Chapter 1: Traditional and Community Nursing Care for Women, Families, and Children

MULTIPLE CHOICE

	1.	The clinic nurse understands the new description of nursing art/aesthetics as the way that nurses and patients help each other through a circular process. What is the event that begins this process?
A.	A health threat	
B.	Experiencing new possibilities for health	
C.	Hope and understanding for the future	
D.	Relationship building	

ANS:	A
Nursing aesthetics consists of the low-tech, high-touch caring in a nurse–patient encounter. This transformative process begins with a health threat. The event that begins the process is not experiencing new possibilities for health, hope and understanding for the future, or relationship building.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Caring
Difficulty: Moderate

PTS:	1

	2.	A nurse manager in a community clinic is concerned because the local refugee population does not seek health care routinely. What action by the nurse would be most helpful?
A.	Assess clinic staff and procedures for evidence of ethnocentrism.	
B.	Put up flyers advertising the clinic’s services in local retailers.	
C.	Reward preventative health patients with coupons for needed items.	
D.	Try to meet with community leaders to work on the problem.	

ANS:	A
Ethnocentrism is the view that the beliefs, values, and behaviors of one culture are superior to those of other cultures. Ethnocentrism is dangerous in health care because it is blind to the possibilities of other solutions and viewpoints and alienates people in need of health care. The nurse manager would be wise to assess the clinic’s staff and procedures for ethnocentrism. Meeting with a community leader is always a good idea to learn the viewpoints of the community, but unless ethnocentric behaviors change, it is unlikely that the refugee community will increase its use of the clinic. Flyers and incentives may also be helpful in some cases, but not as helpful as reducing the barriers imposed by ethnocentrism. 

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Caring
Difficulty: Moderate

PTS:	1

	3.	The nursing faculty explains to students that ethnopluralism is an important force shaping health care today. What concept is most important in understanding this trend?
A.	The decreased need for cultural competency	
B.	The growth in one ethnic group in a single area	
C.	The increased impact of diverse cultures on health care	
D.	The percentage increase of the non-Caucasian population	

ANS:	C
Ethnopluralism means diverse cultures. As the population of different ethnic (non-Euro-Caucasian) groups grows, their impact on health care will increase exponentially. Ethnopluralism is not just the growth of one ethnic group in one location. It is also more than just the percentage change in the non-Euro-Caucasian population, although that is part of the phenomenon. As ethnopluralism continues to impact health care, providers will need to be more, not less, culturally competent.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS:	1

	4.	A nursing faculty member is explaining recent shifts in nursing practice. What change has been important in applying the nursing process?
A.	A change to a spiral or circular process	
B.	A focus on more independent nursing actions	
C.	A return to the nurse-as-expert model of care	
D.	An emphasis on attaining a disease-free state	

ANS:	A
The nursing process has recently changed from a linear one to a spiral or circular process in which the patient/family is motivated toward promotion, maintenance, and restoration of health. The focus has not changed to include more independent actions, a return to the nurse-as-expert model, or an emphasis on attaining a disease-free state of being.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS:	1

	5.	A nurse is working in an urban clinic with a diverse population. What action by the nurse is most important?
A.	Determine patients’ definitions of health and desired outcomes of health care.	
B.	Explain policies such as appointment cancellations to ensure compliance.	
C.	Learn to speak one or two common languages of the patients in the clinic.	
D.	Read about different folk remedies common among the populations seen.	

ANS:	A
Divergent populations enter the health-care system with differing beliefs about health care and wellness and differing expectations for the outcomes of such experiences. Understanding these expectations will help the nurse plan care that has a better chance of meeting these expectations. Learning languages and becoming familiar with folk remedies is helpful as well, but these two solutions are very limited in scope and a nurse cannot hope to become proficient in all the languages/behaviors of every population seen, leaving some patients with a lessened experience. Explaining policies is important too, but simply telling someone the rules does not take his or her cultural norms into account and may not be successful.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS:	1

	6.	A nurse is working with a minority group that has a high incidence of cardiovascular disease, including hypertension and stroke. When participating in a community health fair with this group, what action by the nurse will be most effective?
A.	Educate the participants about weight loss and a low-sodium, low-fat diet.	
B.	Explain the genetic basis for the high incidence of cardiovascular disease in the group.	
C.	Help participants make lifestyle changes that are culturally congruent.	
D.	Present statistics on the mortality and morbidity of cardiovascular disease.	

