Wong's Essentials of Pediatric Nursing 9th Edition by Marilyn J. Hockenberry-Test Bank

Wong’s Essentials of Pediatric Nursing
9th Edition By Marilyn J. Hockenberry-

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Sample Test
Chapter 03: Family Influences on Child Health Promotion
MULTIPLE CHOICE
1. A nurse is selecting a family theory to assess a patient’s family dynamics.

Which family theory best describes a series of tasks for the family throughout
its life span?
a. Interactional theory
b. Developmental systems theory
c. Structural-functional theory
d. Duvall’s developmental theory
ANS: D
Duvall’s developmental theory describes eight developmental tasks of the family

throughout its life span. Interactional theory and structural-functional theory are
not family theories. Developmental systems theory is an outgrowth of Duvall’s
theory. The family is described as a small group, a semiclosed system of
personalities that interact with the larger cultural system. Changes do not occur
in one part of the family without changes in others.
PTS: 1 DIF: Cognitive Level: Understand

REF: 24-26
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance
2. Which family theory explains how families react to stressful events and
suggests factors that promote adaptation to these events?
a. Interactional theory
b. Developmental systems theory
c. Family stress theory

d. Duvall’s developmental theory
ANS: C
Family stress theory explains the reaction of families to stressful events. In

addition, the theory helps suggest factors that promote adaptation to the stress.
Stressors, both positive and negative, are cumulative and affect the family.
Adaptation requires a change in family structure or interaction. Interactional
theory is not a family theory. Interactions are the basis of general systems
theory. Developmental systems theory is an outgrowth of Duvall’s theory. The
family is described as a small group, a semiclosed system of personalities that
interact with the larger cultural system. Changes do not occur in one part of the
family without changes in others. Duvall’s developmental theory describes eight
developmental tasks of the family throughout its life span.

REF: 24
3. Which is the term for a family in which the paternal grandmother, the
parents, and two minor children live together?
a. Blended
b. Nuclear
c. Binuclear
d. Extended

ANS: D
An extended family contains at least one parent, one or more children, and one
or more members (related or unrelated) other than a parent or sibling. A blended
family contains at least one step-parent, step-sibling, or half-sibling. The nuclear
family consists of two parents and their children. No other relatives or
nonrelatives are present in the household. In binuclear families, parents continue
the parenting role while terminating the spousal unit. For example, when joint
custody is assigned by the court, each parent has equal rights and
responsibilities for the minor child or children.
PTS: 1 DIF: Cognitive Level: Remember

REF: 24-26
TOP: Integrated Process: Nursing Process: Planning
4. A nurse is assessing a family’s structure. Which describes a family in

which a mother, her children, and a stepfather live together?
a. Blended
b. Nuclear
c. Binuclear
d. Extended
ANS: A
A blended family contains at least one step-parent, step-sibling, or half-sibling.
The nuclear family consists of two parents and their children. No other relatives
or nonrelatives are present in the household. In binuclear families, parents
continue the parenting role while terminating the spousal unit. For example,
when joint custody is assigned by the court, each parent has equal rights and
responsibilities for the minor child or children. An extended family contains at
least one parent, one or more children, and one or more members (related or
unrelated) other than a parent or sibling.

REF: 24-26
5. Which is considered characteristic of children who are the youngest in

their family?
a. More dependent than firstborn children
b. More outgoing than firstborn children
c. Identify more with parents than with peers
d. Are subject to greater parental expectations
ANS: B
Later-born children are obliged to interact with older siblings from birth and
seem to be more outgoing and make friends more easily than firstborns. Being
more dependent, identifying more with parents than peers, and being subject to
greater parental expectations are characteristics of firstborn children and only
children.


