Test Bank Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents 4th Edition

Test Bank Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents 4th Edition Table of Contents Bright Futures Health Promotion Themes ...................................................................................... 2 Unit 1: An Introduction to the Bright Futures Health Promotion Themes .................................................... 2 Unit 2: Promoting Lifelong Health for Families and Communities .............................................................. 6 Unit 3: Promoting Family Support .............................................................................................................. 12 Unit 4: Promoting Health for Children and Youth With Special Health Care Needs ................................. 17 Unit 5: Promoting Healthy Development .................................................................................................... 23 Unit 6: Promoting Mental Health ................................................................................................................ 29 Unit 7: Promoting Healthy Nutrition ........................................................................................................... 34 Unit 8: Promoting Physical Activity ........................................................................................................... 39 Unit 9: Promoting Oral Health .................................................................................................................... 46 Unit 10: Promoting Healthy Sexual Development and Sexuality ............................................................... 48 Unit 11: Promoting the Healthy and Safe Use of Social Media .................................................................. 56 Unit 12: Promoting Safety and Injury Prevention ....................................................................................... 62 Bright Futures Health Supervision Visits ...................................................................................... 71 Unit 13: An Introduction to the Bright Futures Health Supervision Visits/ Evidence and Rationale .......... 71 Unit 14: Infancy Visits (Prenatal Through 11 Months) ............................................................................... 76 Unit 15: Prenatal Visit/Newborn Visit/First Week Visit (3 to 5 Days) ....................................................... 80 Unit 16: Early Childhood Visits (1 Through 4 Years) ................................................................................ 91 Unit 17: Middle Childhood Visits (5 Through 10 Years) ........................................................................... 95 Unit 18: Adolescence Visits (11 Through 21 Years) Early Adolescence Visits (11 Through 14 Year Visits) Middle Adolescence Visits (15 Through 17 Year Visits) Late Adolescence Visits (18 Through 21 Year Visits) ............................................................................................................................................... 100 1 | P a g eBright Futures Health Promotion Themes Unit 1: An Introduction to the Bright Futures Health Promotion Themes MULTIPLE CHOICE 1. A nurse is reviewing changes in healthcare delivery and funding for pediatric populations. Which current trend in the pediatric setting should the nurse expect to find? a. Increased hospitalization of children b. Decreased number of uninsured children c. An increase in ambulatory care d. Decreased use of managed care ANS: C One effect of managed care is that pediatric healthcare delivery has shifted dramatically from the acute care setting to the ambulatory setting. The number of hospital beds being used has decreased as more care is provided in outpatient and home settings. The number of uninsured children in the United States continues to grow. One of the biggest changes in healthcare has been the growth of managed care. OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment 2. A nurse is referring a low-income family with three children under the age of 5 years to a program that assists with supplemental food supplies. Which program should the nurse refer this family to? a. Medicaid b. Medicare c. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program d. Women, Infants, and Children (WIC) program ANS: D WIC is a federal program that provides supplemental food supplies to low-income women who are pregnant or breast-feeding and to their children until the age of 5 years. Medicaid and the Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program provides for well-child examinations and related treatment of medical problems. Children in the WIC program are often referred for immunizations, but that is not the primary focus of the program. Public Law 99-457 provides financial incentives to states to establish comprehensive early intervention services for infants and toddlers with, or at risk for, developmental disabilities. Medicare is the program for Senior Citizens. OBJ: Nursing Process Step: Implementation MSC: Health Promotion and Maintenance 2 | P a g e3. In most states, adolescents who are not emancipated minors must have parental permission before: a. treatment for drug abuse. b. treatment for sexually transmitted diseases (STDs). c. obtaining birth control. d. surgery. ANS: D An emancipated minor is a minor child who has the legal competence of an adult. Legal counsel may be consulted to verify the status of the emancipated minor for consent purposes. Most states allow minors to obtain treatment for drug or alcohol abuse and STDs and allow access to birth control without parental consent. DIF: Cognitive Level: Application REF: dm. 12 OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment 4. A nurse is completing a clinical pathway for a child admitted to the hospital with pneumonia. Which characteristic of a clinical pathway is correct? a. Developed and implemented by nurses b. Used primarily in the pediatric setting c. Specific time lines for sequencing interventions d. One of the steps in the nursing process ANS: C Clinical pathways measure outcomes of client care and are developed by multiple healthcare professionals. Each pathway outlines specific time lines for sequencing interventions and reflects interdisciplinary interventions. Clinical pathways are used in multiple settings and for clients throughout the life span. The steps of the nursing process are assessment, diagnosis, planning, implementation, and evaluation. DIF: Cognitive Level: Comprehension REF: dm. 6 OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment 5. When planning a parenting class, the nurse should explain that the leading cause of death in children 1 to 4 years of age in the United States is: a. premature birth. b. congenital anomalies. 