OB Chapt 2 Family-Centered, Community-Based Care
You are a nurse focused only on tertiary prevention. Which of the following most likely describes your actions in your current role? a) Caring for new mothers in a maternity clinic b) Identifying a child with pediculosis in an elementary school c) Taking case histories in an orthopedic clinic d) Providing care for an elderly patient in a home-care setting
Taking case histories in an orthopedic clinic Explanation: Orthopedic patients are typically recovering from injury or are in need of rehabilitation. Tertiary prevention focus is on rehabilitation activities and would be the focus of a nurse in an orthopedic clinic, aligning with the needs of the patients in the clinic. p41
A pregnant woman experiencing morning sickness has asked her nurse about ways to reduce or alleviate it. After receiving education and information from the nurse, which of the following statements would indicate that the client understood the information?
"I'll discuss with my doctor whether it is a good idea for me to use sea-bands." Correct Explanation: All therapies (complementary and alternative) should be discussed with the physician. Although some CAM therapies can help alleviate pain or sickness, all pregnant women should understand that these substances cross the placenta and can reach the growing embryo. In addition, many CAM therapies have not undergone scientific study and can place the woman at risk when mixed with traditional medicine.
You evaluate a family to see if they are a good candidate for home care. Which of the following factors would be most important to see in their home or family? a) A one-floor building plan b) Nearby fire department c) An above-average income d) A dedicated home-care provider
A dedicated home-care provider Correct Explanation: Home care is only successful if there is a family member able to assume primary care of the child. p50
You are preparing an hour-long prenatal seminar for a group of 27 teenage mothers. Which type of information will you gather to help ensure the success of your program? a) Age, education levels, and language barriers of each of the participants b) Names of each of the participants c) Medical histories of each of the participants d) Incomes of each of the participants
Age, education levels, and language barriers of each of the participants Correct Explanation: When teaching a group of patients, the group leader should seek demographic information to help develop an appropriate teaching plan for all participants in the group. This is an impersonal group, and taking the medical histories or learning their names or incomes is not appropriate. p54
The nurse is concluding her initial visit with a patient 28 weeks pregnant on bedrest for premature rupture of membranes. What data should the nurse consider when determining the timing of the next home visit? a) Patient's type of health insurance b) Amount of supervision and health education needed by the patient c) The location of the home d) The home visit schedule and needs of the agency to plan the visit
Amount of supervision and health education needed by the patient Correct Explanation: The nurse should complete an assessment on the patient to include the amount of education and ability of the patient to understand the health care provider's orders. The nurse should allow the agency to work with the insurance company, and the location of the home should not influence the decision of the nurse.
A woman in her third trimester of pregnancy has difficulty travelling from her inner-city apartment to the doctor's office for ultrasound imaging. She has no car and is unfamiliar with the public transportation available in the area of the doctor's office. Which of the following interventions would most likely address this woman's challenges? a) An ecomap including information on public transportation b) Home care visits by the nurse c) Home care visits by a home care assistant d) Support from a lactation specialist after the birth of her child
An ecomap including information on public transportation Correct Explanation: Drawing an ecomap or a diagram of a family's relationship to its community can help identify what community resources are being used by a family or its "fit" into the community. Home care visits would not be appropriate in this situation, as the woman must receive ultrasound imaging at the doctor's office. Support from a lactation specialist would also not address this woman's immediate need.
Being a community-based nurse means that you have a different set of skills than those of your counterparts who work in a hospital. As a community-based nurse you also face unique issues and challenges. What is one of the unique aspects of community-based nursing? a) Less holistic b) Teamwork c) Autonomous d) Disease-oriented
Autonomous Correct Explanation: Community-based nursing practice is autonomous. There are often no other members of the health care team to consult, or no members within the area when you need to consult with them. Team work is important in community-based nursing, but it is not a unique aspect of this type of nursing. Disease orientation is the medical model of health care. Community-based nursing takes in all aspects of the client, including community aspects such as education—not just the disease process. Therefore, it is more holistic rather than less holistic. p54
A couple has recently been divorced. The couple has joint custody of their 15-year-old daughter. The nurse recognizes that the daughter is now at a 50% greater risk for which of the following? a) Being exposed to violence on television b) Experiencing upper respiratory infections c) Beginning smoking or drinking alcohol d) Being the victim of abuse
Beginning smoking or drinking alcohol Correct Explanation: Findings have revealed that adolescents living in shared physical custody had higher rates of health risk behaviors such as beginning smoking or drinking alcohol compared with adolescents from two-parent families (60% and 50% higher). Children with parents who are both employed would be more likely to be exposed to violence on television if they are at home alone or to experience upper respiratory infections if in daycare. Although incidence of child maltreatment remains high, there is no correlation between joint custody and a 50% increase in risk for abuse.
A 40-year-old pregnant client tells her nurse that she would like to give birth in a birthing center because she wants several friends and family members to be there and will have more freedom at the center. What would be the most important factor for the nurse to point out when discussing this option with the client? a) Birthing centers do not always have pediatricians on staff if the newborn has special needs. b) Birthing centers limit the number of friends and family who can attend the birth. c) Birthing centers allow the client to eat and move around during labor. d) Birthing centers allow the client to give birth in any position.
