Maternal Child Nursing Care Womens Health 2nd Edition By Ward Hisley – Test Bank
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Sample Test
Chapter 3: The Evolving Family
MULTIPLE CHOICE
1. The
clinic nurse is taking a history from a woman who came to the clinic to get
test results. The patient brought a coworker with her because she is worried.
The patient asks to have her coworker remain in the exam room when the doctor
describes the test findings. The patient states that the friend is “like a
sister.” The nurse would most correctly identify the two women as which of the
following?
|
A. |
Extended family |
|
B. |
Family |
|
C. |
Family of choice |
|
D. |
Family of origin |
ANS: A
A family consists of two or more members who self-identify as a
“family” and interact and depend on one another socially, emotionally, and
financially. Because the patient self-identifies the friend as “like a sister,”
the patient and friend consider themselves a family.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Easy
PTS: 1
2. The
clinic nurse understands that children who come for well-child visits at age 10
are in the process of developing which of the following attributes?
|
A. |
Attachment |
|
B. |
Coordination |
|
C. |
Personal values |
|
D. |
Self-identity |
ANS: D
During the school-aged and adolescent/teenage developmental
stage, personal values are shaped and clarified and ethical development occurs.
This stage provides the optimal opportunity for teaching about drugs, sex, and
health promotion.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
3. A new
mother with a 2-month-old daughter tells the family clinic nurse that she is
experiencing a lack of sleep because of infant night feedings and her husband’s
shift work and excessive overtime. Which of the following is the best
description of this family concern?
|
A. |
Caregiver strain |
|
B. |
Coping stress |
|
C. |
Lack of support |
|
D. |
Parental maladaptation |
ANS: A
Caregiver strain occurs when the main caregiver becomes overwhelmed
and feels “underhelped” regarding the tasks concerned with the care of the
family member. In this situation, mounting bitterness and withdrawal from other
family members may cause caregivers to push away any potential helpers.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Easy
PTS: 1
4. A
patient describes her spouse’s dependence on oxycodone terephthalate
(Percocet), which began following knee surgery last year. Although the
prescription was finished some time ago, the spouse continues to obtain and
take Percocet. Because of the spouse’s “need” for the medication, the patient
“has to” do all the yard work, child care, and meal preparation. How would the
nurse describe the patient’s behavior?
|
A. |
Enabler |
|
B. |
Impaired caregiver |
|
C. |
Inadequate dyad partner |
|
D. |
Overstressed parent |
ANS: A
An enabler is a common role in families with addictions. The
enabler makes excuses for the addicted person’s behavior. The patient’s
behavior allows the spouse to continue with the addiction without being held
accountable.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Easy
PTS: 1
5. A
mother brings her 8-year-old daughter to the clinic for the third time in 2
months. The mother states that her daughter is very active and often falls
down. The mother states that her daughter eats well, but the child’s weight
falls below the 10th percentile. The clinic record shows the child had multiple
bruises on her arms at the time of the last two visits. Today the nurse notes
that the child has areas of ecchymosis on her left leg and ankle. Which action
by the nurse is best?
|
A. |
Ask the child and her
mother again about the child’s bruises. |
|
B. |
Question the child about
her accident-prone behaviors. |
|
C. |
Speak with the child alone,
asking if she feels safe at home. |
|
D. |
Teach the mother to keep a
diary of what her child is eating. |
ANS: C
This child’s presentation is suspicious. If child abuse is
suspected, the nurse should question the child privately. In all situations the
nurse is legally obligated to report the abuse to the proper investigating
agency.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Easy
PTS: 1
6. The
clinic nurse notices that each time a child with leukemia is brought in to see
the doctor, her mother and aunt accompany her. The mother states that she finds
her daughter’s illness to be very traumatic and is having difficulty coping.
The child’s aunt encourages the child’s mother and distracts the child while
her blood work is being drawn. The child’s aunt could be described as taking on
which of the following roles?
|
A. |
Child-caregiver role |
|
B. |
Kinship role |
|
C. |
Socializer role |
|
D. |
Therapist role |
ANS: D
Structural-functional theory focuses on the functioning of the
family and the roles assumed by each family member to promote family function.