ANS:	C
The ever-increasing culturally diverse population interacting with the health-care system brings its own beliefs, values, and health-related practices that impact health and well-being. In order to help people make healthy lifestyle changes, the changes must be culturally congruent and acceptable. Forcing an incongruent practice makes it highly unlikely to succeed. Education is important, but it must be done in a culturally congruent way. Pathophysiology and statistical knowledge, by itself, is not likely to be beneficial. 

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS:	1

	7.	What does the practicing nurse understand to be the most important influence on interdependent, assertive nursing practice today?
A.	Higher education of registered nurses	
B.	Improved working conditions and salaries	
C.	Increased numbers of female physicians	
D.	Use of the nursing process for patient care	

ANS:	D
Nurses were passive, deferential, and compliant to the knowledge and orders of mostly male physicians until the late 20th century. The nursing process changed that. The nursing process is a framework for systematic problem solving and implementation of both independent and dependent nursing actions. The nursing process allows nurses to make decisions regarding patient care based on critical thinking and clinical judgment. The other options listed were not vital in creating a nursing practice that is interdependent and assertive. 

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Nursing Process 
Difficulty: Difficult

PTS:	1

	8.	A child who has been hospitalized for a long time is preparing to go home, where care will be continued. Which action by the nurse is most beneficial to assist the family in this transition?
A.	Advise the family to call the local visiting nurses association for home visits.	
B.	Call the child’s school to inquire about requirements for returning to school.	
C.	Consult a social worker to help evaluate insurance coverage and transportation.	
D.	Give the family brochures for the local support group for chronically ill children.	

ANS:	C
Preparing a family for home-based care, or other community-based care, involves ensuring that the family is able to provide the care needed by the child at home or in another setting. This can include discussing specialized equipment in the home, health insurance coverage, transportation, and/or returning to school. If the family needs or desires visiting nurses, the nursing staff or social worker at the hospital should arrange this for the family. Calling the school to get information about the child’s return to school yields helpful information, but may not be needed yet, and is too limited in scope to be the best answer. Simply giving parents brochures for support groups may or may not be helpful; the parents may not be literate or may not understand the benefit without discussion.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Communication and Documentation
Difficulty: Difficult

PTS:	1

	9.	A nurse manager wants to make the pediatric clinic a more family-centered health-care setting. Which of the following actions by the nursing staff would best meet this goal?
A.	Encourage family members to be present in the exam room and to ask questions.	
B.	Incorporate the use of a community health map for all new patients in the clinic.	
C.	Recognize family members as experts on their child and incorporate them in decision making.	
D.	Use evidence-based practice to develop policies and procedures used in the clinic.	

ANS:	C
The role of the family-centered nurse is to facilitate and assist the family in making informed choices that lead to the outcome the patient and family desire. This requires the nurse to give up the paternalistic role of authority on health care. The family knows the child best and should be assumed to make decisions that are in the best interests of both child and family. The other options are all good interventions, but are too limited in scope to be the best way to create a family-centered environment. 

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Difficult

PTS:	1

	10.	A clinic nurse is explaining to a student nurse the function of the community health map in assessing families. Which description of this assessment tool is most accurate?
A.	It assesses how the family interacts with outside social systems.	
B.	It locates health-care settings in, or close to, their neighborhood.	
C.	It outlines family problems and social resources to help with them.	
D.	It shows how the health of the community impacts each family.	

