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Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition Chapter 02: Family, Social, Cultural, and Religious 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?
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. DIF:Cognitive Level: UnderstandREF:p. 17 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?
|b.||Developmental systems 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. DIF:Cognitive Level: UnderstandREF:p. 16 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?
|b.||Developmental systems theory|
|c.||Family stress theory|
|d.||Duvall’s developmental theory|
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 stepparent, 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. DIF:Cognitive Level: RememberREF:p. 18 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 which a mother, her children, and a stepfather live together?
ANS: A A blended family contains at least one stepparent, 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. DIF:Cognitive Level: UnderstandREF:p. 18 TOP:Integrated Process: Nursing Process: Assessment MSC:Area of Client Needs: Health Promotion and Maintenance 5.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:
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. DIF:Cognitive Level: ApplyREF:p. 29 TOP:Integrated Process: Nursing Process: Implementation MSC:Area of Client Needs: Health Promotion and Maintenance 6.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.||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: 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. DIF:Cognitive Level: UnderstandREF:p. 17 TOP:Integrated Process: Nursing Process: Evaluation MSC:Area of Client Needs: Health Promotion and Maintenance 7.When assessing a family, the nurse determines that the parents exert little or no control over their children. What is this style of parenting called?
|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 parent’s previous experience with children makes the role transition more difficult.”|
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. DIF:Cognitive Level: RememberREF:p. 20 TOP:Integrated Process: Nursing Process: Diagnosis MSC:Area of Client Needs: Health Promotion and Maintenance 8.When discussing discipline with the mother of a 4-year-old child, the nurse should include which instruction?
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. DIF:Cognitive Level: ApplyREF:p. 20 TOP:Integrated Process: Teaching/Learning MSC:Area of Client Needs: Health Promotion and Maintenance 9.Which is most characteristic of the physical punishment of children, such as spanking?
|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: 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. DIF:Cognitive Level: UnderstandREF:p. 20 TOP:Integrated Process: Teaching/Learning MSC:Area of Client Needs: Health Promotion and Maintenance 10.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.||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: 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. DIF:Cognitive Level: UnderstandREF:p. 22 TOP:Integrated Process: Teaching/Learning MSC:Area of Client Needs: Health Promotion and Maintenance 11.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.||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: 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 parenting, or an unusual response that indicates need for referral in school-age children after parental divorce. DIF:Cognitive Level: ApplyREF:p. 24 TOP:Integrated Process: Teaching/Learning MSC: Area of Client Needs: Psychosocial Integrity 12.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.||Indication of maladjustment|
|b.||Common reaction to divorce|
|c.||Lack of adequate parenting|
|d.||Unusual response that indicates need for referral|
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. DIF:Cognitive Level: ApplyREF:p. 27 TOP:Integrated Process: Communication and Documentation MSC: Area of Client Needs: Psychosocial Integrity 13.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.||“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: 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 humankind 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. DIF:Cognitive Level: RememberREF:p. 29 TOP:Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity 14.Which term best describes the emotional attitude that one’s own ethnic group is superior to others?
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. DIF:Cognitive Level: UnderstandREF:p. 30 TOP:Integrated Process: Nursing Process: Assessment 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.)
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. DIF:Cognitive Level: UnderstandREF:p. 19 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.||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, 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. DIF:Cognitive Level: ApplyREF:p. 21 TOP:Integrated Process: Teaching/Learning MSC: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 types of behaviors? (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: 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. He or she 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. DIF:Cognitive Level: ApplyREF:p. 24 TOP:Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Teaching and Learning COMPLETION
|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|
CHAPTER 1 SM NOT EXISTENT Chapter 2 Descriptive Statistics Case Problem: Heavenly Chocolates Website Traffic
- Descriptive statistics for the time spent on the website, number of pages viewed, and amount spent are shown below.
The mean time a shopper is on the Heavenly Chocolates website is 12.8 minutes, with a minimum time of 4.3 minutes and a maximum time of 32.9 minutes. The following histogram demonstrates that the data are skewed to the right. The meannumber of pages viewed during a visit is 4.8 pages with a minimun of 2 pages and a maximum of 10 pages A histogram of the number of pages viewed indicates that the data are slightly skewed to the right. The mean amount spent for an on-line shopper is $68.13 with a minimum amount spent of $17.84 and a maximum amount spent of $158.51. The following histogram indicates that the data are skewed to the right.