Birthing centers do not always have pediatricians on staff if the newborn has special needs. Explanation: With this particular client, the nurse should point out that many birthing centers do not have pediatricians on site. The nurse should include all information related to birthing centers, such as the freedom to eat, move around, and give birth in any position so that the client can make the best decision. Birthing centers do not limit the number of friends and family who can attend the birth. p48
Working in a clinic, you are following up on the doctor's recommendation that your patient consult a nutritionist. By giving a list of referrals to this patient, you are fulfilling part of your role of a) Secondary prevention b) Client advocacy c) Community-based nursing d) Primary care
Client advocacy Explanation: Client advocacy is speaking or acting on behalf of clients to help them gain greater independence and to make the health care delivery system more responsive and relevant to their needs. Community-based nursing focuses on prevention and is directed toward persons and families within a community. Primary care is the direct action of the physician. Secondary prevention involves health screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects occur. p56
Which of the following is most critical to effective home care? a) A health problem that is mild to moderate in nature b) The client's ability to get along with home care assistants c) Commitment to home care from family and other essential people d) Provision of care by an experienced nurse
Commitment to home care from family and other essential people Correct Explanation: Home care works best when a family is strongly committed to home care and well prepared to cooperate with health care providers. p39
The nurse is providing a secondary prevention activity when a) Conducting a skin cancer screening fair b) Teaching a group of adolescents about sexually transmitted diseases c) Showing a patient proper application of a colostomy device d) Instructing a group of senior citizens on use of the Internet
Conducting a skin cancer screening fair Correct Explanation: Secondary prevention measures are those taken to screen for diseases, delayed development according to criteria, or use of medication. p41
The nursing instructor is teaching students about the importance of active listening when communicating with patients. She informs them that which of the following might happen if the nurse does not listen? a) Trust will be established. b) Concerns will be discovered. c) Fears will be uncovered. d) Critical information may be missed.
Critical information may be missed. Correct Explanation: Active listening is critical to the communication process. Listening may uncover fears or concerns that the nurse may not have discovered through questioning. By not listening, critical information may be missed. p52
A pregnant woman with a premature ruptured membrane is trying to decide whether home care might be the best option for her. Which of the following is an advantage the nurse should mention to her that is most pertinent to her condition? a) Decreased exposure to infection b) Lower cost for the health care delivery system c) Prevention of social isolation d) Prevention of disruption of the family
Decreased exposure to infection Explanation: There may be an advantage of placing women with premature ruptured membranes on home care rather than hospital care because of the decreased exposure to infection in their own homes compared to hospitals. Although prevention of disruption to the family and lower cost for the health care delivery system may be advantages, they are not the most pertinent to the patient's condition. Home care would be more likely to cause social isolation than prevent it.
How can the home health nurse assist with achieving National Health Goals when caring for a woman with placental previa at 28 weeks' gestation who is on bed rest? a) Educate the patient on the benefits of bed rest for the pregnancy and access community resources to assist her with compliance. b) Inform the patient that if she continues to get out of bed, she will lose the baby. c) Inform the mother that she must have someone come into the home to live with her until after the baby is born. d) Inform the mother that she will need to be in the hospital for the duration of the pregnancy if she is not compliant with care at home.
Educate the patient on the benefits of bed rest for the pregnancy and access community resources to assist her with compliance. Correct Explanation: National Health Goals are concerned with reducing complications of pregnancy, both by better monitoring and preventing complications during pregnancy. Nurses can help the nation achieve these goals by helping women better accept and adhere to home care if it is advised during pregnancy. p56
A client at 28 weeks' gestation is required to maintain bed rest for the duration of the pregnancy because she has placenta previa. What suggestions can the nurse make for the client to help her cope with the experience? a) Allow the client to go on short walks and then right back to bed. b) Encourage the client to learn a new skill while confined to bed. c) Tell the client to watch television for distraction. d) Maintain quiet and no activity.
Encourage the client to learn a new skill while confined to bed. Correct Explanation: Most women can name activities they would like to do but have never had time to begin. One solution to help women cope with the stress of bed rest is for them to keep busy or use their time to learn a new skill. p56
A nursing student states, "When communicating with an interpreter I should speak directly to the interpreter." This statement is which of the following? a) False b) True
False Correct Explanation: When using an interpreter, talk directly to the family, not to the interpreter. p52
A nurse is speaking to a young couple who have recently begun living together and are expecting a child in 3 months. The mother-to-be expresses both joy and fear at the prospect of beginning a new family. The nurse understands that, from the perspective of this young woman, the family referred to is of which type? a) Family of orientation b) Blended family c) Family of procreation d) Family of origin
Family of procreation Correct Explanation: For the purposes of assessing families, two basic family types can be described. The family of orientation is the family one is born into. The family of procreation is the family one establishes. Because the young woman is speaking about the family she is establishing, she is speaking about her family of procreation. Family of origin is the same as the family of orientation. A blended family is one in which a divorced or widowed person with children marries someone who also has children.
A nurse is concerned about a 14-year-old girl under her care because she has recently learned of an outbreak of sexually transmitted diseases at the girl's high school. The nurse asks the girl's parents whether they would be willing to let the nurse discuss it with their daughter in private, along with contraception options. The mother quickly interrupts the nurse and says, "Absolutely not. We will discuss that with her ourselves." Which role is the mother playing in this situation? a) Problem-solver b) Health manager c) Gatekeeper d) Financial manager
Gatekeeper Correct Explanation: The mother is playing the role of the gatekeeper, or the person who allows information into and out of the family. She is not solving a problem, managing her daughter's health, or managing the family's finances in this situation.
A female community health nurse is to be accompanied by a male student nurse for the day. The female nurse asks parents who are scheduled for an upcoming home visit if the student nurse can observe the breastfeeding assessment to be conducted for the new mother and baby. The couple decline. What is the nurse's most appropriate next action? a) Discuss acceptance and tolerance with the couple. b) Reassure the couple that the student nurse will be professional. c) Ask the couple about their concerns. d) Honor the couple's preference.
