Chapter 2: Family-Centered Community-Based Care
The nurse is caring for a child from a different culture. Which statement(s) by the nurse demonstrates an understanding of how culture impacts a client? Select all that apply. "A client's cultural beliefs should be incorporated into the care a client receives. "A client's cultural beliefs can impact spirituality and/or religion." "Culture can impact the diet a client follows." "Culture can impact who a client chooses to see for health care needs." "When a client moves to a different city, the client follows the cultural practices that are prevalent in the new city."
"A client's cultural beliefs can impact spirituality and/or religion." "A client's cultural beliefs should be incorporated into the care a client receives. "Culture can impact who a client chooses to see for health care needs." "Culture can impact the diet a client follows." Culture is a set of traditions and beliefs held by groups of people. Beliefs, diet, language, values, religion and spirituality are included in culture. Some cultures utilize folk healers to provide health care. The nurse should incorporate a client's beliefs as much as possible into care. When a client moves to a different location, the client tends to bring cultural beliefs and does not necessarily follow all the cultural practices of the new location.
A child is seen in the pediatric clinic for update of immunizations prior to starting middle school. During the intake process the nurse asks the parents if the family is involved in any neighborhood or community activities. The parents ask the nurse, "What does that have to do with immunizations?" What is an accurate response by the nurse? "Our physician just likes to know what activities his clients are involved in." "This is a standard question that we ask all of our clients' families prior to starting middle school." "We collect this data for our community health department statistics." "Based on research, our physician feels that better connection to community leads to better health in many ways."
"Based on research, our physician feels that better connection to community leads to better health in many ways." Evidence suggests that the higher education and greater social capital present in a neighborhood or community are associated with positive health behaviors, so collecting this information can help the physician to better evaluate clients.
A couple had decided not to circumcise their newborn for nonreligious reasons. What is the appropriate response from the nurse? "It's much better for the health of your newborn if you circumcise him." "That's very unusual; tell me what has led you to this decision." "OK, great. I will let the physician know." "What arrangements have you made outside the hospital?"
"OK, great. I will let the physician know." The nurse should remain as nonjudgmental as possible when speaking with a client. There are many reasons why a couple may decide to leave their newborn uncircumcised. Both health benefits and risks are associated with circumcision. The nurse should respect the couple's decision
A pregnant woman in her first trimester has come to the clinic for a check-up. The woman mentions to the nurse that she would like to try some complementary and alternative medicine (CAM) therapies to control her nausea. When teaching the woman about these methods, which information would be important for the nurse to emphasize? Select all that apply. "Remember that just because it says the remedy is natural, it does not always mean it is safe." "Check the package to make sure that all the ingredients and their amounts are listed." "It is okay to try more than one remedy with another to get a better effect." "Try using some ginger tea to help control the nausea you are having." "It would be important for you to talk with your provider about what might be best for you."
"Remember that just because it says the remedy is natural, it does not always mean it is safe." "It would be important for you to talk with your provider about what might be best for you." "Check the package to make sure that all the ingredients and their amounts are listed." If clients are considering the use of or are using CAM therapies, it is important to instruct them to check with their health care providers before taking any substance, even if it is natural. In addition, the nurse should instruct the woman that natural does not necessarily mean that the product is safe and that she should check that the product package contains a list of all ingredients and the amounts of each. Although ginger tea may be used to treat nausea of pregnancy, most substances ingested cross the placenta and have the potential to reach the fetus. There is also the potential for harm if therapies are mixed. Therefore, the nurse should stress the need to discuss all remedies with the provider.
As part of an education program for pregnant women and their partners, the nurse illustrates the various settings available for birth. The nurse determines that the program was successful when the group correctly chooses which statement about home births? "There are very rigid screening procedures that must be followed." "Women giving birth at home have control over every part of labor." "A home birth is probably the most expensive setting for childbirth." "A wide range of pain medications is readily available to the woman."
"Women giving birth at home have control over every part of labor." Home births permit the woman to maintain control over every aspect affecting the woman's labor, such as positioning, attire, and support persons present. A home birth involves the least amount of cost. Home births are recommended for pregnant women considered to be at low risk for complications. Some birthing centers may have very rigid screening criteria. The availability for pain medication is limited for home births.
The case manager is looking over the inpatient census on the floor to determine which client would be the best candidate for discharge with home health care follow-up. Which client would the case manager recommend to the practitioner for discharge? 6-year-old asthmatic child who is wheezing and has an O2 saturation of 92%. Adolescent who was admitted in sickle cell crisis yesterday and rates his pain as an 8/10. 10-year-old boy with an infected laceration on his leg who has been treated with IV antibiotics for 3 days. 3-day-old infant with a bilirubin level of 20 who is currently under phototherapy.
10-year-old boy with an infected laceration on his leg who has been treated with IV antibiotics for 3 days. The child with the infected laceration is on IV antibiotics and can safely be discharged to complete the medication at home with home health care. The 6-year-old is too unstable for discharge. The infant's bilirubin is too high for doing home health phototherapy and may need additional hydration. The adolescent is on sickle cell crisis and is not ready for discharge 1 day after admission.
What is the key nursing role when managing the health care of a child living with a foster family? Determining if the child has mental health needs. Advocating for the child and the services needed. Securing proper educational placement. Identifying any developmental delays.
Advocating for the child and the services needed. Advocating for the child is the overarching nursing role. Unmet health needs are likely. Advocacy gives the child a "voice" so that the wide range of health care needs often prevalent in foster children can be met. Determining the presence of mental health issues and developmental status as well as securing educational placement are specific issues among many that advocacy would address.