Necessary roles include provider, housekeeper, child caregiver, socializer,
sexual partner, therapist, recreational organizer, and kinship member. The
therapist role is assumed when one family member expresses concern for
another’s health or emotional well-being. The aunt does not appear to be the
primary caregiver (child-caregiver role). There is no indication that the aunt
fills the socializer role by organizing family social activities. The kinship
role includes maintaining family and social ties by things like remembering
important dates, and the aunt does not appear to function in that role either.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
7. The
nurse observes a woman and her sister who live together. They are trying to
support one another and provide extended care to their mother who has recently
been diagnosed with Alzheimer’s disease. The two sisters describe their
experience with a homemaker who visits their home to help bathe their mother.
They say she is “humorous and cheerful” and absorbs their mother’s attention
for the whole time she is present. This is a positive description of which
component of Bowen’s family systems theory?
|
A. |
Communication |
|
B. |
Family relationship
building |
|
C. |
Family rituals |
|
D. |
Triangulation |
ANS: D
According to Bowen, triangulation occurs when a dyad (the
sisters) focuses on a third person who draws attention away from their
conflicts. The homemaker is serving this function in this family. Bowen’s theory
looks at family problems that are rooted in family processes, such as
communication. Relationship building and rituals are not part of this theory.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
8. A
nurse is assessing a single person at a clinic visit. How would the nurse
classify this patient’s family?
|
A. |
Family of choice |
|
B. |
Family of origin |
|
C. |
Not in a family |
|
D. |
Nuclear family |
ANS: C
Most definitions of family require at least two people who
self-define as being part of that family. Thus, a single individual cannot be a
family. A family of choice is the family adopted through marriage or
cohabitation. A family of origin includes the individuals who reared the person
of interest. A nuclear family consists of a male partner, a female partner, and
their children.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Easy
PTS: 1
9. A
patient tells the nurse about living in a commune. What does the nurse
understand about this family structure?
|
A. |
Family with distant
relatives included |
|
B. |
Group of men, women, and
children |
|
C. |
Kinship care provided to
children |
|
D. |
Unmarried man and woman
living together |
ANS: B
A commune is a group of men, women, and children all living
together. Families with relatives beyond the nuclear family are called extended
families. Kinship care provided to children constitutes a no-parent family. An
unmarried man and woman living together is called cohabitation.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Easy
PTS: 1
10. A
nurse is assessing a child with very poor social skills. What conclusion can
the nurse make about the child’s family?
|
A. |
Emotional or mental illness |
|
B. |
Not filling socialization
needs |
|
C. |
Poorly educated, poor job
skills |
|
D. |
Probably lower-income
status |
ANS: B
Families should fulfill five functions: physical needs, economic
needs, reproductive needs, affective and coping needs, and socialization needs.
A child with poor social skills probably (but not necessarily) comes from a
family that is not fulfilling the child’s socialization needs. Assuming that
the child has an emotional or mental illness without further assessment is
unhelpful. Assuming that the family is lower income, is poorly educated, and
has poor job skills is stereotypical.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
11. A
nurse is working with family members who have been striving to improve their
functioning as a family unit. What behavior would suggest to the nurse that the
family is meeting its goals?
|
A. |
The children are in
multiple activities to develop talents. |
|
B. |
The desire to be understood
guides most communication. |
|
C. |
Family members gave up some
activities in order to eat dinner together on most nights. |
|
D. |
The parents have a strong
desire for the children to succeed. |
ANS: C
Effective tools for families include ways to enhance family
performance. One very effective tool is to put the family first in this very
chaotic world. Giving up some activities in order to eat dinner together shows
the family is putting the unit as a whole first over individual desires. This
is the opposite of children being in multiple activities, which often cuts into
family time and can be disruptive. Communication should be guided by the desire
to understand the other first, then to be understood. A strong desire for the
children’s success does not guarantee successful family functioning.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Evaluation
Difficulty: Difficult
PTS: 1
12. A
nurse works a great deal with refugees and is frustrated because, as a group,
they don’t seem to want to implement desired health behaviors. What action by
the nurse would be most helpful?
|
A. |
Conduct a health screening
and educational event each month. |
|
B. |
Provide written information
in the group’s native language. |
|
C. |
Teach selected group
representatives to be lay health educators. |
|
D. |
Try to establish
relationships within the refugee community. |
ANS: C
According to family systems theory, each family system contains
boundaries that affect how the outside world interacts with the family.