Honor the couple's preference. Correct Explanation: When providing services in the homes of clients, nurses need to respect the family's values and cultural preferences related to the provision of services. The other responses negate the couple's wishes and could be seen as confrontational and not client centered. p36
In what way does assessing a client's community most help the nurse provide better care? a) It allows the nurse to treat many people at once b) It can reveal if there are aspects about a community that contributed to an illness c) It can help the nurse find resources that the client may need during recuperation d) It facilitates the nurse's exposure to different cultures
It can reveal if there are aspects about a community that contributed to an illness Correct Explanation: Community assessment can reveal if there are aspects about a community that contributed to an illness (and therefore need to be corrected) and determine whether the person will be able to return to the community without extra help and counseling after recovering from an illness. p36
Which of the following is true of home care as a whole? a) It is decreasing because many new care measures are too technical for use in the home. b) It is decreasing because the overall incidence of children's illnesses is decreasing in number. c) It is increasing because new technology makes so many procedures available in the home. d) The amount of care remains even because only a limited number of nurses are available to give care.
It is increasing because new technology makes so many procedures available in the home. Explanation: Home care is expanding because it can offer advantages to both caregivers and consumers. New technology makes it successful. p50
As a community health nurse you are asked to present an educational event to the local Junior League. While planning for the event, what is most important for you, the nurse, to do? a) Use posters that everyone in the group can read b) Tell the participants about the nurse's background c) Know the needs of the audience d) Ask questions about the histories of those present
Know the needs of the audience Correct Explanation: To teach a group successfully, it is important to know the needs of the target population and to have the appropriate teaching skills, strategies, and resources. Asking questions about the histories of those who will be attending the event comes under asking about the targeted group's demographics. While it is important to have these facts it is not most important for the nurse to know. Using posters that everyone can read is part of the presentation strategy of the nurse. Again it is not most important. Telling those present at the event a brief synopsis of the nurses' background is usually done by whomever introduces the nurse as the speaker. It is not usually an activity the nurse does himself or herself.
After talking at length with the single mother of a malnourished child, the nurse determines that the child's poor nutrition is a result of improper care of the child by an older sibling while the mother is working. This determination is an example of which step of the nursing process? a) Implementation b) Outcome identification and planning c) Assessment d) Nursing diagnosis
Nursing diagnosis Explanation: Nursing diagnosis is the step in the nursing process in which the nurse determines the cause of the problem the patient is facing. In this case, the cause of the child's nutrition is improper care of the child by his older sibling. Assessment would pertain to the questions posed and measures taken by the nurse to arrive at the diagnosis. Outcome identification and planning would pertain to what outcomes related to the child's nutrition and overall health are desired and what interventions are likely to bring about these outcomes. Implementation would involve putting the plan into action.
What is the foundation for nursing care in the community? a) Nursing process b) Teaching c) Communication d) Case management
Nursing process Correct Explanation: The nursing process serves as the foundation of nursing care in the community, just as it does in a health care facility. Communication is an integral part of community-based nursing, as are teaching and case management, but they are not the foundation for the care provided. p38
A nurse is providing home care to several families who live in a community with limited resources. Which of the following is an example of how the nurse can best "nurse the community"? a) Read a recent journal article on prevention of staph infections in hospitals b) Organize a free flu vaccination in the community c) Attend a leadership training workshop d) Obtain a Master's degree in a nursing field of interest
Organize a free flu vaccination in the community Correct Explanation: Although all of these examples are effective means of professional self-improvement, only organizing a free flu vaccination directly benefits the community itself.
As part of your role as a school nurse, you are conducting a drug education program in a fourth-grade class. This is an example of nursing in a) Primary prevention b) Secondary prevention c) Tertiary prevention d) Home health care
Primary prevention Correct Explanation: Primary prevention is promotion of heath positive activities and includes teaching regarding safety, diet, rest, exercise, and disease prevention. Secondary prevention focuses on health screening activities that aid in early diagnosis and encourage prompt treatment. Tertiary prevention focuses on rehabilitation and instruction on ways to prevent further injury or illness. Home health care refers to practices done in the home by the patient.
A physician writes an order for home visits daily for a postpartum woman. The nurse is to perform dressing changes on an infected cesarean section incision and administer Rocephin 1 GM IV. What type of care will the nurse be providing in the home? a) Indirect home nursing care b) Skilled home nursing care c) Unskilled home nursing care d) Preventative care
Skilled home nursing care Correct Explanation: Home nursing care is considered skilled if it includes physician-prescribed procedures such as dressing changes, medication administration, health teaching, or observation of a woman or child's progress or status through such activities as monitoring vital signs or fetal heart rate. p 38
The father of a child who requires home care following open heart surgery has changed his work schedule to work the night shift so that he can take care of the child during the day. The father is obese, and his work requires strenuous manual labor. He takes insulin for his type 2 diabetes. He complains of being constantly fatigued and irritable, making it difficult to care for his child. Which of the following nursing diagnoses pertaining to home care would best explain the father's fatigue and irritability? a) Fatigue related to the physically demanding nature of his job b) Fatigue related to his obesity c) Impaired physical mobility due to obesity d) Sleep deprivation due to working the night shift and caring for the child
Sleep deprivation due to working the night shift and caring for the child Correct Explanation: Although all of these could be valid reasons for the father to be fatigued and irritable, only the lack of sleep due to working the night shift and caring for the child pertain to the home care.