ANS:	A
A community health map is an assessment tool for family structure, function, and support networks. It displays significant related data and helps the nurse focus on the family as it interacts with the social systems within and around the family. Its purpose is not to locate local health-care settings. The focus is on family health and past successes and current strengths, not on family problems. Correlations can be made between the health of the community and the health of those living in that community, but this is not the purpose of the community health map.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS:	1

	11.	A nurse wishes to improve his or her cultural sensitivity while working with patients. Which action by the nurse would best indicate progress toward this goal?
A.	Demonstrate good knowledge of different cultural health beliefs	
B.	Effectively respond to the needs of people of different cultures	
C.	Interact respectfully with patients who have differing health beliefs	
D.	Recognizes that he or she will never be the expert in other cultures	

ANS:	C
Cultural sensitivity is a way of approaching people who hold health beliefs different from one’s own. A nurse with this characteristic is respectful of and open to others. Cultural competence is the ability to interact effectively with people of different cultures and requires a certain level of knowledge about those cultures. Cultural humility is the recognition that one will never master all information about another culture. 

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Difficult

PTS:	1

	12.	A nurse manager is evaluating staff members on their cultural competence. Which action best demonstrates this characteristic?
A.	Attends workshops on cultural diversity and health practices	
B.	Participates in community health events with minority populations	
C.	Plans care with the family members within their cultural beliefs	
D.	Uses family members as interpreters to make them feel important	

ANS:	C
The culturally sensitive nurse is able to understand and respond to the needs of individuals and families from different cultures. This nurse plans interventions with a solid knowledge of the values and practices of the members of the culture. Being open, listening to the family, and involving them in care demonstrates respect, unifies the nurse–patient relationship, and will motivate the patient (and family) to make positive health changes. Attending workshops is a good way to learn about diverse cultures and attending community events with diverse populations can increase cultural knowledge, but these actions are too limited in scope to demonstrate cultural competence. Nurses should use professional interpreters when needed.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Difficult

PTS:	1

	13.	A nurse is incorporating a cultural assessment into nursing care. Which assessment question by the nurse leads the supervisor to conclude that this nurse needs further education on cultural assessment?
A.	What customs and traditions are important to you?	
B.	What kind of insurance coverage do you have?	
C.	When you are stressed or worried, what comforts you?	
D.	Who in your family is important for support?	

ANS:	B
Cultural influences include family support systems, religious and spiritual beliefs, customs and traditions, communication patterns, coping strategies, and problem-solving techniques. Asking about insurance coverage is not directly related to culture, although this can give information about the patient/family’s living environment and ability to access resources. 

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS:	1

	14.	A nurse is working with a cultural group that has many proscriptions against women seeking health care. What action by women in this community would indicate that they have successfully negotiated a new role in seeking care?
A.	Are able to make and keep medical appointments	
B.	Can afford to pay for desired health-care services	
C.	Follow their traditional roles and responsibilities	
D.	Seek health-care advice from family members	

ANS:	A
Cultural proscriptions are beliefs, practices, and values of a group that tell women and children what they should not do. In many traditional cultures, women do not have permission, decision-making power, or means to access the health-care system. If the women from such a culture successfully negotiate their roles regarding health care, they can access the health-care system on their own. The ability to afford services is not related, although cultural proscriptions might forbid women from making such a transaction. If they follow their traditional roles or seek health care from family members, they have not demonstrated a successful negotiation of a new role.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Caring
Difficulty: Difficult

PTS:	1

	15.	A patient wishes to use complementary therapy when managing a chronic health condition. Which action by the nurse is most appropriate?
A.	Advise the patient that stopping medical treatment may cause it to worsen.	
B.	Inform the patient that there are no complementary therapies for this condition.	
C.	Investigate herbs that can be substituted for prescription drugs.	
D.	Suggest the patient add massage therapy to the medical regimen.	

ANS:	D
Complementary therapy is nontraditional treatment that is used in addition to traditional medical care. Alternative therapies are used in place of traditional therapies. Adding massage to the medical regimen is an example of using complementary therapy. Substituting herbs for prescription medication is an example of alternative therapy. Because the patient is asking about complementary therapy, there is no need to warn him or her of the effects of stopping treatment. There are always complementary therapies that can be added to a medical regimen. 

