Unit B-Introduction to Medical Surgical and Maternal Newborn Nursing Flashcards
A married couple lives in a single-family house with their newborn son and the husband’s
daughter from a previous marriage. On the basis of the information given, what family form
best describes this family?
a. Married-blended family
b. Extended family
c. Nuclear family
d. Same-sex family
ANS: A
Married-blended families are formed as the result of divorce and remarriage. Unrelated family
members join together to create a new household. Members of an extended family are kin, or
family members related by blood, such as grandparents, aunts, and uncles. A nuclear family is
a traditional family with male and female partners and the children resulting from that union.
A same-sex family is a family with homosexual partners who cohabit with or without
children.
In what form do families tend to be most socially vulnerable?
a. Married-blended family
b. Extended family
c. Nuclear family
d. Single-parent family
ANS: D
The single-parent family tends to be vulnerable economically and socially, creating an
unstable and deprived environment for the growth potential of children. The married-blended
family, the extended family, and the nuclear family are not the most socially vulnerable.
The nurse should be aware that the criteria used to make decisions and solve problems within families are based primarily on family: a. rituals and customs. b. values and beliefs. c. boundaries and channels. d. socialization processes.
ANS:B
Values and beliefs are the most prevalent factors in the decision-making and problem-solving
techniques of families. Although culture may play a part in the decision-making process of a
family, ultimately values and beliefs dictate the course of action taken by family members.
Boundaries and channels affect the relationship between the family members and the health
care team, not the decisions within the family. Socialization processes may help families with
interactions with the community, but they are not the criteria used for decision making within
the family
Using the family stress theory as an intervention approach for working with families
experiencing parenting, the nurse can help the family change internal context factors. These
include:
a. Biologic and genetic makeup.
b. Maturation of family members.
c. The family’s perception of the event.
d. The prevailing cultural beliefs of society.
ANS: C
The family stress theory is concerned with the family’s reaction to stressful events; internal
context factors include elements that a family can control such as psychologic defenses. It is
not concerned with biologic and genetic makeup, maturation of family members, or the
prevailing cultural beliefs of society.
While working in the prenatal clinic, you care for a very diverse group of patients. When
planning interventions for these families, you realize that acceptance of the interventions will
be most influenced by:
a. educational achievement.
b. income level.
c. subcultural group.
d. individual beliefs.
ANS: D
The patient’s beliefs are ultimately the key to acceptance of health care interventions.
However, these beliefs may be influenced by factors such as educational level, income level,
and ethnic background. Educational achievement, income level, and subcultural group all are
important factors. However, the nurse must understand that a woman’s concerns from her own
point of view will have the most influence on her compliance.
The nurse’s care of a Hispanic family includes teaching about infant care. When developing a
plan of care, the nurse bases interventions on the knowledge that in traditional Hispanic
families:
a. breastfeeding is encouraged immediately after birth.
b. male infants typically are circumcised.
c. the maternal grandmother participates in the care of the mother and her infant.
d. special herbs mixed in water are used to stimulate the passage of meconium.
ANS: C
In Hispanic families, the expectant mother is influenced strongly by her mother or
mother-in-law. Breastfeeding often is delayed until the third postpartum day. Hispanic male
infants usually are not circumcised. Olive or castor oil may be given to stimulate the passage
of meconium.
The woman’s family members are present when the home care maternal-child nurse arrives
for a after birth and newborn visit. What should the nurse do?
a. Observe the family members’ interactions with the newborn and one another.
b. Ask the woman to meet with her and the baby alone.
c. Do a brief assessment on all family members present.
d. Reschedule the visit for another time so that the mother and infant can be assessed
privately.
ANS: A
The nurse should introduce herself to the patient and the other family members present.
Family members in the home may be providing care and assistance to the mother and infant.
However, this care may not be based on sound health practices. Nurses should take the
opportunity to dispel myths while family members are present. The responsibility of the home
care maternal-child nurse is to provide care to the new after birth mother and her infant, not to
all family members. The nurse can politely ask about the other people in the home and their
relationships with the woman. Unless an indication is given that the woman would prefer
privacy, the visit may continue.
The nurse should be aware that during the childbearing experience an African-American
woman is most likely to:
a. seek prenatal care early in her pregnancy.
b. avoid self-treatment of pregnancy-related discomfort.
c. request liver in the after birth period to prevent anemia.
d. arrive at the hospital in advanced labor.
