Test Bank For Introductory Maternity & Pediatric Nursing 5th edition Nancy Hatfield, Exams of Nursing

Download Test Bank For Introductory Maternity & Pediatric Nursing 5th edition Nancy Hatfield and more Exams Nursing in PDF only on Docsity!

Chapter 1: The Nurse's Role in a Changing Maternal–Child Health Care Environment Hatfield: Introductory Maternity and Pediatric Nursing, 5th Edition

1. The opening up of hospital visiting policies for children and families likely resulted from the work of which individual? A. Joseph Brennaman B. John Bowlby C. Marshal Klaus D. John Kennell Answer: B Rationale: In 1951, John Bowlby received worldwide attention with his study that revealed the negative results of the separation of child and mother because of hospitalization. His work led to a re-evaluation and liberalization of hospital visiting policies for children. Joseph Brennaman suggested that a lack of stimulation for infants contributed to high infant mortality rates at the time. In the 1970s and 1980s, physicians Marshall Klaus and John Kennell carried out important studies on the effect of the separation of newborns and parents. They established that early separation may have long-term effects on family relationships and that offering the new family an opportunity to be together at birth and for a significant period after birth may provide benefitsthat last well into early childhood. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Remember Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 4
2. An expectant mother states that she read that more black mothers die in childbirth than do white mothers. When responding to her questions about the reasons for this, the nurse accurately states that which is the major reason for the high maternal mortality rate? A. Having formal education. B. Being unmarried. C. Income. D. Lack of prenatal care. Answer: D Rationale: Research shows that maternal mortality rate is directly related to lack of prenatal care secondary to lack of access to services or insurance. Income as well as educational level may play a role in the availability of health care, but they are not directly responsible. Being unmarried has no bearing on infant mortality. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Understand

Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 9

3. Which statement correctly defines the term "infant death rate"? A. number of deaths in utero of fetuses 500 g or more per 1,000 live births B. number of deaths occurring in the first 28 days of life per 1,000 live births C. number of deaths occurring at birth or in the first 12 months of life per 1,000 live births D. death of a live-born child before his or her first birthday. Answer: D Rationale: The term infant death refers to the death of a live-born child before he or she reaches age 1 year. It also includes neonatal mortality rate. Neonatal mortality rate is the number of infant deaths during the first 28 days of life for every 1,000 live births. Infant mortality rate is the number of deaths during the first 12 months of life per 1,000 live births. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Remember Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 9
4. The nursing instructor is preparing to teach a group of students about the history of maternity care. What major development will the instructor emphasize as greatly influencing the practice of maternity care in the United States over the past century? A. technologic advances and the use of forceps by primary care providers B. development of anesthesia and acceptance of the germ theory C. advent of birthing centers and the development of family-centered care D. development of pediatric specialty and replacement of midwives as primary birth attendants Answer: B Rationale: The emphasis should be placed on anesthesia and the germ theory. The development of anesthesia allowed women a choice for pain management in birth; the germ theory advanced the progress of general health care and decreased infections in laboring women. Pediatrics as a specialty is an important step forward but is not the greatest development, and midwives are still in practice. Maternity care continues to evolve, and birthing centers are still under development. Forceps are not considered an advance in maternity care. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance

Integrated Process: Teaching/Learning Reference: p. 3

5. When preparing a client for surgery, the nurse explains that the use of an antiseptic during the surgery has greatly improved client survival rates and was started by which physician? A. Louis Pasteur B. Ignaz Philip Semmelweis C. Joseph Lister D. Alexander Gordon Answer: C Rationale: Joseph Lister was a British surgeon who embraced Louis Pasteur's theory of microorganisms as the cause of infection. Lister used carbolic acid as an antiseptic during surgery and improved the survival rates of his patients. Alexander Gordon proposed the theory of infection. Oliver Wendell Holmes and Ignaz Philip Semmelweis confirmed his theory. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 4
6. A young couple are very excited to learn they are expecting their first child and question the nurse about which test they need to discover its gender. Which procedure will best provide this information to the couple? A. Ultrasound B. Amniocentesis C. Chorionic villus sampling D. HGP Answer: A Rationale: Ultrasound is a visual method for assessing the fetus in the uterus and will provide information about the gender. Amniocentesis and chorionic villus sampling provide the entire genetic code of the fetus. HGP refers to the Human Genome Project, which can provide information regarding gene mutations and variations. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Caring Reference: p. 6

