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Chapter 02_LO 01_Q01
Why is it important for the nurse to understand the type of family that a client comes from? Select all that apply.
1. Family structure can influence finances and the ability to purchase nutritious foods.
2. Many types of families exist, and it is important to address the persons who hold power within the family.
3. The nurse can anticipate which problems a client will experience based on the type of family the client has.
4. Understanding if the client’s family is nuclear or blended will help the nurse teach the client the appropriate information.
5. The values of the family will be predictable if the nurse knows what type of family the client is a part of.
Correct Answers: 1, 2
Rationale:
1. Dual-career/dual-earner families tend to have more stable finances, while single-parent families tend to have lower incomes. Nutrition impacts fetal growth and development, and nutritious foods tend to be more costly than nutrient-poor or junk food. Thus understanding the type of family can help the nurse determine the best education for the client.
2. Understanding the family power is important so that the nurse will address the appropriate person(s). This will facilitate effective communication, as the nurse will be perceived as respectful of the family.
3. Each client and family must be assessed as individuals, without making assumptions. Although generalities can be drawn based on the type of family that a client comes from or currently is part of, stereotypes must be avoided.
4. Each client and family must be assessed as individuals, without making assumptions. Although generalities can be drawn based on the type of family that a client comes from or currently is part of, stereotypes must be avoided.
5. Each client and family must be assessed as individuals, without making assumptions. Although generalities can be drawn based on the type of family that a client comes from or currently is part of, stereotypes must be avoided.
Cognitive level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 2.1 Describe how family type can influence nursing care of the childbearing family.

Chapter 02_LO2 _Q02
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.
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.
2. Families with more than one child can experience multiple stages simultaneously.
3. Families with more than one child can experience multiple stages simultaneously.
4. Family development stages describe the changes and adaptations that a family goes through over time as children are added to the family.

Assessment
Health Promotion and Maintenance
Application
Learning Outcome 2.2 Explain the changes that a childbearing family will undergo based on the developmental tasks to be completed.

Chapter 02_LO03 _Q03
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 client 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.
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.
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.
4. This is the main reason for using a family assessment tool.
Cognitive level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 2.3 Identify information that would be useful to collect when performing a family assessment.

Chapter 02_LO 04_Q04
A laboring client has been very quiet during labor, and has made no noise during contractions during the past four hours. The client is of Chinese descent. The nurse understands that this indicates that the client:
1. Believes pain should be endured and not expressed.
2. Is not in the active phase of labor yet.
3. Will not need pain medication during her hospitalization.
4. Has been abused by her husband and is afraid to verbalize fear.
Correct Answer: 1
Rationale:
1. This is a common traditional Chinese belief.
2. Because it is a common traditional Chinese belief to not express pain verbally, the nurse must assess for the progression of labor in other ways.
3. Although it is a common traditional Chinese belief to not express pain verbally, the assumption cannot be made that no pain relief medication will be needed either during the labor and birth or the postpartum period.
4. It is a common traditional Chinese belief to not express pain verbally, and does not indicate domestic abuse.
Cognitive level: Analysis
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Diagnosis
Learning Outcome: 2.4 Integrate the prevalent cultural norms of a family that affect childbearing and child rearing when providing care to that family.

Chapter 02_LO 04_Q05

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 client has refused your offer of ice chips or other cold drinks. The nurse should:
1. Explain to the client that she can have the broth if she will also drink cold water or juice.
2. Encourage the partner to feed the client sips of broth. Ask if the client 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 client.

4. Encourage the client to have the broth, after the nurse takes it to the kitchen and boils it first.

Correct Answer: 2
Rationale:
1. Explaining to the client that she can have broth if she will drink cold water or juice first does not show cultural sensitivity and does not respect the client’s beliefs.
2. Encouraging the partner to feed the client sips of broth and asking if the client 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.
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.
4. Encouraging the client 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.
Nursing Process: Intervention
Category of Client Need: Health Promotion: Growth and Development
Cognitive Level: Application
Learning Outcome: 2.4 Integrate the prevalent cultural norms of a family that affect childbearing and child rearing when providing care to that family.

Chapter 02_LO 05_Q06
The nurse works in a facility that cares for clients 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 client population of the facility?
1. “Our clients come from a broad range of backgrounds, but we have a good interpreter service.”
2. “Many of our clients 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 clients.”
4. “Understanding the common values and health practices of our diverse clients 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 clients. An example is a Spanish interpreter: The interpreter might be from Spain, but interprets language for clients from Guatemala and Nicaragua, countries about which the interpreter might know virtually nothing.
2. Racial, ethnic, cultural, and religious backgrounds of clients have significant implications for how they perceive health, illness, and health care. It is important for nurses to understand the backgrounds of the client population that attend that facility.
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 client population.
4. Because of the implications for care based on cultural background, it is important for nurses to understand the backgrounds of the client population that attend the facility.
Cognitive level: Analysis
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Planning
Learning Outcome: 2.5 Explain the importance of cultural competency in providing nursing care to the childbearing family.

Chapter 02_LO 05_Q07
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 all clients will exhibit pain the same way.”
4. “Improves the quality of care provided to culturally diverse client bases.”
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.
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 client has the same values and beliefs as the nurse, misunderstanding will frequently occur, which in turn can negatively impact nurse–client communication.
3. Expression of pain is one area that varies greatly from one culture to another.
4. The belief that one’s own values and beliefs are the best will not improve the quality of care provided to culturally diverse client bases.
Cognitive Level: Application
Category of Client Need: Psychosocial Integrity
Nursing Process: Planning
Learning Outcome 2.5 Explain the importance of cultural competency in providing nursing care to the childbearing family.