Families that have recently immigrated to the United States might have closed
boundaries and may only be receptive to health information provided by extended
family members or members of their community. Establishing a lay health
educator program in which community members can be taught health information with
the intent of delivering it to their communities would be a good way to work
with these families while respecting their boundaries. Regularly occurring
health events might improve the nurse’s standing in the community. Written
information may or may not be helpful; many refugees are illiterate in their
native languages and some languages do not have a written form. Establishing
relationships within the community is advisable, but does not go far enough to
solve the problem.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
13. A
patient is dismissed from the hospital and is receiving nursing care at home to
help in the recovery from a serious illness and operation. The visiting nurse
notes that the family is in a state of disarray and members are disorganized
and not communicating. The patient is trying to direct everyone’s actions. The
nurse calls a family meeting. What action by the nurse is best?
|
A. |
Encourage family members to
make “to do” lists and assign chores. |
|
B. |
Explain that changes in one
person require changes in the others. |
|
C. |
Make a referral to a
counselor or mental health nurse practitioner. |
|
D. |
Tell the family members
that for the patient to recover, they have to assume his or her role. |
ANS: B
Family systems theory recognizes that changes in one member of a
family affect every other member of the family. In order for the family to
function effectively, all members need to adapt to the major changes in one of
the members. Making lists and assigning chores are simple tasks that might help
with organization, but this does not go far enough in solving the problem. The
family may or may not need a referral for counseling. Simply telling the family
members a fact does not give them enough information to adapt.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
14. A
nurse who works with families uses Duvall’s family developmental theory as the
core of nursing practice. What action by this nurse takes priority?
|
A. |
Assessing the developmental
stage of the family |
|
B. |
Determining how the family
interacts with society |
|
C. |
Observing what roles each
family member assumes |
|
D. |
Tailoring teaching to the
specific needs of the family |
ANS: A
Developmental theory has as its core the idea that every person
moves through developmental stages with tasks that must be mastered before they
can move on to the next stage. Family developmental theory assumes the same
progression for families as a unit. Duvall’s theory identifies eight family
stages. The nurse using Duvall’s family developmental theory must first assess
the stage the family is in, because teaching and all other interventions must
be tailored to that stage. Only tailoring the teaching to specific needs does
not necessarily require assessment of the family using a developmental
approach. Determining how the family interacts with society is more in line
with systems theory. Observing roles is part of structural-functional theory.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
15. A
nurse is working with a blended family of 1 year with five children aged 3, 7,
13 (twins), and 19. The parents seem overly stressed and anxious and do not
seem to work well as a unit. What can the nurse conclude about this family?
|
A. |
Communication problems are
the core of the parents’ stress. |
|
B. |
Economic stressors are
impacting the parental dyad. |
|
C. |
The family is in too many developmental
stages to master any of them. |
|
D. |
There are too many children
to give each one adequate attention. |
ANS: C
In family developmental theory, the age of the child determines
the stage the family is in. If there is more than one child, the family is
probably in multiple developmental stages at the same time. The family is
probably in a combination of beginning families, preschool, school-aged and
adolescent, and launching stages. The competing priorities of all of these
stages pave the way for chaos. Without further information, the nurse cannot
conclude that economic stressors or communication problems are the root cause
of the issue. Simply concluding that the family has too many children is
judgmental and does not leave any room for interventions.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
16. A
family practice nurse is working with a patient who is asking for anti-anxiety
medications to deal with the stress and frustration of an adult child who won’t
leave the home. Based on knowledge of the tasks of launching children, which
resource should the nurse suggest first?
|
A. |
Anger management counseling |
|
B. |
Contact numbers for
vocational training |
|
C. |
Information on a parenting
workshop |
|
D. |
Marriage and couples
counseling |
ANS: B
An adult child who still lives at home is either using home base
as a temporary arrangement while continuing education or as a “nonaction” until
more permanent ties have been established elsewhere. With the parent’s
frustration and anxiety, this situation of incomplete launching needs to be
addressed. The first suggestion should be about vocational assessment and
training for the adult child. There is no indication the patient needs anger
management, a parenting workshop, or marriage counseling.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate
PTS: 1
17. A
patient has been dismissed from the hospital after a serious illness and needs
several weeks of home care and rehabilitation. When the visiting nurse comes to
the house, it is apparent that the family is not functioning. The house is
dirty, there is little food available, and one parent and an older child are
arguing about picking up a younger sibling from school. What action by the
nurse is most appropriate?
