Chapter 2

Question 1

1. The nurse is teaching an athletic father how to stimulate his 7-year-old son who has a ‘slow-to-warm-up’ temperament. Which guidance will be most successful?
   A)
   Telling him to read stories to the child about famous athletes
   B)
   Suggesting he take the child to watch him play softball
   C)
   Urging him to sign the child up for little league football
   D)
   Proposing wrestling with the child and letting him win

Answer 1

Ans:
A

Feedback:

Reading stories to the child would be less active and more acceptable to the child’s temperament. Proposing to wrestle with the child and letting him win or signing the child up for little league football would put the child in an uncomfortable situation, as would attending his father’s adult activities.

Question 2

2.
The nurse is performing a health assessment of a school-age child. Based on the child's developmental level, on which problem would the nurse focus more attention?
A)
Infections
B)
Poisonings
C)
Risk-taking behaviors
D)
Accidents and injuries

Answer 2

Ans:
D

Feedback:

Developmental level has a major impact on the health status of children. The physiologic immaturity of an infant’s body systems increases the risk for infection. Ingestion of toxic substances and risk of poisoning are major health concerns for toddlers as they become more mobile and inquisitive. Because preschool- and school-age children are, generally, very active, they are more prone to injury and accidents. Adolescents are establishing their identity, which may lead them to separate from the family values and traditions for a period of time and attempt to conform to their peers. This journey may lead to risk-taking behaviors, resulting in injuries or other situations that may impair their health.

Question 3

3.
The nurse is caring for a 2-year-old girl who is wheezing and has difficulty breathing. Which interview question would provide the most useful information related to the symptoms of the child?
A)
Inquiring about child safety in the home
B)
Asking about the temperament of the child
C)
Asking about the child’s diet
D)
Asking the parents if they smoke in the home

Answer 3

Ans:
D

Feedback:

Asking the parents if they smoke in the home would provide the most useful information related to the health condition of the child. If they smoke, the nurse could explain that they are affecting their child’s health and urge them to stop for her sake. Asking about the temperament of the child and inquiring about home safety or diet would not reveal any useful information related to the respiratory alteration.

Question 4

4.
The nurse is assessing the ‘resilience’ of a 16-year-old boy. Which exemplifies an external protective factor that may help to promote resiliency in this child?
A)
His ability to take control of his own decisions
B)
His ability to accept his own limitations
C)
His caring relationship with members of his family
D)
His knowledge of when to continue or stop with goal achievement

Answer 4

Ans:
C

Feedback:

The term resilience refers to the qualities that enable an individual to cope with significant adverse events or stresses and still function competently (Lietz, 2007). Various internal and external protective factors promote resiliency. External factors include caring relationships with a family member; a positive, safe learning environment at school (including clubs and social organizations); and positive influences in the community. Internal factors include the person’s ability to take control and be proactive, to be responsible for his or her own decisions, to understand and accept his or her own limits and abilities, and to be goal directed, knowing when to continue or when to stop.

Question 5

5.
The nurse is assessing a family to determine if they have access to adequate health care. Which statement accurately describes how certain families are affected by common barriers to health care?
A)
After a decade of escalation, the percentage of children living in low-income families has been on the decline since 2000.
B)
White, non-Hispanic children overall are more likely than African American and Hispanic children to be in very good or excellent health.
C)
The proportion of children between the ages of 6 and 18 who are overweight is decreasing, but a large increase is occurring in African American females.
D)
The overall health care plan of working families may improve access to specialty care but limit access to preventive services.

Answer 5

Ans:
B

Feedback:

White, non-Hispanic children overall are more likely than African American and Hispanic children to be in very good or excellent health. After a decade of decline, the percentage of children living in low-income families has been on the rise since 2000. In 2005, 39% of children were living in low-income families and 18% were living in poor families (Douglas-Hall & Chau, 2008). The proportion of children between the ages of 6 and 18 who are overweight is increasing, but the largest increase is occurring in African American females (ChildStats.gov Forum on Child and Family Statistics, 2010). The overall plan may improve access to preventive services but may limit the access to specialty care, which has a major impact on children with chronic or long-term illnesses.

