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Ladewig, Contemporary Maternal-Newborn Nursing, 8/E
Chapter 02
Question 1
Type: MCSA
While conducting a family assessment, the nurse determines that a particular family’s structure is binuclear. Some potential challenges inherently faced by binuclear families include:
1. Challenges related to co-parenting and joint custody, including negotiation and compromise between the parents about childrearing decisions.
2. Issues related to both parents being employed, including child care, household chores, and spending time together.
3. Challenges related to children interacting with peers and when revealing their parents’ sexual orientation.
4. Issues related to single parenting, including lack of social and emotional support, need for assistance with childrearing, and financial strain.
Correct Answer: 1
Rationale 1: Because both parents have equal responsibility and legal rights regarding their biologic child, binuclear families may inherently face challenges related to co-parenting and joint custody, including negotiation and compromise between the parents about childrearing decisions.
Rationale 2: Issues inherently faced by the dual-career/dual-earner family include child care, household chores, and spending time together.
Rationale 3: Children raised in gay and lesbian families may face challenges related to interacting with peers and when revealing their parents’ sexual orientation.
Rationale 4: Binuclear families incorporate co-parenting, whereas with single parenting, one parent is responsible for child care. Issues inherently related to single parenting may include lack of social and emotional support, need for assistance with childrearing, and financial strain.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO01 – Describe how family type may influence nursing care of the childbearing family.

Question 2
Type: MCSA
The nurse is preparing a community presentation on family development. Which of the following statements should the nurse include?
1. The youngest child’s age determines the family’s current stage.
2. A family does not experience overlapping of stages.
3. Family development ends when the youngest child leaves home.
4. The stages describe the family’s progression over time.
Correct Answer: 4
Rationale 1: The oldest child’s age is the marker for which stage the family is in, except for the two last stages, which occur after the children have left home.
Rationale 2: Families with more than one child can experience multiple stages simultaneously.
Rationale 3: Families with more than one child can experience multiple stages simultaneously.
Rationale 4: Family development stages describe the changes and adaptations that a family goes through over time as children are added to the family.
Global Rationale:

Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO02 – Explain the changes that a childbearing family will undergo based on the developmental tasks to be completed.

Question 3
Type: MCSA
The nurse is preparing to assess the development of a family new to the clinic. The nurse understands that the primary use of a family assessment tool is to:
1. Obtain a comprehensive medical history of family members.
2. Determine which clinic the patient should be referred to.
3. Predict how a family will likely change with the addition of children.
4. Understand the physical, emotional, and spiritual needs of members.
Correct Answer: 4
Rationale 1: The focus of a family assessment is the family as one entity. Health of the family is one area that is explored using a family assessment tool.
Rationale 2: The family assessment tool facilitates understanding of the physical, emotional, and spiritual needs of members. Although referrals might take place as a result of the family assessment findings, understanding of the family is the primary reason the tool is used.
Rationale 3: The family assessment tool facilitates understanding of the physical, emotional, and spiritual needs of members. Family development models help predict how a family will likely change with the addition of children.
Rationale 4: This is the main reason for using a family assessment tool.
Global Rationale:

Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO03 – Identify information that would be useful to collect when performing a family assessment.

Question 4
Type: MCSA
The registered nurse is caring for a pregnant Muslim patient who is anticipating delivery within the next few days. The nurse asks if she and her husband have chosen a name for their baby. The patient quietly shakes her head, “no.” Based upon the patient’s response, the nurse understands that:
1. The patient is not happily anticipating the arrival of her baby.
2. Cultural beliefs may require the couple to choose the baby’s name following the birth.
3. The patient does not speak English.
4. Cultural beliefs may require that the baby’s name be kept secret until after the delivery.
Correct Answer: 2
Rationale 1: There is no evidence to support that the patient is not happily anticipating her baby’s arrival.
Rationale 2: In the Muslim culture, it is common to avoid naming the baby until after the baby is born.
Rationale 3: The patient has been conversing with the nurse; no prior interaction suggested a language barrier.
Rationale 4: Rather than keeping the baby’s name secret, in the Muslim culture, it is common to avoid naming the baby until the baby is born.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Diagnosis
Learning Outcome: LO04 – Integrate the prevalent cultural norms that affect childbearing and childrearing when providing care to that family.