|
A. |
Ask the parents if they
need financial resources for the basic necessities. |
|
B. |
Assess each family member
for the roles he or she plays in the family. |
|
C. |
Contact child protective
services or social work to assess the home environment. |
|
D. |
Provide referrals for
family and couples counseling in the community. |
ANS: B
According to structural-functional theory, each person in a
family unit occupies a specific role. Sometimes roles are shared. A problem can
occur when one member of the family is unable to fill his or her role and no
one else is doing it. That appears to be the situation here. The nurse should
assess what roles each family member plays and assist them to see how they can
fulfill the role formerly held by the patient. The family may need financial
resources if the patient was the breadwinner. There is no need to conduct an
environmental assessment, as it does not appear that any family member is in
danger. The family may or may not need counseling at this time.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
18. A
nurse who uses the structural-functional theory would assess which of the
following when working with families?
|
A. |
Communication patterns |
|
B. |
How things get done |
|
C. |
If goals are being met |
|
D. |
Looseness of boundaries |
ANS: C
The structural-functional theory focuses on the outcomes, not
the processes, within the family. The nurse using this theory would assess if
the family goals are being met. Communication patterns are critical to
communication theory. Processes are important to family developmental theory,
and boundaries are important in family systems theory.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
19. A
nurse is providing anticipatory guidance to a mother of a toddler. Using
communication theory, which information is the most appropriate?
|
A. |
“Don’t nod your head ‘yes’
when you say ‘no.’” |
|
B. |
“Explain things in several
different ways.” |
|
C. |
“There is no need to see if
a toddler understands.” |
|
D. |
“You shouldn’t yell at such
a young child.” |
ANS: A
According to communication theory, verbal and nonverbal messages
should be congruent. A verbal “no” accompanied by nodding the head “yes” is
sending inconsistent messages. Messages should be clear, so explaining things
in many different ways would not be recommended. Good communicators determine
if the listener has understood. Good communication demonstrates love and
support clearly, but the advice to not yell is vague and seems to send the
message that yelling at an older child would be more acceptable.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
20. A
nurse is working with a woman who is newly married and pregnant and says she is
distressed because she and her husband seem to be so different and they argue
over petty issues. What action by the nurse using group theory would be best?
|
A. |
Ask the woman if she can
remember why she and her husband fell in love. |
|
B. |
Caution her that this level
of disagreement will cause stress to the unborn baby. |
|
C. |
Offer the woman a referral
to a community counseling center for couples therapy. |
|
D. |
Reassure her that this is
normal and help her brainstorm ways to work cooperatively. |
ANS: D
According to group theory, groups evolve through the distinct
stages of forming, storming, norming, performing, and adjourning. Storming
often occurs when a group that has recently formed notices differences in
members, leading to chaos or confusion. This couple is in this stage. At this
point, the nurse’s best action is to reassure the woman and help her brainstorm
ways of working together cooperatively, which might include forming rules or
procedures that both parties agree to follow. Asking about their early
relationship does not give the woman information that will help the present
situation. Warning the patient about the negative effects of stress on her
unborn baby sounds judgmental and threatening. A referral for counseling might
be needed at a future date.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
21. A
clinic nurse is using group theory to assess a family whose youngest child
recently moved back home after graduating from college and is unable to find a
job. Which statement by a parent would indicate to the nurse that goals for
norming have been met?
|
A. |
“I’m glad my son stays in
his room in the basement all day so he doesn’t bother us.” |
|
B. |
“It’s hard to decide how
much food to buy because we don’t know where he’s eating.” |
|
C. |
“My son is gone a lot of
the time, so we really don’t notice that he moved back in.” |
|
D. |
“We have agreed not to have
a curfew as long as we know when he will be home.” |
ANS: D
According to group theory, a healthy family adjusts to changes
in its structure by resetting roles and norms. In this family, a launched child
has moved back in, disrupting the patterns established when he left. Agreeing
to new rules and roles is a sign of adaptation. The other responses do not show
adaptation to the new situation.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Evaluation
Difficulty: Difficult
PTS: 1
22. A
student observes as an adult brother and sister lash out at the nurse caring
for their hospitalized parent. The parent lives at home but is dependent on the
children for care and is obviously neglected. The nurse has informed the
children that social work will be involved in their father’s case. How does the
nurse explain this interaction?