REF: 29-30
6. Parents of a firstborn child are asking whether it is normal for their child
to be extremely competitive. The nurse should respond to the parents that
studies about the ordinal position of children suggest that firstborn children
tend to:
a. be praised less often.
b. be more achievement oriented.
c. be more popular with the peer group.
d. identify with peer group more than parents.
ANS: B
Firstborn children, like only children, tend to be more achievement-oriented.
Being praised less often, being more popular with the peer group, and identifying
with peer groups more than parents are characteristics of later-born children.
PTS: 1 DIF: Cognitive Level:

Apply REF: 29
TOP: Integrated Process: Nursing Process: Implementation

7. A 35-year-old client is currently on fertility treatments. When responding to

a question from the client about multiple births, which statement by the nurse
is accurate?
a. Use of fertility treatments has been associated with an increase in multiple births.
b. Your chance of having multiple births is at the same rate as all women of childbearing a
There is not enough evidence about the use of fertility treatments increasing the rate o
c.
multiple births.
Because of your age and the fertility treatments, you have almost a 100% chance of a
d.
multiple birth.
ANS: A
Because women in their thirties are almost 2.5 times as likely as women in their
twenties to have higher-order plural births, increased childbearing among older
women and the expanded use of fertility drugs have been associated with an
increase in the multiple-birth ratio. The rate of having a multiple birth for this
client is not the same for all women of childbearing age. There are data
indicating that fertility treatments increase the rate of multiple births, but
fertility treatments do not have a 100% rate of multiple births.

REF: 30
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

8. Nicole and Kelly, age 5 years, are identical twins. Their parents tell the
nurse that the girls always want to be together. The nurse’s suggestions
should be based on which statement?
a. Some twins thrive best when they are constantly together.
b. Individuation cannot occur if twins are together too much.
c. Separating twins at an early age helps them develop mentally.
d. When twins are constantly together, pathologic bonding occurs.
ANS: A
Twins work out a relationship that is reasonably satisfactory to both. They

develop a remarkable capacity for cooperative play and considerable loyalty and
generosity toward each other. Parents should foster individual differences and
allow the children to follow their natural inclinations. Individuation does occur.
In twinship, one member of the pair is more dominant, outgoing, and assertive
than the other. Early separation may produce unnecessary stresses for the
children. There is no evidence that pathologic bonding occurs when twins are
constantly together.

REF: 30-31
9. The nurse is teaching a group of new parents about the experience of role
transition. Which statement by a parent would indicate a correct
understanding of the teaching?
a. “My marital relationship can have a positive or negative effect on the role transition.”
“If an infant has special care needs, the parents’ sense of confidence in their new role i
b.
strengthened.”
c. “Young parents can adjust to the new role easier than older parents.”
d. “A parent’s previous experience with children makes the role transition more difficult.”
ANS: A
If parents are supportive of each other, they can serve as positive influences on
establishing satisfying parental roles. When marital tensions alter caregiving
routines and interfere with the enjoyment of the infant, then the marital
relationship has a negative effect. Infants with special care needs can be a
significant source of added stress. Older parents are usually more able to cope
with the greater financial responsibilities, changes in sleeping habits, and
reduced time for each other and other children. Parents who have previous
experience with parenting appear more relaxed, have less conflict in disciplinary
relationships, and are more aware of normal growth and development.

REF: 31-32
TOP: Integrated Process: Nursing Process: Evaluation
10. When assessing a family, the nurse determines that the parents exert little
or no control over their children. This style of parenting is called:
a. permissive.
b. dictatorial.
c. democratic.
d. authoritarian.
ANS: A
Permissive parents avoid imposing their own standards of conduct and allow
their children to regulate their own activity as much as possible. The parents
exert little or no control over their children’s actions. Dictatorial or authoritarian
parents attempt to control their children’s behavior and attitudes through
unquestioned mandates. They establish rules and regulations or standards of
conduct that they expect to be followed rigidly and unquestioningly. Democratic
parents combine permissive and dictatorial styles. They direct their children’s
behavior and attitudes by emphasizing the reasons for rules and negatively
reinforcing deviations. They respect the child’s individual nature.

REF: 33
TOP: Integrated Process: Nursing Process: Diagnosis
11. When discussing discipline with the mother of a 4-year-old child, the nurse
should include which instruction?
a. Children as young as 4 years old rarely need to be punished.
b. Parental control should be consistent.

c. Withdrawal of love and approval is effective at this age.
d. One should expect rules to be followed rigidly and unquestioningly.
ANS: B
For effective discipline, parents must be consistent and must follow through with
agreed-on actions. Realistic goals should be set for this age group. Parents
should structure the environment to prevent unnecessary difficulties. Requests
for behavior change should be phrased in a positive manner to provide direction
for the child. Withdrawal of love and approval is never appropriate or effective.
Discipline strategies should be appropriate to the child’s age, temperament, and
severity of the misbehavior. Following rules rigidly and unquestioningly is beyond
the developmental capabilities of a 4-year-old.

