Chapter 24

Discuss the qualities of functional families

A functional family adapts to change, has coping techniques in place, and demonstrates a sense of commitment and purpose

18.A nurse is caring for the dying mother of a 7-year-old child. What is important for the nurse to understand regarding the child? a.The child associates death with aggression. b.The child believes his or her own death cannot be avoided. c.The child lacks understanding of the concept of death. d.The child understands death as the inevitable end of life.

ANS: A A child from 5 to 9 years old understands that death is final, believes ones own death can be avoided, associates death with aggression or violence, and believes wishes or unrelated actions can be responsible for death. A child between the ages of 9 to 12 years understands that death is the inevitable end of life.

20.Which of the five aspects of human functioning must a nurse address when dealing with a grieving person? (Select all that apply.) a.Physical b.Emotional c.Intellectual d.Financial e.Spiritual

ANS: A, B, C, E The five areas of human function are physical, emotional, intellectual, sociocultural, and spiritual.

The nurse preforms a dressing change on a 7 - year old. The nurse explains that the procedure will not be painful, but the child appears apprehensive. What is the best approach for the nurses to use?

Answer 2: Give the child a role as a helper. This increases the feeling of control and appeals to the developmental task of industry. Praise is an important reinforcer of desired behavior. Demonstrating on a doll is a method used for preschoolers. Coaching the parent would be a good choice if the child had to have ongoing dressing changes at home.

19.The home health nurse assesses that the goal of grief resolution has been accomplished when the nurse observes that a widow has performed which activities? (Select all that apply.) a.Adjusted to an environment without the spouse b.Put financial affairs in order c.Made plans for a lengthy trip d.Sought new relationships e.Acquired a job

ANS: A, D Environmental adjustment and seeking new relationships are clear evidence of grief resolution. A trip, arranging financial affairs, or finding employment may be a form of denial or activities that may be dictated by the situation and is not necessarily resolution of grief.

8.What is the first thing the nurse should do before involving the family in the care of a dying patient? a.Ask the patient if he or she wants family care b.Ask family members if they want to assist with care c.Check the hospital policy on the family giving care d.Set a caring example

ANS: B Ascertaining whether the family wants to assist in the patients daily care will clarify what the family members are comfortable doing.

1.What is the final stage of human growth and development? a.Integrity b.Death c.Despair d.Resolution

ANS: B Death is the final stage of growth and development.

The nurse is accessing a 6 month old infant who was 21 inches lomg at birth. Based on the expected growth patterns, what height would the nurse expect measuring this healthy baby.

Answer 2: Height (length) increases by about 1 inch per month for the first 6 months.

13.After a physician in the emergency department has pronounced a 2-year-old dead following a swimming pool accident, the mother tearfully says to the father, I am so sorry. I am so sorry. What is the mother expressing? a.Fear b.Guilt c.Hostility d.Grief

ANS: B Parents often harbor extreme guilt in an out of sequence death.

15.How is a durable power of attorney helpful to an incapacitated patient? a.It directs treatment in accordance with the patients wishes. b.It directs an agent to make health care decisions. c.It gives power to an agent to make decisions regarding health, property, and other assets. d.It can only be executed by an attorney.

ANS: B The durable power of attorney gives an agent the power to make health care decisions. It can be executed by anyone and does not extend beyond health care issues. A living will directs treatment according to the patients wishes.

10.When the nurse is developing a care plan for a terminally ill patient, what might be a realistic goal? a.The patient will remain pain-free. b.The patient will function optimally. c.The patient will spend time out of bed. d.The patient will demonstrate improved nutritional status.

ANS: B The goal of the care plan for a terminally ill patient is to assist the patient to function optimally. The other options are not realistic.

6.What should the nurse do before approaching a grieving family member? a.Offer sympathy b.Assess level of resolution c.Give assurance that the pain will pass d.Encourage the family member to return to normal activities

ANS: B The nurse should assess each aspect of grieving to fully understand where family members are in their grief in order to offer the most effective assistance.

9.Which of the following would lead the home health nurse to make a nursing diagnosis of unresolved grief for a patient who was widowed 5 months ago? a.Seeing that the patient keeps a picture of the husband by her bed b.The patient said tearfully, I cant believe he is gone. c.Assessing that the patient eats out frequently rather than cooking at home d.The patient says that she attends church three times a week.

