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Women's Health Companion
Chapter 2: Contemporary Issues in Women’s, Families’, and
Children’s Health Care
Chapter 2: Contemporary Issues in Women’s, Families’, and Children’s Health Care
MULTIPLE CHOICE
- The clinic nurse is working with a mother and her 3-year-old child who have arrived for the child’s routine checkup. The nurse encourages the mother to return for her child’s measles-mumps-rubella immunization prior to the child’s entering school. This intervention is an example of what type of care? A. Mandatory health care B. Primary health prevention C. Secondary health prevention D. Tertiary health prevention ANS: B Of the three levels of prevention, the most desirable level is primary prevention. This encompasses health promotion and activities specifically meant to prevent disease from occurring—in this case, scheduling vaccinations. Secondary prevention refers to early identification and prompt treatment of a health problem before it has an opportunity to spread or become more serious. Tertiary prevention is intended to restore health to the highest functioning state that is possible.
Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate
PTS: 1
- A nurse wishing to be an advocate for access to health care would most likely choose to participate in which of the following activities? A. Lobby for improved insurance access for all individuals, whether or not they are employed. B. Help establish fast-track or minor illness areas in local emergency rooms. C. Partner with medical centers to provide free services for low-income patients. D. Work with visiting nurses associations to create on-site clinics at day-care centers.
Women's Health Companion
ANS: A
The biggest determinant of access to and quality of health care is one’s insurance status. The other actions might help improve access too, but would not be as effective as lobbying for improved ability for all individuals to get insurance.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate
PTS: 1
- A nurse working with an after-school program is concerned about the lack of health literacy in the students’ parents. What action would best address this need? A. Conduct a monthly health-related seminar for parents. B. Investigate grants or other funding for a computer bank. C. Invite parents to healthy cooking demonstrations. D. Provide brochures on a variety of health problems. ANS: B The disparity between people who have access to technology and those who do not is directly related to health literacy and knowledge. The amount of information doubles every 6 years, so it is not possible to keep track of all the latest health news by accessing brochures, books, or periodicals. Having access to computers would greatly increase health literacy. The other options are certainly helpful, but would not be as far-reaching as providing access to online material.
Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Difficult
PTS: 1
- A nurse is caring for a patient near the end of life whose wishes regarding care are not known. The two sons disagreed with the two daughters about future medical plans for the patient during a recent
Women's Health Companion
to advocate for the child and to develop a therapeutic relationship characterized by a caring attitude. The nurse should encourage the child to discuss her asthma and modify interventions accordingly.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Difficulty: Difficult
PTS: 1
- The nurse managing a pediatric clinic often sees single mothers with children. What action by the nurse would best help this population of women access health care? A. Arrange to have evening and weekend hours. B. Offer sample medications instead of prescriptions. C. Provide a play center for waiting children. D. Provide bus tokens for transportation to the clinic. ANS: A Single mothers with children constitute 82% of the poverty population. “Welfare to work” programs are now compulsory, and women must work in order to receive aid. Offering evening and weekend hours could accommodate more women who cannot afford to miss time off from work. The other options might be helpful for some patients and families, but to have the greatest impact on the largest group of people, accommodating work schedules is important for this population of women.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Easy
PTS: 1
- A community health nurse explains to the nursing student that the best health-related programming includes which of the following elements? A. Has both individual and societal components B. Is directed toward individual responsibility
Women's Health Companion
C. Provides incentives to compensate healthy choices D. Requires legislation to truly be effective ANS: A Intervention programs must be multi-tiered and oriented to the broader social context in which they occur, because that is where patients are located. Programs directed toward only individuals are less successful. Programs and interventions do not need to include legislation or incentives.
Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy
PTS: 1
- A nursing student wishes to investigate national health goals. Where should the student research this information? A. Cochrane Database B. Cumulative Index of Nursing and Allied Health Literature C. Government websites D. Healthy People initiative ANS: D The Healthy People initiative is the blueprint for the nation’s health goals. Updated every 10 years, it lists national health priorities. Information related to the Healthy People initiative can be found on the other sites, but they are secondary sources. The student would do best to investigate the primary source.
Cognitive Level: Application: Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Easy
PTS: 1
Women's Health Companion
prevention. Tertiary prevention attempts to restore health to its highest level of functioning. Driving cancer patients to their treatments is an example of tertiary prevention.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate
PTS: 1
- A nurse is interested in providing tertiary prevention activities. Which of the following activities would this nurse choose to do? A. Assist with low-cost swimming lessons at the YMCA. B. Conduct monthly educational seminars at a church. C. Join the county pandemic outbreak response team. D. Provide glucose and cholesterol screening at the mall. ANS: C Tertiary prevention attempts to restore health to its highest level of functioning. Working with a county response team in the event of a pandemic outbreak would be an example of tertiary prevention. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Assisting with swimming lessons and conducting monthly seminars will educate the target audiences in order to prevent a health problem. Secondary prevention is screening, early detection, and prompt treatment for health problems. Providing glucose and cholesterol screening is an example of secondary prevention.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate
PTS: 1
- A practicing nurse tells a student nurse that beyond the World Health Organization’s definition of health, providers must also consider which of the following factors when determining the health of a
Women's Health Companion
community? A. The definition of health as described by the community B. The incidence of preventable health problems in the group C. The morbidity caused by genetically related health problems D. The mortality rates that could be lowered with primary prevention ANS: A The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” According to Purnell and Paulanka (2008), one must also consider the definition of health as it is described by people within their own ethnocultural group. The other options are not part of this consideration.
Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate
PTS: 1
- A nurse wants to know the trend concerning death due to cardiovascular disease. What source should the nurse consult? A. Epidemiology data B. Morbidity data C. Mortality data D. Primary prevention data ANS: C Mortality refers to death. Government agencies keep both mortality and morbidity records on public health threats. Morbidity refers to illness. Epidemiology is the statistical analysis of factors related to disease in populations over time. Primary prevention includes activities designed to keep health problems from happening. It often includes education.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance
Women's Health Companion
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate
PTS: 1
- A nurse is working with a parent–teacher association to combat school bullying. What action can the nurse suggest that would best help to decrease this form of interpersonal violence? A. Advise that victims’ parents call law enforcement and press charges. B. Begin offering martial arts classes in the school for bullied children. C. Encourage the school to adopt no-tolerance policies for bullying. D. Suggest limiting television viewing, especially for younger children. ANS: D Some research has shown that violent media exposure is linked to violent behavior. Included in media are computer games, which can also be violent. Younger children may not be able to distinguish between real and fantasy and may be overly influenced by violent images. No-tolerance policies can be helpful, as can a social environment in which children and their parents are held accountable legally. Offering martial arts classes may send the wrong message and would most likely not diminish the incidence of bullying.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Difficulty: Moderate
PTS: 1
- A school nurse is increasingly concerned with a growing absentee problem. To best address this issue, which of the following actions should the nurse take? A. Begin a structured follow-up program for asthmatic children. B. Hold informational meetings on the importance of childhood vaccines. C. Partner with providers on continuity plans for kids with chronic illness. D. Work with law enforcement to develop a truancy response team.
Women's Health Companion
ANS: A
All plans sound like they could be innovative strategies for dealing with school absenteeism. But because asthma is the most common reason for a child to miss school (and the primary reason for visits to pediatric emergency rooms), the nurse’s best response is to develop a structured follow-up program for kids with asthma.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Implementation Difficulty: Moderate
PTS: 1
- A nurse is working with a patient who misses appointments frequently and doesn’t always fill prescriptions for herself or her children. On reviewing the patient’s chart, the nurse sees that the patient has insurance. What action by the nurse would be the most helpful? A. Ask the patient to describe her health insurance coverage. B. Educate the patient about the consequences of skipping medicines. C. Find out if the patient is seeing other health-care providers. D. Remind the patient that she is responsible for her children’s health. ANS: A An important factor in access to health care is insurance. Employer-provided plans are becoming more uncommon, and even those with insurance often have gaps in their coverage, which leads to missed appointments, unfilled prescriptions, and other services being underutilized. The other actions might be useful, although it probably will sound judgmental if the nurse merely tells the patient that she is responsible for her children’s health.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Moderate
PTS: 1
Women's Health Companion
having free will and acting according to one’s own wishes when making decisions. Fidelity is keeping promises. Veracity is truth telling.
Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Difficult
PTS: 1
- A nurse considers beneficence as the guiding ethical principle for nursing practice. Working within that framework, which action by the nurse best demonstrates that concept? A. Administering a pain medication before therapy so that the patient can participate B. Allowing the patient to make informed choices as to his or her plan of care C. Promising a pain medication in 1 hour and returning with it on time D. Turning patients to prevent pressure sores, despite causing temporary discomfort ANS: A Beneficence means acting for the patient’s benefit, or doing good. Giving a pain medication before a therapy session helps the patient fully participate, improving his or her recovery. Allowing the patient to make informed choices demonstrates autonomy. Returning when promised is an example of fidelity. Turning patients, even though it causes temporary discomfort, is non-maleficence.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate
PTS: 1
- A nurse ensures that a patient does not have questions regarding the upcoming surgical procedure and verifies that the signature on the consent form is the patient’s signature. Which ethical principle is this nurse demonstrating? A. Autonomy B. Beneficence
Women's Health Companion
C. Fidelity D. Justice ANS: A Autonomy is the right to make decisions and to have the information necessary to make such decisions. Beneficence is doing good. Fidelity is keeping promises. Justice is treating everyone fairly.
Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Caring Difficulty: Moderate
PTS: 1
- A 45-year-old woman presents to the emergency department complaining of chest pain and feeling anxious. She asks to have an electrocardiogram (EKG) but is told that “heart disease is a man’s disease” and is given a prescription for lorazepam (Ativan). What can the nurse conclude? A. If the woman were older, she may have received an EKG. B. Sex hormones play a powerful role in determining heart disease. C. Stereotyping seriously impacted the care the woman received. D. Women under the age of 45 are at low risk of having heart disease. ANS: C A stereotype is a mental image that portrays members of a specific group with the same attributes. Believing that heart disease is a “man’s disease” is an example of a stereotype. Because the practitioner held this view, the woman’s health care was compromised. The other statements cannot be justified from this example.
