Ricci Chapter 1 - Test Bank - 4th Edition

1. When integrating the principles of family-centered care into the birthing process,

the nurse would base care upon which belief?

A. Birth is viewed as a medical event.

B. Families are unable to make informed choices due to stress.

C. Birth results in changes in relationships.

D. Families require little information to make appropriate decisions for care.

Answer: C

Rationale: Family-centered care is based on the following principles: Birth affects

the entire family, and relationships will change; birth is viewed as a normal, healthy

event in the life of the family; and families are capable of making decisions about

their own care if given adequate information and professional support.

2. The nurse is working with a group of community health members to develop a

plan to address the special health needs of women. The group would design

educational programs to address which priority condition?

A. Smoking

B. Heart disease

C. Diabetes

D. Cancer

Answer: B

Rationale: The group needs to address cardiovascular disease, the number one

cause of death in women regardless of racial or ethnic group. Smoking is related to

heart disease and the development of cancer. However, heart disease and cancer

can occur in any woman regardless of her smoking history. Cancer is the second

leading cause of death, with women having a one in three lifetime risk of

developing cancer. Diabetes is another important health condition that can affect

women. However, it is not the major health problem that heart disease is.

3. A nurse is conducting an orientation program for a group of newly hired nurses.

As part of the program, the nurse is reviewing the issue of informed consent. The

nurse determines that the teaching was effective when the group identifies which

situation as a violation of informed consent?

A. Performing a procedure on a 15-year-old without parental consent

B. Serving as a witness to the signature process on an operative permit

C. Asking whether the client understands what she is signing following receiving

education

D. Getting verbal consent over the phone for an emergency procedure from the

spouse of a unconscious woman

Answer: A

Rationale: In most states, only clients over the age of 18 can legally provide

consent for health care. Serving as a witness to the signature process, asking

whether the client understands what she is signing, and getting verbal consent over

the phone for emergency procedures are all key to informed consent and are not

violations.

4. A pregnant woman is to undergo an invasive procedure to evaluate the status of

her fetus. To ensure informed consent, which action would be the priority

responsibility of the nurse providing care to this woman?

A. Asking relevant questions to determine the client's understanding

B. Providing a detailed description of the risks and benefits of the procedure

C. Explaining the exact steps that will occur during the procedure

D. Offering suggestions for alternative options for treatment

Answer: A

Rationale: The nurse's responsibilities related to informed consent include: Ensuring

the consent form is completed with signatures from the client; serving as a witness

to the signature process; and determining whether the client understands what she

is signing by asking her pertinent questions. The physician, advanced practice

nurse, or midwife is responsible for informing the client about the procedure and

obtaining consent by providing a detailed description of the procedure or treatment,

its potential risks and benefits, and alternative methods available.

5. A 9-month-old with glaucoma requires surgery. The infant's parents are

divorced. To obtain informed consent, which action would be most appropriate?

A. Contacting the father for informed consent

B. Obtaining informed consent from the mother

C. Seeking a court ruling on the course of care

D. Determining sole or joint custody by the parents

Answer: D

Rationale: The most appropriate action would be to determine legal custody by

court decree. If the parents have joint custody, then either parent may give

consent, but it is always best to have consent given by both parents. The parent

with only physical custody may give consent for emergency care. The last resort is

getting a court ruling; usually this is not necessary unless the parents disagree

about the care of the child.

6. Which statement made by a nursing student would best indicate that her

education on family-centered care was fully understood?

A. "Childbirth affects the entire family, and relationships will change."

B. "Families are usually not capable of making health care decisions for themselves,

especially in stressful situations."

C. "Mothers are the only family member affected by childbirth."

D. "Since childbirth is a medical procedure, it may affect everyone."

Answer: A

Rationale: Childbirth affects the entire family, and relationships will change.

Childbirth is viewed as a normal life event, not a medical procedure. Families are

very capable of making health care decisions about their own care with proper

information and support.

7. Which aspect of client wellness has not been a focus of health during the 21st

century ?

