01: Perspectives of Pediatric Nursing Chapter 01: Perspectives of Pediatric Nursing MULTIPLE CHOICE 1. The clinic nurse is reviewing statistics on infant mortality for the United States versus other countries. Compared with other countries that have a population of at least 25 million, the nurse makes which determination? a. The United States is ranked last among 27 countries. b. The United States is ranked similar to 20 other developed countries. c. The United States is ranked in the middle of 20 other developed countries. d. The United States is ranked highest among 27 other industrialized countries. ANS: A Although the death rate has decreased, the United States still ranks last in infant mortality among nations with a population of at least 25 million. The United States has the highest infant death rate of developed nations. DIF: Cognitive Level: Remembering REF: p. 6 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. Which is the leading cause of death in infants younger than 1 year in the United States? a. Congenital anomalies b. Sudden infant death syndrome c. Disorders related to short gestation and low birth weight d. Maternal complications specific to the perinatal period ANS: A Congenital anomalies account for 20.1% of deaths in infants younger than 1 year compared with sudden infant death syndrome, which accounts for 8.2%; disorders related to short gestation and unspecified low birth weight, which account for 16.5%; and maternal complications such as infections specific to the perinatal period, which account for 6.1% of deaths in infants younger than 1 year of age. DIF: Cognitive Level: Remembering REF: p. 7 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 3. What is the major cause of death for children older than 1 year in the United States? a. Heart disease b. Childhood cancer c. Unintentional injuries d. Congenital anomalies ANS: C Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. The leading cause of death for those younger than 1 year is congenital anomalies, and childhood cancers and heart disease cause a significantly lower percentage of deaths in children older than 1 year of age. DIF: Cognitive Level: Understanding REF: p. 7 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 4. In addition to injuries, what are the leading causes of death in adolescents ages 15 to 19 years? a. Suicide and cancer b. Suicide and homicide c. Drowning and cancer d. Homicide and heart disease ANS: B Suicide and homicide account for 16.7% of deaths in this age group. Suicide and cancer account for 10.9% of deaths, heart disease and cancer account for approximately 5.5%, and homicide and heart disease account for 10.9% of the deaths in this age group. DIF: Cognitive Level: Remembering REF: p. 7 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 5. The nurse is planning a teaching session to adolescents about deaths by unintentional injuries. Which should the nurse include in the session with regard to deaths caused by injuries? a. More deaths occur in males. b. More deaths occur in females. c. The pattern of deaths does not vary according to age and sex. d . The pattern of deaths does not vary widely among different ethnic groups. ANS: A The majority of deaths from unintentional injuries occur in males. The pattern of death does vary greatly among different ethnic groups, and the causes of unintentional deaths vary with age and gender. DIF: Cognitive Level: Applying REF: pp. 7-8 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 6. What do mortality statistics describe? a. Disease occurring regularly within a ge ographic location b. The number of individuals who have died over a specific period c. The prevalence of specific illness in the population at a particular time d. Disease occurring in more than the number of expected cases in a community ANS: B Mortality statistics refer to the number of individuals who have died over a specific period. Morbidity statistics show the prevalence of specific illness in the population at a particular time. Data regarding disease within a geographic region, or in greater than expected numbers in a community, may be extrapolated from analyzing the morbidity statistics. DIF: Cognitive Level: Remembering REF: p. 3 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 7. The nurse should assess which age group for suicide ideation since suicide in which age group is the third leading cause of death? a. Preschoolers b. Young school age c. Middle school age d. Late school age and adolescents ANS: D Suicide is the third leading cause of death in children ages 10 to 19 years; therefore, the age group should be late school age and adolescents. Suicide is not one of the leading causes of death for preschool and young or middle school-aged children. DIF: Cognitive Level: Understanding REF: p. 6 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 8. Parents of a hospitalized toddler ask the nurse, “What is meant by family-centered care?” The nurse should respond with which statement? a. Family - centered care reduces the effect of cultural diversity on the family. b. Family - centered care encourages family dependence on the health care system. c. Family - centered care recognizes that the family is the constant in a child’s life. d. Family - centered care avoids expecting families to be part of the decision - making process. ANS: C The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the child’s life. The family should be enabled and empowered to work with the health care system and is expected to be part of the decision-making process. The nurse should also support the family’s cultural diversity, not reduce its effect. DIF: Cognitive Level: Applying REF: p. 8 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 9. The nurse is describing clinical reasoning to a group of nursing students. Which is most descriptive of clinical reasoning? a. Purposeful and goal directed b. A simp le developmental process c. Based on deliberate and irrational thought d. Assists individuals in guessing what is