The nurse is beginning an assessment with a pregnant client from a non-English-speaking culture. The interpreter is having difficulty understanding what the client is trying to say and the client is becoming frustrated. Which nursing diagnosis would be most appropriate for this situation? Anxiety Fear Powerlessness Altered verbal communication
Altered verbal communication For this client, altered verbal communication is the correct diagnosis because of the frustration that is occurring between the client, interpreter, and the nurse. There is no evidence to support the diagnoses of fear, anxiety, or powerlessness with this client.
The nurse is preparing to discuss birthing options with a 25-year-old female who is in a low-risk pregnancy with one older child. Which option will be best for the nurse to recommend for this client? Hospital Home setting Birthing center Any birthing settings
Any birthing settings When a woman is low-risk and has no known medical needs, birth 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 birth locations for women with potential needs or complications. The nurse should present the advantages and disadvantages of each option and allow the client to make the decision.
The nurse in a free clinic is caring for a 1-year-old girl and her single mother. Which nursing intervention would most likely be needed initially? Providing a list of low-cost child care centers. Assessing the child's nutritional status. Obtaining food stamps for the family. Discussing family beliefs.
Assessing the child's nutritional status. A single mother using a free clinic probably means that the two are living in poverty. The child could be malnourished. This would affect all aspects of the child's growth and development. Obtaining food stamps may be a partial solution to a nutritional problem if this is confirmed following assessment. Family beliefs are important but not the first concern. Good child care promotes healthy growth and development. This can be addressed later.
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? Birthing centers do not always have pediatricians on staff if the newborn has special needs. Birthing centers limit the number of friends and family who can attend the birth. Birthing centers allow the client to give birth in any position. Birthing centers allow the client to eat and move around during labor.
Birthing centers do not always have pediatricians on staff if the newborn has special needs. With this particular client, the nurse should point out that many birthing centers do not have pediatricians on site. The nurse should include all information related to birthing centers, such as the freedom to eat, move around, and give birth in any position so that the client can make the best decision. Birthing centers do not limit the number of friends and family who can attend the birth.
The nurse is caring for a 7-year-old boy and his family, who are immigrants. Which intervention will most significantly affect the success of the care provided? Inquiring about common health problems in their home country Asking about transportation to the appointment Referring them to state and local aid programs Communicating with sensitivity using understandable terms
Communicating with sensitivity using understandable terms Being understood is essential to the provision of all nursing care. An interpreter may be needed. Speaking slowly and using simple terms is also useful. Inquiring about common health problems in their home country, asking about transportation, and helping them access aid programs are all secondary to and dependent upon effective communication.
A nurse is teaching a new mother about self-care measures. Which action would the nurse do as the final step in this process? Reinforce positive behavioral changes. Document the teaching and effectiveness. Reassess the teaching plan. Develop goals for the future.
Document the teaching and effectiveness. The steps of client and family education are similar to the steps of the nursing process: the nurse must assess, diagnosis, plan, implement, and evaluate. Part of the evaluation process is to document all actions taken and outcomes achieved.
The nurse is preparing to teach a class on cultural differences to a group of clients from the community. Which principle of culture will the nurse consider while planning the class information? Each generation learns about culture from family and the community. Culture is determined by one's own morals and personal beliefs. Culture is always centered around religious activities and beliefs. Individuals are born with an understanding of their specific culture.
Each generation learns about culture from family and the community. Culture is a shared, not individual, system of beliefs, values, and behavioral expectations that provide social structure for daily living. Culture includes the beliefs, habits, likes and dislikes, and customs and rituals learned from family and the community through a process called enculturation. Individuals are not born with a sense or awareness of culture. Some cultures are heavily centered on religious practices and customs, however, all are not.
To be effective, a community health nurse needs to recognize which factors as being important to families in making health care decisions? Select all that apply. Family financial resources Cultural influences Priorities of the family Lack of understanding of health situation Health care provider values
Family financial resources Cultural influences Priorities of the family Lack of understanding of health situation A community nurse must understand what is going on with the families being caref for to understand how to assist them in accessing health care. Having a clear understanding of the family's finances, cultural beliefs and priorities, and ensuring they understand the situation is the nurse's responsibility. Health care provider values are not a part of the decision-making process for families.
A nurse is working at a community women's health clinic. The nurse is involved in primary prevention activities. Which activity would the nurse be performing? immunizations cholesterol monitoring fecal occult blood testing Papanicolaou (Pap) tests
Immunizations Primary prevention encompasses a vast array of areas, including nutrition, good hygiene, sanitation, immunizations, protection from ultraviolet rays, genetic counseling, bicycle helmets, handrails on bathtubs, drug education for school children, adequate shelter, smoking cessation, family planning, and the use of seat belts. Papanicolaou (Pap) tests, cholesterol monitoring, and fecal occult blood testing are examples of secondary prevention activities.
When orienting a new home health nurse on safety policies, which should the nurse include? Always carry your identification in your purse or wallet. If the client, family, or situation is hostile, call the police. Keep the agency informed of your visit schedule. Night and weekend visits are allowed with permission.
Keep the agency informed of your visit schedule. The agency should always be informed of the nurses' visit schedule to assist in locating the nurse if he or she does not return on time. Any changes to the schedule should be communicated to the agency immediately.
A labor and birth nurse is admitting an adolescent client with her mother. The client appears to be upset, and the nurse wants to find out why. How should the nurse proceed? Select all that apply. Maintain eye contact throughout the discussion. Make note of the client's and parent's nonverbal expressions. Ask another nurse to sit in and participate. Stand opposite the family and lean slightly back during the discussion. During the discussion maintain an open posture, with arms uncrossed.