A. Disease prevention

B. Health promotion

C. Wellness

D. Analysis of morbidity and mortality

Answer: D

Rationale: The focus on health has shifted to disease prevention, health promotion,

and wellness. In the last century, much of the focus was on analyzing morbidity

and mortality rates.

8. A nurse is planning a continuum of care for a client during pregnancy, labor, and

childbirth. What is the most important factor in enhancing the birthing experience?

A. Adhering to strict specific routines

B. Involving a pediatric physician

C. Educating the client about the importance of a support person

D. Assigning several nurses as a support team

Answer: C

Rationale: Educating the client about the importance of a support person during

labor and delivery has been shown to improve and enhance the birthing experience.

9. The nurse is administering a number of therapeutic interventions for neonates,

infants, and children on the pediatric unit. Which intervention contributes to an

increase in chronic illness seen in early childhood?

A. Administering antibiotics to prevent lethal infections

B. Vaccinating children to prevent childhood diseases

C. Using mechanical ventilation for premature infants

D. Using corticosteroids as a treatment for asthma

Answer: C

Rationale: Using mechanical ventilation and medications to foster lung development

in premature infants increases their survival rate. Yet the infants who survive are

often faced with myriad chronic illnesses. Administering antibiotics to prevent lethal infections, vaccinating children to prevent childhood diseases, and using

corticosteroids as a treatment for asthma may cause side effects, but do not

contribute to chronic illness in children.

10. The nurse is reviewing a copy of the U.S. Surgeon General's Report, Healthy

People 2020. Which nursing action best reflects the nurse fostering this health care

agenda?

A. The nurse signs up for classes to obtain an advanced degree in nursing.

B. The nurse volunteers at a local health care clinic providing free vaccinations for

low-income populations.

C. The nurse performs an in-service on basic hospital equipment for student nurses.

D. The nurse compiles nursing articles on evidence-based practices in nursing to

present at a hospital training seminar.

Answer: B

Rationale: Healthy People 2020 is a comprehensive health promotion and disease

prevention agenda that is working toward improving the quantity and quality of life

for all Americans. Overarching goals are to eliminate preventable disease, disability,

injury, and premature death; achieve health equity, eliminate disparities, and

improve the health of all groups; create physical and social environments that

promote good health; and promote healthy development and behaviors across

every stage of life. Volunteering at a local health care clinic directly reflects the goal

of improving the health of all groups of people. Signing up for classes, performing

in-services on equipment, and compiling nursing articles on evidence-based

practices in nursing are all worthwhile activities that foster health care delivery, but

are not as directly linked to the agenda of promoting health in the community.

11. When assessing a family for barriers to health care, the nurse documents the

psychosocial barriers. What is an example of this type of health care deficit?

A. Academic difficulties

B. Respiratory illness

C. Poor sanitation

D. Inherited diseases

Answer: A

Rationale: Environmental and psychosocial factors are now an identified area of

concern in children. They include academic differences, complex psychiatric

disorders, self-harm and harm to others, use of firearms, hostility at school,

substance use disorder, HIV/AIDS, and adverse effects of the media. Respiratory

illness and inherited diseases are health problems, and poor sanitation is an

environmental factor.

12. When integrating the principles of family-centered care, the nurse would include

which concept?

A. Parents want nurses to make decisions about their child's treatment.

B. Families are unable to make informed choices.

C. People have taken increased responsibility for their own health.

D. Families require little information to make appropriate decisions.

Answer: C

Rationale: Due to the influence of managed care, the focus on prevention, better

education, and technological advances, people have taken increased responsibility

for their own health. Parents now want information about their child's illness, to

participate in making decisions about treatment, and to accompany their children to

all health care situations.

13. The nurse is caring for a 2-week-old girl with a metabolic disorder. Which

activity would deviate from the characteristics of family-centered care?