Apply REF: 33
TOP: Integrated Process: Teaching/Learning
12. Which is most characteristic of the physical punishment of children, such

as spanking?
a. Psychological impact is usually minimal.
b. Children rarely become accustomed to spanking.
c. Children’s development of reasoning increases.

d. Misbehavior is likely to occur when parents are not present.
ANS: D
Through the use of physical punishment, children learn what they should not do.
When parents are not around, it is more likely that children will misbehave
because they have not learned to behave well for their own sake, but rather out
of fear of punishment. Spanking can cause severe physical and psychological
injury and interfere with effective parent-child interaction. Children do become
accustomed to spanking, requiring more severe corporal punishment each time.
The use of corporal punishment may interfere with the child’s development of
moral reasoning.

REF: 35
13. A 3-year-old girl was adopted immediately after birth. The parents have
just asked the nurse how they should tell the child that she is adopted. Which
guidelines concerning adoption should the nurse use in planning a response?
a. Telling the child is an important aspect of their parental responsibilities.
b. The best time to tell the child is between ages 7 and 10 years.
c. It is not necessary to tell the child who was adopted so young.
d. It is best to wait until the child asks about it.

ANS: A
It is important for the parents not to withhold information about the adoption
from the child. It is an essential component of the child’s identity. There is no
recommended best time to tell children. It is believed that children should be
told young enough so they do not remember a time when they did not know. It
should be done before the children enter school to keep third parties from telling
the children before the parents have had the opportunity.

REF: 36
14. A parent of a school-age child is going through a divorce. The parent tells
the school nurse the child has not been doing well in school and sometimes
has trouble sleeping. The nurse should recognize this as which implication?
a. Indication of maladjustment
b. Common reaction to divorce
c. Lack of adequate parenting
d. Unusual response that indicates need for referral
ANS: B
Parental divorce affects school-age children in many ways. In addition to
difficulties in school, they often have profound sadness, depression, fear,
insecurity, frequent crying, loss of appetite, and sleep disorders. This is not an
indication of maladjustment, suggestive of lack of adequate parent, or an
unusual response that indicates need for referral in school-age children after
parental divorce.

Apply REF: 37
MSC: Area of Client Needs: Psychosocial Integrity
15. A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She
comments, “I want to go back to work, but I don’t want Eric to suffer because
I’ll have less time with him.” The nurse’s most appropriate answer would be
which statement?
a. “I’m sure he’ll be fine if you get a good babysitter.”
b. “You will need to stay home until Eric starts school.”
c. “You should go back to work so Eric will get used to being with others.”
d. “Let’s talk about the child-care options that will be best for Eric.”
ANS: D
Let’s talk about the child-care options that will be best for Eric is an open-ended
statement that will assist the mother in exploring her concerns about what is
best for both her and Eric. I’m sure he’ll be fine if you get a good babysitter, You
will need to stay home until Eric starts school, and You should go back to work
so Eric will get used to being with others are directive statements. They do not
address the effect of her working on Eric.

Apply REF: 40
TOP: Integrated Process: Communication and Documentation
MULTIPLE RESPONSE
1. Dunst, Trivette, and Deal identified the qualities of strong families that
help them function effectively. Which qualities are included? (Select all that
apply.)
a. Ability to stay connected without spending time together
b. Clear set of family values, rules, and beliefs
Adoption of one coping strategy that always promotes positive functioning in dealing w
c.
events
Sense of commitment toward growth of individual family members as opposed to that o

d.
family unit
e. Ability to engage in problem-solving activities
f. Sense of balance between the use of internal and external family resources

ANS: B, E, F
A clear set of family rules, values, and beliefs that establishes expectations
about acceptable and desired behavior is one of the qualities of strong families
that help them function effectively. Strong families also are able to engage in
problem-solving activities and to find a balance between internal and external
forces. Strong families have a sense of congruence among family members
regarding the value and importance of assigning time and energy to meet needs.
Strong families also use varied coping strategies. The sense of commitment is
toward the growth and well-being of individual family members, as well as the
family unit.