ANS: B Unresolved grief results when a grieving person does not move past some stage of the grief process. The widow is still in denial. It would be expected for the widow to keep pictures of her husband in the home. Eating out frequently and attending church would not lead to a diagnosis of unresolved grief, but instead would be encouraged.

16.When a nurse informs a patients spouse that the patient has died, the spouse states, You must be mistaken. Which of Kbler-Rosss stages of dying is the spouse demonstrating? a.Anger b.Denial c.Depression d.Bargaining

ANS: B When experiencing denial, the individual acts as though nothing has happened and may refuse to believe or understand that loss has occurred.

The nurse determines that the family is primarily autocratic. Which observation supports the nurses analysis?

Answer 2: In the autocratic family pattern, the relationships are unequal. The parents attempt to control the children with strict, rigid rules and expectations. Mother assuming dominance would be a matriarchal family pattern. Uncle controlling finances would be the patriarchal family pattern. Children participating would be the democratic family pattern.

Which patient group is the nurse most likely to assess for possible exposure to teratogens?

Answer 3: Teratogens are substances, agents or processes that interfere with prenatal development and can cause developmental abnormalities.

7.A dying patient uses the call light frequently to ask the nurse to do simple tasks. The nurse recognizes this as a fear of: a.increased pain. b.failure. c.abandonment .d.isolation.

ANS: C A major fear of the dying patient is fear of abandonment.

12.The nurse spends a great deal of time in the room of a dying 12-year-old because the nurse knows that most children are aware of their condition and want the nurse to do which of the following? a.Keep them clean b.Help them eat c.Care about them d.Keep them comfortable

ANS: C Children, like adults, fear abandonment as death approaches and gain comfort from the presence of the nurse.

3.Changes in health care reimbursement measures have resulted in which of the following changes regarding care of the terminally ill? a.Patients spend more time in hospitals b.Nurses provide more care in hospitals c.More patients die at home d.Patients spend more time in rehab facilities

ANS: C Due to changes in reimbursement measures, more patients are dying at home.

4.How does a perceived loss differ from an actual loss? a.A perceived loss is more quickly resolved. b.A perceived loss is situational. c.A perceived loss is easily overlooked. d.A perceived loss has a superficial response.

ANS: C Perceived losses are easily overlooked.

14.What is the termination of tube feedings to a dying patient considered? a.Active euthanasia b.Holistic care c.Passive euthanasia d.Terminal care

ANS: C Permitting the death of a patient by withholding treatments is referred to as passive euthanasia.

5.Upon being told of her fathers death, the daughter cries out, No! Oh, God, no! What stage of grief is the daughter in? a.Anger b.Bargaining c.Denial d.Prayer

ANS: C The daughter is exhibiting signs of denial, which is commonly one of the first stages of grief.

17.A patient whose spouse died 1 year earlier complains of feeling overwhelmingly lonely and has withdrawn from interpersonal interactions. The patient is demonstrating what stage of dying according to Kbler-Rosss stages of dying theory? a.Anger b.Denial c.Depression d.Bargaining

ANS: C When experiencing depression, the individual feels overwhelmingly lonely and withdraws from interpersonal interaction.

2.A young nurse caring for a dying patient hastens through the care and leaves the room as quickly as possible. What common reaction to the care of the dying is the nurse exhibiting? a.Efficiency b.Anger c.Withdrawal d.Anxiety

ANS: C Withdrawal is a common reaction to the care of the dying.

which parent is doing the best job of using good parenting tips in dealing with adolescent child

Answer 2: By setting a good example, the parent has a better chance of talking to adolescent about quitting a bad habit. The other parental actions place the responsibility of mature decision-making on the adolescents. Adolescents can project some of the consequences of actions, but peer influence is also very important at this stage of development.

11.Following the death of a day-old infant, the nurse brings the baby to the parents. What is the rationale for the parents visit with the deceased baby? a.Bond with the family b.Reinforce the individuality of the baby c.Generate preparation for another child d.Make the death a reality

ANS: D When possible, the parents should see, touch, and hold the infant to cope better with the reality of the death.

Which behaviors indicate that young adult is achieving the developmental task of early adulthood? select all that apply

Answer 1, 2, 3, 4: Seeking identity and reaching out to peers is more typical of adolescents . The other behaviors are consistent with the tasks of development during early adulthood.