Question 5
Type: MCSA
A woman of Korean descent has just given birth to a son. Her partner wishes to give her sips of hot broth from a thermos he brought from home. The patient has refused your offer of ice chips or other cold drinks. The nurse should:
1. Explain to the patient that she can have the broth if she will also drink cold water or juice.
2. Encourage the partner to feed the patient sips of broth. Ask if the patient would like you to bring her some warm water to drink as well.
3. Explain to the couple that food can’t be brought from home but that the nurse will make hot broth for the patient.
4. Encourage the patient to have the broth after the nurse takes it to the kitchen and boils it first.
Correct Answer:
Rationale 1: Explaining to the patient that she can have broth if she will drink cold water or juice first does not show cultural sensitivity and does not respect the patient’s beliefs.
Rationale 2: Encouraging the partner to feed the patient sips of broth and asking if the patient would like you to bring her some warm water to drink as well is an approach that shows cultural sensitivity. The equilibrium model of health, based on the concept of balance between light and dark, heat and cold, is the foundation for this belief and practice.
Rationale 3: Explaining to the couple that the hospital does not allow food brought from home but that you will make hot broth for them is an incorrect response.
Rationale 4: Encouraging the patient to have broth after you take it the kitchen and boil it first is an incorrect response because boiling first would make the broth too hot to drink.
Global Rationale:

Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO04 – Integrate the prevalent cultural norms that affect childbearing and childrearing when providing care to that family.

Question 6
Type: MCSA
The nurse works in a facility that cares for patients from a broad range of racial, ethnic, cultural, and religious backgrounds. Which statement should the nurse include in a presentation for nurses new to the facility on the patient population of the facility?
1. “Our patients come from a broad range of backgrounds, but we have a good interpreter service.”
2. “Many of our patients come from backgrounds different from your own, but it doesn’t cause problems for the nurses.”
3. “Because most of the doctors are bilingual, we don’t have to deal with the differences in cultural backgrounds of our patients.”
4. “Understanding the common values and health practices of our diverse patients will facilitate better care and health outcomes.”
Correct Answer: 4
Rationale 1: The role of a foreign language interpreter is to facilitate communication. The interpreter might or might not be able to interpret the cultural practices of patients. An example is a Spanish interpreter: The interpreter might be from Spain but interprets language for patients from Guatemala and Nicaragua, countries about which the interpreter might know virtually nothing.
Rationale 2: Racial, ethnic, cultural, and religious backgrounds of patients have significant implications for how they perceive health, illness, and health care. It is important for nurses to understand the backgrounds of the patient population that attend that facility.
Rationale 3: Bilingual physicians, like all physicians, have very busy schedules and often do not understand nursing care. It is the responsibility of the nurse to become familiar with the backgrounds of the patient population.
Rationale 4: Because of the implications for care based on cultural background, it is important for nurses to understand the backgrounds of the patient population that attend the facility.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO05 – Explain the importance of cultural competency in providing nursing care to the childbearing family.

Question 7
Type: MCSA
The nurse manager in a hospital with a large immigrant population is planning an in-service. The nurse manager is aware of how ethnocentrism affects nursing care. Which statement should the nurse manager include? “The belief that one’s own values and beliefs are the only or the best values:
1. “Means that newcomers to the United States should adopt U.S. norms and values.”
2. “Can create barriers to communication through misunderstanding.”
3. “Leads to an expectation that patients will exhibit pain the same way.”
4. “Improves the quality of care provided to culturally diverse patient bases.”
Correct Answer: 2
Rationale 1: Although acculturation involves adoption of some of the majority culture’s practices and beliefs, each cultural group will continue to hold and express its own set of values and beliefs.
Rationale 2: Ethnocentrism is the conviction that one’s own values and beliefs either are the only ones that exist or are the best. When the nurse assumes that a patient has the same values and beliefs as the nurse, misunderstanding will frequently occur, which in turn can negatively impact nurse–patient communication.
Rationale 3: Expression of pain is one area that varies greatly from one culture to another.
Rationale 4: The belief that one’s own values and beliefs are the best will not improve the quality of care provided to culturally diverse patient bases.
Global Rationale:

Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO05 – Explain the importance of cultural competency in providing nursing care to the childbearing family.

Question 8
Type: MCSA
When preparing to teach a culturally diverse group of childbearing families about hospital birthing options, in order to be culturally competent, the nurse should:
1. Understand that the families have the same values as the nurse.
2. Teach the families how childbearing takes place in the United States.
3. Insist that the clients answer questions instead of their husbands.
4. Learn about the cultural groups that are likely to attend the class.
Correct Answer: 4
Rationale 1: Assuming that the families have the same values is ethnocentrism.
Rationale 2: Although it is important to explain health care during pregnancy and childbearing, this is not the top priority.
Rationale 3: The husband’s answering questions might be a cultural norm, and insisting that the patient answer could decrease the family’s trust in the healthcare system.
Rationale 4: Cultural competence is the development of skills and knowledge necessary to appreciate, understand, and work with individuals from other cultures than the culture of the nurse. Through gaining knowledge of the cultures that are likely to be encountered professionally, the nurse is able to understand the aspects of the patient’s culture that might impact how care should best be given to be accepted by the patient.
Global Rationale:

Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO05 – Explain the importance of cultural competency in providing nursing care to the childbearing family.