|
A. |
“Don’t worry; they will
calm down eventually.” |
|
B. |
“Families often get
emotional in these situations.” |
|
C. |
“They are focusing
attention on me, not the problem.” |
|
D. |
“This family is obviously
highly dysfunctional.” |
ANS: C
This family is dysfunctional, but that does not go far enough to
explain the situation. This behavior is known as triangulation, and occurs when
a dyad diverts attention away from their problems and chooses instead to focus
on a third party, in this case the nurse. Reassuring the student they will calm
down is neither helpful nor accurate as the family members may choose to
continue to lash out. Families often do get emotional, but again, this
information is not really helpful.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
23. A
nurse working with a married couple notes that both parties seem to try to be
dominant in their sessions. According to Bowen’s family systems theory, which
question asked by the nurse would yield the most useful information?
|
A. |
“Are you each a first-born,
middle child, or youngest sibling?” |
|
B. |
“How demonstrative were
each of your parents when you were growing up?” |
|
C. |
“How many children were in
each of your families?” |
|
D. |
“What socioeconomic classes
did you both grow up in?” |
ANS: A
According to this family theory, birth order plays an important
role in predicting certain patterns of behavior. Spouses who occupy the same
birth order may have difficulty functioning together. In this case, both
spouses probably are first-borns with a need for control. The other questions
may yield helpful information as part of a thorough assessment, but are not
related to this theory.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
24. A
nurse working in a pediatric clinic is attempting to assess a school-age child
who is disrespectful of the nurse and parent and tears up a magazine when asked
to sit down. What conclusion can the nurse make about this family?
|
A. |
The child is not getting
enough attention from the parents. |
|
B. |
The family is from an
underserved community group. |
|
C. |
Financial stress has caused
family strife and fighting. |
|
D. |
The parental disciplinary
approach is inconsistent. |
ANS: D
Children whose parents have a laissez-faire disciplinary style
tend to be disrespectful, aggressive, and disobedient. A laissez-faire
disciplinary style includes inconsistent use of discipline, allowing children
(rather than the parents) control over the environment, few rules, and children
making their own decisions rather than being guided by parents. The other
options may be true, but without further assessment, the nurse cannot make
those conclusions.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Evaluation
Difficulty: Difficult
PTS: 1
25. A
family with a loud, disobedient child has been working with a nurse. Which
action observed by the nurse indicates that goals for the diagnosis of impaired
parenting have been met?
|
A. |
The father delivers
consequence to the child calmly. |
|
B. |
The father only asks the
child twice not to do something. |
|
C. |
The mother doesn’t cry when
disciplining her child. |
|
D. |
The mother states that the
child is still testing the limits. |
ANS: A
Consistency in setting and enforcing rules is critical.
Consequences should be delivered immediately, without anger, and consistently.
The father’s disciplining the child without getting mad is demonstrating that
goals have been (or are being) met. The other options do not show consistent,
calm, immediate consequences.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Evaluation
Difficulty: Easy
PTS: 1
26. A
female patient from a refugee community is in the emergency department and
needs urgent surgery. The patient defers making a choice on the operation, preferring
to wait for a cultural elder to arrive. What action by the nurse is most
appropriate?
|
A. |
Encourage the patient’s
family to talk her into having the operation. |
|
B. |
Explain kindly to the
patient that her situation cannot wait. |
|
C. |
Respect the patient’s
choice and wait for the elder to arrive. |
|
D. |
Take the patient to surgery
under the principle of implied consent. |
ANS: C
This is a difficult situation, but because the patient’s wishes
are known, the nurse has no choice other than to wait. In the emergency
department, sometimes surgery is performed under the principle of implied
consent (for instance, on an unconscious patient with no known family), but in
this case, the patient has been clear as to her wishes, so doing that would be
an ethics violation. The nurse must be careful to not be coercive. The nurse
(and physician) would ensure that the patient understands the risks of waiting.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management
of Care
Integrated Process: Communication and Documentation
Difficulty: Difficult
PTS: 1
27. A
nurse wishes to assess how often members of a family consume alcohol or use
drugs during a typical week. What type of family assessment tool would this
nurse choose?