3 | P a g ec. accidental death. d. respiratory tract illness. ANS: C Accidents are the leading cause of death in children ages 1 to 19 years. Disorders of short gestation and unspecified low birth weight make up one of the leading causes of death in neonates. One of the leading causes of infant death after the first month of life is congenital anomalies. Respiratory tract illnesses are a major cause of morbidity in children. DIF: Cognitive Level: Application REF: dm. 9 OBJ: Nursing Process Step: Implementation MSC: Safe and Effective Care Environment 6. Which statement is true regarding the quality assurance or incident report? a. The report assures the legal department that there is no problem. b. Reports are a permanent part of the clients chart. c. The nurses notes should contain the following: Incident report filed and copy placed in chart. d. This report is a form of documentation of an event that may result in legal action. ANS: D An incident report is a warning to the legal department to be prepared for potential legal action; it is not a part of the clients chart or nurse documentation. DIF: Cognitive Level: Knowledge REF: dm. 14 OBJ: Nursing Process Step: Implementation MSC: Safe and Effective Care Environment 7. Which client situation fails to meet the first requirement of informed consent? a. The parent does not understand the physicians explanations. b. The physician gives the parent only a partial list of possible side effects and complications. c. No parent is available and the physician asks the adolescent to sign the consent form. d. The infants teenage mother signs a consent form because her parent tells her to. ANS: C The first requirement of informed consent is that the person giving consent must be competent. Minors are not allowed to give consent. An understanding of information, full disclosure, and voluntary consent are requirements of informed consent, but none of these is the first requirement. DIF: Cognitive Level: Comprehension REF: dm. 12 OBJ: Nursing Process Step: Implementation MSC: Safe and Effective Care Environment 8. A nurse assigned to a child does not know how to perform a treatment that has been 4 | P a g eprescribed for the child. What should the nurses first action be? a. Delay the treatment until another nurse can do it. b. Make the childs parents aware of the situation. c. Inform the nursing supervisor of the problem. d. Arrange to have the child transferred to another unit. ANS: C If a nurse is not competent to perform a particular nursing task, the nurse must immediately communicate this fact to the nursing supervisor or physician. The nurse could endanger the child by delaying the intervention until another nurse is available. Telling the childs parents would most likely increase their anxiety and will not resolve the difficulty. Transfer to another unit delays needed treatment and would create unnecessary disruption for the child and family. DIF: Cognitive Level: Application REF: dm. 11 OBJ: Nursing Process Step: Implementation MSC: Safe and Effective Care Environment 9. A nurse is completing a care plan for a child and is finishing the assessment phase. Which activity is not part of a nursing assessment? a. Writing nursing diagnoses b. Reviewing diagnostic reports c. Collecting data d. Setting priorities ANS: D Setting priorities is a part of planning. Writing nursing diagnoses, reviewing diagnostic reports, and collecting data are parts of assessment. DIF: Cognitive Level: Comprehension REF: dm. 19 OBJ: Nursing Process Step: Planning MSC: Physiological Integrity 10. Which patient outcome is stated correctly? a. The child will administer his insulin injection before breakfast on 10/31. b. The child will accept the diagnosis of type 1 diabetes mellitus before discharge. c. The parents will understand how to determine the childs daily insulin dosage. d. The nurse will monitor blood glucose levels before meals and at bedtime. ANS: A The outcome is stated in client terms, with a measurable verb and a time frame for action. The verb accept is difficult to measure. The goal of accepting a diagnosis before hospital discharge is 5 | P a g eunrealistic. Outcomes should be stated in client terms. Nursing actions are determined after outcomes are developed in the implementation phase of the nursing process. Unit 2: Promoting Lifelong Health for Families and Communities MULTIPLE CHOICE 1. A nurse is selecting a family theory to assess a patients 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. Duvalls developmental theory ANS: D Duvalls 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 Duvalls 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. Duvalls 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 Duvalls 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. Duvalls developmental theory describes eight developmental tasks of the family throughout its life span. PTS: 1 DIF: Cognitive Level: Understand REF: 24 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 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. Extende d 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. 6 | P a g eNo 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 MSC: Area of Client Needs: Health Promotion and Maintenance 4. A nurse is assessing a familys structure. Which describes a family in which a mother, her children, and a stepfather live together? a. Blended b. Nuclear c. Binuclear d. Extende d 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. PTS: 1 DIF: Cognitive Level: Understand REF: 24-26 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 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. PTS: 1 DIF: Cognitive Level: Understand REF: 29-30 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 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 7 | P a g eTOP: 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 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 age. c. There is not enough evidence about the use of fertility treatments increasing the rate of multiple births. d. Because of your age and the fertility treatments, you have almost a 100% chance of a 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. PTS: 1 DIF: Cognitive Level: Understand REF: 30 TOP: Integrated Process: Nursing Process: Implementation 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 nurses 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. PTS: 1 DIF: Cognitive Level: Understand REF: 30-31 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Health Promotion and Maintenance 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. b. If an infant has special care needs, the parents sense of confidence in their new role is strengthened. c. Young parents can adjust to the new role easier than older parents. d. A parents 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 8 | P a g ecare 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. PTS: 1 DIF: Cognitive Level: Understand REF: 31-32 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 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 childrens actions. Dictatorial or authoritarian parents attempt to