REF: 28
TOP: Integrated Process: Nursing Process: Diagnosis
2. A nurse is conducting a teaching session on the use of time-out as a

discipline measure to parents of toddlers. Which are correct strategies the
nurse should include in the teaching session? (Select all that apply.)
a. Time-out as a discipline measure cannot be used when in a public place.
b. A rule for the length of time-out is 1 minute per year.
c. When the child misbehaves, one warning should be given.
d. The area for time-out can be in the family room where the child can see the television.
e. When the child is quiet for the specified time, he or she can leave the room.

ANS: B, C, E
A rule for the length of time-out is 1 minute per year of age; use a kitchen timer
with an audible bell to record the time rather than a watch. When the child
misbehaves, one warning should be given. When the child is quiet for the
duration of the time, he or she can then leave the room. Time-out can be used
in public places and the parents should be consistent on the use of time-out.
Implement time-out in a public place by selecting a suitable area or explain to
children that time-out will be spent immediately on returning home. The time-out
should not be spent in an area from which the child can view the television.
Select an area for time-out that is safe, convenient, and unstimulating but where
the child can be monitored, such as the bathroom, hallway, or laundry room.

Apply REF: 35
3. Divorced parents of a preschool child are asking whether their child will
display any feelings or behaviors related to the effect of the divorce. The nurse
is correct when explaining that the parents should be prepared for which type
of behaviors? (Select all that apply.)
a. Displaying fears of abandonment
b. Verbalizing that he or she “is the reason for the divorce”
c. Displaying fear regarding the future
d. Ability to disengage from the divorce proceedings
e. Engaging in fantasy to understand the divorce

ANS: A, B, E
A child 3 to 5 years of age (preschool) may display fears of abandonment,

verbalize feelings that he or she is the reason for the divorce, and engage in
fantasy to understand the divorce. They would not be displaying fear regarding
the future until school age, and the ability to disengage from the divorce
proceedings would be characteristic of an adolescent.

Apply REF: 38
MSC: Area of Client Needs: Teaching and Learning
COMPLETION
1. A nurse is admitting a child, in foster care, to the hospital. The nurse

recognizes that foster parents care for the child _____ hours a day. (Record
your answer as a whole number.)
ANS:
24
The term foster care is defined as 24-hour substitute care for children outside
of their own homes.

REF: 41

2. A parent of a newborn is expressing concern about returning to work after
taking time off under the Family and Medical Leave Act (FMLA). The nurse
understands that the Act allows a new parent to take off from work for _____
weeks. (Record your answer as a whole number.)
ANS:
12
The passage of the Family and Medical Leave Act (FMLA) in 1993 set the stage
for a greater focus on the issues of contemporary families. FMLA allows eligible
employees to take up to 12 weeks of unpaid leave each year to care for newborn
or newly adopted children, parents, or spouses who have serious health
conditions or to recover from their own serious health condition.

REF: 41
Chapter 04: Social, Cultural, and Religious Influences on Child Health Promotion
MULTIPLE CHOICE
1. Which term best describes a group of people who share a set of values,
beliefs, practices, social relationships, law, politics, economics, and norms of
behavior?
a. Race
b. Culture
c. Ethnicity
d. Social group
ANS: B
Culture is a pattern of assumptions, beliefs, and practices that unconsciously

frames or guides the outlook and decisions of a group of people. A culture is
composed of individuals who share a set of values, beliefs, and practices that
serve as a frame of reference for individual perceptions and judgments. Race is
defined as a division of mankind possessing traits that are transmissible by
descent and are sufficient to characterize it as a distinct human type. Ethnicity
is an affiliation of a set of persons who share a unique cultural, social, and
linguistic heritage. A social group consists of systems of roles carried out in
groups. Examples of primary social groups include the family and peer groups.

REF: 44
2. Which term best describes the emotional attitude that one’s own ethnic
group is superior to others?
a. Culture
b. Ethnicity
c. Superiority
d. Ethnocentrism
ANS: D
Ethnocentrism is the belief that one’s way of living and behaving is the best way.
This includes the emotional attitude that the values, beliefs, and perceptions of
one’s ethnic group are superior to those of others. Culture is a pattern of
assumptions, beliefs, and practices that unconsciously frames or guides the
outlook and decisions of a group of people. A culture is composed of individuals
who share a set of values, beliefs, and practices that serves as a frame of
reference for individual perception and judgments. Ethnicity is an affiliation of a
set of persons who share a unique cultural, social, and linguistic heritage.
Superiority is the state or quality of being superior; it does not include ethnicity.