A nurse has moved into a new community and will begin practicing at the local health department. Why is it important for this nurse to become familiar with the community where he or she will work? a) The workplace may implement alternate methods of treatment than the ones the nurse is used to employing. b) The nurse may not like it and choose to move before settling too deeply in the community. c) The health of a community influences the health of its individuals. d) It is not necessary for the nurse ti become familiar with the community prior to treating the individuals there.
The health of a community influences the health of its individuals. Correct Explanation: Because the health of a community influences the health of its individuals, it is important for the nurse to become acquainted with the community in which he or she practices. Community assessment can reveal aspects of a community that may have contributed to an illness and help determine whether a person will be able to return to the community without extra help and counseling after recovering from an illness. p37
You are counseling a pregnant woman as to the best option for delivering her baby. She is 25 years old, has one other child, and is in a low-risk pregnancy. You advise her that the best option for delivery is a) A home setting b) A birthing center c) A hospital d) There is no evidence of any superiority among settings
There is no evidence of any superiority among settings Correct Explanation: When a women is low-risk and has no known medical needs, delivery location is the choice of the mother. Home births attended with certified nurse midwives are less likely to have complications and require interventions. Birthing centers are an option for an alternative birth setting, and hospitals are required delivery locations for women with potential needs or complications. p48
A nurse is providing home care to a pregnant woman who is on bed rest. The woman has two other children. During her assessment, the nurse asks the woman how she occupies her time. What is the best rationale for asking this question? a) To build rapport with the patient b) To ensure that the woman is not engaging in activities that would disrupt her rest c) To pick up tips to pass on to other patients who are on bed rest d) To learn about the patient's hobbies
To ensure that the woman is not engaging in activities that would disrupt her rest Correct Explanation: If bed rest is required, ask how the client occupies his or her time. A woman is not really resting if she is concerned about her family or finances, is caring for older children, or is so bored, she is frequently turning or sitting up. The other answers are legitimate reasons for asking the question but are not the best rationale for it.
All women during pregnancy should drink six to eight full glasses of fluid a day to obtain adequate fluid for effective kidney function and placental exchange. a) False b) True
True
Client and family education is a priority and is addressed in Healthy People 2010. This statement is which of the following? a) False b) True
True Correct Explanation: This is a true statement. "To cope effectively with illness, to understand and participate in decisions about treatment plans, and to maintain and improve health after treatment, clients and their families must have knowledge and skills relevant to their conditions" (JCAHO, 2008) p37
When giving family-centered care, the nurse recognizes that she needs to view which concept as the constant? a) family b) patient c) individual d) none of the above
family Explanation: Family-centered care recognizes the concept of the family as the constant. The health and functional abilities of the family affect the health of the patient and other members of the family. p36
The nurse is instructing a young woman who wants to get pregnant on the use of folic acid supplement three months before and three months after conception. This is an example of which level of prevention? a) primary b) secondary c) tertiary d) all of the above
primary Correct Explanation: Taking folic acid is an example of primary prevention. Taking it three months before and at least three months after conception will help prevent neural tube defects such as anencephaly and spinal bifida. p40
A genogram is a diagram of family and community relationships. a) True b) False
False Explanation: An ecomap, not a genogram, is a diagram of family and community relationships and is used to document the fit of a family into their community. A genogram is a diagram that details family structure and provides information about the family's health history and the roles of various family members across several generations. It can provide a basis for discussion and analysis of family interaction at health care visits.
The nurse is participating in a poisoning prevention program. This activity is an example of which type of community-based nursing intervention? a) Health system referral b) Nutritional counseling c) Health education program d) Health screening
Health education program Correct Explanation: Health screening interventions include activities such as mammograms, Pap smears, and well child hearing and vision checks. Health system referral interventions include activities such as referring a woman for a breast prosthesis after a mastectomy or arranging for home tutoring for a child with a long-term illness. Nutritional counseling interventions include activities such as Women, Infants, and Children (WIC) programs, counselor interview of a pregnant woman or child and parents with anemia, and eating disorders programs. Health education program interventions include activities such as poisoning prevention programs, childbirth education or breast self-examination classes, child safety programs, and youth drug awareness programs.
A nurse is assigned to perform a blood pressure evaluation on a pregnant patient. This type of care is referred to as a) Primary prevention b) Tertiary prevention c) Secondary prevention d) It is not prevention because the problem did occur.
