Question 1

Which of the following describes the dyad family unit?

Accepted Answer

A dyad family is a husband and wife or other couple living alone without children. A nuclear family is a father and mother with one or more children living together. An extended family is second- and third-generation members related by blood or marriage but not living together. A single-parent family is a divorced, never married, separated, or widowed male or female and at least one child.

Question 2

When performing an assessment that focuses on a set of standardized connections to graphically record basic information about family members and their relationships over three generations, the nurse uses

Accepted Answer

A genogram is defined as a diagram, which uses a standardized set of connections to graphically record basic information about family members and their relationships over three generations. Genograms are updated and/or revised as new information emerges. An ecomap is essentially a sociogram, illustrating the shared relationships between family members and the external environment. Beginning with an individual family unit or patient, the diagram extends to include significant social and community-based systems with whom they have a relationship. These data identify at a glance the family's interaction with environmental supports and its use of resources available through friends and community systems. Adding the ecomap is an important dimension of family assessment, providing awareness of community supports that are, or are not, being used to assist families. A gendergram is used to understand gender role development in families and its influences on current role enactments. Family time lines offer a visual diagram that captures significant family stressors, life events, health, and developmental patterns through the life cycle. Family history and patterns developed through multigenerational transmission are represented as vertical lines. Horizontal lines indicate timing of life events occurring over the current life span. These include such milestones as marriages, graduations, and unexpected life events such as disasters, war, illness, death of person or pet, moves, or births. Timelines are useful in looking at how the family history, developmental stage, and concurrent life events might interact with the current health concern.

Question 3

A family systems theory that conceptualizes the family as an interactive emotional unit in which family members assume reciprocal family roles, develop automatic communication patterns, and react to each other in predictable, connected ways, particularly when family anxiety is high, was created by

Accepted Answer

Murray Bowen's family systems theory conceptualizes the family as an interactive emotional unit. Bowen believed that family members assume reciprocal family roles, develop automatic communication patterns, and react to each other in predictable, connected ways, particularly when family anxiety is high. Evelyn Duvall proposed a family life stage framework for understanding issues that normal families experience based on expected family development through the life span, each with its own set of tasks. Duvall's model describes the life cycle of a family, using the age of the oldest child in the family as the benchmark for determining the family's developmental stage. Developmental tasks represent the challenges and growth responsibilities each family experiences at different life stages. McCubbin & McCubbin's Resiliency Model of Family Stress, Adjustment, and Adaptation is considered the most extensively studied model of family coping with traumatic and chronic illness. In this model, A (an event) interacts with B (resources) and with C (family's perception of the event) to produce X (the crisis). Family structure models, pioneered by Salvador Minuchin, emphasize the structure (subsystems, hierarchies, and boundaries) of the family unit as the basis for understanding family function. Family structure refers to how the family is constructed legally and emotionally. The concept of hierarchy describes how families organize themselves into various smaller units, referred to as subsystems, that compose the larger family system.

Question 4

When focusing on family interrelationships and the impact a serious health alteration has on individual family members and the equilibrium of the family system, the nurse should use

Accepted Answer

Interventive questioning is a nursing intervention that nurses can use with their patient families to identify family strengths; help family members sort out their personal fears, concerns, and challenges in health care situations; and provide a vehicle for exploring alternative options. Questions can be either linear or circular. Circular questions focus on family interrelationships and the impact a serious health alteration has on individual family members and the equilibrium of the family system. The systems principle of equifinality describes how the same outcome, or end state, can be reached through different pathways. This principle helps explain why some individuals at high risk for poor outcomes do not develop maladaptive behaviors. Boundaries, defined as invisible limits surrounding the family unit, protect the integrity of the family system. Boundaries draw a line in the sand by identifying what belongs within the family system and what is external to it. They define the level of participation between family members. Clear generational boundaries provide security for family members by, for example, setting legitimate limits with children and balancing individual needs with the demands of caring for the needs of chronically ill family members. Boundaries regulate the flow of information into and out of the family. Permeable boundaries welcome interactions with others and allow information to flow freely. Families with clear, permeable boundaries are better able to balance the demands of the illness with other family needs and can communicate more effectively with care providers. Diffuse boundaries lead to family overinvolvement, while rigid boundaries are operative in families with little interaction between members and family secrets. Rigid boundaries restrict flow of information. Interaction with outsiders is discouraged, or heavily regulated. Diffuse boundaries are found in enmeshed families. Morphostasis refers to how the family is able to change and grow over time in response to challenges.

