Question 1

A nurse working in a pediatric clinic is attempting to assess a school-age child who is disrespectful of the nurse and parent and tears up a magazine when asked to sit down.What conclusion can the nurse make about this family?

Accepted Answer

Children whose parents have a laissez-faire disciplinary style tend to be disrespectful,aggressive,and disobedient.A laissez-faire disciplinary style includes inconsistent use of discipline,allowing children (rather than the parents)control over the environment,few rules,and children making their own decisions rather than being guided by parents.The other options may be true,but without further assessment,the nurse cannot make those conclusions.

Question 2

A 17-year-old high school senior is resentful about caring for younger siblings so the parents can have a "date night" once every 2 weeks.The teen often "forgets" and schedules work or social activities that override the parents' plans.The parents are angry that the teen is so indifferent to their needs.What action by the family indicates that goals for the diagnosis of impaired family processes have been met?

Accepted Answer

All the outcomes show some positive resolution,but the most optimal response is the parents and teen jointly planning the parents' nights out.This shows collaboration,communication,and mutual respect.In the end,everyone's needs are taken into consideration,and the teen will be more willing to adapt the current role to include watching the siblings.Consistent consequences delivered without anger is a hallmark of healthy discipline.The teen is taking responsibility when he or she acknowledges that the forgetting occurs on purpose.The lines of communication are open when the teen is allowed to verbalize feelings.

Question 3

A nurse is working with a family in which one member has schizophrenia.Using systems theory,for which concern should the nurse specifically assess this family?

Accepted Answer

Systems theory looks at boundaries,balance and homeostasis,and subsystems.An important concern in the family whose member is diagnosed with a mental illness is social isolation,which is related to boundaries.Some families view mental illness as shameful and try to keep the information secret.The nurse should work to ensure the family understands the importance of healthy interaction with outside systems.Children's ages would be assessed using developmental theories.

Question 4

A patient has just been admitted to the hospital in critical condition.In caring for the entire family,what action by the nurse is most important?

Accepted Answer

All options are important activities to keep the family engaged fully with the patient.However,for a patient who is critically ill,determining who makes medical decisions (and if there are advance directives)is crucial.The other actions can occur later.

Question 5

A patient is being discharged from a psychiatric facility after a suicide attempt.The family consists of the patient,two parents,and two other teenage children.What action should the nurse teach the entire family as a priority?

Accepted Answer

Safety is a priority concern in every family and all members should be made aware that the patient could have continued suicidal thoughts.If the siblings notice this,they should be taught to tell the parents immediately and could also be taught some effective communication to use.Looking for drugs or alcohol in the patient's room,encouraging medication use,and planning menus are all actions more appropriate for the parents.

Question 6

A family has weekly game nights and monthly family together days.The nurse documents these events as examples of which of the following?

Accepted Answer

Family-building activities are an extension of family rituals and center on recreation and leisure.They do contribute to family bonding,but the most specific answer is family building.Family activities are influenced by family beliefs.

Question 7

A nurse working with a pregnant woman who is a recent immigrant to the United States notes that her husband rarely accompanies her to prenatal visits,and when he does,he sits in the waiting room.What action by the nurse is best?

Accepted Answer

Culture affects the roles family members assume during times of illness,pregnancy and childbirth,and death.The best option is to ask the woman what role men in her culture play during pregnancy and childbirth.This can open a discussion of how the woman is coping and if she is getting enough support,either from her mate or friends and family.Asking why the man doesn't seem involved is judgmental.Encouraging the man to participate may not be desired by the woman and may be seen as an intrusion by the man.The nurse could research the culture but this would not lead to a discussion until the next visit.It is also important to be aware that there are variations in how people of the same culture behave and believe.

Question 8

A nurse is working with a family that has the nursing diagnosis of altered family processes.When formulating goals,whom does the nurse include?

Accepted Answer

The most effective goals are those that include the entire family.The entire family agrees upon the goals and commits to working on them.

Question 9

An immigrant family is working with a nurse on improving family dynamics.The nurse notes that the teenage children do not subscribe to their parent's social and cultural mores and identify more with their native-born American friends.What description of the children is most accurate to record in the family's chart?

Accepted Answer

Assimilation is the process whereby a family or individual loses its unique cultural identity and identifies more with the dominant culture.The teens appear to be assimilated.Acculturation is the changes in cultural patterns within a group to match those of the host society.Connectedness relates to with whom the family identifies and relates as a family unit.Lost children are often seen in substance-abusing families.

Question 10

A female patient from a refugee community is in the emergency department and needs urgent surgery.The patient defers making a choice on the operation,preferring to wait for a cultural elder to arrive.What action by the nurse is most appropriate?

Accepted Answer

This is a difficult situation,but because the patient's wishes are known,the nurse has no choice other than to wait.In the emergency department,sometimes surgery is performed under the principle of implied consent (for instance,on an unconscious patient with no known family),but in this case,the patient has been clear as to her wishes,so doing that would be an ethics violation.The nurse must be careful to not be coercive.The nurse (and physician)would ensure that the patient understands the risks of waiting.

Question 11

A family with a loud,disobedient child has been working with a nurse.Which action observed by the nurse indicates that goals for the diagnosis of impaired parenting have been met?