A. Softening unpleasant information or prognoses

B. Evaluating and changing the nursing plan of care

C. Collaborating with the child and family as equals

D. Showing respect for the family's beliefs and wishes

Answer: A

Rationale: Family-centered care requires that the nurse provide open and honest

information to the child and family. It is inappropriate to soften unpleasant

information or prognoses. Evaluating and changing the nursing plan of care to fit the needs of the child and family, collaborating with them as equals, and showing

respect for their beliefs and wishes are guidelines for family-centered care.

14. The nurse is caring for a 14-year-old girl with multiple health problems. Which

activity would best reflect evidence-based practice by the nurse?

A. Following blood pressure monitoring recommendations

B. Determining how often the vital signs are monitored

C. Using hospital protocol for ordering diagnostic tests

D. Deciding the prescribed medication dose

Answer: A

Rationale: Using hospital protocol for ordering a diagnostic test, determining how

often the vital signs are monitored, and deciding the medication dose ordered

would be the health care provider's responsibility. However, following blood

pressure monitoring recommendations would be part of evidence-based practice

reflected in the nursing care delivered.

15. The nurse is functioning in the primary role to care for a 12-year-old boy with

metastatic cancer in the liver. Which activity is typical of advocacy?

A. Instructing parents about proper home care

B. Educating the family about choices they have

C. Telling parents about clinical guidelines

D. Teaching the family about types of cancers

Answer: B

Rationale: Educating the family about choices they have regarding therapies for the

cancer in the child's liver is an example of advocacy, in which the nurse advances

the interests of the child and family by informing them of options and assisting

them to make informed decisions. Telling parents about proper home care, clinical

guidelines, and the types of cancers are all done in the primary role of educator.

16. The nurse is caring for a 14-year-old boy with a growth hormone deficiency.

Which action best reflects using the nursing process to provide quality care to

children and their families?

A. Reviewing the effectiveness of interventions

B. Questioning the facility standards for care

C. Earning continuing education credits

D. Ensuring reasonable costs for care provided

Answer: A

Rationale: The nursing process is used to care for the child and family during health

promotion, maintenance, restoration, and rehabilitation. It is a problem-solving

method based on the scientific method that allows nursing care to be planned and

implemented in a thorough, organized manner to ensure quality and consistency of

care. The nursing process is applicable to all health care settings and consists of

five steps: assessment, nursing diagnosis, outcome identification and planning,

implementation, and outcome evaluation. Reviewing the effectiveness of

interventions is related to outcome evaluation in the nursing process. Even though

the three remaining answer options are valuable in ensuring quality of care in

health care facilities, they do not involve the direct care of the child and family

using the nursing process.

17. A preschool child is scheduled to undergo a diagnostic test. Which action by the

nurse would violate a child's bill of health care rights?

A. Arranging for her mother to be with her

B. Telling the child the test will not hurt

C. Assuring the child that the test will be done quickly

D. Introducing the child to the lab technicians

Answer: B

Rationale: Telling the child the test will not hurt lacks veracity. It is not a lie, but it

does not honor the child's right to be educated honestly about his or her health

care. Arranging for the mother to be with the child, assuring the child that the test

will be done quickly, and introducing the child to the lab technicians are actions that

honor the child's bill of health care rights.

18. The pediatric nurse knows that the children being treated are considered

minors. Which statement accurately describes the regulations related to consent for

medical treatment?

A. Children older than age 16 can provide their own consent for, or refusal of,

medical procedures.

B. A guardian

ad litem may be appointed by the parents to serve to protect the child's best

interests.

C. Parents ultimately are the decision makers regarding medical treatment for their

children younger than the age of 18.

D. When divorce occurs, the parent with whom the child is living on a daily basis

will be granted custody of the child.

Answer: C

Rationale: Parents ultimately are the decision makers for their children. Generally,

only persons over the age of majority (18 years of age) can legally provide consent

for health care. Minors (children younger than 18 years of age) generally require

adult guardians to act on their behalf. Biological or adoptive parents are usually

considered to be the child's legal guardian. When divorce occurs, one or both

parents may be granted custody of the child. In certain cases (such as child

violence or neglect, or during foster care), a guardian ad litem may be appointed by

the courts. This person generally serves to protect the child's best interests.