Make note of the client's and parent's nonverbal expressions. Maintain eye contact throughout the discussion During the discussion maintain an open posture, with arms uncrossed. Guidelines for appropriate nonverbal communication include maintaining a relaxed and open posture, with the arms uncrossed. The nurse should sit opposite the family and lean forward slightly, maintaining eye contact. The nurse should also note the child's or parent's posture, eye contact, and facial expressions. Asking another nurse to sit in on the discussion will not enhance the client-nurse relationship.
The nurse has to prepare a discharge plan as a part of the postpartum care of a client, whom the nurse is caring for in a home-based setting. Which aspect of care should the nurse include in the postpartum plan in this environment? Recognize infant needs in the discharge plan. Identify developing complications in the infant. Monitor the physical and emotional well-being of family members. Provide the client with self-help books about infant care.
Monitor the physical and emotional well-being of family members. The nurse should include the monitoring of the physical and emotional well-being of the client's family members as part of the postpartum care in the home environment. The nurse should provide hands-on experience in infant care instead of providing self-help books to the client. The nurse should include parental needs along with the infant needs and focus on each of its areas while preparing the discharge plan, as the nurse should identify potential or developing complications not only in the infant but also in the client.
The nursing instructor is teaching a session outlining the necessary skills of a community nurse. The instructor determines the session is successful when the students correctly choose which factor as the foundation of all nursing care? Case management Teaching Nursing process Communication
Nursing process The nursing process serves as the foundation of nursing care in the community, just as it does in a health care facility. Communication and teaching are parts of the nursing process. Case management is necessary to coordinate care and implement the nursing process.
The nursing instructor is teaching a session on the increase of health care costs associated with the advancement of modern technology. The instructor determines the session is successful when the students correctly choose which focus of community-based health care that has been implemented to combat the increased cost? Keeping clients with chronic illnesses in their homes Tracking reportable diseases Providing care for the client as an individual Preventing disease and its sequelae
Preventing disease and its sequelae 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.
A nursing instructor is teaching a group of nursing students about the various options available to provide nursing care in a community. The instructor determines the session is successful when the students correctly choose which action as the primary focus of home care nursing? Teach and supervise caregivers. Act as a liaison between health care provider and family. Provide direct client care. Provide care based on insurance coverage.
Provide direct client care. The primary focus of home care nursing is to provide direct care. Teaching and supervising caregivers and acting as a liaison between the health care provider and family are additional functions of the home care nurse that support the direct care. The nurse should be aware of potential insurance restrictions so that other options may be explored if insurance will not cover specific treatments or medications that the health care provider has determined essential to the client. In these instances, the nurse can then act as the advocate to help find the necessary resources the client may need.
A nurse is working to develop cultural competence. Which aspect would the nurse need to incorporate as the foundation for this concept? Respect Empathy Knowledge Technical skill
Respect Cultural competence, or respecting cultural differences, allows the nurse to plan culturally competent care and to integrate cultural elements into care.
A school nurse informs parents that a screening for lice will be conducted on all first graders the following week. Which type of prevention is this nurse conducting? Primary prevention It is not a preventive measure. Tertiary prevention Secondary prevention
Secondary prevention Primary prevention is health-promoting activities that help prevent the development of illness or injury. Secondary prevention is health-screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects arise. Tertiary prevention is health-promoting activities that focus on rehabilitation and teaching to prevent further injury or illness and occurs in special settings. Screening is a preventive measure.
The obstetrical nurse notes that a Muslim client has not been eating any of the meals supplied to her. Which actions performed by the nurse best demonstrate cultural competence? The nurse recognizes that Muslim clients do not have an interest in food. A referral will be made to the dietitian to assess the Muslim client's preferences. The nurse recognizes that Muslim clients prefer rest, which encourages appetite. The nurse becomes familiar with the Muslim client's meal practices.
The nurse becomes familiar with the Muslim client's meal practices. The steps to developing cultural competence is to acquire cultural knowledge about the group. Nurses can obtain this knowledge by reading about different cultures, attending continuing education courses on different cultures, accessing websites, and attending cultural diversity conferences. It is not true that after delivery Muslim clients have no interest in food nor is it true that rest will encourage appetite. A referral is not always necessary, as the nurse should be able to coordinate foods that the client will eat after discussing with the client.
A nurse is planning the discharge of a newborn to parents recently immigrated from Syria. Which action best indicates that the nurse provides culturally sensitive care? The nurse approaches the clients in a nonjudgmental way in an attempt to change the clients' cultural beliefs to the unit's beliefs. The nurse strives to keep the clients' cultural background from influencing their health needs. The nurse encourages the continuation of cultural practices in their home setting. The nurse researches the clients' cultural characteristics and beliefs.
The nurse researches the clients' cultural characteristics and beliefs. Nurses must research and understand the cultural characteristics, values, and beliefs of the various people to whom they deliver care. To provide culturally appropriate care to diverse populations, nurses need to know, understand, and respect culturally influenced health behaviors.
A client who does not speak the dominant language becomes upset when the nurse brings in an interpreter, rather than using a family member as the translator. Which would be the best reason for using an official interpreter in this case? Many words have double meanings, challenging the client to try to make sense of what is being communicated. There is no additional cost to the client when a professional interpreter is utilized. The client was unable to pronounce the words the nurse had written down on a sheet of paper. There may be cultural limitations that change how the information is being interpreted by the family.
There may be cultural limitations that change how the information is being interpreted by the family. It is unacceptable to have a family member serve as an interpreter. There may be cultural limitations that change how the information the nurse is stating is being interpreted for a parent or partner. Additionally, the medical terminology used in the health care system is best translated by a trained professional interpreter.