ANS: D
African-American women often arrive at the hospital in far-advanced labor. These women
may view pregnancy as a state of wellness, which is often the reason for delay in seeking
prenatal care. African-American women practice many self-treatment options for various
discomforts of pregnancy, and they may request liver in the after birth period, but this is based
on a belief that the liver has a high blood content.
To provide competent care to an Asian-American family, the nurse should include which of
the following questions during the assessment interview?
a. “Do you prefer hot or cold beverages?”
b. “Do you want milk to drink?”
c. “Do you want music playing while you are in labor?”
d. “Do you have a name selected for the baby?”
ANS: A
Asian-Americans often prefer warm beverages. Milk usually is excluded from the diet of this
population. Asian-American women typically labor in a quiet atmosphere. Delaying naming
the child is common for Asian-American families.
The patient’s family is important to the maternity nurse because:
a. they pay the bills.
b. the nurse will know which family member to avoid.
c. the nurse will know which mothers will really care for their children.
d. the family culture and structure will influence nursing care decisions.
ANS: D
Family structure and culture influence the health decisions of mothers.
A mother’s household consists of her husband, his mother, and another child. She is living in a(n): a. extended family. b. single-parent family. c. married-blended family. d. nuclear family
ANS: A
An extended family includes blood relatives living with the nuclear family. Both parents and a
grandparent are living in this extended family. Single-parent families comprise an unmarried
biologic or adoptive parent who may or may not be living with other adults. Married-blended
refers to families reconstructed after divorce. A nuclear family is where male and female
partners and their children live as an independent unit.
A traditional family structure in which male and female partners and their children live as an independent unit is known as a(n): a. extended family. b. binuclear family. c. nuclear family. d. blended family
ANS:C
About two thirds of U.S. households meet the definition of a nuclear family. Extended
families include additional blood relatives other than the parents. A binuclear family involves
two households. A blended family is reconstructed after divorce and involves the merger of
two families.
Which statement about family systems theory is inaccurate?
a. A family system is part of a larger suprasystem.
b. A family as a whole is equal to the sum of the individual members.
c. A change in one family member affects all family members.
d. The family is able to create a balance between change and stability.
ANS: B
A family as a whole is greater than the sum of its parts. The other statements are
characteristics of a system that states that a family is greater than the sum of its parts.
A pictorial tool that can assist the nurse in assessing aspects of family life related to health care is the: a. genogram. b. family values construct. c. life cycle model. d. human development wheel.
ANS: A
A genogram depicts the relationships of family members over generations.
The process by which people retain some of their own culture while adopting the practices of the dominant society is known as: a. acculturation. b. assimilation. c. ethnocentrism. d. cultural relativism.
ANS: A
Acculturation is the process by which people retain some of their own culture while adopting
the practices of the dominant society. This process takes place over the course of generations.
Assimilation is a loss of cultural identity. Ethnocentrism is the belief in the superiority of
one’s own culture over the cultures of others. Cultural relativism recognizes the roles of
different cultures.
When attempting to communicate with a patient who speaks a different language, the nurse
should:
a. respond promptly and positively to project authority.
b. never use a family member as an interpreter.
c. talk to the interpreter to avoid confusing the patient.
d. provide as much privacy as possible.
ANS: D
Providing privacy creates an atmosphere of respect and puts the patient at ease. The nurse
should not rush to judgment and should make sure that he or she understands the patient’s
message clearly. In crisis situations, the nurse may need to use a family member or neighbor
as a translator. The nurse should talk directly to the patient to create an atmosphere of respect.
In which culture is the father more likely to be expected to participate in the labor and delivery? a. Asian-American b. African-American c. European-American d. Hispanic
ANS: C
European-Americans expect the father to take a more active role in the labor and delivery than
the other cultures.
Which statement about cultural competence is not accurate?
a. Local health care workers and community advocates can help extend health care to
underserved populations.
b. Nursing care is delivered in the context of the patient’s culture but not in the
context of the nurse’s culture.
c. Nurses must develop an awareness of and sensitivity to various cultures.
d. A culture’s economic, religious, and political structures influence practices that
affect childbearing.
ANS: B
The cultural context of the nurse also affects nursing care. The work of local health care
workers and community advocates is part of cultural competence; the nurse’s cultural context
is also important. Developing sensitivity to various cultures is part of cultural competence, but
the nurse’s cultural context is also important. The impact of economic, religious, and political
structures is part of cultural competence; the nurse’s cultural context is also important.