|Time (min)||Pages Viewed||Amount Spent ($)|
- Summary by Day of Week
The above summary shows that Monday and Friday are the best days in terms of both the total amount spent and the averge amount spent per transaction. Friday had the most purchases (11) and the highest value for total amount spent ($945.43). Monday, with nine transactions, had the highest average amount spent per transaction ($90.38). Sunday was the worst sales day of the week in terms of number of transactions (5), total amount spent ($218.15), and average amount spent per transaction ($43.63). However, the sample size for each day of the week are very small, with only Friday having more than ten transactions. We would suggest a larger sample size be taken before recommending any specific stratgegy based on the day of week statistics.
|Day of Week||Frequency||Total Amount Spent ($)||Average Amount Spent ($)|
- Summary by Type of Browser
Chrome was used by 27 of the 50 shoppers (54%).But, the average amount spent spent bycustomers who used Chrome ($61.36)is less than the average amount spent by customers who used Firefox ($76.76) or some other type of browser ($74.48). This result would suggest targeting special promotion offers to Firefox users or users of other types of browsers. But, before recommending any specific strategies based upon the type of browser, we would suggest taking a larger smaple size.
|Browser||Frequency||Total Amount Spent ($)||Average Amount Spent ($)|
- A scatter diagram showing the relationship between time spent on the website and the amount spent follows:
Table of Contents Unit I: Essential Theoretical Concepts for Practice 1. Practicing the Science and the Art of Psychiatric Nursing 2. Mental Health and Mental Illness 3. Theories and Therapies 4. Biological Basis for Understanding Psychopharmacology 5. Settings for Psychiatric Care 6. Legal and Ethical Basis for Practice Unit II: Tools for Practice of the Art 7. Nursing Process and QSEN: The Foundation for Safe and Effective Care 8. Skills: Medium for All Nursing Practice 9. Therapeutic Relationships and the Clinical Interview Unit III: Caring for Patients with Psychobiological Disorders 10. Stress and Stress-Related Disorders 11. Anxiety, Anxiety Disorders, and Obsessive-Compulsive Disorders 12. Somatic Symptom Disorders and Related Disorders 13. Personality Disorders 14. Eating Disorders 15. Mood Disorders: Depression 16. Bipolar Spectrum Disorders 17. Schizophrenia Spectrum Disorders and Other Psychotic Disorders 18. Neurocognitive Disorders 19. Substance-Related and Addictive Disorders Unit IV: Caring for Patients Experiencing Psychiatric Emergencies 20. Crisis and Mass Disaster 21. Child, Partner, and Elder Violence 22. Sexual Violence 23. Suicidal Thoughts and Behaviors 24. Anger, Aggression, and Violence 25. Care for the Dying and Those Who Grieve Unit V: Age-Related Mental Health Disorders 26. Children and Adolescents 27. Adults 28. Older Adults
Test Bank for Essentials of Pharmacology for Health Professions 7th Edition by Woodrow
Table of contents PART I: INTRODUCTION. 1. Consumer Safety and Drug Regulations. 2. Drug Names and References. 3. Sources and Bodily Effects of Drugs. 4. Medication Preparations and Supplies. 5. Abbreviations and Systems of Measurement. 6. Safe Dosage Preparation. 7. Responsibilities and Principles of Drug Administration. 8. Administration by the Gastrointestinal Route. 9. Administration by the Parenteral Route. 10. Poison Control. PART II: DRUG CLASSIFICATIONS. 11. Vitamins, Minerals, and Herbs. 12. Skin Medications. 13. Autonomic Nervous System Drugs. 14. Antineoplastic Drugs. 15. Urinary System Drugs. 16. Gastrointestinal Drugs. 17. Anti-infective Drugs. 18. Eye Medications. 19. Analgesics, Sedatives, and Hypnotics. 20. Psychotropic Medications, Alcohol, and Drug Abuse. 21. Musculoskeletal and Anti-inflammatory Drugs. 22. Anticonvulsants, Antiparkinsonian Drugs, and Agents for Alzheimer’s Disease. 23. Endocrine System Drugs. 24. Reproductive System Drugs. 25. Cardiovascular Drugs. 26. Respiratory System Drugs and Antihistamines. 27. Drugs and Older Adults.