Question 6

6.
The nurse working in a free community clinic knows that access to health care is affected negatively by lack of health insurance. What accurately describes the effect of lack of insurance on family health? Select all that apply.
A)
Parents with uninsured children often delay care for their children.
B)
Parents with uninsured children are less likely to have taken their children to a doctor or dentist in the last 2 years.
C)
Parents with uninsured children are three times less likely to have a usual place of care for their children.
D)
The percentage of children without health insurance rose slightly from 11.7% in 2006 to 13% in 2007.
E)
Currently, the states have improved enrollment in Medicaid and the State Children’s Health Insurance Program (SCHIP).
F)
Despite state efforts to ensure all children, nearly half of children eligible for these public programs are still uninsured.

Answer 6

Ans:
A, B, E, F

Feedback:

Parents with uninsured children often delay care for their children, are less likely to have taken their children to a doctor or dentist in the last 2 years, and are five times less likely to have a usual place of care for their children. The percentage of children without health insurance dropped slightly from 11.7% in 2006 to 11% in 2007. (Sherman, Greenstein, & Parrott, 2008). This decrease is attributed to states’ ability to improve enrollment in Medicaid and SCHIP. Despite these efforts, nearly half of children uninsured are eligible for these public programs. Lack of awareness, difficulty accessing the programs, uncertainty of how to apply for the programs, discomfort related to receiving governmental assistance, and fear of jeopardizing the family’s immigration status continue to be factors in failure to enroll children in these programs.

Question 7

7.
The nurse is assisting low-income families to access health care. The nurse is aware that, in today’s society, this most accurately defines the diversity of a modern family.
A)
A family consists of parents and their offspring living together.
B)
A family is whatever the child and family say it is.
C)
A family is two or more people related or unrelated who are living together.
D)
A family is two or more genetically related persons living together with separate roles.

Answer 7

Ans:
B

Feedback:

The family is considered the basic social unit. The U.S. Census Bureau defines a family as a group of two or more persons related by birth, marriage, or adoption and living together. Traditional definitions of family emphasize the legal ties or genetic relationships of people living in the same household with specific roles. Given the diversity of families in today’s society, however, some believe that family should be defined as whatever the child and family say it is (Patterson, 1995).

Question 8

8.
The nurse caring for families in crisis assesses the affective function of an immigrant family consisting of a father, mother, and two school-age children. Based on Friedman’s structural functional theory, what defines this family component?
A)
Meeting the love and belonging needs of each member
B)
Teaching children how to function and assume adult roles in society
C)
Ensuring the family has necessary resources with appropriate allocation
D)
Involving the provision of physical care to keep the family healthy

Answer 8

Ans:
A

Feedback:

According to Friedman’s structural functional theory, the affective function involves meeting the love and belonging needs of each member. Teaching children how to function and assume adult roles in society is the socialization and social placement function. Ensuring the family has necessary resources with appropriate allocation is related to the economic function, and involving the provision of physical care to keep the family healthy involves the health care function.

Question 9

9.
The nurse is counseling a young couple who in 2 months are having their third baby. The nurse uses Von Bertalanffy’s general system theory applied to families to analyze the family structure. Which best describes the main emphasis of this theory and its application to family dynamics?
A)
It emphasizes the family as a system with interdependent, interacting parts that endure over time to ensure the survival, continuity, and growth of its components.
B)
It emphasizes the social system of family, such as the organization or structure of the family and how the structure relates to the function.
C)
It emphasizes the developmental stages that all families go through, beginning with marriage; the longitudinal career of the family is also known as the family life cycle.
D)
It addresses the way families respond to stress and how the family copes with the stress as a group and how each individual member copes.

Answer 9

Ans:
A

Feedback:

Von Bertalanffy emphasizes the family as a system with interdependent, interacting parts that endure over time to ensure the survival, continuity, and growth of its components. Friedman emphasizes the social system of family, such as the organization or structure of the family and how the structure relates to the function. Duvall emphasizes the developmental stages that all families go through, beginning with marriage; the longitudinal career of the family is also known as the family life cycle. The family stress theory addresses the way families respond to stress and how the family copes with the stress as a group and how each individual member copes.