A pregnant woman with premature ruptured membranes is trying to decide whether home care might be the best option for her. Which advantage should the nurse mention to the client that is most pertinent to her condition? decreased exposure to infection prevention of disruption of the family lower cost for the health care delivery system prevention of social isolation
decreased exposure to infection There may be an advantage of placing women with premature ruptured membranes on home care rather than hospital care because of the decreased exposure to infection in their own homes compared to hospitals. Although prevention of disruption to the family and lower cost for the health care delivery system may be advantages, they are not the most pertinent to the client's condition. Home care would be more likely to cause social isolation than prevent it.
When caring for woman who speaks a different language than one's own, the nurse must ask for an interpreter before having the client sign which forms to ensure clarity can be confirmed? Select all that apply. smoking cessation policy consent to blood transfusions surgical permit end-of-life care dietary preferences
end-of-life care consent to blood transfusions surgical permit When caring for clients who speak a different dialect or language, the nurse should always ask them to repeat instruction to be certain it was interpreted correctly. The nurse should repeat what the client said so he or she can confirm understanding the nurse correctly. The nurse should not be reluctant to ask for an interpreter to help clarify forms, such as consent for blood transfusion, informed consent for surgery, or wishes regarding right-to-life care, as necessary. Dietary preferences and smoking cessation policy are not as important as the other forms that result in invasive procedures.
A nurse is providing care to a client who has undergone a mastectomy. The nurse provides the woman with information about where to obtain a breast prosthesis. This is an example of which type of community-based nursing intervention? health education program health screening program health system referral telephone consultation
health system referral The nurse is passing along information about the location of and services offered for the client, an example of a health system referral. Health education programs assist clients in making health-related decisions about self-care and use of resources. Health screening programs focus on detecting unrecognized or preclinical illness among individuals such as mammography. Telephone consultation involves listening and providing support, information or instruction given over the phone, and documenting the interaction.
A primary care provider tells a pregnant woman with slightly elevated blood pressure to return home on bed rest until her next scheduled checkup. This is an example of which type of care? hospice care home care community care skilled home care
home care This is an example of home care, or care of persons in their own home. Hospice care relates to end-of-life care and care of those with chronic illnesses who are not expected to get any better. Skilled care requires treatments such as administering IV medications, enteral feedings, and dressing changes. Community care relates to care of individuals and/or groups of people living in a specific geographical area.
A woman who just gave birth tells the obstetrical nurse that her mother has noticed that so much has changed in maternity care in recent years. One change she could likely be referring to is: newborns stay at the mother's bedside as long the infant is well. the family is now allowed to visit at prescribed visiting hours. infections are prevented as births happen in highly advanced, sterile rooms. the newborn stays in a newborn nursery for care to allow the mother to rest.
newborns stay at the mother's bedside as long the infant is well. There has been increased access to care for all women (regardless of their ability to pay) and many hospital redesigns of labor, birth, and recovery rooms and postpartum spaces aimed at keeping families together during the birth experience and minimizing interruptions. Rooming-in and liberal visiting policies allow parents and other family members to participate in the child's care. Births happen in birthing suites/rooms as opposed to sterile birth rooms. Family is allowed to visit at most times of the day and night. Rooming in with the newborn is considered standard care now.
A nurse working at a women's health center is engaged in secondary prevention activities. With which activity(ies) would the nurse be involved? Select all that apply. immunizations pregnancy testing osteoporosis screening family planning breast examinations
pregnancy testing breast examinations osteoporosis screening Health screenings are the mainstay of secondary prevention. Pregnancy testing, blood pressure evaluations, cholesterol monitoring, fecal occult blood testing, breast examinations, mammography screening, hearing and vision examinations, osteoporosis screening, and Papanicolaou (Pap) tests are examples of this level of prevention. Immunizations and family planning are examples of primary prevention activities.
A client originally from China is admitted to a medical floor right when lunch trays are being delivered. When the client expresses hunger, the nurse tells the client that the nurse will order some rice for lunch. What is the nurse practicing when telling the client this? prejudice stereotyping assimilation ethnocentrism
stereotyping Stereotyping means expecting a person to act in a characteristic way without regard to his or her individual traits. In this case, the nurse expects that all Chinese people like rice. Prejudice is believing that some people matter less than others based on their physical or cultural traits. Assimilation means that people have adopted the values of the dominant culture. Ethnocentrism is the belief that one's own culture is superior to all others.
Which nursing plan is a good example of how to incorporate cultural diversity preferences into the labor and delivery unit? supplying long-sleeved gowns and head scarves for a woman who requests them assisting a woman in showering, even though she is stating it is against her belief encouraging the spouse to attend the birth rather than allowing the elder women to participate administering pain medication to a laboring woman, even though she requests a "natural" birth
supplying long-sleeved gowns and head scarves for a woman who requests them Agencies may need to change a policy to accommodate a family's cultural preferences, such as the length of visiting hours, types of food served, or type of hospital clothing provided (e.g., women from certain cultures may only feel comfortable in long-sleeved gowns and with head scarves). Different cultures have different preferences; for example, women do not shower or wash up following birth or elder women attend the birth rather than the spouse. If a woman requests a "natural" birth, this should be respected.
A nurse encourages both partners in a lesbian family to come into the examining room with the newborn during a well-baby check. What type of nursing is the nurse practicing? Transcultural nursing community nursing stereotyping nursing ethnic nursing
transcultural nursing Transcultural nursing is care guided by cultural aspects and respects individual differences. Community nursing is nursing care that takes place for a group of people in a specific area. Ethnicity refers to the cultural group into which a person was born. Stereotyping means expecting a person to act in a characteristic way without regard to his or her individual traits.