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS:	1

	16.	A nurse is working with a family that uses multiple complementary and alternative medicine (CAM) modalities. What action by the nurse is best?
A.	Allow the family to continue these practices as desired.	
B.	Assess how these practices reflect religious beliefs.	
C.	Inform the family that most of these practices do not work.	
D.	Provide evidence-based information about the therapies.	

ANS:	D
The nurse working with individuals or families who use CAM practices should respect the beliefs, values, and desires of the patient. The nurse should encourage families to make decisions regarding CAM practices based on evidence and research into their effects. The nurse can best assist in this by providing and discussing information. Although the nurse cannot stop the family from using CAM, he or she should not pass up the teaching opportunity. Many CAM practices have demonstrated benefit, so telling the family they don’t work is false information. A culturally competent nurse will assess how religious and spiritual beliefs affect health-care practices, but the nurse needs to advocate for the patient/family by providing solid information. 

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS:	1

	17.	A nurse acting in the role of teacher is determining learning outcomes. Which action will produce the best outcomes for teaching?
A.	Collaborate with the discharge planner on outcomes.	
B.	Determine the teaching priority, then establish the outcome.	
C.	Develop outcomes mutually agreed on with the patient.	
D.	Enlist other staff members to help prioritize outcomes.	

ANS:	C
The best nursing care (including teaching) is a collaborative effort between nurse and patient. Each participant has knowledge and shares the power of determining what is to be learned. The best outcomes result in patient cooperation, because the patient was instrumental in developing them. The other actions might be helpful in specific situations, but involving the patient (or family) is always appropriate and vital. 

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS:	1

	18.	A nurse uses Nightingale’s theory of nursing to pattern care for patients. Which action by the nurse is most consistent with this theory?
A.	Does for the patient what he or she is unable to do for self	
B.	Focuses patient interactions on caring, healing, and wholeness	
C.	Keeps patient’s room clean and ensures good nutrition	
D.	Incorporates culturally relevant actions in a caring encounter	

ANS:	C
Nightingale focused on the spiritual, physical/environmental, emotional, mental, and social needs of the patient. A major area of emphasis was on improving the patient’s environment (internal and external). For this theorist, the base of nursing practice centered around observation, knowledge of sanitation, nutrition, caring, and compassion. The action most closely associated with Nightingale would be keeping the patient’s room clean and ensuring the patient gets good nutrition. A focus on caring, healing, and wholeness-centered interactions is reflective of Jean Watson’s theory. Incorporation of culture into nursing care reflects the theory of Leininger. Although not mentioned in the text, doing for others what they would do for themselves, if able, is the basis of Dorothea Orem’s self-care theory.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS:	1

	19.	An inpatient nursing unit uses Madeleine Leininger’s theory to organize nursing care. The manager would conclude that a new nurse has successfully integrated this theory into practice when the nurse does which of the following actions?
A.	Emphasizes caring over curing in nursing actions	
B.	Establishes trusting relationships with patients	
C.	Knows the cultural practices of many different groups	
D.	Organizes environmental factors for the patient’s benefit	

ANS:	B
Establishing a trusting nurse–patient relationship is at the core of Leininger’s theory. In order to understand another person’s cultural beliefs, values, methods of providing or showing caring, causes of illness, and how wellness is achieved, the nurse must first establish a trusting relationship with the patient so the patient feels free to share. This is an ongoing process. The emphasis on caring over curing is part of Watson’s theory. Knowing the practices of several different cultural groups would be a valuable asset, but is not required for Leininger’s theory. Organizing the environment to benefit the patient is part of Nightingale’s theory.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Difficult

PTS:	1

	20.	A nurse uses Watson’s theory as a framework for nursing practice. Which nursing action best demonstrates the use of this theory?
A.	Actively clarifies the patient’s health beliefs and practices	
B.	Allows children to visit an ill parent despite visitation restrictions	
C.	Assesses both the physical and spiritual dimensions of the patient	
D.	Ensures the patient is neither too warm nor too hot for comfort	