Question 10

10.
The nurse volunteering at a homeless shelter to assist families with children identifies homelessness as a risk preventing families from achieving positive outcomes in life. What family theory encompasses this approach to assessing family dynamics?
A)
Duvall’s developmental theory
B)
Friedman’s structural functional theory
C)
Von Bertalanffy’s general system theory applied to families
D)
Resiliency model of family stress, adjustment, and adaptation

Answer 10

Ans:
D

Feedback:

The resiliency model of family stress, adjustment, and adaption identified the elements of risks and protective factors that aid a family in achieving positive outcomes. Duvall’s developmental theory described eight chronological stages with specific predictable tasks that each family completes. Friedman’s structural functional theory identified five functions of families, and Von Bertalanffy’s general system theory defined how families interact with, and are influenced by, the members of their family and society.

Question 11

A 10-year-old girl is living with a foster family. Which intervention is the priority for the child in this family structure?
A)
Determining if the child is being bullied at school
B)
Dealing with mixed expectations of parents
C)
Establishing who is the child’s actual caretaker
D)
Performing a comprehensive health assessment

Answer 11

Ans:
D

Feedback:

Because the child may have lived with several different families and may not have complete medical files, performing a comprehensive health assessment will be important. Determining if the child is being bullied at school is not specific to any one family structure. Assessing for problems related to mixed expectations of parents is common to a blended family. Establishing the identity of the caretaker is necessary with a communal family.

Question 12

12.
A mother confides to the nurse that she is thinking of divorce. Which suggestion by the nurse would help minimize the effects on the child?
A)
“Tell the child together using appropriate terms.”
B)
“Reassure him that no one loves him more than you.”
C)
“Do special things with him to make up for the divorce.”
D)
“Share your feelings with the child.”

Answer 12

Ans:
A

Feedback:

Both parents telling the child about the divorce together, using appropriate terms, will minimize the effects on the child. The other responses suggest unacceptable behaviors for the mother, such as competing with the spouse and using the child as a confidante.

Question 13

13.
The nurse is caring for a child and family who just moved out of a dangerous neighborhood. Which of the following approaches is appropriate to the family stress theory?
A)
Determining who is the decision maker
B)
Assessing the child's coping abilities
C)
Finding out how a sibling feels
D)
Having to explain procedures to a sibling

Answer 13

Ans:
B

Feedback:

Assessing the child’s coping abilities would serve the child and family’s needs according to the family stress theory. Finding out how a sibling feels responds to the Von Bertalanffy general system theory. Having to explain procedures to a sibling who is being protective of the child is consistent with the resiliency model. Identifying the decision maker is a problem common with extended families.

Question 14

14.
The mother of an 8-year-old girl with a broken arm is the nurturer in the family. Which nursing activity should be focused on her?
A)
Teaching proper care procedures
B)
Dealing with insurance coverage
C)
Determining success of treatment
D)
Transmitting information to family members

Answer 14

Ans:
A

Feedback:

The mother would be the best family member to learn proper care procedures. Dealing with insurance coverage is the responsibility of the family financial person, transmitting information to family members is the gatekeeper’s duty, and determining success of treatment would likely fall to the family decision maker.

Question 15

15.
A parent of four children being interviewed by the nurse states: 'Whatever my husband and I say goes and the kids need to follow our rules without complaining about them.' What type of parenting style does this attitude represent?
A)
Authoritative
B)
Authoritarian
C)
Permissive
D)
Rejecting-neglecting

Answer 15

Ans:
B

Feedback:

Four major parenting styles seen in our society are authoritarian, authoritative, permissive, and rejecting-neglecting. The authoritarian parent expects obedience from the child and discourages the child from questioning the family’s rules. The authoritative or democratic parent shows some respect for the child’s opinions. Permissive or laissez-faire parents have little control over the behavior of their children. Rejecting or neglecting parents are indifferent or uninvolved.