19. The nurse is caring for a 12-year-old child hospitalized for internal injuries

following a motor vehicle accident. For which medical treatment would the nurse

ensure that an informed consent is completed beyond the one signed at admission?

A. Diagnostic imaging

B. Cardiac monitoring

C. Blood testing

D. Spinal tap

Answer: D

Rationale: Most care given in a health care setting is covered by the initial consent

for treatment signed when the child becomes a client at that office or clinic or by

the consent to treatment signed upon admission to the hospital or other inpatient

facility. Certain procedures, however, require a specific process of informed consent, including major and minor surgery; invasive procedures such as lumbar

puncture or bone marrow aspiration; treatments placing the child at higher risk,

such as chemotherapy or radiation therapy; procedures or treatments involving

research; photography involving children; and applying restraints to children.

20. A child needs a consent form signed for a minor surgical procedure. Which

statement accurately describes the responsibilities of the health care providers

when obtaining the consent?

A. The physician is responsible for ensuring that the consent form is completed with

signatures from the parents or legal guardians.

B. The physician is responsible for serving as a witness to the signature process.

C. The nurse is responsible for informing the child and family about the procedure

and obtaining consent.

D. The nurse is responsible for determining that the parents or legal guardians

understand what they are signing by asking them pertinent questions.

Answer: D

Rationale: The nurse's responsibility related to informed consent includes the

following: determining that the parents or legal guardians understand what they

are signing by asking them pertinent questions, ensuring that the consent form is

completed with signatures from the parents or legal guardians, and serving as a

witness to the signature process. The physician or advanced practitioner providing

or performing the treatment and/or procedure is responsible for informing the child

and family about the procedure and obtaining consent by providing a detailed

description of the procedure or treatment, the potential risks and benefits, and

alternative methods available.

21. The nurse is caring for a child brought to the emergency department by a

babysitter. The child needs an emergency appendectomy and the parents cannot be

contacted. What would be the nurse's best response to this situation?

A. Have the babysitter sign the consent form even if she does not have signed

papers to do so.

B. Have the primary care physician for the child sign the consent form.

C. Document failed attempts to obtain consent to allow emergency care.

D. Delay medical care until the child's next of kin can be contacted.

Answer: C

Rationale: Health care providers can provide emergency treatment to a child

without consent if they have made reasonable attempts to contact the child's

parent or legal guardian (American Academy of Pediatrics, Committee on Pediatric

Emergency Medicine, 2007). If the parent is not available, then the person in

charge may give consent for emergency treatment if that person has a signed form

from the parent or legal guardian allowing him or her to do so. During an

emergency situation, a verbal consent via the telephone may be obtained. In

urgent or emergent situations, appropriate medical care never should be delayed or

withheld due to an inability to obtain consent.

22. The nurse knows that the emancipated minor is considered to have the legal

capacity of an adult and may make his or her own health care decisions. Which

child would potentially be considered an emancipated minor?

A. A minor with financial independence who is living with his parents

B. A minor who is pregnant

C. A child older than 13 years of age who asks for emancipation

D. A minor who puts his or her medical decisions in writing

Answer: B

Rationale: Emancipation may be considered in any of the following situations,

depending on the state's laws: membership in a branch of the armed services,

marriage, court-determined emancipation, financial independence and living apart

from parents, college attendance, pregnancy, mother younger than 18 years of

age, and a runaway.

23. After describing the procedure and medical necessity, the nurse asks a 14-yearold

child to assent to a skin graft. Which statement accurately describes the

requirements for this type of assent?

A. The age of assent occurs at 12 years old.

B. It is not necessary to obtain assent from a minor for a procedure.

C. A minor can dissent to a procedure but his or her wishes are not binding.

D. In some cases, such as cases of significant morbidity or mortality, dissent may

need to be overridden.