7. A family is seeking sources for payment of health care costs. When talking with the family, the nurse determines that the family makes too much money toqualify for the federal program. Which source would the nurse likely recommend? A. Medicaid B. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) C. Centers for Disease Control D. State Child Health Insurance Program Answer: D Rationale: The State Child Health Insurance Program, first known by its acronym "SCHIP" now referred to as "CHIP," was enacted in 1997. CHIP provides health insurance to newborns and children in low-income families who do not otherwise qualify for Medicaid and are uninsured. Based on the information given, the family does not qualify for Medicaid, a federal program that supplies grants to states to provide health care for individuals who have low incomes and meet other eligibility criteria. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional servides to low-income, nutritionally at-risk pregnant, breast- feeding, and postpartum women and their children (as old as 5 years). The Centers for Disease Control does not provide funding for health care services. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 8
8. After discussing the various options with a pregnant client and partner, they have chosen to stay with their newborn and receive care from one nurse at the time of birth. This is referred to as which type of care? A. Regionalized care B. Maternal-child care C. Centralized care D. Couplet care Answer: D Rationale: Couplet care is care in which the mother and child remain in the same room after labor/delivery through the postpartum period. This has become the standard of care. Regionalized or centralized care places the treatment centers in centralized locations and transfers the patient to the facility. Maternal child care allows the mother to be the primary provider of care. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring

Reference: p. 5

9. A group of nursing students are examining the data of the local hospitals to determine the potential maternal needs of the community. Which factor will be the best statistical indicator of the adequacy of prenatal care? A. Number of prenatal visits B. Maternal mortality rate C. Infant mortality rate D. Infant measurements at birth Answer: B Rationale: Maternal mortality rate is the best indicator of a country's level of prenatal care. Increases in prenatal care result in a decrease in maternal mortality. Infant mortality is a reflection of postnatal care. Infant mortality includes all infant deaths from birth to 12 months and can be the result of congenital anomalies, genetic anomalies, or other problems. The number of prenatal visits and measurements of the infant at birth are not the best indicators as they do not accurately reflect the health of the mother. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 9
10. The nurse is teaching a client about lifestyle changes that could help the client reach a higher level of wellness. The nurse is engaged in which aspect of care? A. Infection prevention B. Cost containment C. Health promotion D. Illness treatment Answer: C Rationale: By encouraging healthy lifestyle changes, the nurse is engaging in health promotion activities. Health promotion involves helping people make lifestyle changes to move them to higher levels of wellness. Health promotion includes all aspects of health: physical, mental, emotional, social, and spiritual. Although health promotion can help to contain costs over a longer span, this is not what the nurseis doing. Healthy lifestyle changes are not part of infection prevention or illness treatment. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 7

11. A young female client is pregnant for the first time and is uncertain who to seek prenatal care from. The nurse should point out which health care provider as the likely choice? A. Perinatologist B. Neonatologist C. Family practitioner D. Obstetrician Answer: D Rationale: The obstetrician is the common choice for prenatal care through labor and delivery. Perinatologists may care for women who have a high-risk pregnancy, and neonatologists provide care to infants. Family practitioner physicians may provide care but are less likely to attend in labor and delivery. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Caring Reference: p. 3
12. While preparing to teach a group of nursing students the history of maternity care, which factor will the instructor include to explain as the etiology of most infections in females after birthing in the 1700s? A. Reproductive tract infection B. Breast infection C. Kidney infection D. Urinary tract infection Answer: A Rationale: Prior to the germ theory, women most often died of puerperal fever, an illness marked by high fever caused by infection of the reproductive tract after delivering infants. Women who delivered in hospitals were more likely to develop this infection than women who delivered at home. Breast infections occurred during breast feeding but were not usually fatal. There was no greater incidence of kidney or urinary tract infections. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Teaching/Learning Reference: p. 3 - 4
13. A group of nursing students are comparing the various changes in maternity care over the course of history and discover that the development of what medical