Question 16

16.
The nurse is teaching discipline strategies to the parents of a 4-year-old boy. Which response from the parents indicates a need for more teaching?
A)
“We should remove temptations that lead to bad behavior.”
B)
“We must explain how we expect him to behave.”
C)
“We should let him know he makes us angry with bad behavior.”
D)
“We must praise him for good behavior.”

Answer 16

Ans:
C

Feedback:

The response “We should let him know he makes us angry with bad behavior” indicates the need to restate how it is important to let the child know that it is not him, but rather his behavior, that is bad. Removing temptations, setting expectations, and praising good behavior are concepts the parents have expressed learning.

Question 17

17.
The nurse is teaching parents of a 2-year-old about the extinction method of discipline. What is an example of this method of discipline?
A)
Praising the child for good behavior
B)
Reprimanding the child
C)
Spanking the child
D)
Enforcing a 'time-out'

Answer 17

Ans:
D

Feedback:

Extinction focuses on reducing or eliminating the positive reinforcement for inappropriate behavior. Examples are ignoring the temper tantrums of a toddler, withholding or removing privileges, and requiring “time-out.” Praising the child for good behavior is a form of positive reinforcement and reprimanding and spanking the child are forms of punishment.

Question 18

18.
The nurse is teaching discipline strategies to the parents of a 14-year-old girl. Which topic is an example of positive reinforcement discipline?
A)
Unplugging the DVD player for the weekend
B)
Taking a chore away from her for a week
C)
Having her clean up the kitchen for a week
D)
Ignoring her request if she doesn’t say “please”

Answer 18

Ans:
B

Feedback:

Taking a chore away from the child for a week is an excellent way to reward her for positive behavior. Unplugging the DVD player, assigning an extra chore, and ignoring her until she uses good manners are not examples of positive reinforcement.

Question 19

19.
The nurse who is scheduled to work in a clinic in a Hispanic neighborhood takes time to research Hispanic cultural norms to better provide culturally competent care. This behavior is an example of which cultural component?
A)
Cultural awareness
B)
Cultural knowledge
C)
Cultural skills
D)
Cultural encounter

Answer 19

Ans:
B

Feedback:

Cultural knowledge is the acquisition of information about other cultures from a variety of sources. Cultural awareness is an exploration of one’s own culture and how values, beliefs, and behaviors have influenced personal life. Cultural skills and practices provide for the incorporation of knowledge of cultural background including specific practices for health, and a cultural encounter is participation in, and interaction with, persons of diverse cultural backgrounds.

Question 20

20.
The nurse accepts an assignment that involves caring for new parents and their infants in a clinic in a predominantly African American neighborhood. In order to apply culturally competent care, the nurse investigates the common beliefs and practices that may affect the health of these parents and infants. What are some examples of these beliefs? Select all that apply.
A)
Strong extended family relationships; mother as head of household; elder family members valued and respected
B)
Use of complementary modalities with Western health care practices
C)
View of health as harmony with nature, illness as disruption in harmony
D)
View of pain and suffering as inevitable; relief achieved through prayers and laying on of hands
E)
Health viewed as God’s will maintainable with a balance of hot and cold food intake
F)
Restoration of physical, mental, and spiritual balance through healing ceremonies

Answer 20

Ans:
A, C, D

Feedback:

African Americans have strong extended family relationships, with mother as head of household, and elder family members valued and respected. They also view health as harmony with nature, illness as disruption in harmony, and pain and suffering as inevitable, with relief achieved through prayers and laying on of hands. Asian Americans combine complementary modalities with Western health care practices. Hispanics view health as God’s will maintainable with a balance of hot and cold food intake, and Native Americans see restoration of physical, mental, and spiritual balance through healing ceremonies.