ANS:	C
Jean Watson contends that caring as a nurse requires the nurse to pay attention to both the physical and spiritual dimensions of the patient. Clarifying health beliefs and practices is more related to Leininger’s theory. Allowing children to visit despite restrictions is a caring action, but is not tied to a specific theory. Manipulating the environment for patient comfort and well-being is a core component of Nightingale’s theory.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Moderate

PTS:	1

	21.	A nursing manager wants to increase the staff’s attention to patients’ spirituality. Which action by a nurse would best demonstrate this concept?
A.	Asked about the patient’s religion	
B.	Assessed the patient’s meaning of life	
C.	Consulted a chaplain for a patient case	
D.	Inquired about religious rituals in health	

ANS:	B
Spirituality does not necessarily equate with religion; it is more a concept related to a person’s beliefs about the meaning of life. Although all actions might be incorporated in a comprehensive discussion of spirituality, the best demonstration of attention to this characteristic is inquiring about the meaning the patient ascribes to life.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Difficult

PTS:	1

	22.	A nurse is demonstrating the professional role of provider of care to a nursing student. Which action by the nurse is most relevant to this professional role?
A.	Assesses the patient’s priority physical needs	
B.	Gives the patient a bath instead of delegating it	
C.	Supervises unlicensed assistive personnel	
D.	Uses monitoring and IV equipment correctly	

ANS:	D
One of the major responsibilities of the nurse as provider of care is to maintain competency in using monitoring and therapeutic equipment. This is a vital safety measure for the patient. The nurse as provider of care should assess all of the patient’s physical, psychosocial, and spiritual needs, not just the priority physical needs. Supervising other personnel may or may not be part of a nurse’s job description. Choosing to delegate an activity is not a core role of the provider of care. 

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS:	1

	23.	A nurse is caring for a patient from a culture with which the nurse is totally unfamiliar. What action by the nurse will best promote effective communication?
A.	Call for a professional interpreter to translate information.	
B.	Pattern voice tone and eye contact after the patient’s behaviors.	
C.	Talk slowly and deliberately using simple language and cues.	
D.	Use nonverbal communication as much as possible with the patient.	

ANS:	B
In the situation where the nurse is unfamiliar with the patient’s culture, the nurse should pattern verbal and nonverbal communication after the patient’s own style. There is no indication that this patient does not speak English, so using an interpreter, talking slowly using simple language, and using mostly nonverbal communication is inappropriate. 

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Difficulty: Difficult

PTS:	1

	24.	A nurse has been teaching a patient who seems impatient and does not retain much of what is taught. What action by the nurse would be best to facilitate the patient’s learning?
A.	Assess for unmet personal needs such as pain or hunger.	
B.	Determine why the patient is being uncooperative.	
C.	Give information in writing and let the patient read it.	
D.	Stop the teaching session and return at a later time.	

ANS:	A
Learning is not likely to be effective if the patient has unmet basic human needs such as hunger, pain, a full bladder, or fear. The nurse should assess for those needs and meet them before continuing. Labeling a patient as uncooperative is counterproductive and judgmental and does nothing to enlist the patient’s cooperation. Written information (if the patient is literate) is always a good idea, but doing nothing more than that will not improve the patient’s learning when basic needs are unmet. Returning at a later time also does not meet the patient’s needs.

Cognitive Level: Applying/Application
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Basic Care and Comfort
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS:	1

	25.	A nurse manager expects all employees to be patient advocates. Which nursing action best demonstrates this nursing role?
A.	Arranging a family–physician conference to clarify treatment plans	
B.	Encouraging treatment options based on personal beliefs and values	
C.	Giving contact information for governmental assistance agencies	
D.	Working on a political campaign to reduce poverty in the state	

ANS:	A
In the advocate role, the nurse should promote patient-/family-centered care and work to provide the patient with more control, power, and self-determination in the health-care setting. The nurse who arranges a family–physician conference to clarify treatment plans is advocating for the patient. Giving contact information for assistance agencies and working on political campaigns are also ways of demonstrating advocacy, but are too limited in scope to be the best answer. The nurse advocate must ensure he or she is speaking for the patient and the patient’s desires, not inserting personal values and beliefs into the process.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Caring
Difficulty: Difficult