treatment was most influential in moving birth from the home into the hospital setting? A. Infection control and germ theory B. Planned cesarean birth C. Instruments to assist in birth of infants D. Anesthesia and analgesic therapy Answer: D Rationale: Movement from the home to the hospital for the birth of infants began with the use of medications to control pain during labor. This trend started with the wealthy and followed to include more of society. Cesarean births are a more recent development than the advent of anesthesia. Infection control could be maintained at home, so it was not a driving force. The use of instruments developed along with cesarean technology. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Teaching/Learning Reference: p. 3

14. The nursing instructor is teaching a group of students about the history of maternity and family care. The instructor determines the session is successful when the students correctly choose which major change resulting from research by Klaus and Kennell? A. Limited family visits for children in the hospital B. Family-centered care of today C. Rooming-in for maternity patients D. Isolation of children with infections Answer: B Rationale: Klaus and Kennell conducted studies and determined the optimal outcomes for children occurred when parents had more contact and interaction with the child in the hospital. Limiting visits has detrimental effects on infant development. Rooming-in was not as well received, as patients were not comfortable with the loss of privacy. Isolation of children with infections is still a proper precaution. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 4
15. A client with a history of type 1 diabetes mellitus is confirmed to be pregnant. The nurse determines this client will be best cared for under which practice model?

A. Case management B. The nursing process C. A clinical pathway D. A health maintenance organization Answer: A Rationale: Case management is a system that integrates management and coordination of care with financing in an attempt to improve cost-effectiveness, use, quality, and outcomes. The nursing process involves the practice of nursing; it is not a means of cost saving for the client. The clinical pathway is a treatment regimen. HMOs are insurance organizations. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 7

16. A nursing student is preparing a presentation illustrating the Human Genome Project. Which function will the student point out as being the primary focus? A. Genetic testing in adults B. Detection of genetic mutations in children C. Identification of human genes and functions D. Treatment of gene mutations Answer: C Rationale: The Human Genome Project was founded in 1990 and its primary purpose was to identify and label all human genes and their functions. Information from the HGP may eventually be used in genetic testing, the detection of mutations or variations in children, and gene therapy. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 6
17. A healthy client without a primary care provider is exploring the options available for a health care provider to assist with her pregnancy. Which health care provider can the nurse point out as a best option? A. Women's health nurse practitioner (NP) B. Certified nurse midwife C. Lay midwife D. Clinical nurse specialist (CNS) Answer: B

Rationale: A certified nurse midwife is a nurse with advanced practice training in the care of women, specific to pregnancy and birth. A women's health NP would not be able to deliver the infant. A CNS is an advanced practice role but not specific to the care of pregnancy women. The lay midwife has no formal education. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 3 - 4

18. The nursing instructor is teaching a session comparing the various steps of the nursing process. The instructor determines the session is successful when the students correctly choose which step as the first one? A. Nursing diagnosis B. Planning C. Assessment D. Evaluation Answer: C Rationale: Assessment is the first step in the nursing process. The nurse must complete the assessment and gather information to advance the nursing process. Nursing diagnosis is based on actual or potential health problems that fall within the range of nursing practice. Evaluation measures the success or failure of the nursing plan of care. Planning is a stage of execution. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 13
19. After completing an assessment, the nurse examines the information to develop a wellness diagnosis for the client to identify which potential goal? A. Acute health problems B. Potential problems C. The potential for improvement in health D. Chronic health problems Answer: C Rationale: Wellness diagnosis identifies the potential for a client to move from one level of wellness to a higher level. The identification of potential, acute, and chronic health problems is part of the diagnostic process. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment

Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 14

20. The nurse is organizing health information to teach a client basic principles that will help maintain wellness in the family. Which actions should the nurse prioritize in this teaching? A. encouraging yearly checkups for all clients. B. teaching insulin injection techniques C. medication administration D. assisting in understanding a treatment Answer: A Rationale: The current movement in health care is to focus on health promotion and thereby prevent future illness and diseases. Encouraging yearly checkups would assist with finding problems before they become serious. Prevention, treatment, and rehabilitation are all processes of care. Teaching a client how to give injections, administer medication, or understand a treatment would occur after a specific health issue but not prevent these issues from occurring. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 14
21. Which nursing intervention would best demonstrate evidence-based practice in maternal– child health care? A. Family-centered pediatric care B. Minimizing parental interaction with preterm infants C. Placing adults and children with similar diseases on the same unit D. Decentralizing care to allow clients to be closer to home Answer: A Rationale: Evidence-based practice has become the standard that nurses are to strive for in caring for their clients. By involving the family in caring for ill children, the child and the family are better served and have improved outcomes. Parental interaction is encouraged for preterm infants to foster bonding. Children and adults need to be separated on inpatient units to ensure that the caregivers have a clear understanding of each client's needs, since children are not small adults. Centralized care has proved to be most beneficial to client outcomes by providing resources and specialists in one location. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply

Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 5

22. What societal issues greatly influence delivery of maternal and pediatrichealth care? Select all that apply. A. Cost of health care B. Increase in surrogacy and adoption C. Low income of families D. Increased cultural and ethnic diversity of clients E. Increased number of children born in the U.S. Answer: A, C, D Rationale: Demographic trends such as a decreased number children being born, combined with an increase in a multicultural society seeking health care, are affecting the delivery of maternal–child health care. Poverty and the cost of health care also play a major role in influencing health care delivery for both women and children. Question format: Multiple Select Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 7
23. The United States lags behind other industrialized countries regardinginfant mortality. The main factor that contributes to this is: A. lack of available facilities for caring for the infants. B. older mothers having babies. C. the large number of preterm births in the U.S. D. more congenital anomalies in children born in the U.S. Answer: C Rationale: Two factors that contribute to the fact that the United States lags behind other industrialized countries are the large number of preterm births and the differences in reporting live births in various countries. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 9
24. The nurse reviews the client's plan of care (above). Which nursing action(s) does the nurse identify as independent? Select all that apply. A. assisting out of bed

B. administering ibuprofen C. giving IV normal saline D. reinforcing breathing exercises E. offering oral fluids Answer: A, E Rationale: Independent nursing actions are actions that may be performed based on the nurse's own clinical judgment, for example, getting the client out of bed and offering oral fluids. Dependent nursing actions, such as administering medications or IV fluids, are actions that the nurse performs as a result of a health care provider's prescription. Interdependent nursing actions are actions that the nurse must accomplish in conjunction with other health team members, such as reinforcing breathing exercises with the respiratory therapist. Question format: Multiple Select Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 14

25. A nurse manager is orienting a group of new nurses to the maternity unit. During the orientation, the nurse manager emphasizes the need for accurate and complete documentation based on which reason? A. The facility could lose its standing in the community. B. The facility might not keep its accreditation. C. The records could be used in a legal action in the future. D. The records act as the main source of communication among team members. Answer: C Rationale: One of the most important parts of nursing care is recording information about the client on the permanent record. This record, the client's chart, is a legal document and must be accurate and complete. In maternity and pediatric settings, documentation is extremely important because records can be used in legal situations many years after the fact. Although documentation is a form of communication among team members, it is not the main source for doing so. Incomplete or inaccurate documentation can affect a facility's accreditation and or status in the community, but this is not the main reason for accurate and thorough documentation. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 14