A nurse is teaching an 18-year-old client about circumcision care for her second baby. Which statement made by the nurse would be most appropriate to assess the client's learning ability? "Can I help fill out the forms for government financial assistance for your family?" "Is it difficult having two babies to care for with you being a teenager?" "I notice you're having problems with reading the information. Will you tell me about this?" "Since leaving high school, have you been able to find employment?"
"I notice you're having problems with reading the information. Will you tell me about this?" The American Medical Association reports that poor health literacy skills are a stronger predictor of health status than age, income, employment status, education level, or racial/ethnic group. Poor health literacy leads to increased complications and increased mortality. The fact that the client is 18 years old and in a low socioeconomic situation are predictors of poor health, but finding out about her literacy level is a priority. The other questions will not determine her literacy ability.
The nurse is caring for a child. The nurse is trying to ensure that the family's cultural practices are supported. Which statement by the nurse indicates a lack of understanding regarding cultural competence? "Since your child is only 8, I doubt that your child has any cultural practices we need to be aware of." "Are there any dietary practices related to your culture that we should know about?" "Is there a particular religion that we should note in your chart that may impact your care?" "Most cultures have certain practices that are important to them. We want to honor any that we can."
"Since your child is only 8, I doubt that your child has any cultural practices we need to be aware of." Typically, a child begins to understand his or her culture at approximately 5 years of age, so stating that the child does not have any cultural practices at the age of 8 is inaccurate. Diet, cultural practices, and religious practices related to culture are important for the nurse to know so that the nursing staff can support as many of these practices as possible.
At a prenatal class, the nurse is told by a client that her mother advises her not raise her hands above her head during pregnancy in order to avoid umbilical cord problems. What is the nurse's best response? "This is a belief from your mother's culture about what to avoid during pregnancy." "This really isn't a worry as your mother's advice is not true." "This is a health promotion strategy recommended to avoid harm to the baby." "This belief of your mother's is not evidenced based."
"This is a belief from your mother's culture about what to avoid during pregnancy." Using a family-centered approach is associated with positive outcomes. Communication between the health care team and the family is also improved, leading to greater satisfaction for both health care providers and health care consumers (families). It is important for nurses to remain neutral to all they hear and see in order to enhance trust and maintain open communication lines with all family. Dismissing her mother's advice in a negative way will not enhance the nurse-client relationship. It is a cultural belief that harm would come to the fetus by a pregnant woman raising her arms over her head during pregnancy.
When a pregnant client explains to the nurse that strawberries cause birthmarks, what is the nurse's best response? "Wow, that's very interesting. Where did you learn that?" "That is ridiculous. Strawberries do not cause birthmarks." "Strawberries are high in folic acid and are great food for you and your baby." "You should eat at least 3 to 5 servings of fruit a day. Strawberries are a great way to get a serving in."
"Wow, that's very interesting. Where did you learn that?" Cultural influences can have a large impact on diet, and many clients choose to avoid certain foods at certain times. The most therapeutic response would be to have the client elaborate on this belief so the nurse may gain a better understanding of the client and her conceptions.
A client follows traditions of the Chinese culture. The client is 7 weeks' pregnant and admitted with vaginal bleeding. During admission, the client tells the nurse, "This is all my fault. I never should have raised my arms above my head." Which response by the nurse is most appropriate? "You sound concerned. Let's talk about potential causes of miscarriage." "You should not blame yourself. The cause of your bleeding is unknown." "I know you are scared, but we will do all we can to help your baby." "What caused you to raise your arms up above your head?"
"You sound concerned. Let's talk about potential causes of miscarriage." A myth among the Chinese culture is that raising one's arms above the level of the head during pregnancy will lead to a miscarriage. The nurse would acknowledge the client's concerns and explain potential causes of a miscarriage to the client. What caused the client to raise her arms is not relevant at this time. Asking this immediately after the client's statement would reinforce the myth. The cause of bleeding may not be known at this time; however, it is not appropriate for the nurse to tell the client how to feel or ignore the client's feelings. The client did not state she was scared; therefore, the nurse should not infer this.
The nurse evaluates a family to see if they are a good candidate for home care for a sick child. Which factor would be most important to see in the prospective family's home? A dedicated home-care provider Nearby fire department A one-floor building plan An above-average income
A dedicated home-care provider Home care is successful only if there is a family member able to assume primary care of the child.
A pregnant woman arrives in the L & D unit following premature rupture of membranes along with her spouse, who insists on being present and demands only female nurses assess his wife. When obtaining history and assessment data, the spouse provides all the answers. What is the best approach for the nurse to handle this situation? Call security and then inform the spouse that staff members need to speak with the woman alone. Act as an advocate for the woman who has a male-dominant partner. Evaluate whether it is essential to stand up to the spouse or pacify him. Educate the spouse about his expected role in the birthing process.
Act as an advocate for the woman who has a male-dominant partner. In many cultures, the man is the dominant figure. In a strongly male-dominant culture, if approval for hospital admission or therapy is needed, the man would prefer to give this approval. Since the woman is a nondominant member of the family, the nurse may have to act as an advocate for her with a more dominant partner. Security would be viewed as a threat and not appropriate at this time. To gain information from the woman, the nurse may need to confront the spouse about his role in the birthing process. It is not appropriate to educate the spouse because this is a long-standing family environment, and this is not the time to try to change the family culture toward females.
A nurse is visiting the home of a mother and her newborn. The woman's family members are present when the nurse arrives. What is the nurse's best approach to the situation? Do brief maternal and infant assessments with the family members present. Reschedule the assessment visit for another time without family present. Ask the family to leave to meet to perform the assessments privately. Assess the family members' interactions with the newborn and one another.