Secondary prevention Correct Explanation: Secondary prevention refers to teaching and screening performed to assist early diagnosis and treatment of an existing or potential problem to avoid long-term negative effects. p41
An example of an intervention taken on the tertiary prevention level of care is a) Teaching signs and symptoms of infection to a postoperative patient b) Showing a mother how to diaper her newborn c) Teaching a family about proper child restraint systems d) Teaching cardiopulmonary resuscitation to a group of lifeguards
Teaching signs and symptoms of infection to a postoperative patient Correct Explanation: A tertiary level intervention is one taken to prevent further illness or injury associated with an existing problem. p 41
A nurse in a woman's shelter is counseling a client who has been a victim of abuse. What type of prevention is this treatment? a) Tertiary b) Community-based c) Primary d) Secondary
Tertiary Correct Explanation: Working with victims of abuse or violence is tertiary prevention. Tertiary prevention is designed to reduce or limit the progression of a disease or condition. Primary, tertiary, and secondary are all examples of community-based care. Primary prevention involves preventing a disease or condition before it occurs. Secondary prevention is the early detection and treatment of adverse health conditions. p41
A physician orders a pregnant woman with slightly elevated blood pressure to return home on bed rest until her next scheduled check-up. This is an example of which type of care? a) home care b) hospice care c) skilled home care d) community care
home care Correct Explanation: This is an example of home care, or care of persons in their own home. Hospice care relates to end-of-life care and care of those with chronic illnesses who are not expected to get any better. Skilled care requires treatments such as administering IV medications, enteral feedings, and dressing changes. Community care relates to care of individuals and/or groups of people living in a specific geographical area. p38
When performing an initial home care assessment, the nurse evaluates material resources (eg, hospital beds, oxygen, fetal home monitors) as well as which of the following? a) number of people in the immediate family b) if the family can deal with the stress of home care c) type of dwelling the family lives in d) amount of money the household makes
if the family can deal with the stress of home care Correct Explanation: On the first home care visit, the nurse must perform a thorough history and physical examination of the patient as well as assess resources of the family and whether they will be able to care for the patient at home. Resources include not only material objects such as hospital beds, oxygen, and fetal monitors but also whether the family can deal with the chronic stress of home care. p 38
A client receiving home care is on bed rest. She says to the nurse, "I feel so useless like this. I'm not used to being so inactive. What response from the nurse might help the client cope better with her situation? a) "Let me talk to the doctor to see if the restrictions can be eased back at all." b) "Are there hobbies you enjoy that you can do while resting that you never get a chance to do otherwise?" c) "Think about how much faster you'll recover by following directions." d) "I would love the opportunity to sit back and relax. Take advantage of this while you can."
"Are there hobbies you enjoy that you can do while resting that you never get a chance to do otherwise?" Correct Explanation: Women and children on bed rest react in several ways, but many report feeling "tied down," "like a prisoner," and "as if I'm missing out." One solution to help them cope with the stress of the experience is for them to keep busy or use their time to learn a new skill. Most women can name activities they would like to do but have never had time to begin to do. For example, if a woman likes to read but does not always have the time, bed rest at home may provide an ideal time for her to catch up on her reading. The other options are inappropriate responses. p56
A pre-term newborn is to be discharged home on oxygen therapy and tube feedings. Which statement by the parents would indicate that they need additional teaching and preparation for this transition? a) "We'll make sure that we have enough feeding solution to get through the weekend." b) "Our parents are going to take turns helping out at night so that we can get some sleep." c) "We know how to check to make sure the feeding tube isn't clogged." d) "Our insurance company will pay for all the equipment that we need for the treatments."
"Our insurance company will pay for all the equipment that we need for the treatments." Explanation: High-risk newborn home care involves all family members working together to provide 24-hour care. Managing supplies, trouble-shooting potential problems, and ensuring support are crucial to providing home care. Parents or caregivers must investigate and then negotiate with insurers for reimbursement of medical equipment and supplies. Insurers do not always cover all items necessary for care. p50
As part of an education program for pregnant women and their partners, the nurse describes the various settings available for childbirth. The nurse determines that the program was successful when the group relates which of the following about home births? a) "Women giving birth at home have control over every part of labor." b) "There are very rigid screening procedures that must be followed." c) "A home birth is probably the most expensive setting for childbirth." d) "A wide range of pain medications is readily available to the woman."
"Women giving birth at home have control over every part of labor." Correct Explanation: Home births permit the woman to maintain control over every aspect affecting the woman's labor, such as positioning, attire, and support persons present. A home birth involves the least amount of cost. Home births are recommended for pregnant women considered to be at low risk for complications. Some birthing centers may have very rigid screening criteria. The availability for pain medication is limited for home births. p48
A first-time mother is at home on the third day after delivery and has bleeding, painful nipples after breastfeeding. She calls the hospital to speak to her postpartum nurse. What is the best plan the nurse can implement for this patient? a) Tell the patient to have someone inspect her nipples to see if she is right. b) Advise the patient to nurse less frequently and pump between feedings. c) Arrange for a home visit from a lactation consultant. d) Suggest to the patient that she should change her brand of body wash.
Arrange for a home visit from a lactation consultant. Correct Explanation: This patient needs a skilled lactation consultant to personally assess this situation. Suggesting remedies without further assessment constitutes improper nursing care. An unskilled friend can miss signs of infection and does not have the evidence-based practice knowledge needed to best help this patient.
The nurse is caring for a childbearing family of a different cultural background. In order to provide culturally appropriate and competent care, the nurse should execute which nursing action? a) Ask the family for input into their care based on their cultural beliefs b) Expect the family to adopt the cultural beliefs of that facility c) Use your personal cultural experiences with the family d) Use a standard nursing care plan for the family
Ask the family for input into their care based on their cultural beliefs Correct Explanation: Cultural beliefs vary; care should be based on the individual beliefs of each family. The imposition of personal, institutional, or others beliefs should never be done to a patient. p42
Planning and implementing home care involves many steps. Put the following steps in proper order: Park in a well-lit area Perform a physical examination Document all findings Obtain a copy of client's referral form Assess the suitability of the family Wash your hands
Assess the suitability of the family Obtain a copy of client's referral form Park in a well-lit area Wash your hands Perform a physical examination Document all findings Explanation: The correct order of steps when planning and implementing a home visit are as follows: 1) assess the suitability of the family; 2) obtain a copy of the client's referral form; 3) park in a well-lit area; 4) wash your hands; 5) perform a physical examination; 6) document all findings.