A parent expresses concern because her healthy active 11 year old son seems very short. She reports that all men on both sides of the family are tall. What is the best information that the nurse can give to the mother about growth and development? select all that apply

Answer 1, 2, 3: It is normal for the school-age child to have gradual gains in height and weight, although the full growth potential is yet to come during the adolescent and young adult periods. Nutrients and genetics could be contributing to the child's shorter stature, but it would be inappropriate for the nurse to say this to the mother without first doing a dietary assessment and referring her to a genetic counselor.

Which routine check-up or screening are recommended for school-age children?

Answer 1, 2, 4: Vision, dentition, and signs of scoliosis are recommended for routine screening. Hearing would be tested if the child showed some signs such as inattentiveness while being spoken to, speaking very loudly, or failing to attend to instructions. Cancer screening is recommended by the American Cancer Society for adults. Human immunodeficiency virus testing is not routinely done on children.

Which patient needs to get both pneumococcal and influenza vaccines?

Answer 1: All of these people should be encouraged to get the influenza vaccine, but adults over 65 years should get the pneumococcal and influenza vaccines

The working mother has an 8 month old child who has to go to day care while she works. How can the nurse best help the mother prepare for their first day of daycare?

Answer 1: An 8-month-old child is likely to demonstrate separation anxiety. This is a traumatic time for the parent and the child, but knowing that this is a normal behavior will help the mother feel less anxious and guilty. An 8-month-old should have an established sleep/rest pattern; ideally the daycare staff will interact with the child so that nap pattern is maintained. Parallel play is a form of play used by toddlers. Assess mother's feelings before validating guilt. It is likely that the mother will feel some guilt, but the mother may also want to return to work and it would be inappropriate to imply that she should feel guilty.

Based on the knowledge of normal changes of the cardiovascular system, which reccomendation would the nurse make to an older adult?

Answer 1: Low-fat, low-sodium diet help decrease the risk of atherosclerotic heart disease and hypertension. Streptococcal pneumonia vaccine and coughing and deep-breathing are interventions for expected changes in the respiratory system. Frequent position changes help protect the skin.

Most of the weight gain in the first month of life is in the form of fat. What is the best physiologic explanation for this gain of fat?

Answer 1: The infant's body is using nutrients according to a system of growth and development; thus fat reserves are accumulated in the first several months for insulation and a reserve of nutrition. Muscle and bone are expected to develop around 8 months. Cephalocaudal growth is defined as growth and development that proceeds from the head toward the feet. Breast milk and formula supply the appropriate nutrients for the growth of young infants.

Which nursing actions contribute to the accomplishing the healthy people 2020 health indicators. Select all that apply.

Answer 2, 3, 4, 6: Administering medication on time and showing respect to elderly patients are important to being a good nurse; however, Healthy People 2020 Health Indicators are more about improving the overall health of the general population.

Which behavior most strongly indicates that the older adult is successfully aging?

Answer 2: All of these behaviors have some positive merit, but studying a new subject stimulates mental capacity and linking it to a previous interest suggests satisfaction and continuity with the past. The other behaviors reflect feelings of regret and loss and running out of time.

Which infant behavior is consistent with Piaget's theory that infants are the sensorimotor stage of cognitive development?

Answer 2: Infants use sensory impressions and motor activities to learn about the environment; thus reaching for, tasting, and feeling objects with the mouth gives the child information. Clinging to parents is an intellectual function that occurs as the child learns to distinguish parents from others. Shoulder control prior to hand control is an example of proximodistal growth and development that originates in the center and moves toward the outside. Saying "me" and "no" is a toddler behavior.

Under what circumstances would the nurse advise the parents to contact the provider about their one year old infant?

Answer 2: Persistent crying during a usual sleep period indicates illness or some other type of discomfort. Whenever the infant is inconsolable with usual measures, the provider should be contacted. The other behaviors are normal and expected

The provider asks the nurse to please watch the 4 year old child because she needs to talk privately with her mother. What would be the best way for the nurse to interact with the child?

Answer 2: Preschoolers use imagination and are developing fine motor skills, and drawing is a way to communicate. The nurse should not offer the child a snack without the mother's permission and advice because of potential allergies or food restrictions. Desire to "help" is more related to the school-age child. Talking to a child is always beneficial; however, a 4-year-old is less likely to be able to independently entertain himself with a book.

The nurse is working in LTC facility. Which activity will help the residents to meet the developmental task of ego integrity as described by Erikson?