PTS:	1

	26.	A nurse is describing the use of evidence-based practice (EBP) guidelines to a nursing student. Which explanation of EBP is most accurate?
A.	Includes clinical experience and patient preferences	
B.	MEDLINE used as the primary source for EBP information	
C.	Requires the staff to be active participants in research	
D.	Uses research findings to plan interventions for care	

ANS:	A
EBP combines investigational guidelines and scientifically sound interventions with clinical expertise and the patient’s values and preferences. MEDLINE is one of three primary sources for EBP information; the other two are the Cochrane Database of Systematic Reviews Library and the Agency for Healthcare Research and Quality. The staff members do not have to be actively involved in research to use EBP. Using research findings to plan interventions is part, but not all, of the EBP process. 

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS:	1

	27.	A nurse uses evidence-based practice (EBP) to plan and implement nursing care. What action by the nurse best demonstrates this process?
A.	Assesses, plans, implements, and evaluates nursing interventions	
B.	Incorporates specific research findings into the nursing care plan	
C.	Predicts and assesses for potential problems based on research	
D.	Uses a concept map for nursing care instead of a nursing care plan	

ANS:	C
The nurse who has incorporated EBP into nursing care is able to predict, and assess for, potential problems and complications because of knowledge of relevant research. Assessment, planning, implementation, and evaluating are steps in the traditional nursing process. Specific research findings do not need to be specifically incorporated into a nursing care plan and, in fact, without including clinical expertise and patient preferences, scientific findings are incomplete. A concept map is an alternative to the traditional nursing care plan. 

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS:	1

	28.	A patient and family have the nursing diagnosis of impaired verbal communication secondary to a language barrier. What action by the patient/family would best indicate that short-term goals for this diagnosis have been met?
A.	Able to communicate long-term desires for health of the patient	
B.	Demonstrates comprehension by head nodding and saying “yes”	
C.	States understanding of condition and treatment via an interpreter	
D.	Understands how nonverbal communication varies between cultures	

ANS:	C
For a language barrier, using a professional interpreter is not only the best way to manage communication, it is also legally required. The best short-term goal for the patient and family is to obtain understanding of the patient’s illness and treatment and state, through the interpreter, that this is the case. Communicating long-term desires is a better long-term outcome for this diagnosis. Nodding the head and saying “yes” do not always indicate agreement, understanding, or approval. In some cultures this behavior signifies respect. Understanding the differences in nonverbal communication between cultures is not an appropriate short-term goal.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS:	1

MULTIPLE RESPONSE

	1.	The perinatal nurse is aware of changes in women’s and children’s health-care settings that affect family care. What factors do these changes include? (Select all that apply.)
A.	A decreased pediatric patient population	
B.	A redesign of policies to include families	
C.	Development of alternative care sites	
D.	Increased liberalization of visiting policies	
E.	Increased patient acuity across all settings	

ANS:	B, C, D, E
Many changes have occurred across health-care settings that have affected family care. Hospitals have redesigned their policies to be family-friendly and have liberalized visiting policies to decrease stress on the family. Alternative care settings have been developed in part to combat escalating medical costs, and patients have high-acuity illnesses and needs across all of these settings. There has been no decrease in the population of pediatric patients.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Caring
Difficulty: Easy

PTS:	1

	2.	A nurse wishes to improve critical thinking skills. Which of the following actions would be helpful for this nurse? (Select all that apply.)
A.	Developing checklists for care activities	
B.	Listening intently for true understanding	
C.	Practicing new skills	
D.	Remaining nonobjective in patient encounters	
E.	Searching the literature for new information	

ANS:	B, C, D, E
Critical thinking evolves from experience, seeking knowledge, practicing skills, self-reflection, open-mindedness, calculated risk-taking, and devotion to listening with a goal of true comprehension and understanding. Making checklists is not part of critical thinking.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Caring
Difficulty: Moderate

PTS:	1

	3.	To be effective when providing information to a patient, the nurse should assess the patient for which of the following? (Select all that apply.)
A.	Cultural beliefs and values	
B.	Information desired	
C.	Preferred learning style	
D.	Level of understanding	
E.	Past medical history	

ANS:	A, B, C, D
An effective teacher should assess the patient’s cultural beliefs and values, information desired, preferred learning style, and level of current understanding before planning and implementing teaching. The patient’s past medical history is not essential information for teaching.
 