Answer: D

Rationale: Assent means agreeing to something. In pediatric health care, the term

assent refers to the child's participation in the decision-making process about

health care (McCullough & Stein, 2009). In some cases, such as cases of significant

morbidity or mortality, dissent may need to be overridden. The age of assent

depends on the child's developmental level, maturity, and psychological state. The

converse of assent, dissent (disagreeing with the treatment plan), when given by

an adolescent 13 to 17 years of age, is considered binding in some states.

24. The family is the basic unit of society. Which statement correctly illustrates the

importance of this concept related to how society functions?

A. Healthy, well-functioning families provide members of all ages with fulfilling,

supporting relationships.

B. The family serves as a place that encourages members to autonomously function

in pursuit of personal pleasures.

C. Society functions best when families determine how they will interface with

others without having to deal with the overall consequences.

D. Work is an important part of family function but is not necessary for success if

one member can fulfill multiple roles.

Answer: A

Rationale: The family is the basic unit of society. In order for this to work well,

members of the family must work together. Families make a central contribution to

enhance the quality of our society. Families must consider how their actions will

impact others, and one member cannot fulfill all roles within the family.

25. A nursing group is examining their hospital's maternal outcomes for the

previous 5 years. Which identified factors have contributed to the decline in the

maternal mortality rate? Select all that apply.

A. Increased participation of women in prenatal care

B. Use of ultrasound to detect disorders

C. Increased use of anesthesia with birth

D. Closer monitoring for complications associated with hypertension of pregnancy

E. Better management of hemorrhage and infection

Answer: A, B, D, E

Rationale: The following factors have contributed to the decline in the maternal

mortality rate: increased participation of women in prenatal care; greater detection

of disorders such as ectopic pregnancy or placenta previa; prevention of related

complications through the use of ultrasound; increased control of complications

associated with hypertension of pregnancy; and decreased use of anesthesia with

birth.

26. The nurse is working with a group of community health members to develop a

plan to address the special health needs of women. Which educational program

would the group most likely identify as the priority?

A. risk reduction strategies for diabetes

B. methods for smoking cessation

C. ways to adopt a heart-healthy lifestyle

D. importance of cancer screening and early detection

Answer: C

Rationale: The group needs to address cardiovascular disease, the number one

cause of death in women regardless of racial or ethnic group. Thus, education for

adopting a heart-healthy lifestyle would be the priority. Smoking is related to heart

disease and the development of cancer. However, heart disease and cancer can

occur in any woman regardless of her smoking history. Cancer is the second leading

cause of death, with women having a one in three lifetime risk of developing

cancer. Diabetes is another important health condition that can affect women.

However, it is not the major health problem that heart disease is, and thus

educational programs focusing on smoking cessation, cancer screening and early

detection, and diabetes risk reduction would be lesser priorities.

27. A perinatal nurse is interviewing a group a women in the community about health care services. Assessment of these services reveals that many of them are being underutilized. Which statement from the women would assist the nurse in

identifying potential reasons for this underutilization? Select all that apply.

A. "The services are hard to get to by public transportation."

B. "The clinic is only open during the morning hours."

C. "The staff seems to look down on us when we do come in."

D. "There are staff there that can speak our language."

E. "You need insurance to go to the clinic."

Answer: A, B, C, E

Rationale: Access to care can be jeopardized by lower incomes and greater

responsibilities when juggling work and family. Lack of finances or transportation,

geographic misdistribution of health care providers, no babysitters, language or

cultural barriers, distrust of health care providers, inconvenient clinic hours, and the

poor attitudes of health care workers often discourage clients from seeking health

care. Having staff that speak the language of the client population would be helpful

in encouraging clients to use the services.

28. A nurse is preparing a class discussion on cardiovascular disease in women.

When discussing the priority risk factors for this disease, which would the nurse

least likely include? Select all that apply.

A. Menopause

B. Diabetes diagnosis

C. Weight cycling

D. Gender

E. Age

Answer: D, E

Rationale: CVD is the leading cause of death in women. Risk factors of CVD differ

between men and women with menopause, diabetes, and repeated weight losses

and gains increasing the risk for coronary morbidity and mortality in women. Yo-yo

dieting or yo-yo effect, also known as weight cycling is a major risk factor. Gender

and age are not major risk factors and should not be considered in this list.