most appropriate ANS: A Clinical reasoning is a complex developmental process based on rational and deliberate thought. When thinking is clear, precise, accurate, relevant, consistent, and fair, a logical connection develops between the elements of thought and the problem at hand. DIF: Cognitive Level: Applying REF: p. 12 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 10. Evidence-based practice (EBP), a decision-making model, is best described as which? a. Using information in textbooks to guide care b. Combining knowledge with clinical experience and intuition c. Using a professional code of ethics as a means for decision making d. Gathering all evidence that applies to the child’s health and family situation ANS: B EBP helps focus on measurable outcomes; the use of demonstrated, effective interventions; and questioning what is the best approach. EBP involves decision making based on data, not all evidence on a particular situation, and involves the latest available data. Nurses can use textbooks to determine areas of concern and potential involvement. DIF: Cognitive Level: Remembering REF: p. 11 TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 11. Which best describes signs and symptoms as part of a nursing diagnosis? a. Description of potential risk factors b. Identification of actual health problems c. Human response to state of illness or health d. Cues and clusters derived from patient assessment ANS: D Signs and symptoms are the cues and clusters of defining characteristics that are derived from a patient assessment and indicate actual health problems. The first part of the nursing diagnosis is the problem statement, also known as the human response to the state of illness or health. The identification of actual health problems may be part of the medical diagnosis. The nursing diagnosis is based on the human response to these problems. The human response is therefore a component of the nursing diagnostic statement. Potential risk factors are used to identify nursing care needs to avoid the development of an actual health problem when a potential one exists. DIF: Cognitive Level: Understanding REF: p. 13 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Safe and Effective Care Environment 12. The nurse is talking to a group of parents of school-age children at an after-school program about childhood health problems. Which statement should the nurse include in the teaching? a. Childhood obesity is the most common nutritional problem among children. b. Immunization rates are the same among children of different race s and ethnicity. c. Dental caries is not a problem commonly seen in children since the introduction of fluorida d. Mental health problems are typically not seen in school - age children but may be diagnosed ANS: A When teaching parents of school-age children about childhood health problems, the nurse should include information about childhood obesity because it is the most common problem among children and is associated with type 2 diabetes. Teaching parents about ways to prevent obesity is important to include. Immunization rates differ depending on the child’s race and ethnicity; dental caries continues to be a common chronic disease in childhood; and mental health problems are seen in children as young as school age, not just in adolescents. DIF: Cognitive Level: Applying REF: p. 3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 13. The nurse is planning care for a hospitalized preschool-aged child. Which should the nurse plan to ensure atraumatic care? a. Limit explanation of procedures because the child is preschool aged. b. Ask that all family members leave the room when performing procedures. c. Allow the child to choose the type of juice to drink with the administration of o ral medicati d. Explain that EMLA cream cannot be used for the morning lab draw because there is not tim effective. ANS: C The overriding goal in providing atraumatic care is first, do no harm. Allowing the child a choice of juice to drink when taking oral medications provides the child with a sense of control. The preschool child should be prepared before procedures, so limiting explanations of procedures would increase anxiety. The family should be allowed to stay with the child during procedures, minimizing stress. Lidocaine/prilocaine (EMLA) cream is a topical local anesthetic. The nurse should plan to use the prescribed cream in time for morning laboratory draws to minimize pain. DIF: Cognitive Level: Applying REF: pp. 8-9 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 14. Which situation denotes a nontherapeutic nurse – patient – family relationship? a. The nurse is planning to read a favorite fairy tale to a patient. b. During shift report, the nur se is criticizing parents for not visiting their child. c. The nurse is discussing with a fellow nurse the emotional draw to a certain patient. d. The nurse is working with a family to find ways to decrease the family’s dependence on he providers. ANS: B Criticizing parents for not visiting in shift report is nontherapeutic and shows an underinvolvement with the parents. Reading a fairy tale is a therapeutic and age appropriate action. Discussing feelings of an emotional draw with a fellow nurse is therapeutic and shows a willingness to understand feelings. Working with parents to decrease dependence on health care providers is therapeutic and helps to empower the family. DIF: Cognitive Level: Analyzing REF: p. 9 TOP: Integrated Process: Caring MSC: Client Needs: Psychosocial Integrity 15. The nurse is aware that which age group is at risk for childhood injury because of the cognitive characteristic of magical and egocentric thinking? a. Preschool b. Young school age c. Middle school age d. Adolescent ANS: A Preschool children have the cognitive characteristic of magical and egocentric thinking, meaning they are unable to comprehend danger to self or others. Young and middle school-aged children have transitional cognitive processes, and they may attempt dangerous acts