|
A. |
Ecomap |
|
B. |
Genogram |
|
C. |
Qualitative |
|
D. |
Quantitative |
ANS: D
A quantitative tool measures the frequency at which problems or
behaviors occur. An ecomap is a tool that displays the outside systems used by the
family. A genogram illustrates the family structures and compares generations
within the same family. Qualitative tools measure the descriptions and depth of
family experiences.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
28. A
mother is worried about her three children developing an inherited medical
condition because many members of her family have died from this disease. To
start an assessment of this family, which tool should the nurse choose?
|
A. |
Ecomap |
|
B. |
Genogram |
|
C. |
Problem list |
|
D. |
Quantitative tool |
ANS: B
A genogram is a diagram of at least three generations that
illustrates the present family structures and compares past generations with
the present ones. To determine the prevalence of this inherited disorder in the
family, the nurse would use a symbol to denote each family member with this
disease. An ecomap displays the outside systems with which the family
interacts. A problem list helps family members identify difficulties or
negative characteristics. A quantitative tool assesses the frequency of a
behavior or problem. A genogram has a quantitative influence, as it documents
how many people in the family have the characteristic being studied, but a
genogram is more specific.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Easy
PTS: 1
29. A
nurse explains the benefits of a strengths-and-problems list to a student.
Which is the best explanation?
|
A. |
Can use their strengths to
work on identified priority problems |
|
B. |
Demonstrates that each family
has both strengths and problems |
|
C. |
Forces people to be
accountable and take responsibility for problems |
|
D. |
Lets families see which
members have problems affecting them |
ANS: A
A strengths-and-problems list requires the family members to
list their strengths as well as what each member brings to the group that is
positive. The problems list helps the family prioritize problems to work on. By
seeing this information in writing, the family members can capitalize on their
strengths to work on the problems. It does demonstrate that each family has
both strengths and problems, but that is not the main purpose. It does not
force families to take responsibility, although it does encourage this. Its
purpose is not to point out who has which problems.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
30. A
nurse working with a pregnant woman who is a recent immigrant to the United
States notes that her husband rarely accompanies her to prenatal visits, and
when he does, he sits in the waiting room. What action by the nurse is best?
|
A. |
Ask the patient what role
men in her culture play in pregnancy. |
|
B. |
Ask the woman why her
husband doesn’t seem involved. |
|
C. |
Encourage the man to
participate in order to support his wife. |
|
D. |
Research the couple’s
cultural background and health beliefs. |
ANS: A
Culture affects the roles family members assume during times of
illness, pregnancy and childbirth, and death. The best option is to ask the
woman what role men in her culture play during pregnancy and childbirth. This
can open a discussion of how the woman is coping and if she is getting enough
support, either from her mate or friends and family. Asking why the man doesn’t
seem involved is judgmental. Encouraging the man to participate may not be
desired by the woman and may be seen as an intrusion by the man. The nurse
could research the culture but this would not lead to a discussion until the
next visit. It is also important to be aware that there are variations in how
people of the same culture behave and believe.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Difficulty: Moderate
PTS: 1
31. A
family has weekly game nights and monthly family together days. The nurse
documents these events as examples of which of the following?
|
A. |
Family beliefs |
|
B. |
Family bonding |
|
C. |
Family building |
|
D. |
Family rituals |
ANS: C
Family-building activities are an extension of family rituals
and center on recreation and leisure. They do contribute to family bonding, but
the most specific answer is family building. Family activities are influenced
by family beliefs.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Difficulty: Easy
PTS: 1
32. A
nurse is working with a family that has the nursing diagnosis of altered family
processes. When formulating goals, whom does the nurse include?
|
A. |
Entire family |
|
B. |
No one else |
|
C. |
Parents |
|
D. |
Physician |
ANS: A
The most effective goals are those that include the entire
family. The entire family agrees upon the goals and commits to working on them.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Planning
Difficulty: Easy
PTS: 1
33. A
17-year-old high school senior is resentful about caring for younger siblings
so the parents can have a “date night” once every 2 weeks. The teen often
“forgets” and schedules work or social activities that override the parents’
plans. The parents are angry that the teen is so indifferent to their needs.