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS:	1

	4.	The nurse listens to a mother and her 4-year-old child as they communicate with each other primarily to determine which of the following? (Select all that apply.)
A.	Communication styles that need improvement	
B.	The child’s level of language development	
C.	The family’s culture and its influences	
D.	The family’s personal and group values	
E.	The family’s understanding of health care	

ANS:	B, C, D
Listening to the cultural voices and experiences of family and patients affirms their value and is critically important to unifying the nurse–patient relationship. This method of interaction allows the nurse to understand family values, family developmental aspects, and the family’s cultural aspects. It also motivates patient movement toward positive health-promoting activities. It is not primarily to determine areas for improvement, although the nurse may be able to role model better communication for a patient/family. Listening to communication is also not primarily to determine the family’s understanding of health care. 

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS:	1

	5.	The nurse mentor explains to the new nurse that multiple societal changes have given families greater power in health care. What changes have contributed to this shift? (Select all that apply.)
A.	Alternative community-based care sites	
B.	Costs of obtaining health care	
C.	Decreased health-care regulations	
D.	Multimedia information	
E.	Science and technology	

ANS:	A, B, D, E
The infusion of multiple cultures and beliefs about health-care systems, along with exponential growth in scientific and technologic capabilities, has been a major force in shaping the structure and delivery of nursing care. In addition, increased consumer access to health-related information through the Internet, mass media, and other sources that may or may not be accurate; the unprecedented rise in health-care costs; and the increasing imposition of cumbersome regulations have also contributed to change. Changes in care settings to include new community-based sites have also led to increased power for families/consumers and family-centered decision making. 

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS:	1

	6.	The nurse understands that changes in family characteristics are related to which of the following influences? (Select all that apply.)
A.	Birth control accessibility and knowledge	
B.	Decreased mobility of people	
C.	Increased feminist thinking	
D.	Increased number of women in the workforce	
E.	Mass media influences	

ANS:	A, C, D, E
Social and technological advances of the past half century have changed family structure, function, and definition. With the increasing acceptance and technological methods of birth control options made available to families since the 1970s, family size has also changed. The feminist movement of the 1970s sent large numbers of mothers outside the home and into the work environment. With increased population mobility and two-income families there are fewer support persons available than before, when living near a large extended family was the norm. Mass media is an important determinant of social behavior. 

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Caring
Difficulty: Easy

PTS:	1

	7.	The nurse recognizes that caring for patients and families is challenging due to which of the following factors? (Select all that apply.)
A.	Advances in medical care	
B.	Decreased cultural diversity	
C.	Decreased patient expectations	
D.	Increased technology development	
E.	Potential legal considerations	

ANS:	A, D, E
Advances in medical care, increased technology, and the potential for legal ramifications should nurses not use EBP and best-practice guidelines all increase the complexity and challenges in providing nursing care. Neither cultural diversity nor patient expectations are decreasing.
 
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Caring
Difficulty: Easy

PTS:	1

	8.	The perinatal nurse caring for a 24-year-old mother of an infant born at 26 weeks' gestation is providing discharge teaching. The patient is going to travel to the specialty center approximately 200 miles away, where her daughter is receiving care. The nurse tells the patient that it is normal for her to feel which emotions? (Select all that apply.)
A.	Afraid	
B.	Anxious	
C.	Guilty	
D.	In control	
E.	Overwhelmed	

ANS:	A, B, C, E
Separation of family members needing care in specialty or tertiary care settings often leads to feelings of anxiety, abandonment, fear, and guilt, all of which can be overwhelming in the setting of a serious physical illness in a family member. It would not be common for a family member to feel in control. 