without detailed planning but recognize danger to themselves or others. Adolescents have formal operational cognitive processes and are preoccupied with abstract thinking. DIF: Cognitive Level: Understanding REF: p. 4 TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 16. The school nurse is assessing children for risk factors related to childhood injuries. Which child has the most risk factors related to childhood injury? a. Female, multiple siblings, stable home life b. Male, high activity level, stressful home life c. Male, even tempered, history of previous injuries d. Female, reacts negatively to new situations, no serious previous injuries ANS: B Boys have a preponderance for injuries over girls because of a difference in behavioral characteristics, a high activity temperament is associated with risk-taking behaviors, and stress predisposes children to increased risk taking and self-destructive behaviors. Therefore, a male child with a high activity level and living in a stressful environment has the highest number of risk factors. A girl with several siblings and a stable home life is low risk. A boy with previous injuries has two risk factors, but an even temper is not a risk factor for injuries. A girl who reacts negatively to new situations but has no previous serious illnesses has only one risk factor. DIF: Cognitive Level: Analyzing REF: p. 4 TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 17. The school nurse is evaluating the number of school-age children classified as obese. The nurse recognizes that the percentile of body mass index that classifies a child as obese is greater than which? a. 50th percentile b. 75th percentile c. 80th percentile d. 95th percentile ANS: D Obesity in children and adolescents is defined as a body mass index at or greater than the 95th percentile for youth of the same age and gender. DIF: Cognitive Level: Remembering REF: p. 3 TOP: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 18. The nurse is teaching parents about the types of behaviors children exhibit when living with chronic violence. Which statement made by the parents indicates further teaching is needed? a. “ We should watch for aggressive play.” b. “ Our child may show lasting symptoms of stress.” c. “ We know that our child will show caring behaviors.” d. “ Our child may have difficulty concentrating in school.” ANS: C The statement that the child will show caring behaviors needs further teaching. Children living with chronic violence may exhibit behaviors such as difficulty concentrating in school, memory impairment, aggressive play, uncaring behaviors, and lasting symptoms of stress. DIF: Cognitive Level: Applying REF: p. 6 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 19. The nurse is evaluating research studies according to the GRADE criteria and has determined the quality of evidence on the subject is moderate. Which type of evidence does this determination indicate? a. Strong evidence from unbiased observational studies b. Evidence from randomized clinical trials showed inconsistent results c. Consistent evidence from well - performed randomized clinical trials d. Evidence for at least one critical outcome from randomized clinical trials had serious flaws ANS: B Evidence from randomized clinical trials with important limitations indicates that the evidence is of moderate quality. Strong evidence from unbiased observational studies and consistent evidence from well-performed randomized clinical trials indicates high quality. Evidence for at least one critical outcome from randomized clinical trials that has serious flaws indicates low quality. DIF: Cognitive Level: Remembering REF: p. 12 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment 20. An adolescent patient wants to make decisions about treatment options, along with his parents. Which moral value is the nurse displaying when supporting the adolescent to make decisions? a. Justice b. Autonomy c. Beneficence d. Nonmaleficence ANS: B Autonomy is the patient’s right to be self-governing. The adolescent is trying to be autonomous, so the nurse is supporting this value. Justice is the concept of fairness. Beneficence is the obligation to promote the patient’s well-being. Nonmaleficence is the obligation to minimize or prevent harm. DIF: Cognitive Level: Analyzing REF: p. 11 TOP: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 21. The nurse manager is compiling a report for a hospital committee on the quality of nursing-sensitive indicators for a nursing unit. Which does the nurse manager include in the report? a. The a verage age of the nurses on the unit b. The salary ranges for the nurses on the unit c. The education and certification of the nurses on the unit d. The number of nurses who have applied but were not hired for the unit ANS: C Nursing-sensitive indicators reflect the structure, process, and outcomes of nursing care. For example, the number of nursing staff, the skill level of the nursing staff, and the education and certification of nursing staff indicate the structure of nursing care. The average age of the nurses, salary range, and number of nurses who have applied but were not hired for the unit are not nursing-sensitive indicators. DIF: Cognitive Level: Applying REF: p. 15 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE 1. Which responsibilities are included in the pediatric nurse’s promotion of the health and well-being of children? (Select all that apply.) a. Promoting disease prevention b. Providing financial assistance c. Providing support and counseling d. Establishing lifelong friendships e. Establishing a therapeutic relationship f. Participating in ethical decision making ANS: A, C, E, F The pediatric nurse’s role includes promoting disease prevention, providing support and counseling, establishing a therapeutic relationship, and participating in ethical decision making; a pediatric nurse does not need to establish lifelong friendships or provide financial assistance to children and their families. Boundaries should