Deck 3: The Evolving Family

Question 1

A nurse works a great deal with refugees and is frustrated because,as a group,they don't seem to want to implement desired health behaviors.What action by the nurse would be most helpful?

A) Conduct a health screening and educational event each month.
B) Provide written information in the group's native language.
C) Teach selected group representatives to be lay health educators.
D) Try to establish relationships within the refugee community.

Answer 1

Teach selected group representatives to be lay health educators.

Question 2

A nurse is assessing a single person at a clinic visit.How would the nurse classify this patient's family?

A) Family of choice
B) Family of origin
C) Not in a family
D) Nuclear family

Answer 2

Not in a family

Question 3

A new mother with a 2-month-old daughter tells the family clinic nurse that she is experiencing a lack of sleep because of infant night feedings and her husband's shift work and excessive overtime.Which of the following is the best description of this family concern?

A) Caregiver strain
B) Coping stress
C) Lack of support
D) Parental maladaptation

Answer 3

Caregiver strain

Question 4

A patient describes her spouse's dependence on oxycodone terephthalate (Percocet),which began following knee surgery last year.Although the prescription was finished some time ago,the spouse continues to obtain and take Percocet.Because of the spouse's "need" for the medication,the patient "has to" do all the yard work,child care,and meal preparation.How would the nurse describe the patient's behavior?

A) Enabler
B) Impaired caregiver
C) Inadequate dyad partner
D) Overstressed parent

Question 5

A nurse is working with a woman who is newly married and pregnant and says she is distressed because she and her husband seem to be so different and they argue over petty issues.What action by the nurse using group theory would be best?

A) Ask the woman if she can remember why she and her husband fell in love.
B) Caution her that this level of disagreement will cause stress to the unborn baby.
C) Offer the woman a referral to a community counseling center for couples therapy.
D) Reassure her that this is normal and help her brainstorm ways to work cooperatively.

Question 6

The clinic nurse understands that children who come for well-child visits at age 10 are in the process of developing which of the following attributes?

A) Attachment
B) Coordination
C) Personal values
D) Self-identity

Question 7

A nurse is working with a blended family of 1 year with five children aged 3,7,13 (twins),and 19.The parents seem overly stressed and anxious and do not seem to work well as a unit.What can the nurse conclude about this family?

A) Communication problems are the core of the parents' stress.
B) Economic stressors are impacting the parental dyad.
C) The family is in too many developmental stages to master any of them.
D) There are too many children to give each one adequate attention.

Question 8

A nurse is working with family members who have been striving to improve their functioning as a family unit.What behavior would suggest to the nurse that the family is meeting its goals?

A) The children are in multiple activities to develop talents.
B) The desire to be understood guides most communication.
C) Family members gave up some activities in order to eat dinner together on most nights.
D) The parents have a strong desire for the children to succeed.

Question 9

A patient tells the nurse about living in a commune.What does the nurse understand about this family structure?

A) Family with distant relatives included
B) Group of men, women, and children
C) Kinship care provided to children
D) Unmarried man and woman living together

Question 10

A nurse who works with families uses Duvall's family developmental theory as the core of nursing practice.What action by this nurse takes priority?

A) Assessing the developmental stage of the family
B) Determining how the family interacts with society
C) Observing what roles each family member assumes
D) Tailoring teaching to the specific needs of the family

Question 11

The clinic nurse is taking a history from a woman who came to the clinic to get test results.The patient brought a coworker with her because she is worried.The patient asks to have her coworker remain in the exam room when the doctor describes the test findings.The patient states that the friend is "like a sister." The nurse would most correctly identify the two women as which of the following?

A) Extended family
B) Family
C) Family of choice
D) Family of origin

Question 12

A patient has been dismissed from the hospital after a serious illness and needs several weeks of home care and rehabilitation.When the visiting nurse comes to the house,it is apparent that the family is not functioning.The house is dirty,there is little food available,and one parent and an older child are arguing about picking up a younger sibling from school.What action by the nurse is most appropriate?

A) Ask the parents if they need financial resources for the basic necessities.
B) Assess each family member for the roles he or she plays in the family.
C) Contact child protective services or social work to assess the home environment.
D) Provide referrals for family and couples counseling in the community.

Question 13

A nurse who uses the structural-functional theory would assess which of the following when working with families?

A) Communication patterns
B) How things get done
C) If goals are being met
D) Looseness of boundaries

Question 14

The nurse observes a woman and her sister who live together.They are trying to support one another and provide extended care to their mother who has recently been diagnosed with Alzheimer's disease.The two sisters describe their experience with a homemaker who visits their home to help bathe their mother.They say she is "humorous and cheerful" and absorbs their mother's attention for the whole time she is present.This is a positive description of which component of Bowen's family systems theory?

A) Communication
B) Family relationship building
C) Family rituals
D) Triangulation

Question 15

A nurse is providing anticipatory guidance to a mother of a toddler.Using communication theory,which information is the most appropriate?