Question 5

Regardless of how uniquely they are defined, strong emotional ties and durability of membership characterize

Accepted Answer

A family is who they say they are. Identified family members may or may not be blood related. Strong emotional ties and durability of membership characterize family relationships regardless of how uniquely they are defined. Even when family members are alienated, or distanced geographically, they can never truly relinquish family membership. Family function refers to the roles people take in their families. Family process describes the communication that takes place within the family. An ecomap is essentially a sociogram, illustrating the shared relationships between family members and the external environment. Beginning with an individual family unit or patient, the diagram extends to include significant social and community-based systems with which they have a relationship. These data identify at a glance the family's interaction with environmental supports and its use of resources available through friends and community systems.

Question 6

The nurse is caring for a patient who is extremely dependent on the approval of others, causing them to discount their own needs. The nurse recognizes that the patient is demonstrating

Accepted Answer

Self-differentiation refers to a person's capacity to define himself or herself within the family system as an individual having legitimate needs and wants. It requires making "I" statements based on rational thinking rather than emotional reactivity. Self-differentiation takes into consideration the views of others but is not dominated by them. Poorly differentiated people are so dependent on the approval of others that they discount their own needs. Emotional cutoff refers to a person's withdrawal from other family members as a means of avoiding family issues that create anxiety. Emotional cutoffs range from total avoidance to remaining in physical contact, but in a superficial manner. Emotional cutoffs contain a negative anxiety that drains personal energy. The problems creating the emotional cutoff persist. Rigid boundaries are operative in families with little interaction between members and family secrets. Rigid boundaries restrict flow of information. Interaction with outsiders is discouraged, or heavily regulated.

Question 7

The home health nurse is visiting a family who is having difficulty coping. The family has a 2-month-old malnourished child whom they are feeding diluted formula along with rice cereal. The parents of the child are unemployed and are unable to pay their monthly expenses. The father of the child complains of not being able to find a job, while the mother of the child accuses him of not even trying to find employment. Which of the following techniques would be most helpful for the nurse to use in this situation?

Accepted Answer

Interventive questioning is a nursing intervention that nurses can use with their patient families to identify family strengths; help family members sort out their personal fears, concerns, and challenges in health care situations; and provide a vehicle for exploring alternative options. Interventive questioning can be either linear or circular. Encouraging the family's current coping style is not useful because it clearly has detrimental effects, including a malnourished child.

Question 8

When interviewing the family of a patient who is suffering from alcoholism, the communication technique used by the nurse is called circular questioning. The advantage of this technique is that it

Accepted Answer

Circular questions focus on family interrelationships and the effect of a serious health alteration on individual family members and the equilibrium of the family system. The nurse uses information the family provides as the basis for additional questions. A technique used to examine relationships is called ecomap. Circular questioning assists the nurse in developing interventions, not diagnoses. Circular questioning helps the nurse gain multidimensional, not specific, information.

Question 9

When performing an admission assessment on a patient, the nurse asks about sibling position based on the knowledge that sibling position can shape relationships and influence a person's expression of behavioral characteristics. The concept that each sibling position has its own strengths and weaknesses is based on the work of:

Accepted Answer

Sibling position, a concept originally developed by Walter Toman (1992), refers to a belief that sibling positions shape relationships and influence a person's expression of behavioral characteristics. Each sibling position has its own strengths and weaknesses. This concept helps explain why siblings in the same family can exhibit very different characteristics. Murray Bowen's family systems theory conceptualizes the family as an interactive emotional unit. Bowen believed that family members assume reciprocal family roles, develop automatic communication patterns, and react to each other in predictable, connected ways, particularly when family anxiety is high. Medalie and Cole-Kelly describe the course of chronic illness as being a series of crises with relatively stable times in between McCubbin & McCubbin's Resiliency Model of Family Stress, Adjustment, and Adaptation is considered the most extensively studied model of family coping with traumatic and chronic illness. In this model, A (an event) interacts with B (resources) and with C (family's perception of the event) to produce X (the crisis).

Question 10

The nurse-family relationship in patient care depends on what type of relationship between the nurse and the family?