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS:	1

	9.	The nurse working with patients understands that health promotion can include which of the following? (Select all that apply.)
A.	Belief in the power base of the patient	
B.	Changed attitude to one of meaningfulness	
C.	Nurse-defined state of unity and holism	
D.	Shared understanding of the health threat	
E.	Shared vision about hope for the future	

ANS:	A, B, D, E
Health promotion can and should include a belief in the power base of the patient to make meaningful changes in his or her life, an attitude that finds meaning in the shared experience of illness, a shared understanding of the nature of the health threat, and a shared vision about hopes for the future. The nurse needs to recognize and honor the patient-defined state of unity and holism in order to engage nursing aesthetics in practice. 
 
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Caring
Difficulty: Easy

PTS:	1

	10.	A clinic nurse is evaluating a child who has been treated for a cough and fever for several weeks, without resolution of the symptoms. The child and family are recent immigrants to America. What actions by the nurse are most appropriate? (Select all that apply.)
A.	Ask the parents about culturally relevant health-care practices.	
B.	Assess the family’s understanding of the illness and treatment.	
C.	Investigate illnesses endemic to the family’s native country.	
D.	Tell the family members they must stop using herbal or folk treatments.	
E.	Utilize a professional interpreter to communicate with the family.	

ANS:	A, B, C, E
Increased international travel and immigration require the nurse to be culturally sensitive and also aware of the possibility of a patient having a disease not commonly seen in the United States. In this scenario, the nurse should assess for culturally relevant health-care practices to ensure that the prescribed treatment is acceptable to the family members, investigate their understanding using a professional interpreter if needed, and research illnesses endemic to the family’s country of origin. The nurse should not simply tell the family members that they cannot use herbal or folk remedies. The nurse should attempt to include these traditional methods of healing when possible.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment and Implementation
Difficulty: Moderate

PTS:	1

	11.	The nursing faculty member explains to the nursing student that using nursing aesthetics includes which of the following activities? (Select all that apply.)
A.	Care planning	
B.	Imagery	
C.	Medication administration	
D.	Music therapy	
E.	Touch	

ANS:	B, D, E
Nursing aesthetics is the low-tech, high-touch art of nursing. Components can include imagery, music therapy, and touch. Care planning and administering medications do not fall under this category of nursing action.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS:	1

	12.	A new nurse manager wants to initiate changes on the inpatient pediatric unit at a regional referral center. Which actions by the manager would be most helpful? (Select all that apply.)
A.	Create a system of nurse-driven care to allow families to rest and de-stress.	
B.	Discuss proposed changes with families, soliciting feedback on potential impact.	
C.	Ensure around-the-clock resources to help families with emotional needs.	
D.	Make changes based on knowledge of growth and development theories.	
E.	Use evidence-based practice to formulate new policies and procedures.	

ANS:	B, C, D, E
Caring for children at regional referral centers creates problems for families who are impacted by the separation and the high-acuity illness of their child. Changes should consider the emotional needs of the families, both child and family growth and development theories, and evidence-based practice. Family partnering is a way to involve families in the care of their children and is more beneficial to families than nurse-driven care.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Difficult

PTS:	1

OTHER

	1.	Place the steps of creating a concept map in the correct order.

_____ Determine beneficial goals and outcomes.
_____ Categorize assessment data under patient problem areas.
_____ Assess the patient and draw a skeleton diagram.
_____ Evaluate the patient’s response to the interventions.
_____ Analyze the relationships among factors and prioritize diagnoses.

ANS:	
4, 2, 1, 5, 3
A concept map is similar to the nursing process and uses five steps. Begin with assessing the patient and draw a skeleton diagram using the medical diagnosis as the center. Next, categorize all the assessment data under patient problem areas. Step 3 is to analyze relationships among the factors and to prioritize patient responses. The fourth step is to determine beneficial goals and outcomes with the patient/family. The final step is evaluation.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Nursing Process  
Difficulty: Easy

PTS:	1