Question 21

21.
The nurse is caring for a 4-year-old girl of Mexican descent who is recovering in the hospital following a diagnosis of epileptic seizures. The child’s mother insists on a visit from her curandera to provide healing powers to her daughter. What would be the best intervention of the nurse in this situation?
A)
Explain to the mother that hospital policy does not allow visits from unlicensed practitioners.
B)
Encourage the mother to arrange a visit with her curandera when her daughter is released from the hospital.
C)
Discuss the situation with the child’s physician and arrange for a visit from the curandera at the hospital if appropriate.
D)
Distract the child’s mother from her demands by focusing on child and family teaching related to her daughter’s condition.

Answer 21

Ans:
C

Feedback:

The curandero (male) or the curandera (female) of the Mexican American community is believed to have healing powers as a gift from God. If the folk remedies or practices of the folk healers are compatible with the health regimen and support appropriate health practices, these practices and beliefs do no harm; in fact, they may even benefit the child and family. However, use of a folk healer can lead to a delay in beneficial treatment or create other problems; therefore, the child’s physician should be consulted prior to arranging a visit.

Question 22

22.
The pediatric nurse is caring for the families of immigrant migrant workers in a small town community. For which risk factor should the nurse provide screening?
A)
Diabetes
B)
Depression
C)
Mental illness
D)
Child abuse

Answer 22

Ans:
B

Feedback:

Immigration can affect the health, educational, and social services provided in the United States. It also presents issues related to access to care and the types of care that need to be offered. Immigration imposes unique stresses on children and families, including depression, grief, or anxiety associated with migration and acculturation; separation from support systems; inadequate language skills in a society that is not tolerant of linguistic differences; disparities in social, professional, and economic status between the country of origin and the United States; and traumatic events such as war or persecution that may have occurred in their native country. The incidence of diabetes, mental illness, and child abuse is similar to the mainstream populations.

Question 23

23.
The school nurse is caring for a 10-year-old boy whose single mother’s boyfriend is living with them. Which may be an indicator of violence in the home?
A)
He expresses his feeling with art.
B)
He reports no health issues such as stomachaches.
C)
He recently started smoking.
D)
He is involved in after-school activities.

Answer 23

Ans:
C

Feedback:

Early initiation of smoking can be an indication of multiple adverse events of home violence. Expressing feelings with art and involvement in school activities can be a coping behavior or a sign that the child is well adjusted. Frequent stomachaches could be caused by anxiety about school.

Question 24

24.
The parents of a 14-year-old girl complain about the amount of time she spends on the Internet. Which question would the nurse ask the parents to assess her psychosocial development?
A)
“Do you limit her usage of the Internet to an hour per day?”
B)
“Does she do her homework and have fun with her peers?”
C)
“Did you place the computer where you can keep an eye on her?”
D)
“Did you warn her about protecting her identity online?”

Answer 24

Ans:
B

Feedback:

It helps to determine if the child is neglecting responsibilities or other forms of personal interaction. After deciding that issue, the parents should determine what will be reasonable limits for the child’s use of the Internet. Having the computer in a family area is better than putting it in her room, and warning her about protecting her identity is a critical safety issue.

Question 25

25.
The nurse is assessing a toddler for temperament and documents a 'difficult' temperament. Which traits are often seen in this type of personality?
A)
Moodiness
B)
Irritability
C)
Even-temperedness
D)
Overly active
E)
Regular biologic functions

Answer 25

Ans:
B, D

Feedback:

Children’s temperaments may be categorized into three major groups: easy, difficult, and slow to warm up. Easy children are even-tempered and have regular biological functions, predictable behavior, and a positive attitude toward new experiences. Difficult children are irritable, overactive, and intense; they react to new experiences by withdrawing and are frustrated easily. Children in the slow-to-warm-up category are moody and less active and have more irregular reactions; they react to new experiences with mild but passive resistance and need extra time to adjust to new situations.

Question 26

26.
The nurse is talking with a newly married couple who are asking questions about genetic testing. Which statement by the couple indicates the need for further teaching regarding genetics?
A)
“We are thankful that our child’s temperament won’t be anything like either of our fathers’ temperaments.”
B)
“We have a 62. chance of our child being a boy!”
C)
“Genetic testing will help in identifying at least some genetic disorders.”
D)
“We are glad that heart disease just runs in our family and can’t be a genetic disease.”
E)
“Since both of our parents are Asian, we will definitely be having an Asian baby.”