29. A nurse is preparing a class discussion on the clinical manifestations of a heart

attack observed in women. Which symptoms would the nurse include as key

assessment data? Select all that apply.

A. syncope

B. unusual fatigue

C. sleep disturbances

D. arm pain

E. extreme hunger

Answer: B, C, D

Rationale: Nurses need to go beyond the obvious crushing chest pain textbook

symptom that indicates heart attack in men. Clinical manifestations of a heart

attack observed in women include nausea, dizziness, irregular heartbeat, unusual

fatigue, sleep disturbances, indigestion, anxiety, shortness of breath, pain or

discomfort in one or both arms, and weakness.

30. A nurse is preparing a breast cancer presentation for a health forum. Which fact

would the nurse expect to address in this presentation?

A. Breast cancer is more advanced in Black women when found.

B. Black women have the BRCA1 and BRCA2 gene.

C. More Hispanic women smoke, which increases their risk.

D. White women respond better to breast cancer treatment.

Answer: A

Rationale: White women get breast cancer at a higher rate than Black women;

however, Black women are more likely to die becuase they get breast cancer before

40 years of age, cancer is more advanced when found, and survival at every cancer

stage is worse among Black women. Black women are not at greater risk due to the

BRCA1 or BRCA2 genes that cause breast cancer. There is no evidence that

Hispanic women smoke more, placing them at risk. White women do not respond

better to cancer treatment.

31. A nurse is making a presentation at a parenting class dealing with divorce. A

participant asks the nurse, "How should a parent handle telling the children about a

divorce?" Which statements are the most helpful? Select all that apply.

A. "Tell your children about the divorce and the reasons for it."

B. "Reassure your children that the divorce is not their fault."

C. "Make sure your children are aware of the potential financial issues."

D. "Let them know they can decide how the future family will look."

E. "Inform them in advance of someone moving out of the family home."

F. "Routines, rules, and discipline can be minimized until a later time."

Answer: A, B, E

Rationale: Rules for divorcing parents suggest to tell the children about the divorce

and the reasons for the divorce in terms that they can understand; reassure the

children that the divorce is not their fault; inform the children about the family

structure after the divorce; inform them in advance of any changes in the

household (i.e., someone moving out); do not discuss money or finances with your

children; and maintain rules and routines.

32. A nurse is preparing for a presentation on parenting at a local school. Which

information would the nurse include when describing the results of an authoritarian

parent? Select all that apply.

A. The child will have lower self-esteem.

B. The child will have increased feeling of security.

C. Children will have higher achievements.

D. An increase in aggression may be a result.

E. The child will have increased social skills.

F. There is a greater childhood happiness.

Answer: A, D

Rationale: This parenting style is associated with negative effects on self-esteem,

happiness and social skills, increased aggression, and defiance. The child will not

feel more secure as the parent is always in control. It will not result in higher

achievements or an increase in social skills.

33. Parents who recently experienced the death of their unborn child ask the nurse,

"What is a fetal death?" What is the nurse's best response?

A. "Fetal deaths occur later in pregnancy after 20 weeks' gestation."

B. "It refers to the intrauterine fetal death at any time during pregnancy."

C. "Fetal deaths occur earlier in pregnancy before 20 weeks' gestation."

D. "Fetal death occurs only at the birth of the newborn."

Answer: B

Rationale: Fetal death refers to the spontaneous intrauterine death of a fetus at any

time during pregnancy. Fetal deaths later in pregnancy (after 20 weeks of

gestation) are referred to as stillbirths, and deaths earlier than 20 weeks are

referred to as a miscarriage.

34. Which factors are causes of the high infant mortality rate? Select all that apply.

A. postmaturity

B. low birth weight

C. sudden infant death syndrome

D. cardiac complications

E. viral infections

F. necrotizing enterocolitis

Answer: B, C, F

Rationale: The main causes of early infant death in the United States include

problems occurring at birth or shortly thereafter, such as prematurity, low birth

weight, congenital and chromosomal anomalies, sudden infant death syndrome,

respiratory distress syndrome, unintentional injuries, bacterial sepsis, and

necrotizing enterocolitis.

