whole populations within a community, community-based nursing is centered on the health care needs of individuals and families. Nurses practicing community-based nursing provide interventions to manage acute or chronic health problems, promote health, and facilitate self-care. Nursing care provided within a community must be culturally competent and family centered.
The nurse is caring for an 85-year-old client hospitalized for dehydration. The nurse notices that the client is shivering and takes the client's temperature. The nurse notes an oral temperature of 97.8°F (36.6°C). The client also reports being "chilly." Which nursing action is most appropriate?
Offer the client an extra blanket. Explanation: Thermoregulation is a physiological need. The human body functions within a narrow temperature range with an oral temperature of 97.5 to 99.5°F (36 to 38°C). Homeostatic mechanisms and adaptive responses, such as shivering (to increase body temperature) or sweating (to reduce body temperature), help to maintain body temperature. Offering the client a blanket is appropriate because the external body covering will increase the client's low body temperature. Notifying the physician is not necessary because the temperature is within normal range. A normal or low temperature is not an indicator of dehydration, so increasing the intake of oral fluids is not necessary. A normal or low temperature is not an indication of respiratory distress, so an assessment of the client's respiratory rate is not necessary.
A nurse in the emergency department assesses a 3-year-old child with a fractured femur, a hematoma on the back of the head, and multiple 1-cm round scabs and blisters on the upper back. The parents state that their child sustained the injuries by falling out of a high chair. What is the best action for the nurse to take?
Report the suspected child abuse to Child Protective Services. Explanation: The physical function of the family is to provide a safe environment necessary for growth and development. The child's injuries (a fractured femur with head injury and 1-cm round scabs and blisters on the upper back) suggest physical abuse by slamming the child into a wall while holding on to his leg, along with cigarette burns. All suspected cases of abuse must be reported to the appropriate agency or authority. Failure to report suspected child abuse is considered nursing negligence. Documenting "suspected abuse" in the client's record is inappropriate. Only the objective physical findings and observations should be documented. Referring the family for follow-up care to social services does not satisfy the legal obligation to report the suspected crime of child abuse to the proper authorities. Asking the physician to question the parents about the suspected abuse can jeopardize the child's safety by alienating the parents and creating distrust between the parents and the healthcare providers.
Parents raising two school-aged children incorporate their religious beliefs into the family's daily life. The family's beliefs regarding religion include dietary considerations, worship practices, attitudes, and values. This is an example of which function of the family?
Socialization Explanation: Through socialization, the family teaches; transmits beliefs, values, attitudes, and coping mechanisms; provides feedback; and guides problem solving. Incorporating religious beliefs, values, and attitudes is an example of socialization. Physical functions of the family include providing a safe, comfortable environment necessary for growth and development, rest, and recuperation. The reproductive function of the family is raising children. The affective and coping function of the family involves providing emotional comfort to family member
A nurse is caring for a client newly diagnosed with diabetes mellitus and developing a holistic plan of care. For this plan of care to be successful, it must what?
Address the disease but also incorporate the mind, body, and spirit. Explanation: A holistic plan of care seeks to balance and integrate the use of crisis medicine, advanced technology, and the mind, body, and spirit, which are incorporated though the use of the nursing process. Taking into account the cost of care is only one facet of a holistic picture. Connecting families, friends, and the environment is important, but mind, body, and spirit define holism. A holistic plan of care may provide a connection between medicine and nursing, but it does not define it.
A nurse is evaluating a child for new onset of bedwetting. Which nursing action is the priority?
Collect a urine sample for the prescribed urinalysis (UA). Explanation: To prioritize client care, a nurse will consider the client's physical needs as a priority, and address other psychosocial needs as secondary. In this instance, collecting a urine sample is an assessment, looking for a physical cause of the bedwetting. This would be done prior to implementation of orders, such as administration of medication and sending the child to radiology. Since asking the parent about stressful situations at home is psychosocial, it is not the priority.
What are examples of meeting physiologic needs according to Maslow's hierarchy of needs? (Select all that apply.)
A nurse administers pain medication to a postoperative client. A home care practitioner requests quiet so that a client can sleep. Explanation: Physiological needs—for oxygen, water, food, elimination, temperature, sexuality, physical activity, and rest—must be met at least minimally to maintain life. These needs are the most basic in the hierarchy of needs, are the most essential to life, and, therefore, have the highest priority. Examples of addressing physiological needs would be administering pain medication to a postoperative client and requesting a quiet environment for a client who needs to sleep. The nurse washing hands would be Level 2, safety and security. The nurse inviting a client's estranged son to visit would be Level 3, love and belonging. The nurse counseling an overweight teenager would be Level 4, self-esteem. A nurse attaining a master's degree would be Level 5, self-actualization (for the nurse).
A client comes to the health center for a follow-up visit. Assessment reveals that the client is experiencing problems ambulating and moving about due to degenerative joint disease; in addition, the client is feeling isolated due to the limitations in mobility. The client also reports feeling anxious about the future related to the mobility issues and being unable to fulfill the role as the major provider. Which need would the nurse identify as the priority?
Mobility Explanation: Although all of the needs listed need to be addressed, the nurse would identify mobility issues as the priority need based on Maslow's hierarchy. In addition to it being a physiologic need, it also appears to be the underlying issue related to the client's other needs. Addressing mobility may have a positive impact on the client's other needs.