control their childrens 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 childrens behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the childs individual nature. PTS: 1 DIF: Cognitive Level: Remember REF: 33 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance 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 childs age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old. PTS: 1 DIF: Cognitive Level: Apply REF: 33 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 as spanking? a. Psychological impact is usually minimal. b. Children rarely become accustomed to spanking. c. Childrens development of reasoning increases. d. Misbehavior is likely to occur when parents are not present. ANS: D 9 | P a g eThrough 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 childs development of moral reasoning. PTS: 1 DIF: Cognitive Level: Understand REF: 35 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 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 childs 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. PTS: 1 DIF: Cognitive Level: Understand REF: 36 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 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. PTS: 1 DIF: Cognitive Level: Apply REF: 37 TOP: Integrated Process: Teaching/Learning 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 dont want Eric to suffer because Ill have less time with him. The nurses most appropriate answer would be which statement? a. Im sure hell 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. Lets talk about the child-care options that will be best for Eric. ANS: D Lets 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. Im sure hell 10 | P a g ebe 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. PTS: 1 DIF: Cognitive Level: Apply REF: 40 TOP: Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 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 c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the 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. PTS: 1 DIF: Cognitive Level: Understand REF: 28 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance 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. PTS: 1 DIF: Cognitive Level: Apply REF: 35 TOP: Integrated Process: Teaching/Learning 11 | P a g eMSC: Area of Client Needs: Health Promotion and Maintenance 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. PTS: 1 DIF: Cognitive Level: Apply REF: 38 TOP: Integrated Process: Nursing Process: Implementation 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. PTS: 1 DIF: Cognitive Level: Understand REF: 41 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 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. Unit 3: Promoting Family Support MULTIPLE CHOICE 1. A nurse is teaching parents how to apply time-out as a disciplinary method for their 4 year old. Parents have understood the teaching if they state which formula correctly guides the use of time- out? a. Use the guideline of 1 minute per each year of the childs age. 12 | P a g eb. Relate the length of the time-out to the severity of the behavior. c. Never use time-out for a child younger than age 4 years. d. Follow the time-out with a treat. ANS: A In time-out, the child is told to sit on a chair for a predetermined time, usually 1 minute per year of age. Relating time to a behavior is subjective and inappropriate when the child is very young. Time-out can be used with a toddler. Negative behavior should not be reinforced with a positive action. DIF: Cognitive Level: Comprehension REF: dm. 34 OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance 2. What is the nurses best approach when an 8-year-old boy frequently causes a disruption in the playroom by taking toys from other children? a. Exclude the child from the playroom. b. Explain to the children in the playroom that he is very ill and should be allowed to have the toys. c. Approach the child in his room and ask, Would you like it if the other children took your toys from you? d. Approach the child in his room and state, I am concerned that you are taking the other childrens toys. It upsets them and me. ANS: D The nurse can focus on the behavior most effectively by using I rather than you messages. A you message criticizes the child and uses guilt in an attempt to change behavior. Banning the child from the playroom will not solve the problem. The problem is the childs behavior, not the place where the child exhibits it. Illness is not a reason for a child to be undisciplined. When the child recovers, the parents will have to deal with a child who is undisciplined and unruly. The child should not be made to feel guilty and to have his or her self-esteem attacked. DIF: Cognitive Level: Application REF: dm. 34 OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity 3. Families that deal most effectively with stress have which behavior patterns? a. Focus on family problems. b. Feel weakened by stress. c. Expect that some stress is normal. d. Feel guilty when stress exists. 13 | P a g eANS: C Healthy families recognize that some stress is normal in all families, focus on family strengths rather than on the problems, and know that stress is temporary and may be positive. Because some stress is normal in all families, there is no reason to feel guilty. Guilt only immobilizes the family and does not lead to a resolution of the stress. DIF: Cognitive Level: Comprehension REF: dm. 25 OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity 4. Which family will most likely have the greatest difficulty in coping with an ill child? a. A single-parent mother who has the support of her parents and siblings b. Parents who have just moved to the area and are living in an apartment while they look for a house c. The family of a child who has had multiple hospitalizations related to asthma and has adequate relationships with the nursing staff d. A family in which there is a young child and four older married children who live in the area ANS: B Parents who are in a new environment will have increased stress related to their lack of a support system. If only one parent is available but has the support of her extended family, this will assist in her adjustment to the crisis. The family that has had positive experiences in the past with hospitalizations can draw from those experiences and feel confident about the current setting. For the family with one younger child and four older married children who live in the area, the family has an extensive support system, which will assist the parents in adjusting to the crisis. DIF: Cognitive Level: Application REF: dm. 27 OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity 5. Which is the priority nursing intervention for the family of a child who has been admitted to the hospital? a. Begin discharge teaching. b. Identify and mobilize internal and external strengths. c. Identify ways in which the family could have prevented their childs hospitalization.