35. A nurse is preparing for a health promotion presentation for new mothers.

Which topics would be appropriate for the nurse to include in the presentation?

Select all that apply.

A. Breastfeeding encouragement

B. Proper infant sleep position

C. Infants in smoke-free environments

D. How to swaddle their infants

E. How to bed share with their infants

Answer: A, B, C

Rationale: Health promotion strategies can significantly improve an infant's health

and chances of survival. Breastfeeding has been shown to reduce rates of infection

in infants and to improve their long-term health. Emphasizing the importance of

placing an infant on his or her back to sleep will reduce the incidence of sudden

infant death syndrome (SIDS). Parents/partners should not share a bed with an

infant younger than 12 weeks old and should avoid exposing the infant to tobacco

smoke. Encouraging mothers to join support groups to prevent postpartum

depression will improve the health of both mothers and their infants. Swaddling an

infant and bed sharing is discouraged due to SIDS.

36. A client asks the nurse about her potential risk factors for breast cancer. Which

risks would be important for the nurse to include in the response? Select all that

apply.

A. Oral contraceptive use

B. Age when children were born

C. Irregularities in menstruation

D. Smoking

E. Obesity

Answer: A, C, E

Rationale: A positive family history of breast cancer, aging, and irregularities in the

menstrual cycle at an early age are major risk factors for breast cancer. Other risk

factors include excess weight or obesity, not having children, oral contraceptive

use, excessive alcohol consumption, a high-fat diet, sedentary lifestyle, and longterm

use of hormones. Smoking is not a major risk factor for breast cancer,

although it is considered. The age of the mother when children are born is not a

risk factor.

37. A public health nurse is preparing a presentation for a parenting class with the

focus on childhood discipline. Which principles of childhood discipline would the

nurse expect to emphasize? Select all that apply.

A. The use of punishment will reduce or eliminate undesirable behaviors.

B. Discipline methods should ensure the preservation of the child's self-esteem.

C. Time-out technique for discipline is no longer acceptable.

D. Positive reinforcement will increase desirable behaviors.

E. Maintain a positive, supportive, nurturing parent-child relationship.

Answer: B, D, E

Rationale: Discipline should focus on the development of the child while ensuring to

preserve the child's self-esteem and dignity. The American Academy of Pediatrics

suggests three strategies for effective discipline: maintaining a positive, supportive,

nurturing caregiver-child relationship; using positive reinforcement to increase

desirable behaviors; and removing positive reinforcements or using punishment to

reduce or eliminate undesirable behaviors. When using time-out, use 1 minute per

year of the child's age (a 3-year-old would have time-out for 3 minutes). Do not

exceed 5 minutes.

38. When teaching a parenting class on childhood discipline, the nurse is asked by a

parent, "How long do I place my child in time-out?" How should the nurse best

respond?

A. "Use the amount of time it takes to elicit a behavior change."

B. "Use 1 minute per year of age, but do not exceed 5 minutes."

C. "Use as much time as is needed to control the behavior."

D. "Use 1 minute per year of the child's age as needed."

Answer: B

Rationale: Another form of discipline is extinction, which focuses on reducing or

eliminating the positive reinforcement for inappropriate behavior. Examples are

"time-out." When using time-out, use 1 minute per year of the child's age (a 3-

year-old would have time-out for 3 minutes). Do not exceed 5 minutes.

39. After teaching a group of parents on childhood discipline, the nurse understands

that which statement, made by a parent, demonstrates an understanding of

spanking as a form of discipline?

A. "When responding to inappropriate behavior it is OK to lightly spank."

B. "Use a combination of spanking along with other methods of discipline."

C. "Use spanking as a last resort when time-out has failed."

D. "Use methods other than spanking to respond to inappropriate behavior."

Answer: D

Rationale: Some research says spanking provides children with a model of

aggressive behavior as a solution for conflict, is associated with increased

aggression in children, and can lead to an altered parent-child relationship.