Test Bank for Essentials of Human Anatomy & Physiology 10th Edition MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) A section that divides the body on the longitudinal plane into equal right and left parts is called: 1) _______ A) median (midsagittal) B) oblique C) transverse D) frontal E) coronal 2) Which of the following is the correct sequence, going from simplest to most complex, in the levels of structural organization of the human body: 2) _______ A) chemical level, tissue level, cellular level, organ system level, organ level, organismal level B) cellular level, chemical level, tissue level, organ system level, organismal level, organ level C) chemical level, cellular level, tissue level, organ level, organ system level, organismal level D) cellular level, chemical level, tissue level, organ level, organ system level, organismal level E) cellular level, tissue level, chemical level, organ level, organ system level, organismal level 3) Which of these regions are associated with the parts of the arm: 3) _______ A) femoral, popliteal, patellar B) brachial, antecubital, carpal C) nasal, oral, occipital D) pelvic, pubic, inguinal E) acromial, sacral, gluteal 4) The muscular system consists of the: 4) _______ A) muscles in the walls of hollow organs B) muscles of the heart and those in the walls of the hollow organs C) skeletal muscles D) skeletal muscles and the muscles of the heart E) muscles of the heart 5) The lymphatic system: 5) _______ A) synthesizes vitamin D B) responds to internal and external changes by activating appropriate muscles and glands C) secretes hormones that regulate processes such as growth, reproduction, and nutrient use (metabolism) by body cells D) picks up fluid leaked from blood vessels and returns it to the blood E) produces heat 6) Which system covers the external surface of the body and manufactures vitamin D: 6) _______ A) endocrine system B) skeletal system C) nervous system D) integumentary system E) lymphatic system 7) Which of these regions are NOT associated with the ventral (anterior) portion of the head: 7) _______ A) oral B) orbital C) buccal D) nasal E) occiptal 8) Which of the following systems is matched most accurately to the life function it provides: 8) _______ A) respiratory system - digestion B) nervous system - excretion C) muscular system - maintaining boundaries D) integumentary system - movement E) nervous system - responsiveness 9) Which of the following elements of a control system detects a change: 9) _______ A) receptor B) control center C) effector D) stimulus E) efferent pathway 10) Which of the following statements is correct regarding the location of the spleen and stomach: 10) ______ A) both of these organs are located medially B) both of these organs are located in the left upper quadrant C) the spleen is located in the left upper quadrant and the stomach is located in the right upper quadrant D) both of these organs are located in the right upper quadrant E) the spleen is located in the right upper quadrant and the stomach is located in the left upper quadrant 11) Which of these is NOT a survival need: 11) ______ A) oxygen B) water C) reproduction D) body temperature E) nutrients 12) Which of the following is the correct order of elements in a control system: 12) ______ A) receptor, stimulus, afferent pathway, control center, efferent pathway, effector, response B) stimulus, receptor, efferent pathway, control center, afferent pathway, effector, response C) receptor, stimulus, efferent pathway, control center, afferent pathway, effector, response D) stimulus, receptor, afferent pathway, control center, efferent pathway, effector, response E) effector, stimulus, efferent pathway, control center, afferent pathway, receptor, response 13) Which of the following activities does not represent an anatomical study: 13) ______ A) viewing muscle tissue through a microscope B) studying how the nerves conduct electrical impulses C) observing the parts of a reproducing cell D) examining the surface of a bone E) making a section through the heart to observe its interior 14) The dorsal body cavity houses the: 14) ______ A) heart and lungs B) spinal cord and brain C) tongue D) urinary and reproductive organs E) digestive and reproductive organs 15) The stomach, liver, intestines, bladder, rectum, and reproductive organs are housed in the: 15) ______ A) abdominopelvic cavity B) dorsal cavity C) spinal cavity D) cranial cavity E) thoracic cavity 16) Which of the following is NOT a necessary life function: 16) ______ A) nutrients B) maintaining boundaries C) movement D) responsiveness E) metabolism 17) The study of the function of the body and body parts is called: 17) ______ A) homeostasis B) anatomy C) physiology D) irritability E) negative feedback 18) Which of these regions in the abdominopelvic cavity are medial: 18) ______ A) epigastric, umbilical, and hypogastric regions B) umbilical, right lumbar, and left lumbar regions C) epigastric, right, and left hypochondriac regions D) iliac (inguinal), lumbar, and hypogastric regions E) right and left iliac (inguinal), and hypogastric regions 19) The region that contains the navel is the: 19) ______ A) umbilical region B) orbital region C) carpal region D) anterior knee E) inguinal region 20) The gluteal region is the: 20) ______ A) posterior knee area B) posterior surface of the head C) shoulder blade region D) buttock E) curve of the shoulder 21) Which of the following orientation terms have opposite meanings (in humans): 21) ______ A) medial and anterior B) superficial and proximal C) posterior and intermediate D) distal and proximal E) medial and distal 22) Your body thermostat is located in a part of the brain called the hypothalamus. Which of the following elements of a control system does this area in the brain represent: 22) ______ A) stimulus B) afferent pathway C) efferent pathway D) effector E) control center