Assess the family members' interactions with the newborn and one another. The philosophy of family-centered care recognizes the family as the constant. The health and functioning of the family affect the health of the client and other members of the family. Family members support one another well beyond the health care provider's brief time with them, such as during the birth process or during a child's illness.
A 4-year-old adopted child has begun to ask questions about when she was born. Which suggestions by the clinic nurse would be considered the most appropriate answer for this child related to her birth? Select all that apply. Explain that her biological mom could not care for her so she was given away. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them. Tell the child that her biological mom could not care for her after birth because she was HIV positive. Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. Inform the child that her biological mom was in prison and would not be able to care for her for a long time.
Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them. Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. At least by 4 years, children are old enough to fully understand the story of their adoption: they grew inside the body of another woman who, because she could not care for them after they were born, gave them to the adopting parents to raise and love. It is important for parents not to criticize a birth mother as part of the explanation because children need to know, for their own self-esteem, that their birth parents were good people and they were capable of being loved by them, but things just did not work out that way. At age 4, children do not understand HIV status, not being able to provide for the needs of an infant, or prison terms.
The home care nurse is visiting a client and family for the first time. Which initial action can the nurse take to build trust with the client and family? Communicate in an organized and professional manner. Assist the client in making informed health care decisions. Inform the client who will have access to the medical record. Validate the client's feelings of frustration and anger.
Communicate in an organized and professional manner. Communicating with the client in an organized and professional manner displays a level of competence by the nurse that promotes trust and respect. Next, the nurse will also want to inform the client who will have access to the medical record to build confidentiality and promote security.
What is a key element of providing family-centered care? Be in control of the way care is given. Give only the health information that is necessary while providing care. Avoid cultural issues by providing care in a standardized fashion. Communicate specific health information.
Communicate specific health information. Key elements in the provision of family-centered care include demonstrating interpersonal sensitivity, providing general health information and being a valuable resource, communicating specific health information, and treating people respectfully. Giving as much control as possible to the client and his or her family is essential in family-centered care. The nurse should give all the health information, both good and bad, that the client or the family requests and be culturally sensitive to the client and the family.
A nurse is working with a culturally diverse patient population. Which strategy would the nurse most likely use to assist in recognizing cultural influences on pain perception? Select all that apply. Assume that everyone who is in pain will behave like they are in pain. Use an assessment tool (e.g., rating scale from 0 to 10) to assist in measuring the pain. Appreciate that the meaning of pain varies among cultures. Develop an awareness of personal values and beliefs. Remember that if someone is in enough pain, he or she will inform others. Appreciate that not all people communicate or express their level of pain in the same way. Recognize that communication of pain may not even be acceptable within a culture.
Develop an awareness of personal values and beliefs. Use an assessment tool (e.g., rating scale from 0 to 10) to assist in measuring the pain. Appreciate that the meaning of pain varies among cultures. Appreciate that not all people communicate or express their level of pain in the same way. Recognize that communication of pain may not even be acceptable within a culture. Strategies to help recognize cultural influences on pain perception are to appreciate that the meaning of pain varies among cultures; appreciate that not all people communicate their level of pain the same way; recognize that communication of pain may not even be acceptable in a culture; develop an awareness of personal beliefs and your responses; and use an assessment tool to measure the degree of pain. The nurse should never assume that everyone will act like they are in pain, nor should he or she think that all people in pain will inform the nurse.
An 8-year-old with cystic fibrosis has had a noted decline on the growth chart. Which nursing intervention is best for maintaining adequate nutrition? Delay pancreatic enzymes until food enters the small intestine. Provide high caloric meals to the client's liking. Encourage high calorie, high protein snacks. Limit sodium to a 2 gram sodium restricted diet
Encourage high calorie, high protein snacks. The best nursing intervention is a high calorie, high protein snack. Calories can be obtained from non-nutritious foods. It is not only that the client needs calories for energy, but nutrition needs to be present. Pancreatic enzymes aid in digestion so they need to be available for foods; thus they are given prior to ingestion. Sodium is encouraged due to the high sodium loss.
Which action by the nurse in a community clinic would best meet a family's need of physical sustenance? Providing weekly exercise classes for the neighborhood families Offering parenting classes to teenage mothers Enrolling the pregnant mother in a WIC program Holding monthly educational sessions on nutrition
Enrolling the pregnant mother in a WIC program Physical sustenance deals with meeting the basic needs of food, clothing, shelter and protection from harm of each family member. By enrolling the pregnant mother in WIC, her physical needs of nutrition are addressed. Parenting classes, nutrition classes, and exercise classes are all good ideas but do not directly address physical sustenance.
A nursing instructor is teaching the class about community-based nursing. The instructor determines the session is successful when the students correctly choose which activity as an example of tertiary prevention? Identifying a child with pediculosis in an elementary school Ensuring the client attends physical therapy after orthopedic surgery Reviewing dietary habits with parents of a slightly anemic child Caring for new mothers and infants in a maternity clinic
Ensuring the client attends physical therapy after orthopedic surgery Tertiary prevention focuses on rehabilitation activities and would be the focus of a nurse in an orthopedic clinic, aligning with the needs of the clients in that clinic. Orthopedic clients are typically recovering from injury or surgery and are in need of rehabilitation such as physical therapy. Secondary prevention includes health screening activities that aid in early diagnosis and encourage prompt treatment, such as screening for head lice in schools and reviewing dietary habits in individuals who are experiencing anemia. Primary prevention includes health promoting activities to prevent the development of illness or injury, such as new mothers bringing their infants to the clinic for follow-up well-child appointments.