Cognitive Level: Analysis/Analyzing Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Difficult
PTS: 1
Women's Health Companion
Integrated Process: Caring Difficulty: Easy
PTS: 1
- A nurse is working with a woman who is 4 months pregnant. The woman has had a series of temporary housing, has no job, and is wearing clothing that is obviously way too big for her. What action can the nurse take to most improve the health of this woman and child? A. Arrange transportation for her to get to a community food bank. B. Consult a social worker to help her apply for the WIC program. C. Encourage the woman to make her return appointment before leaving. D. Ask the woman to fill out an application for the federal Medicare program. ANS: B WIC, or the Women, Infants, and Children Program, targets pregnant women, infants, and children up to age 5 who are nutritionally at risk. WIC provides supplemental nutritious foods and nutrition counseling. Forty-five percent of infants born in this country participate in the WIC program. Helping with transportation needs and facilitating return appointments is helpful too, but not to the degree that improving this woman’s nutrition will be. The woman might be eligible for Medicaid, but not Medicare, which is for the elderly.
Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Caring Difficulty: Moderate
PTS: 1
MULTIPLE RESPONSE
- A nurse working in a women’s health clinic has several patients who are from a minority culture, live in the inner city, lack employment that offers benefits, have large families, and often lack transportation to health care. Which of these factors are considered broad determinants of health? (Select all that apply.) A. Access to health care B. Employment
Women's Health Companion
C. Environment D. Family size E. Race ANS: A, B, C, E Broad determinants of health care are personal, community, and societal systems and include environment, employment, insurance, class, race, social support, access to health services, genetic endowment, and personal histories. Family size itself is not a broad determinant of health care; however, it could be included in the larger category of personal history.
Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy
PTS: 1
- The community health nurse knows that the public health intervention model is focused on which of the following intervention levels? (Select all that apply.) A. Community B. Family C. Government D. Hospitals E. Patient ANS: A, B, E The public health intervention model is an inclusive framework that encompasses three levels at which interventions can be initiated, from the micro-level of the individual to the macro-level environment. Interventions are targeted toward individuals/families, communities, and larger institutional and societal systems. Government and hospitals are not one of the three levels.
Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy
Women's Health Companion
ANS: A, C, D
Goals of the Healthy People 2020 document include the following: (1) To attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) to achieve health equity, eliminate disparities, and improve the health of all groups; (3) to create social and physical environments that promote good health for all; and (4) to promote quality of life, healthy development, and healthy behaviors across all life stages. The blueprint does not call for developing healthy behaviors only in children and teens, nor does it call for simply increasing the average life span.
Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Planning Difficulty: Difficult
PTS: 1
- What does the nursing student understand about health disparities in the United States? (Select all that apply.) A. African American babies die by age 1 at a rate times that of European Americans. B. Asian American babies have the highest rate of preterm birth of any other group. C. Despite large expenditures, health resources are unevenly distributed. D. European Americans have double the number of low-birth-weight babies than other groups. E. Sudden infant death syndrome is most prevalent in American Indian and Alaska native babies. ANS: A, C, E Many health disparities exist in America, despite huge outlays of money. A major problem is that health resources are not distributed evenly across demographic and geographic groups. This leads to such problems as the high rate at which African American babies die before age 1, and the high incidence of sudden infant death syndrome in American Indian and Alaska Native populations. Asian American babies do not have the highest rate of preterm birth, and European American women do not have double the number of low-birth-weight babies of other groups.
Cognitive Level: Comprehension/Understanding Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance
Women's Health Companion
Integrated Process: Nursing Process: Assessment Difficulty: Moderate
PTS: 1
- The public health nurse explains to students that diversity is an increasing phenomenon in this country. What facts about this phenomenon does the nurse share with the students? (Select all that apply.) A. As immigrants acculturate, their unique cultural care needs will diminish. B. By 2050, the minority population in America is estimated to be 50%. C. Hispanics, blacks, and Asians are the historically designated minority groups. D. One in five people in this country will be over the age of 65 by the year 2030. E. Racial differences are rooted in biological factors that explain illness trends. ANS: B, D The population of ethnic minorities is expected to reach 50% by the year 2050, which increases the need for culturally competent health care. One in five people will be over the age of 65 by 2030, increasing the impact of chronic illnesses. Hispanics, blacks, Asians, and Native Americans are the historically designated minority groups. There is no biologic basis for race; racial and ethnic categories are socially created.
Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity Patient Needs: Health Promotion and Maintenance Integrated Process: Nursing Process: Assessment Difficulty: Easy
PTS: 1
- Which of the following activities should the perinatal nurse encourage women who come for preconceptional counseling to consider? (Select all that apply.) A. Choosing breastfeeding or bottle feeding B. Decreasing risk for exposure to toxoplasmosis C. Decreasing fetal risks related to the work environment D. Ensuring folic acid supplementation E. Ensuring iron supplementation ANS: B, C, D