What type of family is one in which all members are related by blood?
a. Consanguineous
b. Affinal
c. Family of origin
d. Household
ANS: A
A consanguineous family is one of the most common types and consists of members who
have a blood relationship. The affinal family is one made up of marital relationships.
Although the parents are married, they may each bring children from a previous relationship.
The family of origin is the family unit that a person is born into. Considerable controversy has
been generated about the newer concepts of families (i.e., communal, single-parent, or
homosexual families). To accommodate these other varieties of family styles, the descriptive
term household is frequently used.
A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse
how they should tell the child that she is adopted. Which guideline concerning adoption
should the nurse use in planning her response?
a. Telling the child is an important aspect of their parental responsibilities.
b. The best time to tell the child is between ages 7 and 10 years.
c. It is not necessary to tell the child who was adopted so young.
d. It is best to wait until the child asks about it.
ANS: A
It is important for the parents not to withhold information about the adoption from the child. It
is an essential component of the child’s identity. There is no recommended best time to tell
children. It is believed that children should be told young enough so they do not remember a
time when they did not know. It should be done before the children enter school to keep third
parties from telling the children before the parents have had the opportunity.
The mother of a school-age child tells the school nurse that she and her spouse are going
through a divorce. The child has not been doing well in school and sometimes has trouble
sleeping. The nurse should recognize this as:
a. indicative of maladjustment.
b. common reaction to divorce.
c. suggestive of lack of adequate parenting.
d. unusual response that indicates need for referral
ANS: B
Parental divorce affects school-age children in many ways. In addition to difficulties in
school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of
appetite, and sleep disorders. Uncommon responses to parental divorce include indications of
maladjustment, the suggestion of lack of adequate parenting, and the need for referral.
A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, “I
want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.”
The nurse’s most appropriate answer is:
a. “I’m sure he’ll be fine if you get a good baby-sitter.”
b. “You will need to stay home until Eric starts school.”
c. “You should go back to work so Eric will get used to being with others.”
d. “Let’s talk about the child care options that will be best for Eric.”
ANS: D
“Let’s talk about the child care options that will be best for Eric” is an open-ended statement
that will assist the mother in exploring her concerns about what is best for both her and Eric.
“I’m sure he’ll be fine if you get a good baby-sitter,” “You will need to stay home until Eric
starts school,” and “You should go back to work so Eric will get used to being with others”
are directive statements and do not address the effect of her working on Eric.
Which term best describes a group of people who share a set of values, beliefs, practices,
social relationships, law, politics, economics, and norms of behavior?
a. Race
b. Culture
c. Ethnicity
d. Social group
ANS: B
Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides
the outlook and decisions of a group of people. A culture is composed of individuals who
share a set of values, beliefs, and practices that serve as a frame of reference for individual
perceptions and judgments. Race is defined as a division of humankind who possesses traits
transmissible by descent and sufficient to characterize it as a distinct human type. Ethnicity is
an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. A
social group consists of systems of roles carried out in groups. Examples of primary social
groups include the family and peer groups.
Which term best describes the emotional attitude that one’s own ethnic group is superior to others? a. Culture b. Ethnicity c. Superiority d. Ethnocentrism
ANS: D
Ethnocentrism is the belief that one’s way of living and behaving is the best way. This
includes the emotional attitude that the values, beliefs, and perceptions of one’s ethnic group
are superior to those of others. Culture is a pattern of assumptions, beliefs, and practices that
unconsciously frames or guides the outlook and decisions of a group of people. A culture is
composed of individuals who share a set of values, beliefs, and practices that serve as a frame
of reference for individual perception and judgments. Ethnicity is an affiliation of a set of
persons who share a unique cultural, social, and linguistic heritage. Superiority is the state or
quality of being superior; it does not include ethnicity.
A Chinese toddler has pneumonia. The nurse notices that the parent consistently feeds the
child only the broth that comes on the clear liquid tray. Food items such as Jell-O, Popsicles,
and juices are left. What would best explain this?
a. The parent is trying to feed child only what child likes most.
b. The parent is trying to restore normal balance through appropriate “hot” remedies.
c. Hispanics believe that the “evil eye” enters when a person gets cold.
d. Hispanics believe that an innate energy called chi is strengthened by eating soup.
ANS: B
In several groups, including Filipino, Chinese, Arabic, and Hispanic cultures, hot and cold
describe certain properties completely unrelated to temperature. Respiratory conditions such
as pneumonia are “cold” conditions and are treated with “hot” foods. This may be true, but it
is unlikely that a toddler would consistently prefer the broth to Jell-O, Popsicles, and juice.