Answer 26

Ans:
A, D

Feedback:

A child’s gender and race; the child’s biological traits, including some behavioral traits or aspects of temperament; and certain diseases or illnesses are directly linked to genetic inheritance. Stating that the child’s temperament won’t be like their grandfathers’ and stating that heart disease can’t be genetic warrants the nurse to further explain genetic influences on their future child’s health.

Ans:
A, D

Feedback:

A child’s gender and race; the child’s biological traits, including some behavioral traits or aspects of temperament; and certain diseases or illnesses are directly linked to genetic inheritance. Stating that the child’s temperament won’t be like their grandfathers’ and stating that heart disease can’t be genetic warrants the nurse to further explain genetic influences on their future child’s health.

Question 27

27.
The nurse is caring for a child of divorced parents on the postoperative unit. Both parents are with the child upon returning from surgery. The nurse hears the parents arguing just outside the child’s room. What is the best response by the nurse?
A)
“If you are going to argue can you please take it outside?”
B)
“I’m not sure if you care, but your child can hear you arguing.”
C)
“I know this is a stressful time, but your child can hear you arguing outside the room.”
D)
“It is important that your child gets some rest so arguing outside the room doesn’t help.”

Answer 27

Ans:
C

Feedback:

The nurse stating “I know this is a stressful time” is a therapeutic way of being empathetic while still ensuring that they know their child can hear them arguing.

Question 28

28.
A 14-year-old tells the nurse that he feels like he can never live up to his parents' standards and that they won't even discuss their rules. What parenting style do this child's parents most likely practice?
A)
Authoritative
B)
Rejecting
C)
Uninvolved
D)
Authoritarian

Answer 28

Ans:
D

Feedback:

The authoritarian parent expects obedience from the child and discourages the child from questioning the family’s rules. This parenting style often causes negative effects on the child’s self-esteem, happiness, and social skills and leads to increased aggression and defiance from the child.

Question 29

29.
The mother of a 4-year-old is discussing discipline methods with the nurse. She states that she has never tried using “time-outs” with her child and wonders how and if this method works. Which responses from the nurse are appropriate? Select all that apply.
A)
“I think time-outs are the best method of discipline for this age of child.”
B)
“Time-out is a way of removing positive reinforcement of an unwanted or inappropriate behavior.”
C)
“If you decide to try this method, be sure to use time-out in a nonthreatening, safe area where no interaction occurs with you.”
D)
“Time-out is a method that is recognized by many pediatricians and experts in pediatrics.”
E)
“I never found time-outs to work with my children, regardless of their age.”

Answer 29

Ans:
B, C, D

Feedback:

Time-out is an extinction discipline method that is most effective with toddlers, preschoolers, and early school-aged children. Providing information so that the mother can make the decision about this method of discipline is appropriate. Giving the mother advice and personal evaluation is not appropriate.

Question 30

30.
The nurse is caring for a child just admitted to the medical-surgical unit and notes that the patient records indicate the family’s religion as Roman-Catholic. Which statements by the nurse are appropriate when considering the patient’s religion while providing care? Select all that apply.
A)
“I will add you to the list of patients for hospital clergy to visit.”
B)
“Is there anything I can do to help your family maintain any religious practices during your child’s stay here?”
C)
“I am Catholic too so if you would like to pray I would be happy to pray with you.”
D)
“If there are any religious dietary practices that we should be aware of, please don’t hesitate to let our staff know.”
E)
“I have several friends who are Catholic. I’m not sure I understand all of your practices but I will respect them.”

Answer 30

Ans:
B, D

Feedback:

Asking the patient and family about ways to help maintain or follow any religious practices is appropriate because it shows caring by the nurse and allows the family to address any issues. The nurse should not make assumptions about a family’s religious or spiritual affiliation. Although they may belong to a particular religion, they may not adhere to all of the beliefs or participate in all aspects of the religion, so notifying the clergy without the family requesting this would not be appropriate. In addition, the nurse should not offer personal information into this professional relationship.