Test Bank For Maternal-Child Nursing Care with The Women's Health Companion: Optimizing Outcomes for Mothers, Children, and Families, 2nd Edition

Chapter 2: Contemporary Issues in Women’s, Families’, and Children’s Health Care MULTIPLE CHOICE 1. The clinic nurse is working with a mother and her 3-year-old child who have arrived for the child’s routine checkup. The nurse encourages the mother to return for her child’s measles-mumps-rubella immunization prior to the child’s entering school. This intervention is an example of what type of care? A. Mandatory health care B. Primary health prevention C. Secondary health prevention D. Tertiary health prevention ANS: B Of the three levels of prevention, the most desirable level is primary prevention. This encompasses health promotion and activities specifically meant to prevent disease from occurring—in this case, scheduling vaccinations. Secondary prevention refers to early identification and prompt treatment of a health problem before it has an opportunity to spread or become more serious. Tertiary prevention is intended to restore health to the highest functioning state that is possible. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 2. A nurse wishing to be an advocate for access to health care would most likely choose to participate in which of the following activities? A. Lobby for improved insurance access for all individuals, whether or not they are employed. B. Help establish fast-track or minor illness areas in local emergency rooms. C. Partner with medical centers to provide free services for low-income patients. D. Work with visiting nurses associations to create on-site clinics at day-care centers. ANS: A The biggest determinant of access to and quality of health care is one’s insurance status. The other actions might help improve access too, but would not be as effective as lobbying for improved ability for all individuals to get insurance. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 3. A nurse working with an after-school program is concerned about the lack of health literacy in the students’ parents. What action would best address this need? A. Conduct a monthly health-related seminar for parents. B. Investigate grants or other funding for a computer bank. C. Invite parents to healthy cooking demonstrations. D. Provide brochures on a variety of health problems. ANS: B The disparity between people who have access to technology and those who do not is directly related to health literacy and knowledge. The amount of information doubles every 6 years, so it is not possible to keep track of all the latest health news by accessing brochures, books, or periodicals. Having access to computers would greatly increase health literacy. The other options are certainly helpful, but would not be as far-reaching as providing access to online material. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Difficult PTS: 1 4. A nurse is caring for a patient near the end of life whose wishes regarding care are not known. The two sons disagreed with the two daughters about future medical plans for the patient during a recent family conference, and now the sons and daughters are not talking to one another. What action by the nurse would be best to help resolve this dilemma? A. Call the facility’s ethics committee and request a formal consultation. B. Have social work coordinate another family meeting to discuss the issue. C. Meet with the sons and daughters separately to discuss their wishes. D. Request that the physician tell the family what is in the patient’s best interests. ANS: A Ethical principles in health care are often in conflict, and it takes a skilled person to negotiate and mediate these situations. Ethics committees exist in most health-care facilities that are experienced in confronting these difficult situations. The best response would be for the nurse to request a consultation from the ethics committee. Another family meeting may not work, as the family already disagrees and tensions are high. The other options may be helpful, but are not as vital as a formal ethics committee consultation. Meeting privately with the sons and daughters might give the nurse some insight into their positions, but would not be as effective as utilizing the expertise on the committee. The physician should not decide what is in the patient’s best interests, as this is paternalistic and violates the principle of autonomy. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Difficulty: Moderate PTS: 1 5. A mother and her 12-year-old daughter visit the clinic often because of the daughter’s asthma. The clinic nurse recognizes that one of the most important nursing actions in this situation is which of the following? A. Continue to schedule regular clinic visits for the child to follow her condition. B. Give the mother time to talk about her daughter’s illness while she is present. C. Listen patiently to the child as she talks about her illness, letting her tell her story. D. Regulate and modify the child’s medications in response to her asthma symptoms. ANS: C Research shows that children feel that health-care providers don’t really listen to them. It is important to advocate for the child and to develop a therapeutic relationship characterized by a caring attitude. The nurse should encourage the child to discuss her asthma and modify interventions accordingly. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Difficult PTS: 1 6. The nurse managing a pediatric clinic often sees single mothers with children. What action by the nurse would best help this population of women access health care? A. Arrange to have evening and weekend hours. B. Offer sample medications instead of prescriptions. C. Provide a play center for waiting children. D. Provide bus tokens for transportation to the clinic. ANS: A Single mothers with children constitute 82% of the poverty population. “Welfare to work” programs are now compulsory, and women must work in order to receive aid. Offering evening and weekend hours could accommodate more women who cannot afford to miss time off from work. The other options might be helpful for some patients and families, but to have the greatest impact on the largest group of people, accommodating work schedules is important for this population of women. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Easy PTS: 1 7. A community health nurse explains to the nursing student that the best health-related programming includes which of the following elements? A. Has both individual and societal components B. Is directed toward individual responsibility C. Provides incentives to compensate healthy choices D. Requires legislation to truly be effective ANS: A Intervention programs must be multi-tiered and oriented to the broader social context in which they occur, because that is where patients are located. Programs directed toward only individuals are less successful. Programs and interventions do not need to include legislation or incentives. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 8. A nursing student wishes to investigate national health goals. Where should the student research this information? A. Cochrane Database B. Cumulative Index of Nursing and Allied Health Literature C. Government websites D. Healthy People initiative ANS: D The Healthy People initiative is the blueprint for the nation’s health goals. Updated every 10 years, it lists national health priorities. Information related to the Healthy People initiative can be found on the other sites, but they are secondary sources. The student would do best to investigate the primary source. Cognitive Level: Application: Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 9. A nurse is interested in primary prevention programs. Which of the following activities would this nurse choose to do? A. Assist with blood pressure screening at the local mall. B. Collect and distribute used eyeglasses for poor people. C. Staff a mobile mammogram unit for underserved groups. D. Teach teenagers about the dangers of texting and driving. ANS: D Primary prevention includes activities designed to keep health problems from happening. It often includes education. Teaching teens the dangers of texting and driving will (hopefully) prevent motor vehicle crashes. Secondary prevention is screening, early detection, and prompt treatment for health problems. Providing blood pressure screening and mammograms are examples of secondary prevention. Tertiary prevention attempts to restore health to its highest level of functioning. Providing eyeglasses for needy people with vision problems is an example of tertiary prevention. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 10. A nurse wants to work in the community providing secondary prevention activities. Which action would this nurse choose to do? A. Educate teenage girls about birth control options. B. Provide STD/STI testing at the local youth center. C. Staff the county health department flu shot clinic. D. Volunteer to drive cancer patients to receive their treatments. ANS: B Secondary prevention is screening, early detection, and prompt treatment for health problems. Testing youths for STD/STIs is an example of secondary prevention. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Educating teenage girls about birth control options will (hopefully) prevent unintentional pregnancies and is an example of primary prevention. Likewise, staffing the flu shot clinic is also an example of primary prevention. Tertiary prevention attempts to restore health to its highest level of functioning. Driving cancer patients to their treatments is an example of tertiary prevention. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 11. A nurse is interested in providing tertiary prevention activities. Which of the following activities would this nurse choose to do? A. Assist with low-cost swimming lessons at the YMCA. B. Conduct monthly educational seminars at a church. C. Join the county pandemic outbreak response team. D. Provide glucose and cholesterol screening at the mall. ANS: C Tertiary prevention attempts to restore health to its highest level of functioning. Working with a county response team in the event of a pandemic outbreak would be an example of tertiary prevention. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Assisting with swimming lessons and conducting monthly seminars will educate the target audiences in order to prevent a health problem. Secondary prevention is screening, early detection, and prompt treatment for health problems. Providing glucose and cholesterol screening is an example of secondary prevention. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 12. A practicing nurse tells a student nurse that beyond the World Health Organization’s definition of health, providers must also consider which of the following factors when determining the health of a community? A. The definition of health as described by the community B. The incidence of preventable health problems in the group C. The morbidity caused by genetically related health problems D. The mortality rates that could be lowered with primary prevention ANS: A The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” According to Purnell and Paulanka (2008), one must also consider the definition of health as it is described by people within their own ethnocultural group. The other options are not part of this consideration. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 13. A nurse wants to know the trend concerning death due to cardiovascular disease. What source should the nurse consult? A. Epidemiology data B. Morbidity data C. Mortality data D. Primary prevention data ANS: C Mortality refers to death. Government agencies keep both mortality and morbidity records on public health threats. Morbidity refers to illness. Epidemiology is the statistical analysis of factors related to disease in populations over time. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 14. A nurse enjoys working with patients who have chronic illnesses. What group of people would this nurse enjoy working with most? A. Ethnic minorities B. Men and boys C. Older adults D. Women and girls ANS: C The older adult population is growing steadily and rapidly and will have a huge impact on health care in the future, due to the prevalence of chronic illness in this group. Chronic illness occurs in all groups, but for the older adult population, it is a special concern. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Easy PTS: 1 15. A nurse would like to improve the health of the community. Which action by the nurse would have the greatest impact? A. Blood glucose screening at the local Korean church B. Blood pressure screening at a predominantly black church C. Teaching immigrants heart-healthy cooking for traditional foods D. Teaching men the signs and symptoms of heart attacks ANS: B Although all activities are good nursing interventions for specific communities, more than half of black women aged 45–64 years have hypertension, so a blood pressure screening at a predominantly black church could have the greatest impact. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 16. A nurse is working with a parent–teacher association to combat school bullying. What action can the nurse suggest that would best help to decrease this form of interpersonal violence? A. Advise that victims’ parents call law enforcement and press charges. B. Begin offering martial arts classes in the school for bullied children. C. Encourage the school to adopt no-tolerance policies for bullying. D. Suggest limiting television viewing, especially for younger children. ANS: D Some research has shown that violent media exposure is linked to violent behavior. Included in media are computer games, which can also be violent. Younger children may not be able to distinguish between real and fantasy and may be overly influenced by violent images. No-tolerance policies can be helpful, as can a social environment in which children and their parents are held accountable legally. Offering martial arts classes may send the wrong message and would most likely not diminish the incidence of bullying. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 17. A school nurse is increasingly concerned with a growing absentee problem. To best address this issue, which of the following actions should the nurse take? A. Begin a structured follow-up program for asthmatic children. B. Hold informational meetings on the importance of childhood vaccines. C. Partner with providers on continuity plans for kids with chronic illness. D. Work with law enforcement to develop a truancy response team. ANS: A All plans sound like they could be innovative strategies for dealing with school absenteeism. But because asthma is the most common reason for a child to miss school (and the primary reason for visits to pediatric emergency rooms), the nurse’s best response is to develop a structured follow-up program for kids with asthma. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 18. A nurse is working with a patient who misses appointments frequently and doesn’t always fill prescriptions for herself or her children. On reviewing the patient’s chart, the nurse sees that the patient has insurance. What action by the nurse would be the most helpful? A. Ask the patient to describe her health insurance coverage. B. Educate the patient about the consequences of skipping medicines. C. Find out if the patient is seeing other health-care providers. D. Remind the patient that she is responsible for her children’s health. ANS: A An important factor in access to health care is insurance. Employer-provided plans are becoming more uncommon, and even those with insurance often have gaps in their coverage, which leads to missed appointments, unfilled prescriptions, and other services being underutilized. The other actions might be useful, although it probably will sound judgmental if the nurse merely tells the patient that she is responsible for her children’s health. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 19. A nurse reads in the paper that the death rate for women overall has declined substantially. To what does the nurse correlate this finding? A. Abundant new choices in contraception B. Better detection and treatment of breast cancer C. Greater access to sources of fresh produce D. Improved diagnosis of heart disease in women ANS: D The leading cause of death in women overall is heart disease. Women face significant barriers to timely diagnosis and treatment of heart disease than do men. The nurse can conclude that this has improved, leading to the significant decrease in the female death rate. Contraception choices would not lead to a significant decrease in mortality, as childbirth is not a common fatal event, although the number of perinatal deaths has not declined in recent years. And even with multiple choices in contraception, at least half of all pregnancies are unintended or mistimed. Access to fresh produce could improve many health conditions for women. Cancer is the second leading cause of death in women. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Evaluation Difficulty: Moderate PTS: 1 20. A nurse working with the elderly population is distressed that in order to obtain public funding for long-term care, the elderly must expend nearly all of their resources. When considering bioethical principles, which principle should the nurse choose to act from to make the biggest difference in this situation? A. Autonomy B. Fidelity C. Justice D. Veracity ANS: C The principle of justice means treating everyone fairly. Requiring the elderly to divest themselves of their resources in order to obtain funding for housing could be seen as a justice issue. Autonomy is having free will and acting according to one’s own wishes when making decisions. Fidelity is keeping promises. Veracity is truth telling. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Difficult PTS: 1 21. A nurse considers beneficence as the guiding ethical principle for nursing practice. Working within that framework, which action by the nurse best demonstrates that concept? A. Administering a pain medication before therapy so that the patient can participate B. Allowing the patient to make informed choices as to his or her plan of care C. Promising a pain medication in 1 hour and returning with it on time D. Turning patients to prevent pressure sores, despite causing temporary discomfort ANS: A Beneficence means acting for the patient’s benefit, or doing good. Giving a pain medication before a therapy session helps the patient fully participate, improving his or her recovery. Allowing the patient to make informed choices demonstrates autonomy. Returning when promised is an example of fidelity. Turning patients, even though it causes temporary discomfort, is non-maleficence. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate PTS: 1 22. A nurse ensures that a patient does not have questions regarding the upcoming surgical procedure and verifies that the signature on the consent form is the patient’s signature. Which ethical principle is this nurse demonstrating? A. Autonomy B. Beneficence C. Fidelity D. Justice ANS: A Autonomy is the right to make decisions and to have the information necessary to make such decisions. Beneficence is doing good. Fidelity is keeping promises. Justice is treating everyone fairly. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate PTS: 1 23. A 45-year-old woman presents to the emergency department complaining of chest pain and feeling anxious. She asks to have an electrocardiogram (EKG) but is told that “heart disease is a man’s disease” and is given a prescription for lorazepam (Ativan). What can the nurse conclude? A. If the woman were older, she may have received an EKG. B. Sex hormones play a powerful role in determining heart disease. C. Stereotyping seriously impacted the care the woman received. D. Women under the age of 45 are at low risk of having heart disease. ANS: C A stereotype is a mental image that portrays members of a specific group with the same attributes. Believing that heart disease is a “man’s disease” is an example of a stereotype. Because the practitioner held this view, the woman’s health care was compromised. The other statements cannot be justified from this example. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Difficult PTS: 1 24. A nurse has heard of the “digital divide” between people who have access to technology and those who don’t. The nurse asks a mentor how this can affect health care. What response by the mentor is most accurate? A. “It’s just easier and faster to make appointments online.” B. “Much health-care information is available only digitally.” C. “The so-called digital divide really doesn’t have much impact.” D. “You can chat with your doctor on social media sites.” ANS: B The explosion in information makes digital access to health-care resources vital. There are even applications for smart phones that have a health-care function. Not all clinics and physician offices have online appointment scheduling. Most people surveyed would like to connect with their physicians via email but not on social networking sites. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 25. One goal of the Healthy People 2020 initiative is to increase the number of people who have some form of health insurance. What percentage of the population is the target? A. 25% B. 35% C. 55% D. 100% ANS: D Healthy People 2020 has the ambitious goal of increasing the proportion of people with health insurance to 100%. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Easy PTS: 1 26. A nurse is working with a woman who is 4 months pregnant. The woman has had a series of temporary housing, has no job, and is wearing clothing that is obviously way too big for her. What action can the nurse take to most improve the health of this woman and child? A. Arrange transportation for her to get to a community food bank. B. Consult a social worker to help her apply for the WIC program. C. Encourage the woman to make her return appointment before leaving. D. Ask the woman to fill out an application for the federal Medicare program. ANS: B WIC, or the Women, Infants, and Children Program, targets pregnant women, infants, and children up to age 5 who are nutritionally at risk. WIC provides supplemental nutritious foods and nutrition counseling. Forty-five percent of infants born in this country participate in the WIC program. Helping with transportation needs and facilitating return appointments is helpful too, but not to the degree that improving this woman’s nutrition will be. The woman might be eligible for Medicaid, but not Medicare, which is for the elderly. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Moderate PTS: 1 MULTIPLE RESPONSE 1. A nurse working in a women’s health clinic has several patients who are from a minority culture, live in the inner city, lack employment that offers benefits, have large families, and often lack transportation to health care. Which of these factors are considered broad determinants of health? (Select all that apply.) A. Access to health care B. Employment C. Environment D. Family size E. Race ANS: A, B, C, E Broad determinants of health care are personal, community, and societal systems and include environment, employment, insurance, class, race, social support, access to health services, genetic endowment, and personal histories. Family size itself is not a broad determinant of health care; however, it could be included in the larger category of personal history. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 2. The community health nurse knows that the public health intervention model is focused on which of the following intervention levels? (Select all that apply.) A. Community B. Family C. Government D. Hospitals E. Patient ANS: A, B, E The public health intervention model is an inclusive framework that encompasses three levels at which interventions can be initiated, from the micro-level of the individual to the macro-level environment. Interventions are targeted toward individuals/families, communities, and larger institutional and societal systems. Government and hospitals are not one of the three levels. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 3. A nurse working in the community uses the public health intervention model to combat diabetes mellitus type 2. Using this model, which interventions are appropriate? (Select all that apply.) A. Community: Encourage high-risk patients to have glucose screening. B. Community: Lobby for funds to build walking and biking trails. C. Community: Subsidize community gardens in areas where produce is expensive. D. Individual/family: Educate about the benefits of daily exercise. E. Societal: Pressure Congress for laws requiring insurance incentives for health promotion. ANS: B, C, D, E The public health intervention model, also known as the Intervention Wheel, is a framework that contains three levels for health-care interventions, from the micro-level of the individual to the macro-level of the environment. Interventions are aimed at individuals/families, communities, and larger institutional and social systems. Lobbying to build walking/biking trails and assisting with community gardens are examples of community-level interventions. Encouraging high-risk individuals to have glucose screening is at the individual/family level, as is education about the benefits of daily exercise. An example of an institutional or societal intervention would be lobbying Congress to pass laws requiring insurance companies to provide incentives for health promotion activities. Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Difficult PTS: 1 4. The community health nurse is aware that the goals of Healthy People 2020 include which of the following? (Select all that apply.) A. Creating physical environments that promote health B. Developing healthy behaviors in children and teens C. Eliminating health disparities and increasing equity D. Improving the health of all groups in the country E. Increasing the average life span for all adults ANS: A, C, D Goals of the Healthy People 2020 document include the following: (1) To attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) to achieve health equity, eliminate disparities, and improve the health of all groups; (3) to create social and physical environments that promote good health for all; and (4) to promote quality of life, healthy development, and healthy behaviors across all life stages. The blueprint does not call for developing healthy behaviors only in children and teens, nor does it call for simply increasing the average life span. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Planning Difficulty: Difficult PTS: 1 5. What does the nursing student understand about health disparities in the United States? (Select all that apply.) A. African American babies die by age 1 at a rate times that of European Americans. B. Asian American babies have the highest rate of preterm birth of any other group. C. Despite large expenditures, health resources are unevenly distributed. D. European Americans have double the number of low-birth-weight babies than other groups. E. Sudden infant death syndrome is most prevalent in American Indian and Alaska native babies. ANS: A, C, E Many health disparities exist in America, despite huge outlays of money. A major problem is that health resources are not distributed evenly across demographic and geographic groups. This leads to such problems as the high rate at which African American babies die before age 1, and the high incidence of sudden infant death syndrome in American Indian and Alaska Native populations. Asian American babies do not have the highest rate of preterm birth, and European American women do not have double the number of low-birth-weight babies of other groups. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 6. The public health nurse explains to students that diversity is an increasing phenomenon in this country. What facts about this phenomenon does the nurse share with the students? (Select all that apply.) A. As immigrants acculturate, their unique cultural care needs will diminish. B. By 2050, the minority population in America is estimated to be 50%. C. Hispanics, blacks, and Asians are the historically designated minority groups. D. One in five people in this country will be over the age of 65 by the year 2030. E. Racial differences are rooted in biological factors that explain illness trends. ANS: B, D The population of ethnic minorities is expected to reach 50% by the year 2050, which increases the need for culturally competent health care. One in five people will be over the age of 65 by 2030, increasing the impact of chronic illnesses. Hispanics, blacks, Asians, and Native Americans are the historically designated minority groups. There is no biologic basis for race; racial and ethnic categories are socially created. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy PTS: 1 7. Which of the following activities should the perinatal nurse encourage women who come for preconceptional counseling to consider? (Select all that apply.) A. Choosing breastfeeding or bottle feeding B. Decreasing risk for exposure to toxoplasmosis C. Decreasing fetal risks related to the work environment D. Ensuring folic acid supplementation E. Ensuring iron supplementation ANS: B, C, D Folic acid supplementation helps to prevent certain birth defects. A fetus’s exposure to harm could potentially be prevented if a woman were counseled prior to pregnancy about the adverse effects of alcohol, tobacco, toxoplasmosis, and other teratogens in her home or workplace. During the preconception period, it is too early for the woman to take iron supplements (unless she is anemic), and debating infant feeding methods is not the priority at this time. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 8. A mother brings her 6-month-old infant and 18-month-old child to the health clinic for a routine visit. The nurse counsels the mother about lead exposure testing. Which information should the nurse include? (Select all that apply.) A. “About one-fourth of all homes where kids under 6 live are contaminated by lead.” B. “Both of your children should have testing for lead at this time.” C. “Lead exposure may cause anemia, seizures, and mental retardation if not treated.” D. “Lead testing for children is recommended by the American Academy of Pediatrics.” E. “We can test your older child for lead exposure, but it is too early for the 6-month-old.” ANS: A, C, D, E The American Academy of Pediatrics recommends that all children between the ages of 1 and 2 years receive testing for lead exposure, as 25% of homes presently occupied by children under the age of 6 have known lead contamination. Lead exposure has been linked to a number of medical and developmental problems, including anemia, seizures, and mental retardation. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate PTS: 1 9. The clinic nurse is interviewing a woman and her daughter who describe their address as“temporary.” The mother appears thin, pale, and tired. Her blood work confirms anemia and pregnancy. What actions by the nurse would be most helpful? (Select all that apply.) A. Call the Department of Children and Family Services. B. Discuss nutrition needs for pregnancy. C. Facilitate the woman’s opportunity to return for prenatal care. D. Determine if the family is in a safe location. E. Provide shelter information for this family. ANS: C, D, E A priority for this family is to provide information regarding shelters, to facilitate follow-up clinic visits for the mother to address her pregnancy and anemia, and to determine if the family is currently in a safe place or if the family is vulnerable to violence. Nutrition in pregnancy should be discussed, but it is not the priority intervention at this point. There is no reason to call the Department of Children and Family Services unless abuse is suspected. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate PTS: 1 10. The clinic nurse explains to a student that an appropriate nursing action is screening all children for child abuse. What other information does the nurse give the student about child abuse? (Select all that apply.) A. It is frequently carried out by a stranger. B. The most common form is neglect. C. It is most often perpetrated by a parent. D. Only 1 out of 1,000 girls is sexually abused. E. It is part of an ongoing cycle of violence. ANS: B, C, E The National Child Abuse and Neglect Data System reports that three children die of child abuse in the home each day. Children are most commonly abused by someone they know, and in 79% of cases, the perpetrator is a parent. Child abuse can set up a perpetuating cycle of suffering and more violence later in life, potentially reaching to future generations. Neglect is the most common form of child abuse. One out of every four girls will be sexually abused by the time she reaches 18. Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Difficulty: Easy PTS: 1 11. The jail nurse is interviewing a woman who has been brought to the clinic for prenatal care. Which of the following are appropriate actions for the nurse to perform? (Select all that apply.) A. Assess the woman for drug and alcohol abuse and possible withdrawal. B. Assess the woman’s health knowledge and health literacy. C. Ask if the woman has other children and who is caring for them. D. Determine if the woman has risk factors for pregnancy complications. E. Inquire about the woman’s criminal history and background. ANS: A, B, C, D A nurse who is able to deliver culturally competent care to incarcerated women quickly becomes cognizant of the challenges of caring for this population. These women tend to have many health problems, including substance abuse and dependency. They frequently have not had access to health-related knowledge. Because nearly 1.3 million children of incarcerated women have no mother figure in their lives, women in prison or jail are often deeply concerned about their welfare. This demonstrates caring and can often be the motivation for making changes. The nurse needs to complete a thorough obstetrical history, including determining risk factors for high-risk pregnancy. The nurse does not need to know about the woman’s criminal history. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate PTS: 1 12. Which childhood illnesses are the subject of a Healthy People initiative regarding vaccinations? (Select all that apply.) A. Asthma B. Measles C. Meningitis D. Mumps E. Pertussis ANS: B, D, E One goal of the Healthy People initiative is to reduce vaccine-preventable illnesses such as measles, mumps, and rubella to zero cases and to reduce pertussis in children under 7 to no more than 2,000 cases/year. Asthma and meningitis are not included in this goal. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Planning Difficulty: Easy PTS: 1 13. A nurse is working with a patient determined to have low health literacy and has taught the patient vital self-care measures for a chronic illness. How will the nurse best determine if the patient has understood the information? (Select all that apply.) A. Ask for a return demonstration of the skills taught. B. Assess if the patient will take brochures written for this illness. C. Encourage the patient to explain how the information fits into his or her daily life. D. Give the patient a written quiz at the end of the teaching session. E. Have the patient repeat the information in her or his own words. ANS: A, C, E Communicating with people who have low health literacy can be challenging. Some strategies the nurse can employ are: specific training, asking open-ended questions, asking patients to restate information or provide a return demonstration of skills, using plain and culturally sensitive language, and developing health information tailored to specific populations. To assess for cultural congruency, the nurse can ask the patient to explain how the self-care measures fit into the patient’s life. Simply giving the patient brochures does not guarantee that the patient understands or will use them, or even whether the patient can read. Giving a quiz might be seen as intimidating. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Evaluation Difficulty: Difficult PTS: 1 14. A nurse has helped organize and staff a free vaccination clinic for underserved populations in a central location of the city. The nurse is unhappy that so few people came to the clinic. In evaluating this outcome, what factors does the nurse recognize as potentially leading to the problem? (Select all that apply.) A. Clinic hours B. Inability to miss work C. Lack of insurance D. Lack of transportation E. Language barriers ANS: A, B, D, E Underserved, typically poor, populations face multiple obstacles to obtaining health care that need to be considered when organizing events. If the clinic hours were during the day, parents might be reluctant to pull children out of school for fear of being labeled as truant. Parents participating in “welfare to work” programs or who have low-skill, low-wage jobs might not be able to miss work, or would forfeit pay by doing so. Participants need transportation to the clinic, which is located in one area of town. Language barriers could lead to confusion or misunderstanding or lack of awareness of the clinic. The lack of insurance shouldn’t be a concern because the vaccinations are free, but it is possible this was a point that some misunderstood. Cognitive Level: Evaluation/Evaluating Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Moderate PTS: 1