The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals
believe in chi as an innate energy.
The nurse discovers welts on the back of a Vietnamese child during a home health visit. The
child’s mother says that she has rubbed the edge of a coin on her child’s oiled skin. The nurse
should recognize that this is:
a. child abuse.
b. a cultural practice to rid the body of disease.
c. a cultural practice to treat enuresis or temper tantrums.
d. a child discipline measure common in the Vietnamese culture
ANS: B
A cultural practice to rid the body of disease is descriptive of coining. The welts are created
by repeatedly rubbing a coin on the child’s oiled skin. The mother is attempting to rid the
child’s body of disease. The mother was engaged in an attempt to heal the child. This
behavior is not child abuse, a cultural practice to treat enuresis or temper tantrums, or a
disciplinary measure.
The father of a hospitalized child tells the nurse, “He can’t have meat. We are Buddhist and
vegetarians. ” The nurse’s best intervention is to:
a. order the child a meatless tray.
b. ask a Buddhist priest to visit.
c. explain that hospital patients are exempt from dietary rules.
d. help the parent understand that meat provides protein needed for healing
ANS: A
It is essential for the nurse to respect the religious practices of the child and family. The nurse
should arrange a dietary consultation to ensure that nutritionally complete vegetarian meals
are prepared by the hospital kitchen. The nurse should be able to arrange for a vegetarian tray.
The nurse should not encourage the child and parent to go against their religious beliefs.
Nutritionally complete, acceptable vegetarian meals should be provided.
In which cultural group is good health considered to be a balance between yin and yang?
a. Asians
b. Australian aborigines
c. Native Americans
d. African-Americans
ANS: A
In Chinese health beliefs, the forces termed yin and yang must be kept in balance to maintain
health. This belief is not consistent with Australian aborigines, Native Americans, or
African-Americans.
The nurse case manager is planning a care conference about a young child who has complex
health care needs and will soon be discharged home. Whom should the nurse invite to the
conference?
a. Family and nursing staff
b. Social worker, nursing staff, and primary care physician
c. Family and key health professionals involved in child’s care
d. Primary care physician and key health professionals involved in child’s care
ANS: C
A multidisciplinary conference is necessary for coordination of care for children with complex
health needs. The family and key health professionals who are involved in the child’s care are
included. The nursing staff can address the nursing care needs of the child with the family, but
other involved disciplines must be included. The family must be included in the discharge
conferences, which allow them to determine what education they will require and the
resources needed at home. A member of the nursing staff must be included to review the
nursing needs of the child.
Lindsey, age 5 years with a diagnosis of cerebral palsy, will be starting kindergarten next
month and will be placed in a special education classroom. The parents are tearful when
telling the nurse about this and state that they did not realize that their child’s disability was so
severe. How should the nurse interpret this parental response?
a. This is a sign that parents are in denial.
b. This is a normal anticipated time of parental stress.
c. The parents need to learn more about cerebral palsy.
d. The parents are used to having expectations that are too high.
ANS: B
Parenting a child with a chronic illness can be very stressful for parents. There are anticipated
times that parental stress increases. One of these identified times is when the child begins
school. Nurses can help parents recognize and plan interventions to work through these
stressful periods. The parents are not in denial; they are responding to the child’s placement in
school. The parents are not exhibiting signs of a knowledge deficit or expectations that are too
high; this is their first interaction with the school system with this child.
Which behavior is considered an approach behavior in parents of chronically ill children?
a. Inability to adjust to a progression of the disease or condition.
b. Anticipation of future problems and seeking guidance and answers.
c. Looking for new cures without a perspective toward possible benefit.
d. Failing to recognize seriousness of child’s condition despite physical evidence.
ANS: B
Approach behaviors are coping mechanisms that result in a family’s movement toward
adjustment and resolution of the crisis of having a child with a chronic illness or disability.
The parents who anticipate future problems and seek guidance and answers are demonstrating
approach behaviors. They are demonstrating positive actions in caring for their child.
Avoidance behaviors include being unable to adjust to a progression of the disease or
condition, looking for new cures without a perspective toward possible benefit, and failing to
recognize the seriousness of the child’s condition despite physical evidence. These behaviors
would suggest that the parents are moving away from adjustment or adaptation in the crisis of
a child with chronic illness or disability.