REF: 47
3. Currently, the fastest-growing segment of the homeless population in the

United States consists of:
a. families.
b. “runaway” adolescents.
c. migrant farm workers.
d. individuals with mental disorders.

ANS: A
Homeless individuals lack resources and community ties necessary to provide

for their own adequate shelter. One of the most pressing problems in the United
States is the rapidly growing number of homeless families, which currently
account for 50% of the nation’s homeless. “Runaway” (or throwaway)
adolescents are often victims of physical and social abuse. Although it is a
significant issue, this is not the fastest-growing segment of the homeless
population. Migrant farm workers form one of the most severely disadvantaged
groups in the United States. They have a mobile existence, which is detrimental
for children. They do not constitute the fastest-growing segment of the homeless
population. Individuals with mental disorders may be homeless. They do not
constitute the fastest-growing segment of the homeless population.

REF: 51
4. Maria, a Spanish-speaking 5-year-old girl, has started kindergarten in an

English-speaking school. Crying most of the time, she appears helpless and
unable to function in this new situation. Which description best explains
Maria’s behavior?
a. Lacks adequate culture for attending school
b. Lacks the maturity needed in school
c. Is experiencing culture shock
d. Is experiencing minority group discrimination

ANS: C
Culture shock is the helpless feeling and state of disorientation felt by an

outsider attempting to adapt to a different culture group. Her inability to speak
English inhibits her ability to interact. This would explain Maria’s inability to
function in this new situation. There is no evidence to support that Maria lacks
adequate culture or maturity needed in school, or that she is experiencing
minority group discrimination.

Analyze REF: 46
5. When minority groups immigrate to another country, a certain degree of

cultural or ethnic blending occurs through the involuntary process of:
a. acculturation.
b. ethnocentrism.
c. culture shock.
d. cultural sensitivity.
ANS: A
Acculturation is the gradual changes that are produced in a culture by the
influence of another culture that cause one or both cultures to become more
similar. The minority culture is forced to learn the majority culture to survive.
Ethnocentrism is the belief that one’s way of living and behaving is the best way.
This includes the emotional attitude that the values, beliefs, and perceptions of
one’s ethnic group are superior to those of others. This would limit the blending.
Culture shock is the helpless feeling and state of disorientation felt by an
outsider attempting to adapt to a different culture group. This would limit the
blending. Cultural sensitivity is an awareness of cultural similarities and
differences. The nurse should develop the dynamics of cultural sensitivity to
provide culturally competent care.

REF: 46
6. Which is a frequent health problem of migrant children and adolescents in

the United States?
a. Suicide
b. Diabetes
c. Tuberculosis
d. Cardiovascular disease
ANS: C
The rate of tuberculosis among migrant families is high. A high-risk factor for the
children of migrant families is the migration of the families from areas that have
high prevalence of tuberculosis; significant health issues, suicide, diabetes, and
cardiovascular disease are not more prevalent in this population.

REF: 51-52
7. The nurse observes that the families who do not show up for scheduled
clinic appointments are usually from minority cultural groups. The best
explanation for this is that these families often differ from the dominant
culture because they:
a. lack education.
b. avoid health care.
c. are more forgetful.
d. view time differently.
ANS: D
Each cultural group has different conceptions of time and waiting. The dominant
culture in the United States has a fairly rigid view of time. Other cultures may be
late or miss activities because other issues take precedence over the
appointment. Education is not the issue. It is the concept of time in the cultural
group. It is not done to avoid health care. The family usually believes that the
appointment can be made for a later time. The family does not forget the time,
but other issues take priority.

Apply REF: 52
8. The Vietnamese mother of a child being seen in the clinic avoids eye
contact with the nurse. The best explanation for this, considering cultural
differences, is that the parent:
a. feels responsible for her child’s illness.
b. feels inferior to the nurse.
c. is embarrassed to seek health care.
d. is showing respect for the nurse.
ANS: D
In some ethnic groups, eye contact is avoided. In the Vietnamese culture, an

individual may not look directly into the nurse’s eyes as a sign of respect. The
nurse providing culturally competent care would recognize that feeling
responsible for the illness, feeling inferior, or embarrassment are not reasons for
the mother to avoid eye contact with the nurse.