26. A community-based nurse is part of an agency sponsoring a booth at a local health fair. An acute care nurse comes up to the booth and asks the community- based nurse, "How is your practice different from practice in a hospital?" Which response(s) by the community- based nurse would be appropriate? Select all that apply. A. "In the community, we rely on other disciplines for decision-making." B. "We are more autonomous when providing client care." C. "We tend to address the client's needs more holistically." D. "Our major focus is on illness and treatment." E. "We care for clients over a longer span of time." Answer: B, C, E Rationale: Unlike the hospital setting, community-based nursing practice is autonomous and the nurse is often called on to be self-reliant. Community practice tends to be more holistic and focuses on wellness rather than illness. In addition, the nurse in a community-based setting sees the client over time. Question format: Multiple Select Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Reference: p. 28 - 29
27. A nurse is developing a program for families to promote spending more time together. Which cause(s) of decreased family togetherness will the nurse incorporate into the program? Select all that apply. A. increase in families with one working parent B. rise in children participating in extracurricular activities C. increase in television use over discussion among family members D. rise in time spent sitting down to meals as a family E. greater focus on material things rather than relationships Answer: B, C, E Rationale: There is a trend for families to spend less time together. Many factors contribute to this trend which may include two working parents, rather than just one; the children participating in many extracurricular activities; family members watching television, rather than talking together at mealtime, or eating fast food or individual meals without sitting down together as a family; or an emphasis on the acquisition of material goods, rather than the development of relationships. Question format: Multiple Select Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Understand Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 22

28. A nurse will conduct an information session for a group of parents who have children in elementary school. The session will focus on child growth and development. Which information about the parents would be important for the nurse to obtain before planning the session to promote the success of the session? Select all that apply. A. ages B. educational levels C. primary language(s) spoken D. cultural attitudes E. financial background Answer: A, B, C, D Rationale: A successful group experience relies on the nurse being prepared before the session in addition to providing factual, unbiased information. It is important to know the needs of the target population to provide information to a group successfully. Important information about the group includes age, educational level, ethnic and gender mix, language barriers, cultural attitudes regarding receiving and acknowledging information, and any previous education the group has already had on the subject. Question format: Multiple Select Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 28
29. A community-based nurse caring for a family gives the family information about free transportation services to medical appointments. Which skill is the nurse is using? A. nursing process B. data collection C. education D. client advocacy Answer: D Rationale: Client advocacy is speaking or acting on behalf of clients. This helps them gain greater independence and to make the health care delivery system more responsive and relevant to their needs. Giving the family information about free transportation is an example. The nursing process is a proven form of problem- solving based on the scientific method and involves data collection. Education is a fundamental part of community-based care and involves the relaying of information to improve outcomes. Question format: Multiple Choice Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care

Integrated Process: Caring Reference: p. 28

30. A nurse working at a child health clinic is involved in primary and secondary prevention activities. Which activity(ies) reflects secondary prevention? Select all that apply. A. vision screening at all well-child visits B. safety education for bicycles and skateboards C. administration of immunizations D. instructions for treatment of head lice E. drug education program Answer: A, D Rationale: Secondary prevention involves health screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects arise. Therefore, vision screening and instructions for head lice treatment wouldbe appropriate. Safety education, immunizations, and drug education are examples of primary prevention activities, which are health-promoting activities to prevent the development of illness or injury. Question format: Multiple Select Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 23

Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing

1. A young couple are asking the nurse for suggestions on the best way to help their newborn develop properly. Which is the best response by the nurse? A. Provide nutritional supplements. B. Start reading to the child on first birthday. C. Minimize distractions in the nursery. D. Provide a variety of brightly colored toys. Answer: D Rationale: Children, from an early age, need stimulation and interaction to develop the five senses optimally. Many parents buy brightly colored toys to facilitate stimulation. You should encourage proper nutrition through diet rather than supplementation. Reading should begin immediately, not on first birthday. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 19
2. Which situation may occur in immediate families at a greater level than insome other types of families? A. financial difficulties B. problems with allocation of resources C. formation of a poor parent–child relationship D. lack of support people in a crisis Answer: D Rationale: People in an immediate family may all be so involved in a crisis that there is no objective support person. Financial difficulties, resource allocation problems, and poor relationships may be formed in any family situation. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Caring Reference: p. 21 - 22
3. Which of the following may be a strength of the single-parent type of family? A. financial security B. readily available support in a crisis C. development of a special parent-child relationship D. child wishing for no other siblings

Answer: C Rationale: Because there is no competition for time from a spouse, single-parent families can promote special parent-child relationships. Financial security, support in a crisis, and the desire for no siblings can occur in any family situation. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 21- 22