Accepted Answer

Consistency in setting and enforcing rules is critical.Consequences should be delivered immediately,without anger,and consistently.The father's disciplining the child without getting mad is demonstrating that goals have been (or are being)met.The other options do not show consistent,calm,immediate consequences.

Question 12

A hospice nurse is making the initial home visit to a patient who just returned home after a lengthy hospitalization.What action by the nurse is most appropriate to help the family continue to function?

Accepted Answer

In the at-home hospice setting,family members must find a balance between direct caregiving activities and their own needs for personal time.The nurse must assess this to help the family avoid caregiver strain and resentment and to maintain roles necessary for family functioning.Ensuring the family understands the hospice concept and providing information are also important,but are not directly related to family functioning.The family may or may not need counseling.

Question 13

A student observes as an adult brother and sister lash out at the nurse caring for their hospitalized parent.The parent lives at home but is dependent on the children for care and is obviously neglected.The nurse has informed the children that social work will be involved in their father's case.How does the nurse explain this interaction?

Accepted Answer

This family is dysfunctional,but that does not go far enough to explain the situation.This behavior is known as triangulation,and occurs when a dyad diverts attention away from their problems and chooses instead to focus on a third party,in this case the nurse.Reassuring the student they will calm down is neither helpful nor accurate as the family members may choose to continue to lash out.Families often do get emotional,but again,this information is not really helpful.

Question 14

A mother is worried about her three children developing an inherited medical condition because many members of her family have died from this disease.To start an assessment of this family,which tool should the nurse choose?

Accepted Answer

A genogram is a diagram of at least three generations that illustrates the present family structures and compares past generations with the present ones.To determine the prevalence of this inherited disorder in the family,the nurse would use a symbol to denote each family member with this disease.An ecomap displays the outside systems with which the family interacts.A problem list helps family members identify difficulties or negative characteristics.A quantitative tool assesses the frequency of a behavior or problem.A genogram has a quantitative influence,as it documents how many people in the family have the characteristic being studied,but a genogram is more specific.

Question 15

A nurse working with a married couple notes that both parties seem to try to be dominant in their sessions.According to Bowen's family systems theory,which question asked by the nurse would yield the most useful information?

Accepted Answer

According to this family theory,birth order plays an important role in predicting certain patterns of behavior.Spouses who occupy the same birth order may have difficulty functioning together.In this case,both spouses probably are first-borns with a need for control.The other questions may yield helpful information as part of a thorough assessment,but are not related to this theory.

Question 16

A clinic nurse is using group theory to assess a family whose youngest child recently moved back home after graduating from college and is unable to find a job.Which statement by a parent would indicate to the nurse that goals for norming have been met?

Accepted Answer

According to group theory,a healthy family adjusts to changes in its structure by resetting roles and norms.In this family,a launched child has moved back in,disrupting the patterns established when he left.Agreeing to new rules and roles is a sign of adaptation.The other responses do not show adaptation to the new situation.

Question 17

A nurse wishes to assess how often members of a family consume alcohol or use drugs during a typical week.What type of family assessment tool would this nurse choose?

Accepted Answer

A quantitative tool measures the frequency at which problems or behaviors occur.An ecomap is a tool that displays the outside systems used by the family.A genogram illustrates the family structures and compares generations within the same family.Qualitative tools measure the descriptions and depth of family experiences.

Question 18

A nurse explains the benefits of a strengths-and-problems list to a student.Which is the best explanation?

Accepted Answer

A strengths-and-problems list requires the family members to list their strengths as well as what each member brings to the group that is positive.The problems list helps the family prioritize problems to work on.By seeing this information in writing,the family members can capitalize on their strengths to work on the problems.It does demonstrate that each family has both strengths and problems,but that is not the main purpose.It does not force families to take responsibility,although it does encourage this.Its purpose is not to point out who has which problems.

Question 19

A nurse is working with a family with the diagnosis of impaired family processes.Although both parties worked,one person worked part time and had the main responsibility for the household.The other spouse retired recently and has not taken on more of this role.Both people are angry and resentful.What goal would be best for this couple?

Accepted Answer

A good goal or outcome is specific,measurable,and has a time element.The goal that best meets that description is expressing feelings using "I" statements within 1 month.Adapting to role changes is vague and not measurable.Dividing duties more evenly is not measurable and has no time element.Learning to discuss negative emotions does not mean using what is learned,so it is not as specific as the correct answer.

Question 20

A grade school nurse is conducting vision screening before school and notes the student is accompanied by an older sister who has also brought a middle school child.The older child states that time is a problem because middle school starts in a few minutes and tells the younger child to go right to the classroom after the screening,then leaves.What question by the nurse would be most appropriate to ask the youngest child during the screening?

Accepted Answer

In substance-abusing families,one child often takes the role as the responsible person,allowing the family to continue functioning.The fact that a sibling was bringing the children to school is a little unusual,and the nurse should assess the reason behind it.However,substance-abusing families often keep secrets for both social and legal reasons.The nurse should not ask directly about substance abuse,but rather open a line of discussion by introducing a nonthreatening question.There is no indication of abuse,so asking if the child is safe is not appropriate at this time.In a secret-keeping family,asking directly about drinking or drug use would most likely elicit a negative response.Asking "why" questions is confrontational.

Quiz 3: The Evolving Family