be set and clear. DIF: Cognitive Level: Applying REF: pp. 9-11 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 2. The nurse is conducting a teaching session for parents on nutrition. Which characteristics of families should the nurse consider that can cause families to struggle in providing adequate nutrition? (Select all that apply.) a. Homelessness b. Lower income c. Migrant status d. Working parents e. Single parent status ANS: A, B, C Families that struggle with lower incomes, homelessness, and migrant status generally lack the resources to provide their children with adequate food intake, nutritious foods such as fresh fruits and vegetables, and appropriate protein intake. Working parents and single parent status do not mean the families will struggle to provide adequate nutrition. DIF: Cognitive Level: Applying REF: p. 2 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 3. The nurse is preparing to complete documentation on a patient’s chart. Which should be included in documentation of nursing care? (Select all that apply.) a. Reassessments b. Incident reports c. Initial assessments d. Nursing care provided e. Patient’s response of care provided ANS: A, C, D, E The patient’s medical record should include: initial assessments, reassessments, nursing care provided, and the patient’s response of care provided. Incident reports are not documented in the patient’s chart. DIF: Cognitive Level: Applying REF: p. 14 TOP: Integrated Process: Communication and Documentation MSC: Client Needs: Safe and Effective Care Environment 4. Which actions by the nurse demonstrate overinvolvement with patients and their families? (Select all that apply.) a. Buying clothes for the patients b. Showing favoritism toward a patient c. Focusing on technical aspects of care d. Spending off - duty time with patients and families e. Asking questions if families are not participating in care ANS: A, B, D Actions that show overinvolvement include buying clothes for patients, showing favoritism toward a patient, and spending off-duty time with patients and families. Focusing on technical aspects of care is an action that indicates underinvolvement, and asking questions if families are not participating in care indicates a positive action. DIF: Cognitive Level: Analyzing REF: pp. 9-10 TOP: Integrated Process: Caring MSC: Client Needs: Health Promotion and Maintenance 5. Which are included in the evaluation step of the nursing process? (Select all that apply.) a. Determination if the outcome has been met b. Ascertaining if the plan requires modification c. Establish priorities and selecting expected patient goals d. Selecting alternative interventions if the outcome has not been met e. Determining if a risk or actual dysfunctional health problem exists ANS: A, B, D Evaluation is the last step in the nursing process. The nurse gathers, sorts, and analyzes data to determine whether (1) the established outcome has been met, (2) the nursing interventions were appropriate, (3) the plan requires modification, or (4) other alternatives should be considered. Establishing priorities and selecting expected patient goals are done in the outcomes identification stage. Determining if a risk or actual dysfunctional health problem exists is done in the diagnosis stage of the nursing process. DIF: Cognitive Level: Understanding REF: p. 14 TOP: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 6. Which should the nurse teach to parents regarding oral health of children? (Select all that apply.) a. Fluoridated water should be used. b. Early childhood caries is a preventable disease. c. Dental caries is a rare chronic disease of childhood. d. Dental hygiene should begin with the first tooth eruption. e. Childhood caries does not happen until after 2 years of age. ANS: A, B, D Oral health instructions to parents of children should include use of fluoridated water and dental hygiene beginning with the first tooth eruption. In addition, early childhood caries is a preventable disease and should be included in the teaching session. Dental caries is a common, not rare, chronic disease of childhood. Childhood caries may begin before the first birthday. DIF: Cognitive Level: Applying REF: p. 2 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 7. The school nurse is explaining to older school children that obesity increases the risk for which disorders? (Select all that apply.) a. Asthma b. Hypertension c. Dyslipidemia d. Irritable bowel disease e. Altered glucose metabolism ANS: B, C, E Overweight youth have increased risk for a cluster of cardiovascular factors that include hypertension, altered glucose metabolism, and dyslipidemia. Irritable bowel disease and asthma are not linked to obesity. DIF: Cognitive Level: Applying REF: p. 3 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance 8. The nurse is reviewing the Healthy People 2020 leading health indicators for a child health promotion program. Which are included in the leading health indicators? (Select all that apply.) a. Decrease tobacco use. b. Improve immunization rates. c. Reduce incidences of cancer. d. Increase access to health care. e. Decrease the number of eating disorders. ANS: A, B, D The Healthy People 2020 leading health indicators provide a framework for identifying essential components for child health promotion programs designed to prevent future health problems in our nation’s children. Some of the leading health indicators include decreasing tobacco use, improving immunization rates, and increasing access to health care. Reducing the incidence of cancer and decreasing the number of eating disorders are not on the list as leading health indicators. DIF: Cognitive Level: Analyzing REF: p. 2 TOP: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 9. Which actions by the nurse demonstrate clinical reasoning? (Select all that apply.) a. Basing decisions on intuition b. Considering alternative action c. Using formal and informal thinking to gather data d. Giving deliberate thought to a patient’s problem