Question 9
Type: MCSA
The nurse is admitting a Mexican woman scheduled for a cholecystectomy. The nurse uses a cultural assessment tool during the admission. Which question would be most important for the nurse to ask?
1. “What other treatments have you used for your abdominal pain?”
2. “What is your country of origin; where were you were born?”
3. “When you talk to family members, how close do you stand?”
4. “How would you describe your role within your family?”
Correct Answer: 1
Rationale 1: This question is most important because some traditional or folk remedies include the use of herbs. Because some herbs have medication interactions, this physiologic question is imperative to ask.
Rationale 2: Although this information is helpful, it is not a physiological issue. Asking about other treatments is a higher priority.
Rationale 3: Although understanding the patient’s perception of appropriate personal space is helpful, it is not a physiological issue. Asking about other treatments is a higher priority.
Rationale 4: Although understanding the patient’s family roles is helpful, it is not a physiological issue. Asking about other treatments is a higher priority.
Global Rationale:

Cognitive Level: Evaluating
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO06 – Interpret the information collected from a cultural assessment to provide culturally sensitive care.

Question 10
Type: MCSA
The labor and delivery nurse is caring for a laboring patient who has asked for a priest to visit her during labor. The patient’s mother died during childbirth, and although there are no complications during the patient’s pregnancy, she is fearful of her own death during labor. What is the best response of the nurse?
1. “Nothing is going to happen to you. We’ll take very good care of you during your birth.”
2. “Would you like to have an epidural so that you won’t feel the pain of the contractions?”
3. “The priest won’t be able to prevent complications and might get in the way of your providers.”
4. “Would you like me to contact your parish or our hospital chaplain to come see you?”
Correct Answer: 4
Rationale 1: Avoid statements of false reassurance, as there are no guarantees in the outcomes during health care. Using these statements shuts down effective communication, as the patient’s concern is downplayed.
Rationale 2: The patient’s expressed concern is not about pain; it is a fear of death and a desire to see a priest. Address the patient’s concerns directly.
Rationale 3: Although this statement is true, it is not therapeutic. It downplays the patient’s concerns and will shut down effective communication. Address the concerns the patient expresses.
Rationale 4: When the patient states she wants to see a priest, the nurse should attempt to make arrangements for this visit to occur in a timely manner. Most hospitals have a chaplaincy department that can provide assistance in obtaining the services of a wide variety of religious leaders. Depending on the day of the week and the time of day, the patient’s own home parish church might be able to provide a priest for pastoral care at the bedside.
Global Rationale:

Cognitive Level: Evaluating
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO07 – Identify ways a nurse might accommodate the religious rituals and practices of the childbearing family.

Question 11
Type: MCSA
A pregnant patient reports experiencing occasional gastroesophageal reflux. She explains that she relieves her symptoms through acupressure treatments, as well as by taking an over-the-counter medication recommended by her obstetrician. The nurse recognizes acupressure to be a form of:
1. Homeopathy.
2. Alternative therapy.
3. Biofeedback.
4. Complementary therapy.
Correct Answer: 4
Rationale 1: Homeopathy entails using diluted amounts of substances that, if ingested in larger amounts, would produce effects similar to the symptoms of the disorder being treated.
Rationale 2: Alternative therapy involves the use of a procedure or substance in place of conventional medicine.
Rationale 3: Biofeedback control pertains to using the mind to control physiologic responses based on the concept that the mind controls the body.
Rationale 4: Complementary therapy incorporates the use of a procedure or product as an adjunct to conventional medical treatment.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: LO08 – Distinguish among complementary and alternative therapies.

Question 12
Type: MCSA
A patient reports using “homeopathic remedies” to ease her back pain. In order to more fully explore the patient’s use of complementary and alternative medicine (CAM), the nurse should ask:
1. “Will you tell me more about the homeopathic remedies you’re using?”
2. “Are you aware that some complementary and alternative therapies can be dangerous?”
3. “Does your physician approve of your use of homeopathic remedies?”
4. “Have you prioritized your need for comfort above your concern for your baby’s health?”
Correct Answer: 1
Rationale 1: The nurse should ask direct, nonjudgmental questions when seeking to gain information about a patient’s use of CAM.
Rationale 2: While tactful warnings regarding the use of CAM may be appropriate, the nurse should first explore the patient’s use of CAM in a nonjudgmental manner.
Rationale 3: Patients may be reluctant to discuss their use of CAM with their healthcare providers; the nurse should explore the topic using nonjudgmental language.
Rationale 4: Additional information is needed in order to evaluate the patient’s use of CAM, and the topic should be approached without use of disparaging comments.
Global Rationale:

Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO08 – Distinguish between complementary and alternative therapies.