Chapter 02_LO 05_Q08

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.
Answer: 4
Rationale:
1. Assuming that the families have the same values is ethnocentrism.
2. Although it is important to explain health care during pregnancy and childbearing, this is not the top priority.
3. The husband’s answering questions might be a cultural norm, and insisting that the client answer could decrease the family’s trust in the health care system.
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 client’s culture that might impact how care should best be given to be accepted by the client.
Cognitive Level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Planning
Learning Outcome 2.5 Explain the importance of cultural competency in providing nursing care to the childbearing family.

Chapter 02_LO 06_Q09
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.
2. Although this information is helpful, it is not a physiological issue. Asking about other treatments is a higher priority.
3. Although understanding the client’s perception of appropriate personal space is helpful, it is not a physiological issue. Asking about other treatments is a higher priority.
4. Although understanding the client’s family roles is helpful, it is not a physiological issue. Asking about other treatments is a higher priority.
Cognitive level: Application
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Planning
Learning Outcome: 2.6 Interpret the information collected from a cultural assessment to provide culturally sensitive care.

Chapter 02_LO 07_Q10
The Labor and Delivery nurse is caring for a laboring client who has asked for a priest to visit her during labor. The client’s mother died during childbirth, and although there are no complications during the client’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 client’s concern is downplayed.
2. The client’s expressed concern is not about pain, it is a fear of death and a desire to see a priest. Address the client’s concerns directly.
3. Although this statement is true, it is not therapeutic. It downplays the client’s concerns, and will shut down effective communication. Address the concerns the client expresses.
4. When the client 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 client’s own home parish church might be able to provide a priest for pastoral care at the bedside.
Cognitive level: Application
Category of Client Need: Psychosocial Integrity
Nursing Process: Planning
Learning Outcome: 2.7 Identify ways a nurse might accommodate the religious rituals and practices of the childbearing family.

Chapter 02_LO 08_Q11
The nurse is assessing a client who reports seeing an acupuncturist on a weekly basis to treat back pain. The nurse understands that acupuncture is an example of:
1. A risky practice without evidence of efficacy.
2. Folk remedy use.
3. Complementary therapy.
4. Alternative therapy.
Correct Answer: 3
Rationale:
1. Acupuncture has been a traditional Chinese medicine for over 3,000 years. Good evidence is available on the efficacy of acupuncture for treatment of chronic pain.
2. A folk remedy is a practice of a cultural group that either has no evidence to support efficacy or has been found not to have an effect. Acupuncture has been a traditional Chinese medicine for over 3,000 years.
3. Acupuncture is a therapy that is used in conjunction with conventional medical treatment, and therefore is an example of a complementary therapy.
4. An alternative therapy is usually considered a substance or procedure that is used in place of conventional medicine. Acupuncture is categorized as a complementary therapy.
Cognitive level: Application
Category of Client Need: Physiologic Integrity
Nursing Process: Diagnosis
Learning Outcome: 2.8 Distinguish between complementary and alternative therapies.

Chapter 02_LO 08_Q12

The client states, “I am using homeopathic remedies to help with my morning sickness.” The nurse understands that the client is utilizing:
1. A complementary therapy.
2. An alternative therapy.
3. Traditional Chinese medicine.
4. Naturopathy.
Answer: 1
Rationale:
1. A complementary therapy is that which is an adjunct to traditional medical treatment, and has been shown through rigorous scientific testing to be reliable.
2. Alternative therapies are those that have not undergone rigorous scientific testing.
3. Traditional Chinese medicine includes acupuncture and herbology.
4. Naturopathy is an eclectic combination of nutrition, botanical medicine, homeopathy, acupuncture, hydrotherapy, and physiotherapy.
Cognitive Level: Analysis
Category of Client Need: Physiologic Integrity
Nursing Process: Assessment
Learning Outcome 2.8 Distinguish between complementary and alternative therapies.

Chapter 02_LO09_Q13
The client pregnant with her first child reports that her husband wants her to visit a homeopath for help with her nausea and vomiting. The client 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.
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.
3. It is appropriate for the nurse to provide factual information to educate a client who has asked a question. Not all clients have access to computers, nor do they know how to do an internet search.
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.
Cognitive level: Analysis
Category of Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 2.9 Describe the benefits and risks of the various complementary and alternative therapies to the childbearing family.

Chapter 02_LO09_Q14

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? 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 Answers: 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.

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.

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.

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.

5. Joining a group that practices tai chi weekly to help with physical fitness and movement is a perfectly good use of complementary therapies.
Nursing Process: Assessment
Category of Client Need: Safe, Effective Care Environment: Management of Care
Cognitive Level: Analysis
Learning Outcome: 2.9 Describe the benefits and risks of the various complementary and alternative therapies to the childbearing family.

Chapter 02_LO 10_Q15
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 make to the nursing staff during an in-service educational presentation?
1. “Policies have been developed for using massage and aromatherapy.”
2. “When clients 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 clients 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 client safety.
2. Online information can vary in its accuracy. Reputable sources (electronic or print) should be recommended for further client education.
3. This statement is false. Many herbs can be safely used during pregnancy.
4. What the client 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.
Cognitive level: Application
Category of Client Need: Physiological Integrity
Nursing Process: Planning
Learning Outcome: 2.10 Formulate nursing care within the nurse practice act and with the informed consent of the client when using appropriate complementary therapies with childbearing families.