Advocacy for your client is an important aspect of community-based nursing. What is one way a community-based nurse can advocate for a child that is her client? a) Assisting the family to apply for Medicaid or other forms of health care reimbursement b) Assuring a young mother that you will not report the suspicious bruises on her toddler to social services c) Arranging for educational events for the local hospital staff d) Reporting a new case of whooping cough to the county health authorities
Assisting the family to apply for Medicaid or other forms of health care reimbursement Correct Explanation: The nurse working in a community setting may often develop a long-standing relationship with childbearing and child-rearing families because of the continuous nature of client contact in an outpatient, school, or other setting. This type of relationship may allow the nurse to advocate for her client on a broader scale in health and welfare issues. Examples of interventions include helping the family apply for Medicaid or other forms of health care reimbursement. Reporting new cases of whooping cough is done to state authorities, not county authorities, and is not advocating for a client. Arranging educational events for the local hospital staff is not a community-based function. Assuring a mother that the bruises on her toddler will not be reported to social services when it is mandated that any suspected case of child abuse be reported is not advocating for the child.
Advocacy for your client is an important aspect of community-based nursing. What is one way a community-based nurse can advocate for a child that is her client? a) Arranging for educational events for the local hospital staff b) Reporting a new case of whooping cough to the county health authorities c) Assuring a young mother that you will not report the suspicious bruises on her toddler to social services d) Assisting the family to apply for Medicaid or other forms of health care reimbursement
Assisting the family to apply for Medicaid or other forms of health care reimbursement Correct Explanation: The nurse working in a community setting may often develop a long-standing relationship with childbearing and child-rearing families because of the continuous nature of client contact in an outpatient, school, or other setting. This type of relationship may allow the nurse to advocate for her client on a broader scale in health and welfare issues. Examples of interventions include helping the family apply for Medicaid or other forms of health care reimbursement. Reporting new cases of whooping cough is done to state authorities, not county authorities, and is not advocating for a client. Arranging educational events for the local hospital staff is not a community-based function. Assuring a mother that the bruises on her toddler will not be reported to social services when it is mandated that any suspected case of child abuse be reported is not advocating for the child. p56
The nurse is caring for a pregnant woman and her family who are immigrants. Which intervention would be the priority for helping to achieve a successful outcome? a) Referring them to state and local aid programs b) Communicating using understandable terms c) Asking how they got to the appointment d) Inquiring about the family's ability to buy medicine
Communicating using understandable terms Correct Explanation: Communicating using understandable terms, whether that means using an interpreter or speaking slowly and using simple terms, will greatly affect the success of the care provided. Inquiring about their financial situation, assessing transportation issues, and helping them access aid programs are secondary to the need for effective communication. p42
An ill child will be cared for at home by the parents. What resources will be most advantageous for this family? a) Financial assistance to buy medications b) Social service referral c) Visits from the nurse daily d) Effective support people from the family or community to offer help
Effective support people from the family or community to offer help Correct Explanation: Home care is most successful effective support people from the family or community offer help. Otherwise, parents and children can experience loneliness and low self-esteem that interfere with their ability to remain on continuous bed rest or continue with a medical regimen. p37-41
The role of a home care assistant includes not only recording a blood pressure reading but evaluating the reading and explaining its significance to the patient. a) True b) False
False Explanation: When making assignments for home care assistants, be certain they understand that making an assessment (such as recording a blood pressure) is not the same as evaluating the meaning of the assessment. That requires professional expertise
Which of the following is an advantage of home care over hospital care for the pregnant patient? a) Families can be better kept intact. b) Although it is more costly, it is more satisfying. c) It allows for stricter control of diet and exercise. d) Women can rest more efficiently.
Families can be better kept intact. Explanation: The main advantages of home care are cost-effectiveness and the ability to keep a family intact during extended therapy. p48
A family with limited income must make the entrance to their house wheelchair accessible for their 11-year-old son, who is now receiving home care. Which of the following would be the most appropriate recommendation for the nurse to make? a) Have a wheelchair lift installed alongside the front steps b) Provide the boy with a pair of tongs so that he can reach items on high shelves c) Have local carpenter build a ramp across the front steps to the house d) Place furniture along the walls to increase safe turning space
Have local carpenter build a ramp across the front steps to the house Correct Explanation: If the client will use a wheelchair to ambulate, family members need to consider if adaptations of their home will be necessary. A local carpenter can build a ramp across the house steps or a split-level elevation to allow wheelchair access. Wheelchair lifts or elevators can be purchased and mounted alongside house steps, but they are more expensive. Placing furniture along the walls and providing tongs do not pertain to making the entrance to the house wheelchair accessible.