Accepted Answer

The nurse-family relationship in patient care depends on a reciprocal relationship between the nurses and family in which both are equal partners and sources of information. The initial encounter sets the tone for the relationship. How nurses interact with each family member may be as important as what they choose to say. The nurse should begin with formal introductions and explain the purpose of gathering assessment data.

Question 11

Which of the following is a true statement when comparing biological and blended families?

Accepted Answer

In blended families, family is born of loss and rules are varied and complicated. In biological families, one set of family rules evolves. There are two sets of family traditions in blended families.

Question 12

When interviewing the family of a patient newly diagnosed with Alzheimer's disease, the nurse's primary goal is to help the family members sort out their personal fears and identify family strengths through the use of

Accepted Answer

Interventive questioning is an intervention that nurses can use with their patient families to identify family strengths; help family members sort out their personal fears, concerns, and challenges in health care situations; and provide a vehicle for exploring alternative options. A genogram uses a standardized set of connections to graphically record basic information about family members and their relationships over three generations. Genograms are updated and/or revised as new information emerges. An ecomap is essentially a sociogram illustrating the shared relationships between family members and the external environment. Beginning with an individual family unit or patient, the diagram extends to include significant social and community-based systems with whom they have a relationship. These data identify at a glance the family's interaction with environmental supports and its use of resources available through friends and community systems. Adding the ecomap is an important dimension of family assessment, providing awareness of community supports that are, or are not, being used to assist families. Offering commendations is the practice of noticing, drawing forth, and highlighting previously unobserved, forgotten, or unspoken family strengths, competencies, or resources.

Question 13

When caring for patients, it is important for the nurse to understand that

Accepted Answer

Meaningful involvement in the patient's care not only differs from family to family, it also differs among individual family members. Individual family members have different perspectives. Hearing each family member's perspective helps the family and nurse develop a unified understanding of significant treatment goals and implications for family involvement. Although treatment plans should be tailored around personal patient goals, acknowledging family needs, values, and priorities enhances compliance, especially if they are different.

Question 14

The nurse is caring for a patient who reports having marital difficulties. When experiencing heightened anxiety related to his health issues, the patient chooses to discuss his feelings with a female friend rather than with his spouse. The nurse recognizes the patient's actions as a defensive way of reducing, neutralizing, or defusing heightened anxiety known as

Accepted Answer

Triangles refer to a defensive way of reducing, neutralizing, or defusing heightened anxiety between two family members by drawing a third person, or object into the relationship. If the original triangle fails to contain or stabilize the anxiety, it can expand into a series of "interlocking" triangles, for example into school issues or an affair. Systems' thinking maintains that the whole is greater than the sum of its parts, with each part reciprocally influencing its function. If one part of the system changes or fails, it affects the functioning of the whole. Feedback loops describe the patterns of interaction that facilitate movement toward morphogenesis, or morphostasis; they impact goal setting in behavior systems. Multigenerational transmission refers to the emotional transmission of behavioral patterns, roles, and communication response styles from generation to generation. It explains why family patterns tend to repeat behaviors in marriages, child rearing, choice of occupation, and emotional responses across generations, without understanding why it happens.

Question 15

The nurse is designing therapeutic interventions for a family whose child is hospitalized with a terminal condition. The nurse recognizes that nursing actions that can be offered to the family that can promote positive change in family functioning include which of the following?

Accepted Answer

Suggested nursing actions to promote positive change in family functioning include:
F1F1F1S1F1F1F10 encouraging the telling of illness narratives.
F1F1F1S1F1F1F10 commending family and individual strengths.
F1F1F1S1F1F1F10 offering information and opinions.
F1F1F1S1F1F1F10 validating or normalizing emotional responses.
F1F1F1S1F1F1F10 encouraging family support.
F1F1F1S1F1F1F10 supporting family members as caregivers.
F1F1F1S1F1F1F10 encouraging respite.

Question 16

When the nurse cares for a patient with a terminal illness, a question that the nurse can ask the patient's family to elicit information about family strengths is

Accepted Answer

Questions nurses can use specifically to elicit family strengths include, "What has the family been doing so far that has been helpful?" Questions regarding level of understanding, comfort, and who is taking care of the house are not the best questions that the nurse can ask the patient's family to elicit information about family strengths.

Quiz 12: Communicating With Families