Question 13
Type: MCSA
The patient pregnant with her first child reports that her husband wants her to visit a homeopath for help with her nausea and vomiting. The patient asks what the nurse’s opinion of homeopathy is. The best response by the nurse is:
1. “Homeopathy is unproven and potentially dangerous. Avoid using homeopathic remedies.”
2. “The FDA has approved homeopathic remedies, and practitioners undergo education and certification.”
3. “I can’t give you advice about what alternatives to try. Go online and do some research to get information.”
4. “Homeopathy is the same as herbal remedies. Some are safe during pregnancy and some are not.”
Correct Answer: 2
Rationale 1: Homeopathic remedies are not dangerous. Homeopathic remedies are FDA-approved and have been proven to be effective in treating a wide range of chronic and acute illnesses and conditions.
Rationale 2: Homeopathic remedies are FDA-approved and have been proven to be effective in treating a wide range of chronic and acute illnesses and conditions.
Rationale 3: It is appropriate for the nurse to provide factual information to educate a patient who has asked a question. Not all patients have access to computers, nor do they know how to do an internet search.
Rationale 4: Herbalism and homeopathy are not the same. Herbs are available in many stores and preparations; some have been proven to be dangerous during pregnancy. Homeopathy is a system of “like curing like,” in which the symptom being treated would be a symptom of taking too much of the substance in a non-homeopathic form.
Global Rationale:

Cognitive Level: Evaluating
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO09 – Describe the benefits and risks of the various complementary and alternative therapies to the childbearing family.

Question 14
Type: MCMA
Complementary and alternative therapies have many benefits for the childbearing family and others. However, many of these remedies have associated risks. Which of the following situations would be considered risks?
Standard Text: Select all that apply.
1. Getting a massage from a licensed massage therapist for back pain, prescribed by the primary caregiver
2. Trying out a homeopathic medicine from a friend to reduce swelling in the legs
3. Getting a chiropractic treatment for low back pain due to discomforts of pregnancy without telling the primary health care provider
4. Taking an herbal preparation suggested by a health food store worker for treatment of leg pain
5. Joining a group that practices tai chi weekly to help with physical fitness and movement
Correct Answer: 2,3,4
Rationale 1: Getting a massage from a licensed massage therapist for back pain, prescribed by the primary caregiver, is a perfectly good use of complementary therapies.
Rationale 2: Trying out a homeopathic medicine from a friend to reduce swelling in your legs is a risk factor when considering these therapies. Lack of standardization, lack of regulation and research to substantiate their safety and effectiveness, and inadequate training and certification of some healers make some therapies risky.
Rationale 3: Getting a chiropractic treatment for low back pain due to discomforts of pregnancy without telling the primary health care provider is a risk factor when considering these therapies. Lack of standardization, lack of regulation and research to substantiate their safety and effectiveness, and inadequate training and certification of some healers make some therapies risky.
Rationale 4: Taking an herbal preparation suggested by a health food store worker for treatment of leg pain is a risk factor when considering these therapies. Lack of standardization, lack of regulation and research to substantiate their safety and effectiveness, and inadequate training and certification of some healers make some therapies risky.
Rationale 5: Joining a group that practices tai chi weekly to help with physical fitness and movement is a perfectly good use of complementary therapies.
Global Rationale:

Cognitive Level: Evaluating
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: LO09 – Describe the benefits and risks of the various complementary and alternative therapies to the childbearing family.

Question 15
Type: MCSA
The labor and delivery unit nurse manager is incorporating complementary and alternative therapies into the unit’s policies and procedures. Which statement should the nurse manager include during an in-service educational presentation for the nursing staff?
1. “Policies have been developed for using massage and aromatherapy.”
2. “When patients ask questions you don’t know, tell them to look online.”
3. “Because herbs are dangerous during pregnancy, we will not use them.”
4. “Be sure to ask patients what alternative therapies they have used.”
Correct Answer: 1
Rationale 1: The development of written policies and procedures facilitates safe nursing practice, which in turn promotes patient safety.
Rationale 2: Online information can vary in its accuracy. Reputable sources (electronic or print) should be recommended for further patient education.
Rationale 3: This statement is false. Many herbs can be safely used during pregnancy.
Rationale 4: What the patient has used in the past does not predict what she is open to using at present. It is more important to develop written policies and procedures.
Global Rationale:

Cognitive Level: Evaluating
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO10 – Formulate nursing care within the nurse practice act and with the informed consent of the patient when using appropriate complementary therapies with childbearing families.

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