The nurse is working with a same-sex couple, both of whom have children from previous relationships. Although the couple have no plans of marrying, they view their relationship as monogamous and long-term. Which family structure would apply to this family? Select all that apply. Extended family Gay or lesbian family Blended family Foster family Cohabitation family
Gay or lesbian family Cohabitation family Blended family 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 foster family, as the children are related biologically to at least one of the parents.
The nurse is providing an educational program for the staff working at a homeless shelter. The program is focused on the impact of homelessness on children. What information should be included in the presentation? Select all that apply. Homeless children are at an increased risk for sexual abuse. A short period of uncertain housing is not detrimental as long as the family are able to remain available. Homeless children are at risk for developing chronic health problems. Acute health conditions are increased in homeless children. Having space in a shelter will neutralize the health risks to the homeless child.
Homeless children are at risk for developing chronic health problems. Acute health conditions are increased in homeless children. Homeless children are at an increased risk for sexual abuse. Homelessness is a psychological and physiological stressor on the family unit. Children who are homeless are at an increase risk for both acute and chronic health concerns. Even when homeless families have beds in shelter settings these children and their parents are still at an elevated risk for health problems. Incidence of sexual abuse is increased in homeless children. Although the family unit may remain together, this does not minimize the overall risk of homelessness.
A community health nurse is preparing to teach childbirth classes at the local high school. This nurse is actively involved in which type of community health care? Tertiary prevention Couplet care Secondary prevention Primary prevention
Primary prevention Primary prevention involves teaching and promotes health and prevention of injury. Childbirth classes are primary prevention. Secondary prevention focuses on health-screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects. Tertiary prevention includes health-promoting activities that focus on rehabilitation and providing information to prevent further injury or illness. Couplet care is allowing the newborn and mother to stay in the same room after delivery.
The nurse is preparing to teach a drug education class at a local elementary school. The nurse is focused on providing which type of care to the community? Secondary prevention Primary prevention Tertiary prevention Preventive care
Primary prevention Primary prevention is promotion of healthy activities and includes education concerning 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. "Preventive care" is not considered a specific category but is a general function that encompasses all three levels.
The charge nurse overhears another nurse state, "I do not like caring for clients from a culture different from my own." Which action by the charge nurse is appropriate? Recommend the nurse attend a cultural competence class. Report the nurse to the nurse manager. Assign the nurse to care for clients with the same culture. Privately discuss the comment with the nurse.
Privately discuss the comment with the nurse. The change nurse would first discuss the overheard comment with the nurse to ensure the context of what was heard and to get a better understanding of how to help the nurse. It is not appropriate for the nurse to only be assigned clients of the same cultural background. Reporting the nurse to the nurse manager or referring the nurse to a class does not take care of the current situation, nor does the charge nurse have enough information at this time for these actions.
What could be the consequence of a nurse assigning a client to a staff member who is of the same culture as the client? Helping in assessing client's cultural heritage Ensuring better care and understanding Stereotyping Helping build nurse-client relationship
Stereotyping A nurse who thinks stereotypically may assign a client to a staff member who is of the same culture as the client because the nurse assumes that all people of that culture are alike. The nurse also may believe that clients with the same skin color have similar social situations. Because stereotypes are preconceived ideas unsupported by facts, they may not be real or accurate. They can be dangerous because they are dehumanizing and interfere with accepting others as unique individuals. Assigning a client to a staff member who is of the same culture as the client will not help in ensuring better care and understanding; assessing the client's cultural heritage; or building nurse-client relationships.
A homeless client diagnosed with human papillomavirus (HPV) is seen in the maternity clinic requesting a pregnancy test. Which nursing action would be the best example of the secondary level of prevention? Suggest she have a Papanicolaou test. Arrange for her to have the HPV vaccination. Discuss with her the need for folic acid supplementation. Send a referral to social work for adequate housing assessment.
Suggest she have a Papanicolaou test. Secondary prevention is the early detection and treatment of adverse health conditions and is aimed at halting the disease. Health screenings are the mainstay of secondary prevention. Papanicolaou tests are at this level of prevention. Primary prevention encompasses immunizations, and as she is already infected with HPV, the vaccine would not be effective. The referral for social work and the use of folic acid supplements while pregnant are examples of primary prevention.
A nursing instructor is teaching a class on the levels of preventive care. The instructor determines the class is successful when the students correctly choose which activity as a tertiary level? Showing a mother how to diaper her newborn Teaching a family how to monitor blood pressures Teaching signs and symptoms of infection to a postoperative client Teaching a family about proper child restraint systems
Teaching signs and symptoms of infection to a postoperative client A tertiary level intervention is one taken to prevent further illness or injury associated with an existing problem, such as teaching the signs and symptoms of an infection after surgery. Primary prevention involves teaching individuals necessary skills to prevent injury or disease, such as the proper use of child restraints and how to diaper a newborn. Secondary prevention involves health-screening activities that aid in early diagnoses and encourage prompt treatment before long term negative effects arise, such as monitoring blood pressure in family members who may be prehypertensive.
A community health nurse is actively involved in various community projects. The nurse is providing a secondary prevention activity by organizing which event? a skin cancer screening fair sexually transmitted infection (STI) education internet instruction for older adults application of a colostomy device
a skin cancer screening fair Secondary prevention measures are those taken to screen for diseases (such as skin cancer screening), delayed development according to criteria, or use of medication. Primary prevention involves health promotion activities to prevent the development of illness or injury. This level of prevention includes giving information which could include teaching older adults how to use the internet to find reliable information concerning various diseases, or providing STI education to prevent the spread of the disease. Tertiary prevention includes health promotion activities that focus on rehabilitation and that provide information to prevent further injury or illness, such as teaching a client how to properly apply a colostomy device.