REF: 54

9. The belief that health is “a state of harmony with nature and the universe”
is common in which culture?
a. Japanese
b. African-American
c. Native American
d. Hispanic-American
ANS: C
Many cultures ascribe attributes of health to natural forces. Many individuals of

the Native-American culture view health as a state of harmony with nature and
the universe. This belief is not consistent with the Japanese, African-American,
or Hispanic-American cultural groups.

REF: 59
10. A Hispanic toddler has pneumonia. The nurse notices that the parent
consistently feeds the child only the broth that comes on the clear liquid tray.
Food items, such as Jell-O, Popsicle, and juices are left. Which statement
would best explain this?
a. Parent is trying to feed child only what child likes most.

b. Parent is trying to restore normal balance through appropriate “hot” remedies.
c. Hispanics believe the “evil eye” enters when a person gets cold.
d. Hispanics believe an innate energy, called chi, is strengthened by eating soup.
ANS: B
In several groups, including Filipino, Chinese, Arabic, and Hispanic

cultures, hot and cold describe certain properties completely unrelated to
temperature. Respiratory conditions such as pneumonia are “cold” conditions
and are treated with “hot” foods. The parent may be trying to feed the child only
what the child likes most, but it is unlikely that a toddler would consistently
prefer the broth to Jell-O, Popsicle, and juice. The evil eye applies to a state of
imbalance of health, not curative actions. Chinese individuals believe in chi as
an innate energy.

Apply REF: 59
11. A nurse is taking a history on a low-income Hispanic toddler. The parent

tells the nurse that occasional diarrhea is treated with azogue, a mercury
compound commonly used in the parent’s native Mexico. What should the
nurse recognize about this remedy?
a. It is harmless.
b. It is dangerous.
c. It has a scientific basis.
d. It has importance in certain religious practices.
ANS: B
The ingestion of mercury is extremely dangerous for children. Solutions

containing mercury are not harmless. The nurse should work with folk healers or
respected members of the culture to teach the family of the dangers of mercury
ingestion. No scientific basis exists for the use of mercury to treat diarrhea.

REF: 56
12. The nurse discovers welts on the back of a Vietnamese child during a
home health visit. The child’s mother says she has rubbed the edge of a coin
on her child’s oiled skin. What explanation should the nurse recognize about
this?
a. Child abuse
b. Cultural practice to rid the body of disease
c. Cultural practice to treat enuresis or temper tantrums
d. Child discipline measure common in the Vietnamese culture

ANS: B
Rubbing the edge of a coin on a child’s oiled skin is descriptive of coining. The
welts are created by repeatedly rubbing a coin on the child’s oiled skin. The
mother is attempting to rid the child’s body of disease. The mother was engaged
in an attempt to heal the child. This is not child abuse or discipline.

REF: 56
MSC: Area of Client Needs: Psychosocial Integrity: Cultural Diversity
13. The father of a hospitalized child tells the nurse, “He can’t have meat. We
are Buddhist and vegetarians.” The nurse’s best intervention is to:
a. order the child a meatless tray.
b. ask a Buddhist priest to visit.
c. explain that hospital patients are exempt from dietary rules.
d. help the parent understand that meat provides protein needed for healing.
ANS: A
It is essential for the nurse to respect the religious practices of the child and
family. The nurse should arrange a dietary consult to ensure that nutritionally
complete vegetarian meals are prepared by the hospital kitchen. It is not
necessary to ask a Buddhist priest to visit. The nurse should be able to arrange
for a vegetarian tray. The nurse should not encourage the child and parent to go
against their religious beliefs. Nutritionally complete, acceptable vegetarian
meals should be provided.

Apply REF: 61
14. In which cultural group is good health considered to be a balance between

yin and yang?
a. Asians
b. Australian aborigines
c. Native Americans
d. African-Americans
ANS: A
In Chinese health beliefs, the forces termed yin and yang must be kept in

balance to maintain health. The belief in this balance is not consistent with
Australian aborigines, Native Americans, or African-Americans.

REF: 58
15. A young child from Mexico is hospitalized for a serious illness. The father
tells the nurse that the child is being punished by God for being bad. The nurse
should recognize that this is a(n):
a. health belief common in this culture.
b. early indication of potential child abuse.
c. misunderstanding of the family’s common beliefs.
d. belief common when fortune tellers have been used.
ANS: A
A common health belief in the Mexican-American cultural group is that health is

controlled by the environment, fate, and the will of God. The father’s comment
has no relation to child abuse. The father would not misunderstand the family’s
beliefs. It is a cultural belief that health is controlled by the environment, fate,
and the will of God. Mexicans may use the services of curandero (healers), not
fortune tellers.