Answer 2: Reminiscing or reviewing one's life and past accomplishments validates the meaning and importance of life. The other activities are important for the socialization and health of the elderly residents.

A 52 year old women tells the nurse that she has been experiencing flushingm mood swings, night sweats, and breast tenderness for the past several months. Based on knowledge of life-span development, which question is the nurse most likely to ask?

Answer 2: The nurse recognizes that based on the patient's age and description of symptoms, perimenopause or menopause is most likely. Increased incidence of cancer, changes in libido and osteoporosis may also occur for women as they age.

A mother reports that her child occasionally complains of pain in the legs particularly at night. Which question would the nurse ask to determine if this is an expected symptom.

Answer 2: The nurse should ask the age of the child because complaints of "growing pains" related to rapid growth are reported by school-aged children. Obvious growth in the long bones and increase in height of approximately 2 inches per year for both boys and girls are physical characteristics of the school-age child. The other questions could help to identify contributing factors.

The nurse is interviewing a woman who is from a different culture than the nurse's. The nurse directs the questions to the woman, but the woman consistently looks toward her husband and he gives all the answers. What should that nurse do first?

Answer 2: The nurse would continue the interview and assess the interaction between the wife and husband and how they are responding to each other. After additional assessment, the nurse might ask the husband to leave if the wife seems fearful to speak in front of him. The nurse could seek advice about cultural norms, but discontinuing the interview may be impractical. Directing the questions towards the husband is likely to feel awkward, but it is possible that the wife prefers that he provide the answers.

The mother of a 5 year old infant reports the child is irritable; gums are red and edematous, and he demonstrated excessive drooling. What would the nurse reccomend?

Answer 2: The signs and symptoms reported by the mother are the first expected evidence of teething. Massaging the gums and giving water are recommended for infant dental hygiene. Brushing the teeth is recommended after the first tooth has erupted. The nurse would advise the mother to contact the provider if the nurse believes that infant acetaminophen is needed to relieve discomfort. The nurse would not recommend medication to the mother.

The nurse is interviewing the parents of a toddler who must be admitted for 23-hours observation for a febrile illness. What would be the most important question to ask about the child's bedtime?

Answer 2: The toddler prefers ritualistic behaviors; therefore, the nurse would assess nighttime rituals and try to approximate them as much as possible (e.g., favorite bedtime story). Night bottles with milk or juice should not be encouraged because they contribute to dental caries. Amount of sleep is a relevant question, but it is more likely that he will have trouble falling asleep in a strange environment. Once he is asleep, he is likely to sleep for the accustomed period of hours. Keep explanations simple and honest.

The nurse is assessing the vision of an older adult patient. Which findings is not associated with the aging process.

Answer 2: Visualization of half the field is a pathologic condition that is usually associated with stroke or damage to the brain. The other options are part of the normal aging process.

The nuyrse is teaching the parents of an infant the principles of introducing new foods. Which information should be provided? Select all that apply

Answer 3, 4, 5: Introducing cereals first and then slowly introducing other foods allow the child and the parent to have new experiences and evaluate the outcomes. There is a possibility that the child could have a bad physical reaction or a dislike for a certain food, so the foods should not be mixed or introduced simultaneously. Early introduction of citrus fruits may contribute to the development of allergies; waiting until after 6 months is recommended.

Which behavior demonstrates that a 60-year-old adult is meeting his developmental task of generativity?

Answer 3: Generativity is accepting responsibility for and offering guidance to the next generation. Focusing on fears, concerns, and failures is evidence of stagnation, which is the opposite of generativity. Reviewing a personal will and belongings is more typical of late adulthood.

The mother is ordering lunch for her toddler. The nurse would intervene if the mother selected which food for the toddler.

Answer 3: Small hard foods have a greater potential for aspiration and choking. Reassure the mother that her nutritional logic is sound, but carrot sticks can be served when the child gets older.

The home health nurse is interviewing an older patient who lives alone. The patient is underweight and the kitchen is so cluttered that it appears impossible to do any cooking or cleaning. What should the nurse do first?

Answer 3: The nurse can see several of the problems, but additional assessment should be made for contributing factors, such as loneliness, poor dentition, poverty, food intolerances, and constipation. The nurse should also assess the patient's ability to maintain a household and live independently. Based on assessment findings, the nurse may decide to use the other options.