The nurse is informing a young pregnant patient of the many different maternal community health services that are available. She tells the patient about the group that provides mother-to-mother support for breast-feeding, nutrition, and infant care problem-solving strategies. This group is known as which of the following? a) AFDC b) La Leche League c) WIC d) Breastfeeding Club
La Leche League Correct Explanation: La Leche League provides mother-to-mother support for breast feeding, nutrition, and infant care. WIC is a federally funded program that provides food, nutrition, and other services for low income women, infants and children. AFDC stands for Aid to Families with Dependent Children. There are no groups known as the Breastfeeding Club. p46
Modern health care has seen many technological advances. While improving many aspects of health care these advances have been a part of the reason for the increases in the cost of health care and the necessity of finding alternative health care approaches. These alternative approaches have different foci and goals than traditional health care. Community-based health care is one of these alternative approaches. What is the focus of community-based health care? a) Preventing disease and its sequelae b) Keeping clients with chronic illnesses in their homes c) Providing care for the client as an individual d) Tracking reportable diseases
Preventing disease and its sequelae Correct Explanation: Community-based nursing focuses on prevention and is directed toward persons and families within a community. Community-based nursing is holistic in nature and provides care for the client as part of a family and community, not just as an individual. It strives to keep clients with chronic illnesses in their homes, but that is not the focus of the care provided. A function of community-based nursing is reporting and tracking reportable diseases; again, that is not the focus of community-based nursing. p37
A nurse is reading about care of patients in the home. The role of the nurse in home care is a) Based only on the request of the patient b) Provider of direct patient care after receipt of health care provider orders c) Limited due to the lack of increase in home care costs d) As a visitor only, not to provide direct care in the home
Provider of direct patient care after receipt of health care provider orders Correct Explanation: Nurses are providers of home health care and follow the orders of the health care provider. Cost should not be an issue for the nurse. Patient requests can be listened to, but not at the detriment of care. The job of the nurse is direct care of the patient, the nurse is not a visitor in the home. p51
Community care settings for the pediatric client are as varied in their settings as they are in their functions. Much of the care of the pediatric client has been shifted from the hospital setting to a community setting suitable for the care being provided. Which community care setting is appropriate for assessing vision and hearing in children? a) Vision and hearing centers b) Schools c) Pediatric rehabilitation centers d) Pediatric acute care clinics
Schools Correct Explanation: Assessing the vision and hearing of a child is a function of the school nurse who makes these assessments several times during the course of a child's school career. Vision and hearing centers, while in the community, are not settings to provide routine pediatric screenings for vision and hearing problems. Pediatric rehabilitation centers are not settings for vision and hearing screenings. Pediatric acute care clinics are for treating acute injuries and illnesses. They are not appropriate settings for routine screenings of a child. p46
Community-based nursing focuses on prevention. As a school nurse in a community you send home information to let the parents know that during the following week you will be screening for lice infestations in all the first-grade classrooms. What type of prevention is this an example of? a) Secondary prevention b) Primary prevention c) It is not a preventative measure d) Tertiary prevention
Secondary prevention Correct Explanation: Primary prevention is health-promoting activities that help prevent the development of illness or injury. Secondary prevention is health-screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects arise. Tertiary prevention is health-promoting activities that focus on rehabilitation and teaching to prevent further injury or illness, occurs in special settings. Screening is a preventative measure, so the last answer is incorrect. p41
During pregnancy, women should drink at least eight glasses of fluid daily. For a woman on bed rest at home, which of the following would be the best method to encourage her to drink this amount? a) She drinks the eight glasses before her husband leaves for work in the morning. b) She drinks primarily cool liquids and avoids hot liquids, because they increase thirst. c) She keeps a pitcher of fluid readily available beside her on a table. d) She gets up every hour, stretches, and gets a drink from the refrigerator.
She keeps a pitcher of fluid readily available beside her on a table. Correct Explanation: Ready access to fluids is important to allow the patient to maintain bed rest. Getting out of bed would defeat the purpose of bed rest; drinking eight glasses at once would be uncomfortable. p56
A nurse in the community is working on primary prevention of illness by a) Teaching family members about administration of antibiotics b) Teaching a child how to manage his insulin dosage c) Teaching a patient how to assess the healing of a wound d) Teaching how to properly apply sunscreen
Teaching how to properly apply sunscreen Correct Explanation: Primary prevention consists of interventions taken to prevent an illness or promote a healthful behavior. It takes place before a problem exists.
A home care nurse knows the importance of assessing a patient's community because: a) the health of a person is influenced by the health of the community b) a community has no influence on a patient, but it is good to know about it c) the community might hold festivals that the nurse would be interested in attending d) the particular community might offer the nurse things that another community does not
the health of a person is influenced by the health of the community Correct Explanation: Because the health of individuals is influenced by the health of their community, it is important for the nurse to become acquainted with the community in which she/he practices. Community assessments may reveal if there are aspects about a community that contributed to an illness and determine whether the person will be able to return to the community without extra help and counseling. p 37
The patient who gives birth at a hospital can expect a shorter hospital stay after a normal delivery. This is mainly due to which of the following? a) the father's desire to bring the baby home as soon as possible b) the recent reforms in health care financing c) the over-crowding of most nurseries d) the mother's desire to get home quickly
the recent reforms in health care financing Correct Explanation: Although it might be true that the mother wants to go home and the father wants the baby home as soon as possible, the reason for short hospital stays is due to changes in health care financing. Some nurseries may be more crowded than others, but it should not determine when a mother and baby is discharged. p50
The nurse knows that patient education is a very important part of nursing care and that it begins when? a) after discharge b) with the first encounter of the patient c) when the patient asks for information d) prior to discharge
with the first encounter of the patient Correct Explanation: Patient education begins with the first patient encounter and proceeds through discharge and beyond. Reassessment after each step or change in the process is crucial to ensuring success. p55
The nurse is working with a same-sex couple, both of whom have children from previous relationships. Although the couple are not married and have no plans of marrying, they view their relationship as monogamous and long-term. Which of the following family types would apply to this family? (Select all that apply.) a) Dyad family b) Cohabitation family c) Foster family d) Gay or lesbian family e) Blended family f) Extended family
• Cohabitation family • Gay or lesbian family • Blended family Correct Explanation: As the members of the couple in this scenario are of the same sex, this is a gay or lesbian family. As the couple is not married, it is a cohabitation family. And as they each have children from previous relationships, it is a blended family. It is not an extended family, as it does not include extended family relations, such as grandmothers, grandfathers, aunts, uncles, cousins, or grandchildren. It is not a dyad family, as there are more than two members, and it is not a foster family, as the children are related biologically to at least one of the parents.