4. 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? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Preventive care Answer: A Rationale: 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. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 23
5. The primary health care provider has recommended a client consult a nutritionist for specialized care. The nurse, by providing a list of referrals to the client, is providing which service? A. Client advocacy B. Community-based nursing C. Primary care D. Secondary prevention Answer: A Rationale: Client advocacy is speaking or acting on behalf of clients to help them gain greater independence and to make the health care delivery system more

responsive and relevant to their needs. Community-based nursing focuses on prevention and is directed toward persons and families within a community. Primary care is the direct action of the primary care provider. Secondaryprevention involves health screening activities that aid in early diagnosis and encourage prompt treatment before long-term negative effects occur. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 28

6. A community-based nurse is assessing the needs of a family of four, which includes a physically challenged 9-year-old. Which activity would the nurse prioritize to be an advocate for this family? A. Ensure case history is complete for all family members. B. Establish eligibility for assistive devices for child. C. Ensure the client follows physical therapy recommendations. D. Train the school nurse on the needs of the child. Answer: B Rationale: Client advocacy is acting on behalf of the client. Making calls to arrange for special equipment is one role of a nurse who is acting on behalf of the client. A case history would be taken at the initial visit to the treatment center by the attending nurse. The client's progress in physical therapy is to be noted by the therapist or PT assistant. The community-based nurse should not have to train the school nurse but would share the needs of the child so that the school nurse is prepared to provide appropriate care. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 28
7. The nurse is preparing a prenatal seminar for young mothers. Which type of information should the nurse gather to ensure success of the program? A. Who will be accompanying the mother B. Approximate education level of the participants C. Names of each of the participants D. Incomes of each of the participants Answer: B Rationale: When teaching a group of clients, the nurse should seek demographic information, such as the education level of the participants, to help develop an

appropriate teaching plan for the group. This is an impersonal group, so learning who is accompanying the mothers, their names, or their incomes is not appropriate. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 27- 28

8. A nursing student is exploring community-based nursing as a career focus. The nurse is prepared to prioritize which activity as a primary focus? A. Wellness B. Cost containment C. Rehabilitation D. Emergency care Answer: A Rationale: The community-based nurse is in a unique position of health promotion for the community. Wellness is health promotion and aligns with the holistic practice of the community-based nurse. Cost containment, rehabilitation, and emergency care are the responsibility of direct care facilities. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 23 - 24
9. The community health nurse is assessing a new client who reports having recently moved to the area and living with an aunt and her parents. The nurse determines this client resides in which type of family structure? A. extended B. immediate C. communal D. blended Answer: A Rationale: The extended family is an immediate family with other family members in the same house. The immediate family is composed of an individual's smallest family unit (commonly parents and their children), all of whom share a common household. Members of a communal family share responsibility for homemaking and child rearing; all children are the collective responsibility of adult members. In a blended family, both partners in the marriage bring children from a previous marriage into the household. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing

Cognitive Level: Understand Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 20

10. The nurse at a family planning clinic is meeting with a young couple who have decided not to have any children after they marry since they are both bringing children into the relationship. The nurse will document this as which type of family structure? A. Blended family B. Immediate family C. Extended family D. Communal family Answer: A Rationale: The blended family consists of each parent bringing their own children into the family when they marry. It may also consist of additional children if the couple decide to have more. The immediate family is composed of a man, a woman, and their children (either biological or adopted), who share a common household. Members of a communal family share responsibility for homemaking and child rearing; all children are the collective responsibility of adult members. An extended family consists of one or more nuclear families plus other relatives, often crossing generations to include grandparents, aunts, uncles, and cousins. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 21
11. The nurse is assessing a child of a different cultural background. Which nursing action should the nurse prioritize when providing nursing care? A. Use personal cultural experiences with the family. B. Use a standard nursing care plan for the family. C. Expect the family to adopt the cultural beliefs of that facility. D. Ask the family for input into their care based on their cultural beliefs. Answer: D Rationale: Cultural beliefs vary; care should be based on the individual beliefs of each family. The imposition of personal or institutional beliefs, as well as the beliefs of others, should never be placed on a client. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process