What action by the family indicates that goals for the diagnosis of impaired
family processes have been met?
|
A. |
Parents and teen mutually
plan date nights in advance. |
|
B. |
Parents consistently
discipline teen for “forgetting.” |
|
C. |
Teen acknowledges
“forgetting” date night on purpose. |
|
D. |
Teen expresses feelings
about being made to babysit. |
ANS: A
All the outcomes show some positive resolution, but the most
optimal response is the parents and teen jointly planning the parents’ nights
out. This shows collaboration, communication, and mutual respect. In the end,
everyone’s needs are taken into consideration, and the teen will be more willing
to adapt the current role to include watching the siblings. Consistent
consequences delivered without anger is a hallmark of healthy discipline. The
teen is taking responsibility when he or she acknowledges that the forgetting
occurs on purpose. The lines of communication are open when the teen is allowed
to verbalize feelings.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate
PTS: 1
34. A
nurse is working with a family with the diagnosis of impaired family processes.
Although both parties worked, one person worked part time and had the main
responsibility for the household. The other spouse retired recently and has not
taken on more of this role. Both people are angry and resentful. What goal
would be best for this couple?
|
A. |
Adapt to role changes
positively within 2 months. |
|
B. |
Divide up household duties
between spouses more evenly. |
|
C. |
Express feelings using “I”
statements within 1 month. |
|
D. |
Learn to discuss anger and
other negative emotions. |
ANS: C
A good goal or outcome is specific, measurable, and has a time
element. The goal that best meets that description is expressing feelings using
“I” statements within 1 month. Adapting to role changes is vague and not
measurable. Dividing duties more evenly is not measurable and has no time
element. Learning to discuss negative emotions does not mean using what is
learned, so it is not as specific as the correct answer.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Planning
Difficulty: Moderate
PTS: 1
35. A
patient is being discharged from a psychiatric facility after a suicide
attempt. The family consists of the patient, two parents, and two other teenage
children. What action should the nurse teach the entire family as a priority?
|
A. |
Assess for drugs or alcohol
in the patient’s room. |
|
B. |
Encourage the patient to
take medications. |
|
C. |
Monitor the patient for
signs of suicidal thoughts. |
|
D. |
Plan menus that contain
nutritious food items. |
ANS: C
Safety is a priority concern in every family and all members
should be made aware that the patient could have continued suicidal thoughts.
If the siblings notice this, they should be taught to tell the parents
immediately and could also be taught some effective communication to use.
Looking for drugs or alcohol in the patient’s room, encouraging medication use,
and planning menus are all actions more appropriate for the parents.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
36. A
nurse is working with a family in which one member has schizophrenia. Using
systems theory, for which concern should the nurse specifically assess this
family?
|
A. |
Balance |
|
B. |
Boundaries |
|
C. |
Children’s ages |
|
D. |
Subsystems |
ANS: B
Systems theory looks at boundaries, balance and homeostasis, and
subsystems. An important concern in the family whose member is diagnosed with a
mental illness is social isolation, which is related to boundaries. Some
families view mental illness as shameful and try to keep the information
secret. The nurse should work to ensure the family understands the importance
of healthy interaction with outside systems. Children’s ages would be assessed
using developmental theories.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
37. A
grade school nurse is conducting vision screening before school and notes the
student is accompanied by an older sister who has also brought a middle school
child. The older child states that time is a problem because middle school
starts in a few minutes and tells the younger child to go right to the
classroom after the screening, then leaves. What question by the nurse would be
most appropriate to ask the youngest child during the screening?
|
A. |
“Do you feel safe at home
or is someone hurting you there?” |
|
B. |
“Does your sister always
bring you and your sibling to school?” |
|
C. |
“Have you ever seen your
parents drinking a lot or using drugs?” |
|
D. |
“Why aren’t your parents
available to bring you to school?” |
ANS: B
In substance-abusing families, one child often takes the role as
the responsible person, allowing the family to continue functioning. The fact
that a sibling was bringing the children to school is a little unusual, and the
nurse should assess the reason behind it. However, substance-abusing families
often keep secrets for both social and legal reasons. The nurse should not ask
directly about substance abuse, but rather open a line of discussion by
introducing a nonthreatening question. There is no indication of abuse, so
asking if the child is safe is not appropriate at this time. In a
secret-keeping family, asking directly about drinking or drug use would most
likely elicit a negative response. Asking “why” questions is confrontational.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
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