Families progress through various stages of reactions when a child is diagnosed with a chronic
illness or disability. After the shock phase, a period of adjustment usually follows that may be
characterized by what reaction?
a. Anger
b. Overprotectiveness
c. Social reintegration
d. Guilt
ANS: B
For most families, the adjustment phase is accompanied by several responses that are
normally part of the adjustment process. Overprotectiveness, rejection, denial, or gradual
acceptance are common reactions. The initial diagnosis of a chronic illness or disability often
is often met with intense emotion and characterized by guilt and anger. Social reintegration is
the culmination of the adjustment process.
The nurse comes into the room of a child who was just diagnosed with a chronic disability.
The child’s parents begin to yell at the nurse about a variety of concerns. What is the nurse’s
best response?
a. “What is really wrong?”
b. “Being angry is only natural.”
c. “Yelling at me will not change things.”
d. “I will come back when you settle down.”
ANS: B
Parental anger after the diagnosis of a child with a chronic disability is a common response.
One of the most common targets for parental anger is members of the staff. The nurse should
recognize the common response of anger to the diagnosis and allow the family to express their
feelings and emotions. “What is really wrong?” “Yelling at me will not change things,” and “I
will come back when you settle down” are all possible responses, but they are not addressing
the parent’s need to express their anger effectively.
A common parental reaction to a child with special needs is parental overprotection. Parental
behavior suggestive of this includes which behavior?
a. Attempting to avoid frustrating situations.
b. Providing consistent, strict discipline.
c. Forcing child to help self, even when not capable.
d. Encouraging social and educational activities not appropriate to child’s level of
capability.
ANS: A
Parental overprotection is manifested by the parents’ fear of letting the child achieve any new
skill, avoiding all discipline, and catering to the child’s every desire to prevent frustration. The
overprotective parents usually do not set limits and or institute discipline, and they usually
prefer to remain in the role of total caregiver. They do not allow the child to perform self-care
or encourage the child to try new activities.
Most parents of children with special needs tend to experience chronic sorrow. How may
chronic sorrow be characterized?
a. Lack of acceptance of the child’s limitation.
b. Lack of available support to prevent sorrow.
c. Periods of intensified sorrow when experiencing anger and guilt.
d. Periods of intensified sorrow and loss that occur in waves over time.
ANS: D
Chronic sorrow is manifested by feelings of sorrow and loss that recur in waves over time.
The sorrow is in response to the recognition of the child’s limitations. The family should be
assessed in an ongoing manner to provide appropriate support as the needs of the family
change. The sorrow is not preventable. The chronic sorrow occurs during the reintegration and
acknowledgment stage.
Which intervention will encourage a sense of autonomy in a toddler with disabilities?
a. Avoiding separation from family during hospitalization
b. Encouraging age appropriate independence in as many areas as possible
c. Exposing child to pleasurable experiences as much as possible
d. Helping parents learn special care needs of their child
ANS: B
Encouraging the toddler to be independent encourages a sense of autonomy. The child can be
given choices about feeding, dressing, and diversional activities, which will provide a sense of
control. Avoiding separation from family during hospitalization and helping parents learn
special care needs of their child should be practiced as part of family-centered care. They do
not particularly foster autonomy. Exposing the child to pleasurable experiences, especially
sensory ones, is a supportive intervention. It does not particularly support autonomy.
The feeling of guilt that the child “caused” the disability or illness is especially critical in which child? a. Toddler b. Preschooler c. School-age child d. Adolescent
ANS: B
Preschoolers are most likely to be affected by feelings of guilt that they caused the
illness/disability or are being punished for wrongdoings. Toddlers are focused on establishing
their autonomy. The illness will foster dependency. The school-age child will have limited
opportunities for achievement and may not be able to understand limitations. Adolescents are
faced with the task of incorporating their disabilities into their changing self-concept.
The father, of a 9 year old diagnosed with several physical disabilities, explains to the nurse
that his child concentrates on what he/she can do rather than cannot do and is as independent
as possible. How should the nurse’s best interpret this statement?
a. The father is experiencing denial.
b. The father is expressing his own views.
c. The child is using an adaptive coping style.
d. The child is using a maladaptive coping style.
ANS: C
The father is describing a well-adapted child who has learned to accept physical limitations.
These children function well at home, at school, and with peers. They have an understanding
of their disorder that allows them to accept their limitations, assume responsibility for care,
and assist in treatment and rehabilitation. The father is not denying the child’s limitations or
expressing his own views. This is descriptive of an adaptive coping style.