The nursing students are learning about using a family-centered approach to achieve positive outcomes. This family-centered care refers to which of the following? a) It refers to preventing illness and improving health of populations. b) It refers to the collaborative partnership among the individual, family, and caregivers to determine goals, share information, offer support and formulate plans for health care. c) It refers to providing care to a large population or potential or at-risk patients. d) none of the above
• It refers to the collaborative partnership among the individual, family, and caregivers to determine goals, share information, offer support and formulate plans for health care. Explanation: Family-centered care refers to the collaborative partnership among the individual, family, and caregivers to determine goals, share information, offer support and formulate plans for health care. Commnunity health nursing focuses on preventing illness and improving the health of populations and communities. In community-based care the community is the unit of service and the providers are concerned for the patients who seek service, but also with the larger population of potential or at-risk patients. p36
The nurses who works in the community understands the importance of becoming culturally competent. Steps to gain cultural competence include which of the following? (Check all that apply.) a) cultural knowledge b) cultural encounters c) cultural skills d) cultural self-awareness e) replacing one's own cultural identity
• cultural knowledge • cultural encounters • cultural skills • cultural self-awareness Correct Explanation: Nurses working in the community need to develop cultural competence. Steps to gaining cultural competence include cultural self-awareness, cultural knowledge, cultural skills, and cultural encounters. Cultural competence does not mean replacing one's own cultural identity with another, ignoring the variability within cultural groups, or even appreciating the cultures being served. Instead, nurses skilled at cultural competence show a respect for difference, an eagerness to learn, and a willingness to accept multiple views of the world. 43
The nursing instructor is teaching students about the benefits of CAM. Which of the following are examples of CAM? (check all that apply) a) guided imagery b) therapeutic touch c) aromatherapy d) medication therapy e) acupressure
• guided imagery • therapeutic touch • aromatherapy • acupressure Correct Explanation: CAM is the use of complementary and alternative medicine. It is used widely by people in all areas of the community and is used more often by women than men. Some examples include aromatherapy, homeopathy, acupressure, feng shui, guided imagery, reflexology, therapeutic touch, herbal medicine and spiritual healing. p45
The experienced nurse has seen many changes in health care throughout the last few decades. One such change has been to move from acute care settings out into the community with an emphasis on which of the following? (Check all that apply.) a) health promotion b) acute illnesses c) chronic illnesses d) illness prevention e) none of the above
• health promotion • illness prevention Explanation: Health care delivery has moved from the acute care settings out into the community. It now has a focus on health promotion and illness prevention. It wants to prevent acute and chronic illnesses so that they are not a focus of health care delivery but instead and outcomes if the goal of prevention is not achieved. p52
The nurse reinforces to the patient that prenatal care is associated with improved pregnancy outcomes. She lists the basic components of good prenatal care to be which of the following? (Check all that apply.) a) medical and psychosocial interventions b) terminating employment while pregnant c) early and continuing risk assessment d) follow-up e) health promotion
• medical and psychosocial interventions • early and continuing risk assessment • follow-up • health promotion Correct Explanation: Early prenatal care can improve pregnancy outcomes. Basic components of prenatal care are early and continuing risk assessment, health promotion, medical and psychosocial interventions and follow-up. Not working while pregnant does not necessarily help. Keeping active usually provides a healthier lifestyle and in turn a better outcome. p46
The nursing student demonstrates an understanding of what is included in postpartum home visits when she correctly lists which of the following? (Check all that apply.) a) monitoring the physical and emotional well-being of the family members b) performing any home cleaning that the mother cannot perform c) administering all of the newborn vaccinations d) bridging the gap between discharge and ambulatory follow-up for mothers and their newborns e) identifying potential or developing complications for the mother and newborn
• monitoring the physical and emotional well-being of the family members • bridging the gap between discharge and ambulatory follow-up for mothers and their newborns • identifying potential or developing complications for the mother and newborn Correct Explanation: Home visits give the nurse an opportunity to assess the family's adaptation and dynamics and the home environment. Postpartum care includes monitoring the physical and emotional well-being of the family members, identifying potential or developing complications for the mother and newborn, and bridging the gap between discharge and ambulatory follow-up for mothers and their newborns. Administering all of the newborn vaccinations is not feasible as they are numerous and are scheduled at different intervals and are not given in the home but instead in a physician's office or clinic. The nurse does not perform any home cleaning for the family. p50
The community nurse who is working with women, children, and families knows the importance of using good communication, both verbal and nonverbal. Some examples of nonverbal communication include which of the following? (Check all that apply.) a) attending to others b) singing c) speaking d) nodding e) active listening
• nodding • attending to others • active listening Explanation: Verbal communication is the spoken word and it includes singing. Nodding, attending to others, and active listening are forms of nonverbal communication. p52
The nurse takes on many roles, especially in the community setting. One important role of the nurse in the community is educator. Patient and family education allows for which of the following? (Check all that apply.) a) promotes recognition of problem situations and their appropriate responses b) ensures the presence of basic health care skills c) helps families and patients to feel helpless and powerless d) allows for families and patients to make informed decisions e) allows for questions to be answered
• promotes recognition of problem situations and their appropriate responses • ensures the presence of basic health care skills • allows for families and patients to make informed decisions • allows for questions to be answered Correct Explanation: Overall, patient and family education allows patients and families to make informed decisions, ensures the presence of basic health care skills, promotes recognition of problem situations, promotes appropriate responses to problems, and allows for questions to be answered. Through patient education patients can overcome feelings of helplessness and powerlessness and gain the confidence to be active members in their plan of care. p54-55