The nurse is working with groups of parents of HS students. During the discussion, the following statements are made by the parents. Based on an understanding of the needs of adolescents, which statement requires follow-up by the nurse

Answer 3: The nurse should follow up on the statement about sex education and reinforce that sex education should be provided by someone. If they prefer to give the information at home, the nurse can offer to help with resources and communication methods. The other statements indicate that parents are helping teenagers by setting boundaries.

The nurse must give the school-age child an immunizaton. Based on the nurse's awareness, that the child is in the concrete operational stage, what would the nurse do prior to giving an injection?

Answer 3: The school-age child is able to think logically and apply principles to specific cases. Using a helper is recommended for younger children, especially toddlers who are strong-willed. Magical thinking is also more relevant to younger children. Modesty and privacy are more important for adolescents.

The nurse is watching a group of mothers interact with their young children. Which behavior by a mother would most likely strongly suggest that additional assessment for potential child abuse might be required?

Answer 3: Toddlers are unable to share because of their egocentric nature, so this mother is demonstrating expectations beyond the ability of the child. Harsh discipline techniques can be evidence of how the mother was treated as a child. The nurse would carefully assess for other risks factors, behaviors, and signs and symptoms before making any conclusions. Continuously retrieving a toddler will cause frustration for the child, but this mother is demonstrating anxiety about his safety. Rather than allowing the child to climb onto eating surfaces, the nurse could suggest that the mother redirect the child to climb on equipment that is designed for the purpose of climbing. Ignoring a fussy toddler is probably a strategy that this mother has developed to use if the child is not hurt, but is not getting his own way.

Which health care worker is demonstrating ageism?

Answer 4: By continuously smiling and nodding, the nurse is nonverbally dismissing the patient's complaint, because the nurse's nonverbal behavior does not match the intended meaning of the communication. Ageism is manifest among health care workers when concerns, physical, emotional, social, etc. concerns are minimized or dismissed because of the belief that the elderly have many age-related behaviors and changes.

The school nurse is talking to a child who sustained an abrasion and bruise during recess. When the nurse asks the child what happened, he begins to cry, shake his head and refuses to answer. What should the nurse do?

Answer 4: The child's nonverbal behavior indicates to the nurse that something has happened that causes the child to feel fear, embarrassment, or possibly anger. The child has to trust the nurse before sharing the events associated with the strong feelings. The nurse should not promise confidentiality. Parents have to be informed about injuries and illnesses that occur at school and if there is some violence, bullying, or safety issue, the principal must be informed.

The parent reports that her 15 year old daughter seems more moody than usual and hse is concerned because there was a teenager in the neighborhood talking about suicide. What is the most important question that the nurse should ask to determine if the daughter has a high risk of suicide?

Answer 4: The more concrete the plan, the greater the risk for committing suicide. The other questions are relevant because these are indicators of depression.

The school nurse notices that an 8 year old boy comes to her office during recess for a tummy ache, which seems to disappear as soon as recess is over. What should the nurse do?

Answer 4: The nurse suspects that something is happening at recess that is causing the child to seek a temporary haven in the nurse's office. The nurse should contact the parents first to alert them about the tummy ache and the association with recess time. The nurse should tell parents, signs and symptoms that would prompt a doctor's appointment. Parents, nurse, teachers and school administrators should be involved if there are suspected incidents of bullying or violence in the school.

The parents report that their 3-year old child has not started talking, but he seems happy and active and very interactive with the world in nonverbal ways. What should the nurse advise the parents to do?

Answer 4: Three year-olds are usually able to carry on a conversation. Children do grow at their own pace, but if expected milestones are not being met, then consulting a provider is recommended. Reading and playing do help to expand vocabulary once the child is talking.

The nurse is accessing a 1 year old who weighed 9lbs at birth. Based on expected growth patterns, how much should this healthy child weigh?

Answer: 27 pounds. By the time the baby is 1 year of age, the birth weight has tripled

Identify factors that have contributed to the changes that families today have undergone and are still undergoing

Factors contributing to the changed family include economic changes, feminist movement, better birth control, legalized abortion, postponement of marriage and childbearing, and increased divorce rate.

three common causes of family stress

Family stress may be caused by chronic illness, working mothers, abuse, and divorce.

21.The nurse explains to a grieving husband that the process of the resolution of the hurt and the reestablishment of his life is called the __________ ___________.

grief process grieving process The grief process includes the resolution of the hurt and the reestablishment of life activities following bereavement.