Apply REF: 59

MULTIPLE RESPONSE
1. Children are taught the values of their culture through observation and
feedback, relative to their own behavior. In teaching a class on cultural
competence, the nurse should be aware that which factor(s) may be culturally
determined? (Select all that apply.)
a. Degree of competition
b. Racial variation
c. Determination of status
d. Social roles
e. Geographic boundaries
ANS: A, C, D
Degree of competition, determination of status, and social roles are all factors
that are determined by the assumptions, beliefs, and practices of the members
of the culture. In cultures that value individual resourcefulness, competition
would be acceptable. Status is culturally determined and varies according to
each culture. Some will ascribe higher status to age or socioeconomic status.
Social roles also are influenced by the culture. Race and culture are two distinct
attributes. The racial grouping describes transmissible traits, whereas the
culture is determined by the pattern of assumptions, beliefs, and practices that
unconsciously frames or guides the outlook and decisions of a group of people.
Cultural development may be limited by geographic boundaries. It is not the
boundaries that are culturally determined.

Analyze REF: 44
2. Research is being done on the development of assets in children. A

community that is supportive of children has which external assets? (Select all
that apply.)
a. Unstructured environments to allow for freedom of choice
b. Social competencies to make positive choices
c. Empowerment to feel safe and secure
d. Positive values to direct choice
e. Boundaries to set expectations and actions
ANS: C, E
Young people need to feel valued by their community and able to contribute to
others. They need to feel safe and secure. They also need boundaries to help set
expectations and actions. To develop appropriately, children need boundaries
and expectations. With these, they will learn what is expected of them and what
behaviors are acceptable to the community. Social competencies to make
positive choices and boundaries to set expectations and actions are internal
assets that, when developed, help the child make positive choices.

Analyze REF: 48
3. A nurse is planning care for a Spanish-speaking child and family. The nurse
speaks limited Spanish. Which interventions should the nurse plan when caring
for this child and family? (Select all that apply.)
a. Ask a visitor to interpret.
b. Use a language-line telephone interpreter if a hospital interpreter is not available.
c. Use written cards with common phrases in the Spanish language.
d. Ask the family to provide an interpreter.
e. When using a hospital interpreter, speak to the family not the interpreter.
ANS: B, C, E
If a live interpreter is not available, the nurse should use a language line
telephone interpreter. The nurse should use cards with common greetings,
phrases, and names of body parts in the family’s language. When using a hospital
interpreter, the nurse should speak directly to the family and allow the
interpreter to translate. Visitors or other family members should not be used as
interpreters because of the risk of misinterpretation of medical terms.

Apply REF: 53

4. A nurse is working in a clinic that serves a culturally diverse population of

children. The nurse should plan care, understanding that which
complementary and alternative practices may be used by families of this
diverse population? (Select all that apply.)
a. Seeking another doctor’s opinion
b. Seeking advice from a curandero or curandera
c. Using acupuncture or acupressure as a therapy
d. Consulting an herbalist
e. Consulting a kahuna
ANS: B, C, D, E
The curandero (male) or curandera (female) of the Mexican-American

community is believed to have healing powers that are a gift from God. The
Asian family may consult an herbalist, knowledgeable in medicines, or perhaps a
specialized practitioner of Asian therapies, including acupuncture (insertion of
needles) or acupressure (application of pressure). Native Hawaiians
consult kahunas and practice ho’oponopono to heal family imbalance or
disputes. The nurse may encounter use of these practices. Consulting another
doctor would not be a complementary or alternative practice expected in a
culturally diverse population.

Apply REF: 56

5. A nurse is caring for an African-American child recently admitted to the

hospital. The nurse should be aware of which broad cultural characteristics for
this child when planning care? (Select all that apply.)
a. Silence may indicate a lack of trust.
b. Maintaining constant eye contact may be viewed as aggressive.
c. Self-care and folk medicine do not play a role in healthcare.
d. Illness may be seen as the “will of God.”
e. No importance is attached to nonverbal behavior.
ANS: A, B, D
A nurse should be aware of the African-American broad cultural characteristics,

which include: initial eye contact to show respect; maintaining eye contact can
be viewed as aggressive, silence may indicate a lack of trust, and illness may be
seen as the “will of God.” Self-care and folk medicine are prevalent in this
culture, and importance is placed on nonverbal behavior.