Reference: p. 22

12. The nurse is explaining the differences of language development in children. Which example would be appropriate for the nurse to include in the explanation? A. Firstborn children are slower to develop language skills than their siblings. B. Second-born children are quicker to develop language skills than their siblings. C. Boys raised with older sisters are slower to develop language skills than their siblings. D. Girls raised with older brothers are quicker to develop language skills thantheir siblings. Answer: C Rationale: Birth order has an impact on the development of children. Firstborn children command a great deal of attention and tend to be higher achievers than siblings; thus language skills develop sooner in the firstborn child. With second and subsequent children, parents tend to be more relaxed and permissive. These children are likely to be more relaxed and are slower to develop language skills. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 21
13. 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? A. Caring for new mothers and infants in a maternity clinic B. Identifying a child with pediculosis in an elementary school C. Ensuring the client attends physical therapy after orthopedic surgery D. Reviewing dietary habits with parents of a slightly anemic child Answer: C Rationale: 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. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance

Integrated Process: Teaching/Learning Reference: p. 23

14. 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? A. Home setting B. Birthing center C. Hospital D. Any birthing settings Answer: D Rationale: 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. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 24
15. Which action by the nurse in a community clinic would best meet a family's need of physical sustenance? A. Enrolling the pregnant mother in a WIC program B. Offering parenting classes to teenage mothers C. Holding monthly educational sessions on nutrition D. Providing weekly exercise classes for the neighborhood families Answer: A Rationale: 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. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Reference: p. 19

16. A mother voices her concerns to the nurse that her daughter is an "only child" and she is worried that having no siblings may be detrimental to the child. The nurse can reassure the mother that an "only child" tends to excel in what area(s)? Select all that apply. A. Being more relaxed around others B. Advanced language development C. Intellectual achievement D. Less dependence upon the parent E. Closer identification with peers instead of parents Answer: B, C Rationale: It is shown that "only children" tend to have more advanced language skills and intellectual achievement than children from larger families. This is thought to be from the fact that the parents have more one-on-one time with the only child. "Only children" more closely identify with their parents, are more dependent upon the parents and are not necessarily more relaxed around others. Question format: Multiple Select Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 21
17. The nurse is providing tertiary care to a young, uninsured family who has a child with frequent seizures. Which action by the nurse would demonstrate tertiary care? A. Performing a well-child checkup, noting weight gain B. Educating the parents regarding appropriate play activities for the child C. Finding a company to provide a helmet for the child to wear daily. D. Nutritional guidance for healthy meals for the family. Answer: C Rationale: Tertiary care involves health promotion focused on rehabilitation and prevention of further injury or illness, and it optimizes function. By providing a safety helmet to the child with a history of seizures, the nurse is preventing further injury to the child. Nutritional guidance is an example of primary prevention, focusing on good nutrition to prevent risk factors that may cause impairment. Performing the well-child checkup and educating about appropriate play activities address secondary prevention, which reflects health screening and prompt treatment of problems. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Caring Reference: p. 23

18. A 7-year-old child who has recently immigrated with the family is brought to the school nurse because the child refuses to eat lunch. Which response should the nurse prioritize? A. Eat lunch with the child. B. Discuss the situation with the child. C. Investigate for potential cultural issues. D. Refer the family to a nutritionist. Answer: C Rationale: Culture influences the family's health beliefs. A newly immigrated family may have attitudes toward food that are culturally founded. The nurse should seek to clarify the cultural food influences of the family and the needs of this child. Discussing the issue with the parents may be an option if the nurse is unable to detect a possible cultural connection by talking with the child. Referring the family to a nutritionist would be inappropriate. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 22

19. 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? A. Cohabitation B. Adoptive C. Immediate D. Extended Answer: C Rationale: 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. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 20

20. A nursing instructor is teaching a group of nursing students about the various options available to provide nursing care in a community. The instructordetermines the session is successful when the students correctly choose which action as the primary focus of home care nursing? A. Provide care based on insurance coverage. B. Teach and supervise caregivers. C. Provide direct client care. D. Act as a liaison between health care provider and family. Answer: C Rationale: 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. Question format: Multiple Choice Chapter 2: Family-Centered and Community-Based Maternal and Pediatric Nursing Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 24