Because of the negative consequences of spanking, and because it has been shown

to be no more effective than other methods for managing inappropriate behavior, it

is recommended that parents use methods other than spanking to respond to

inappropriate behavior.

40. A public health nurse visits the home of a young toddler. What aspect of the

home environment would the nurse expect to address with the parents?

A. The presence of power cords plugged into capped outlets

B. Cartoons playing on a television in the child's room

C. The family dog is present in the house during the visit

D. The presence of pots on the stove with handles pointing toward back

Answer: B

Rationale: The nurse is encouraged to ask questions regarding the amount of

recreational screen time and if the child has a television or Internet-connected

device in his or her bedroom. The American Academy of Pediatrics discourages any

screen media before the age of 2. The nurse would question why the TV is being

used in the child's room. The family dog may be a threat to observe during the

visit, but having a TV in the child's room indicates that it is being exposed to earlier

than advised screen time. Pot handles are in the appropriate position. Cords are

plugged into capped outlets, which is safe.

41. The nurse notes that an older adult client receives only one visitor and asks the

client if family members could be called. The client states, "I consider her to be all

of my family." What would the nurse consider in responding to the client?

A. The nurse could encourage the client to reconnect with other family members.

B. The client defines who is and who is not part of the family without undue

influence.

C. The nurse realizes individuals exist without a family and do not often adopt

substitutes.

D. Family is more important to those individuals with a large number of family

members.

Answer: B

Rationale: It is important for nurses to remain neutral to all they hear and see in

order to enhance trust and maintain open communication lines with all family

members. Nurses need to remember that clients are experts of their own health

and can define their own family.

42. The nurse working in a maternity clinic suspects that a client and her children

are in a violent relationship. While waiting for test results, the nurse decides to

teach the client about intimate partner violence. What would be the best rationale

for the nurse's decision?

A. The nurse knows that the woman may be weak and controlled by her partner.

B. The nurse has a legal responsibility to protect clients.

C. The nurse understands there is an ethical responsibility to protect clients.

D. The nurse knows that children exposed to family violence are likely to be victims

of abuse.

Answer: D

Rationale: Children exposed to family violence are more likely to be physically,

sexually, or emotionally abused themselves. Children have died from family

violence and neglect when no one has intervened on their behalf. Children who are

exposed to stressors such as family violence or who are victims of childhood

violence or neglect are at high risk for short- and long-term problems. Witnessing

and being exposed to violence in childhood results in a higher tolerance, and

greater use, of violence as an adult. The nurse may feel an ethical responsibility

towards clients, but the nurse does not have a legal responsibility to protect clients.

Women being the weaker sex is a myth.

43. A public health nurse is developing programs to educate parents on infant

mortality. Which complications would the nurse include in the education? Select all

that apply.

A. Tricuspid atresia

B. 39-week gestation birth

C. 3,6 kg birth weight

D. Anencephalus

E. Spina bifida

Answer: A, D, E

Rationale: The main causes of early infant death in this country include problems

occurring at birth or shortly thereafter. These include prematurity, low birth weight,

congenital anomalies, sudden infant death syndrome (SIDS), and respiratory

distress syndrome. A pregnancy at 39 weeks would be considered a term

pregnancy. A birth weight of 3.6 kg would be considered appropriate.

44. The pediatric nurse would be participating in the role of advocate when

completing which action?

A. Instructing parents on the side effects of vaccinations they are requesting for

their child

B. Contributing input on a task force with the aim to reduce the rate of mortality of

infants and children

C. Teaching parents to keep their prescribed medication safely out of reach of

children

D. Explaining to parents the reason for each medication their child was recently

prescribed

Answer: B

Rationale: The role of advocacy is being fulfulled when the nurse works to

safeguard and advance the interest of children and infants through many means,

including contributing to the learning and application of a task force aimed at

reducing infant and children mortality. The actions of instructing about side effects,

explaining the purposes of medications, and teaching about medication safelty

would fall under the role of educator.