Apply REF: 58

COMPLETION
1. Poverty has serious implications for children and families. Social and
cultural deprivation, including limited employment opportunities, inferior
educational opportunities, inferior or no access to health care, and a lack of
public services, is referred to as the _______________ type of poverty.
ANS:
invisible
“Social and cultural deprivation, including limited employment opportunities,

inferior educational opportunities, inferior or no access to health care, and a
lack of public services” is the definition of “invisible poverty.” Visible poverty is
the lack of money or material resources, including insufficient clothing, poor
sanitation, and deteriorating housing.

REF: 50
2. A parent of a 12-year-old child states to the nurse, “My 12-year-old

watches TV constantly while at home—is this OK?” The nurse should
recommend to the parent that television viewing should be limited to _____
hours a day? (Record your answer in a whole number.)
ANS:
Children may identify closely with people or characters portrayed in reading

materials, movies, and television programs and commercials. Pediatric nurses
can educate and support parents on the effects of mass media on their children
by recommending that television viewing should be limited to 2 hours a day or
less.


Apply REF: 49

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1. A nurse is selecting a family theory to assess a patient’s family dynamics.

d. Duvall’s developmental theory

Duvall’s developmental theory describes eight developmental tasks of the family

PTS: 1 DIF: Cognitive Level: Understand

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

b. Developmental systems theory

c. Family stress theory

Family stress theory explains the reaction of families to stressful events. In

PTS: 1 DIF: Cognitive Level: Understand

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

PTS: 1 DIF: Cognitive Level: Remember

TOP: Integrated Process: Nursing Process: Planning

MSC: Area of Client Needs: Health Promotion and Maintenance

4. A nurse is assessing a family’s structure. Which describes a family in

PTS: 1 DIF: Cognitive Level: Understand

TOP: Integrated Process: Nursing Process: Assessment

MSC: Area of Client Needs: Health Promotion and Maintenance

5. Which is considered characteristic of children who are the youngest in

a. More dependent than firstborn children

b. More outgoing than firstborn children

c. Identify more with parents than with peers

d. Are subject to greater parental expectations

PTS: 1 DIF: Cognitive Level: Understand

TOP: Integrated Process: Nursing Process: Planning

MSC: Area of Client Needs: Health Promotion and Maintenance

a. be praised less often.

b. be more achievement oriented.

c. be more popular with the peer group.

d. identify with peer group more than parents.

Firstborn children, like only children, tend to be more achievement-oriented.

PTS: 1 DIF: Cognitive Level:

TOP: Integrated Process: Nursing Process: Implementation

MSC: Area of Client Needs: Health Promotion and Maintenance

7. A 35-year-old client is currently on fertility treatments. When responding to

PTS: 1 DIF: Cognitive Level: Understand

TOP: Integrated Process: Nursing Process: Implementation

a. Some twins thrive best when they are constantly together.

b. Individuation cannot occur if twins are together too much.

c. Separating twins at an early age helps them develop mentally.

d. When twins are constantly together, pathologic bonding occurs.

Twins work out a relationship that is reasonably satisfactory to both. They

PTS: 1 DIF: Cognitive Level: Understand

TOP: Integrated Process: Nursing Process: Implementation

MSC: Area of Client Needs: Health Promotion and Maintenance

PTS: 1 DIF: Cognitive Level: Understand

TOP: Integrated Process: Nursing Process: Evaluation

MSC: Area of Client Needs: Health Promotion and Maintenance

PTS: 1 DIF: Cognitive Level: Remember

TOP: Integrated Process: Nursing Process: Diagnosis

MSC: Area of Client Needs: Health Promotion and Maintenance

a. Children as young as 4 years old rarely need to be punished.

b. Parental control should be consistent.

d. One should expect rules to be followed rigidly and unquestioningly.

PTS: 1 DIF: Cognitive Level:

TOP: Integrated Process: Teaching/Learning

MSC: Area of Client Needs: Health Promotion and Maintenance

12. Which is most characteristic of the physical punishment of children, such