e. Developing an outcome focused on optimum patient care ANS: B, C, D, E Clinical reasoning is a cognitive process that uses formal and informal thinking to gather and analyze patient data, evaluate the significance of the information, and consider alternative actions. Clinical reasoning is a complex developmental process based on rational and deliberate thought and developing an outcome focused on optimum patient care. Clinical reasoning is based on the scientific method of inquiry; it is not based solely on intuition. DIF: Cognitive Level: Applying REF: p. 12 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment COMPLETION 1. The nurse is determining if a newborn is classified in the low birth weight (LBW) category of less than 2500 g. The newborn’s weight is 5 lb, 4 oz. What is the newborn’s weight in grams? Record your answer in a whole number. __________________ ANS: 2386 Convert the 4 oz to a decimal by dividing 4 by 16 = 0.25. Use 5.25 lb and divide by 2.2 to get 2.386 kg. Multiply by 1000 to convert to grams = 2386. DIF: Cognitive Level: Applying REF: p. 3 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance MATCHING The nursing process is a method of problem identification and problem solving that describes what the nurse actually does. Match each step of the nursing process with its definition. a. Assessment b. Diagnosis c. Outcomes identification d. Planning e. Implementation f. Evaluation 1. Problem identification 2. Expected patient goals 3. Purposeful collection of data 4. Development of a care plan 5. Determines if the outcome was met 6. Interventions are put into action 1. ANS: B DIF: Cognitive Level: Understanding REF: p. 13 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 2. ANS: C DIF: Cognitive Level: Understanding REF: p. 13 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 3. ANS: A DIF: Cognitive Level: Understanding REF: p. 13 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 4. ANS: D DIF: Cognitive Level: Understanding REF: p. 13 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 5. ANS: F DIF: Cognitive Level: Understanding REF: p. 14 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 6. ANS: E DIF: Cognitive Level: Understanding REF: p. 14 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance Ethical dilemmas arise when competing moral considerations underlie various alternatives. Match each competing moral value with its definition. a. Autonomy b. Nonmaleficence c. Beneficence d. Justice 7. The obligation to promote the patient’s well-being 8. The obligation to minimize or prevent harm 9. The patient’s right to be self-governing 10. The concept of fairness 7. ANS: C DIF: Cognitive Level: Understanding REF: p. 11 TOP: Integrated Process: Caring MSC: Client Needs: Health Promotion and Maintenance 8. ANS: B DIF: Cognitive Level: Understanding REF: p. 11 TOP: Integrated Process: Caring MSC: Client Needs: Health Promotion and Maintenance 9. ANS: A DIF: Cognitive Level: Understanding REF: p. 11 TOP: Integrated Process: Caring MSC: Client Needs: Health Promotion and Maintenance 10. ANS: D DIF: Cognitive Level: Understanding REF: p. 11 TOP: Integrated Process: Caring MSC: Client Needs: Health Promotion and Maintenance 02: Social, Cultural, Religious, and Family Influences on Child Health Promotion Chapter 02: Social, Cultural, Religious, and Family Influences on Child Health Promotion MULTIPLE CHOICE 1. Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined? a. Ethnicity b. Racial variation c. Status d. Geographic boundaries ANS: C Status is culturally determined and varies according to each culture. Some cultures ascribe higher status to age or socioeconomic position. Social roles also are influenced by the culture. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. It is one component of culture. Race and culture are two distinct attributes. Whereas racial grouping describes transmissible traits, culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries, but the boundaries are not culturally determined. DIF: Cognitive Level: Analyzing REF: p. 39 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 2. The nurse is aware that if patients’ different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what? a. Acculturation b. Ethnocentrism c. Cultural shock d. Cultural sensitivity ANS: B Ethnocentrism is the belief that one’s way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one’s ethnic group are superior to those of others. Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Cultural sensitivity, a component of culturally competent care, is an awareness of cultural similarities and differences. DIF: Cognitive Level: Understanding REF: p. 35 TOP: Integrated Process: Caring MSC: Client Needs: Psychosocial Integrity 3. Which term best describes the sharing of common characteristics that differentiates one group from other groups in a society? a. Race b. Culture c. Ethnicity d. Superiority ANS: C Ethnicity is a classification aimed at grouping individuals who consider themselves, or are considered by others, to share common characteristics that differentiate them from the other collectivities in a society, and from which they develop their distinctive cultural behavior. Race is a term that groups together people by their outward physical appearance. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Superiority is the state or quality of being superior; it does not apply to ethnicity. DIF: Cognitive Level: Understanding REF: p. 39 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 4. After the family, which has the greatest influence on providing continuity between generations? a. Race b. School c. Social class d. Government ANS: B Schools convey a tremendous amount of culture from the older members to the younger members of society. They prepare children to carry out the traditional social roles that will be expected of them as adults. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize race as a distinct human type; although race may have an influence on childrearing practices, its role is not as significant as that of schools. Social class refers to the family’s economic and educational levels. The social class of a family may change between generations. The government establishes parameters for children, including amount of schooling, but this is usually at a local level. The school culture has the most significant influence on continuity besides family. DIF: Cognitive Level: Remembering REF: p. 33 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 5. The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal? a. Adapt, as necessary, ethni c practices to health needs. b. Attempt, in a nonjudgmental way, to change ethnic beliefs. c. Encourage continuation of ethnic practices in the hospital setting. d. Strive to keep ethnic background from influencing health needs. ANS: A Whenever possible, nurses should facilitate the integration of ethnic practices into health care provision. The ethnic background is part of the individual; it should be difficult to eliminate the influence of ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting. DIF: Cognitive Level: Applying REF: p. 34 TOP: Integrated Process: Caring MSC: Client Needs: Psychosocial Integrity 6. The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child’s mother says she has rubbed the edge of a coin on her child’s oiled skin. The nurse should recognize this as what? a. Child abuse b. Cultural practice to rid the body of disease c. Cultural practice to treat enuresis or temper tantrums d. Child discipline measure common in the Vietnamese culture ANS: B This is descriptive of coining. The welts are created by repeatedly rubbing a coin on the child’s oiled skin. The mother is attempting to rid the child’s body of disease. Coining is a cultural healing practice. Coining is not specific for enuresis or temper tantrums. This is not child abuse or discipline. DIF: Cognitive Level: Understanding REF: p. 41 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 7. A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this? a. The parent is trying to feed the child only what the child likes most. b. Hispanics believe the “evil eye” enters when a person gets cold. c. The parent is trying to restore normal balance through appropriate “hot” remedies. d. Hispanics believe an innate energy called chi is strengthened by eating soup. ANS: C In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are “cold” conditions and are treated with “hot” foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy. DIF: Cognitive Level: Applying REF: p. 40 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 8. How is family systems theory best described? a. The family is viewed as the sum of individual members. b. A change in one family member cannot create a change in other members. c. Individual family members are readily identified as the source of a problem. d. When the family system is disrupted, change can occur at any point in the system. ANS: D Family systems theory describes an interactional model. Any change in one member will create change in others. Although the family is the sum of the individual members, family systems theory focuses on the number of dyad interactions that can occur. The interactions, not the individual members, are considered to be the problem. DIF: Cognitive Level: Analyzing REF: p. 18 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 9. Which family theory is described as a series of tasks for the family throughout its life span? a. Exchange theory b. Developmental theory c. Structural - functional theory d. Symbolic interactional theory ANS: B In developmental systems theory, the family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Exchange theory assumes that humans, families, and groups seek rewarding statuses so that rewards are maximized while costs are minimized. Structural-functional theory states that the family performs at least one societal function while also meeting family needs. Symbolic interactional theory describes the family as a unit of interacting persons with each occupying a position within the family. DIF: Cognitive Level: Remembering REF: p. 19 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 10. Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Family stress theory c. Erikson’s psychosocial theory d. Developmental systems theory ANS: B Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Erikson’s theory applies to individual growth and development, not families. Developmental systems theory is an outgrowth of Duvall’s theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. DIF: Cognitive Level: Remembering REF: p. 19 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 11. Which type of family should the nurse recognize when the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Extended d. Binuclear ANS: C An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, stepsibling, or half-sibling. A nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. DIF: Cognitive Level: Remembering REF: pp. 20-21 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 12. Which type of family should the nurse recognize when a mother, her children, and a stepfather live together? a. Traditional nuclear b. Blended c. Extended d. Binuclear ANS: B A blended family contains at least one stepparent, stepsibling, or half-sibling. A traditional nuclear family consists of a married couple and their biologic children. No other relatives or nonrelatives are present in the household. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children. DIF: Cognitive Level: Remembering REF: p. 20 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 13. Which is an accurate description of homosexual (or gay-lesbian) families? a. A nurturing environment is lacking. b. The children become homosexual like their parents. c. The stability needed to raise healthy children is lacking. d. The quality of parenting is equivalent to that of nongay parents. ANS: D Although gay or lesbian families may be different from heterosexual families, the environment can be as healthy as any other. Lacking a nurturing environment and stability is reflective on the parents and family, not the type of family. There is little evidence to support that children become homosexual like their parents. DIF: Cognitive Level: Understanding REF: pp. 21-22 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 14. The nurse is teaching a group of new nursing graduates about identifiable qualities of strong families that help them function effectively. Which quality should be included in the teaching? a. Lack of congruence among family members b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with d. Sense of commitment toward growth of individual family members as opposed to that of th ANS: B A clear set of family rules, values, and beliefs that establish expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Varied coping strategies are used by strong families. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit. DIF: Cognitive Level: Applying REF: p. 22 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 15. When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called which? a. Permissive b. Dictatorial c. Democratic d. Authoritarian ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children’s actions. Dictatorial or authoritarian parents attempt to control their children’s behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children’s behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect their children’s individual natures. DIF: Cognitive Level: Remembering REF: p. 24 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 16. When discussing discipline with the mother of a 4-year-old child, which should the nurse include? a. Parental control should be consistent. b. Withdrawal of love and approval is effective at this age. c. Children as young as 4 years rarely need to be disciplined. d. One should expect rules to be followed rigidly and unquestioningly. ANS: A For effective discipline, parents must be consistent and must follow through with agreed-on actions. Withdrawal of love and approval is never appropriate or effective. The 4-year-old child will test limits and may misbehave. Children of this age do not respond to verbal reasoning. Realistic goals should be set for this age group. Discipline is necessary to reinforce these goals. Discipline strategies should be appropriate to the child’s age and temperament and the severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old child. DIF: Cognitive Level: Applying REF: p. 24 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 17. Which is a consequence of the physical punishment of children, such as spanking? a. The psychologic impact is usually minimal. b. The child’s development of reasoning increases. c. Children rarely become accustomed to spanking. d. Misbehavior is likely to occur when parents are not present. ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake but rather out of fear of punishment. Spanking can cause severe physical and psychologic injury and interfere with effective parent – child interaction. The use of corporal punishment may interfere with the child’s development of moral reasoning. Children do become accustomed to spanking, requiring more severe corporal punishment each time. DIF: Cognitive Level: Analyzing REF: p. 26 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 18. The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include? a. Send the child to his or her room if the child has one. b. A general rule for length of time is 1 hour per year of age. c. Select an area that is safe and nonstimulating, such as a hallway. d. If the child cries, refuses, or is more disruptive, try another approach. ANS: C The area must be nonstimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The child’s room may have toys and activities that negate the effect of being separated from the family. The general rule is 1 minute per year of age. An hour per year is excessive. When the child cries, refuses, or is more disruptive, the time-out does not start; the time-out begins when the child quiets. DIF: Cognitive Level: Remembering REF: p. 26 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 19. A 3-year-old child was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guideline concerning adoption should the nurse use in planning a response? a. It is best to wait until the child asks about it. b. The best time to tell the child is between the ages of 7 and 10 years. c. It is not necessary to tell a child who was adopted so young. d. Telling the child is an important aspect of their parental responsibilities. ANS: D It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child’s identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to prevent third parties from telling the children before the parents have had the opportunity. DIF: Cognitive Level: Analyzing REF: p. 27 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 20. Children may believe that they are responsible for their parents’ divorce and interpret the separation as punishment. At which age is this most likely to occur? a. 1 year b. 4 years c. 8 years d. 13 years ANS: B Preschool-age children are most likely to blame themselves for the divorce. A 4-year- old child will fear abandonment and express bewilderment regarding all human relationships. A 4-year-old child has magical thinking and believes his or her actions cause consequences, such as divorce. For infants, divorce may increase their irritability and interfere with the attachment process, but they are too young to feel responsibility. School-age children will have feelings of deprivation, including the loss of a parent, attention, money, and a secure future. Adolescents are able to disengage themselves from the parental conflict. DIF: Cognitive Level: Analyzing REF: p. 29 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 21. A parent of a school-age child tells the school nurse that the parents are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as what? a. Indicative of