A client with hypertension tells the nurse about wanting to use an herbal substance to lower blood pressure instead of taking the antihypertensive medication. The nurse should: show the client how to take blood pressure so the client can monitor it closely. tell the client that if choosing to use the herbal substance, check the blood pressure daily. tell the client that using herbal substances is dangerous and should not be done. advise the client to speak with the health care provider about combining herbal substances with the prescribed medication.
advise the client to speak with the health care provider about combining herbal substances with the prescribed medication. The nurse should ensure that the client speaks with the health care provider. Clients who are being treated with conventional medication therapy should be advised about using herbal substances because they may lead to unknown interaction effects.
A woman in labor has brought a butcher knife with her and insists on putting it under her hospital mattress to "cut the labor pain." Your best response to this practice would be to: tell her that she cannot keep the knife because it is a lethal weapon. allow her to keep the knife under her mattress during labor. teach her to use chest breathing with contractions. educate her about the cause of labor pain.
allow her to keep the knife under her mattress during labor. Respect for cultural values is important for developing effective nurse-client relationships
A community-based nurse has a different set of skills than those of counterparts who work in a hospital. Community-based nurses also face unique issues and challenges. What is one of the unique aspects of community-based nursing? less holistic focus teamwork disease-oriented autonomous action
autonomous action 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 to consult with. Teamwork 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.
The nurse is discharging home a client with gestational hypertension at 30 weeks' gestation with instructions to go on bed rest. Which activities can be managed at home? Select all that apply. uterine monitoring stress test monitoring fetal ultrasound monitoring amniocentesis assessments blood pressure monitoring
blood pressure monitoring fetal ultrasound monitoring uterine monitoring The intent is to reduce health care costs and to monitor women with complications of pregnancy in the home rather than in the hospital. Examples of services offered in the home setting might include infusion therapy to treat infections or combat dehydration; hypertension monitoring for women with gestational hypertension; uterine monitoring for mothers who are at high risk for preterm labor; fetal monitoring to evaluate fetal well-being; and portable ultrasound to perform a biophysical profile to assess fetal well-being. Amniocentesis would not be done in the home. Stress test monitoring would be high risk and done on specialty units.
A clinical nurse specialist is conducting a review class for a group of nurses about cultural competence and cultural diversity. Which term reflects the view of the world and set of traditions of a specific social group passed down through generations? culture ethnicity values race
culture Culture consists of the world view and group of traditions shared by a social group and passed down through generations.
A nurse is reviewing a journal article that describes a view of the world and a set of traditions that a specific social group uses and transmits to the next generation. The nurse is reading an article about which concept? culture ethnicity cultural values ancestry group
culture Culture is a view of the world and a set of traditions that a specific social group uses and transmits to the next generation. Cultural values are preferred ways of acting based on those traditions. Ethnicity refers to the cultural group into which a person was born, although the term is sometimes used in a narrower context to mean only race. An ancestry group would be what a person identifies as one's heritage or lineage group.
A family that regularly takes in foster children is visiting the junior high school nurse to inform the staff that there will be a new 8th grade foster child beginning school the following week. The school nurse should monitor this new student for which psychosocial response to being moved to the foster care system? high level of insecurity aggressive behavior as the child acts out feelings eating disorders like anorexia nervosa refusal to complete required immunizations
high level of insecurity Theoretically, foster home placement is temporary until children can be returned to their own parents. Unfortunately, if return does not become possible, children may be raised to adulthood in a series of foster care families. Such children can experience a high level of insecurity, concerned that they will have to soon move again. Aggressiveness and eating disorders should be assessed, but these responses are not the priority for most foster children. Immunization completion is not a psychosocial response to being a foster child.
The nurse is assessing an infant girl at her first well-baby visit. The nurse also observes the actions of the 6-year-old brother and parents who share that she was the best anniversary present they received this year. Which type of family will the nurse conclude these individuals represent? cohabitation adoptive immediate extended
immediate An immediate family is defined as consisting of parents and children. An extended family consists of one or more nuclear families plus other relatives, often crossing generations to include grandparents, aunts, uncles, and cousins. In the cohabitation family, couples live together but are not married. The children in this family may be children of earlier unions, or they may be a result of this union. The adoptive family is created when parents take in children who are not biologically theirs but raise them as if they were.
A nurse doing an admission assessment on a new Chinese American client notices that the client will not make eye contact. The most likely reason for this is that it: implies the client is not interested. is a sign of respect. implies the client wants to avoid the nurse. is a sign of disrespect.
is a sign of respect. Whether people look at one another when talking is culturally determined. Chinese Americans, for example, may not make eye contact during a conversation. This social custom shows respect for the position of the health care provider and is a compliment and not an avoidance issue.
A nurse working in a busy urban family clinic has noted a high percentage of single mothers. What should the nurses in this clinic be prepared to offer these single mothers? organizational and time management skills support when a problem related to childrearing occurs financial planning for college accounts for each child contraceptive advice to prevent future pregnancies
support when a problem related to childrearing occurs Single-parent families may not have even one other adult to offer them support. Single parents have difficulty working full-time plus taking total care of young children. Trying to fulfill several central roles (mother and father) is not only time-consuming but also mentally and physically exhausting and, in many instances, not rewarded. This causes families to look more and more to health care providers, especially nurses, for guidance when a problem with pregnancy or childrearing occurs. Nurses are not educated to offer financial guidance or time management strategies to these families. The health care provider for the clinic can best address contraceptive advice if the parent is asking these questions.
The term used to guide the cultural aspects of nursing care and respect individual differences is: transcultural nursing. diversity nursing. family nursing. ethnicity nursing.
transcultural nursing. Transcultural nursing is the nursing care method that is guided by cultural aspects and respects individual differences.