maladjustment b. A common reaction to divorce c. Suggestive of a lack of adequate parenting d. An unusual response that indicates a need for referral ANS: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. The child’s responses are common reactions of school-age children to parental divorce. DIF: Cognitive Level: Applying REF: p. 29 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 22. A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, “I want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.” Which is the nurse’s most appropriate answer? a. “ I’m sure he’ll be fine if you get a good babysitter.” b. “ You will need to stay home until Eric starts school.” c. “ Let’s talk about the child care options that will be best for Eric.” d. “ You should go back to work so Eric will get used to being with others.” ANS: C Asking the mother about child care options is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. The other three answers are directive; they do not address the effect that her working will have on Eric. DIF: Cognitive Level: Applying REF: p. 32 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 23. A foster parent is talking to the nurse about the health care needs for the child who has been placed in the parent’s care. Which statement best describes the health care needs of foster children? a. Foster children always come from abusive households and are emotionally fragile. b. Foster children tend to have a higher than normal incidence of acute and chronic health pro c. Foster children are usually born prematurely and require technologically advanced health c d. Foster children will not stay in the home for an extended period, so health care needs are no emotional fulfillment. ANS: B Children who are placed in foster care have a higher incidence of acute and chronic health problems and may experience feelings of isolation and confusion; therefore, they should be monitored closely. Foster children do not always come from abusive households and may or may not be emotionally fragile; not all foster children are born prematurely or require technically advanced health care; and foster children may stay in the home for extended periods, so their health care needs require attention. DIF: Cognitive Level: Applying REF: p. 32 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 24. The nurse is planning to counsel family members as a group to assess the family’s group dynamics. Which theoretic family model is the nurse using as a framework? a. Feminist theory b. Family stress theory c. Family systems theory d. Developmental theory ANS: C In family systems theory, the family is viewed as a system that continually interacts with its members and the environment. The emphasis is on the interaction between the members; a change in one family member creates a change in other members, which in turn results in a new change in the original member. Assessing the family’s group dynamics is an example of using this theory as a framework. Family stress theory explains how families react to stressful events and suggests factors that promote adaptation to stress. Developmental theory addresses family change over time using Duvall’s family life cycle stages based on the predictable changes in the family’s structure, function, and roles, with the age of the oldest child as the marker for stage transition. Feminist theories assume that privilege and power are inequitably distributed based upon gender, race, and class. DIF: Cognitive Level: Applying REF: p. 18 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 25. The nurse is reviewing the importance of role learning for children. The nurse understands that children’s roles are primarily shaped by which members? a. Peers b. Parents c. Siblings d. Grandparents ANS: B Children’s roles are shaped primarily by the parents, who apply direct or indirect pressures to induce or force children into the desired patterns of behavior or direct their efforts toward modification of the role responses of the child on a mutually acceptable basis. DIF: Cognitive Level: Analyzing REF: pp. 22-23 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 26. The nurse is caring for an adolescent hospitalized for asthma. The adolescent belongs to a large family. The nurse recognizes that the adolescent is likely to relate to which group? a. Pe ers b. Parents c. Siblings d. Teachers ANS: A Adolescents from a large family are more peer oriented than family oriented. Adolescents in small families identify more strongly with their parents and rely more on them for advice. DIF: Cognitive Level: Understanding REF: p. 23 TOP: Integrated Process: Caring MSC: Client Needs: Psychosocial Integrity 27. The nurse is explaining different parenting styles to a group of parents. The nurse explains that an authoritative parenting style can lead to which child behavior? a. Shyness b. Self - reliance c. Submissiveness d. Self - consciousness ANS: B Children raised by parents with an authoritative parenting style tend to have high self- esteem and are self-reliant, assertive, inquisitive, content, and highly interactive with other children. Children raised by parents with an authoritarian parenting style tend to be sensitive, shy, self-conscious, retiring, and submissive. DIF: Cognitive Level: Applying REF: p. 24 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Psychosocial Integrity 28. Parents of a preschool child ask the nurse, “Should we set rules for our child as part of a discipline plan?” Which is an accurate response by the nurse? a. “ It is best to delay the punishment if a rule is broken.” b. “ The child is too young for rules. At this age, unrestricted freedom is best.” c. “ It is best to set the rules and reason with the child when the rules are broken.” d. “ Set clear and reasonable rules and expect the same behavior regardless of the circumstanc ANS: D Nurses can help parents establish realistic and concrete “rules.” The clearer the limits that are set and the more consistently they are enforced, the less need there is for