A) "Don't nod your head 'yes' when you say 'no.'"
B) "Explain things in several different ways."
C) "There is no need to see if a toddler understands."
D) "You shouldn't yell at such a young child."

Question 16

A nurse is assessing a child with very poor social skills.What conclusion can the nurse make about the child's family?

A) Emotional or mental illness
B) Not filling socialization needs
C) Poorly educated, poor job skills
D) Probably lower-income status

Question 17

A patient is dismissed from the hospital and is receiving nursing care at home to help in the recovery from a serious illness and operation.The visiting nurse notes that the family is in a state of disarray and members are disorganized and not communicating.The patient is trying to direct everyone's actions.The nurse calls a family meeting.What action by the nurse is best?

A) Encourage family members to make "to do" lists and assign chores.
B) Explain that changes in one person require changes in the others.
C) Make a referral to a counselor or mental health nurse practitioner.
D) Tell the family members that for the patient to recover, they have to assume his or her role.

Question 18

The clinic nurse notices that each time a child with leukemia is brought in to see the doctor,her mother and aunt accompany her.The mother states that she finds her daughter's illness to be very traumatic and is having difficulty coping.The child's aunt encourages the child's mother and distracts the child while her blood work is being drawn.The child's aunt could be described as taking on which of the following roles?

A) Child-caregiver role
B) Kinship role
C) Socializer role
D) Therapist role

Question 19

A mother brings her 8-year-old daughter to the clinic for the third time in 2 months.The mother states that her daughter is very active and often falls down.The mother states that her daughter eats well,but the child's weight falls below the 10th percentile.The clinic record shows the child had multiple bruises on her arms at the time of the last two visits.Today the nurse notes that the child has areas of ecchymosis on her left leg and ankle.Which action by the nurse is best?

A) Ask the child and her mother again about the child's bruises.
B) Question the child about her accident-prone behaviors.
C) Speak with the child alone, asking if she feels safe at home.
D) Teach the mother to keep a diary of what her child is eating.

Question 20

A family practice nurse is working with a patient who is asking for anti-anxiety medications to deal with the stress and frustration of an adult child who won't leave the home.Based on knowledge of the tasks of launching children,which resource should the nurse suggest first?

A) Anger management counseling
B) Contact numbers for vocational training
C) Information on a parenting workshop
D) Marriage and couples counseling

Question 21

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?

A) The child is not getting enough attention from the parents.
B) The family is from an underserved community group.
C) Financial stress has caused family strife and fighting.
D) The parental disciplinary approach is inconsistent.

Question 22

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?

A) Parents and teen mutually plan date nights in advance.
B) Parents consistently discipline teen for "forgetting."
C) Teen acknowledges "forgetting" date night on purpose.
D) Teen expresses feelings about being made to babysit.

Question 23

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?

A) Balance
B) Boundaries
C) Children's ages
D) Subsystems

Question 24

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?

A) Assessing who in the family will make decisions
B) Determining if the family needs financial resources
C) Ensuring each member understands the situation
D) Orienting the family to visiting hours on the unit

Question 25

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?

A) Assess for drugs or alcohol in the patient's room.
B) Encourage the patient to take medications.
C) Monitor the patient for signs of suicidal thoughts.
D) Plan menus that contain nutritious food items.

Question 26

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

A) Family beliefs
B) Family bonding
C) Family building
D) Family rituals

Question 27

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?

A) Ask the patient what role men in her culture play in pregnancy.
B) Ask the woman why her husband doesn't seem involved.
C) Encourage the man to participate in order to support his wife.
D) Research the couple's cultural background and health beliefs.

Question 28

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

A) Entire family
B) No one else
C) Parents
D) Physician

Question 29

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?

A) Acculturated
B) Assimilated
C) Disconnected
D) Lost children

Question 30

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?

A) Encourage the patient's family to talk her into having the operation.
B) Explain kindly to the patient that her situation cannot wait.
C) Respect the patient's choice and wait for the elder to arrive.
D) Take the patient to surgery under the principle of implied consent.

Question 31

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?

A) The father delivers consequence to the child calmly.
B) The father only asks the child twice not to do something.
C) The mother doesn't cry when disciplining her child.
D) The mother states that the child is still testing the limits.

Question 32

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?

A) Assess the degree of comfort in family caregiving.
B) Ensure the family understands the hospice concept.
C) Provide information about available hospice services.
D) Refer the family to a community counseling center.

Question 33

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?

A) "Don't worry; they will calm down eventually."
B) "Families often get emotional in these situations."
C) "They are focusing attention on me, not the problem."
D) "This family is obviously highly dysfunctional."

Question 34

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?

A) Ecomap
B) Genogram
C) Problem list
D) Quantitative tool

Question 35

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?

A) "Are you each a first-born, middle child, or youngest sibling?"
B) "How demonstrative were each of your parents when you were growing up?"
C) "How many children were in each of your families?"
D) "What socioeconomic classes did you both grow up in?"

Question 36

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?

A) "I'm glad my son stays in his room in the basement all day so he doesn't bother us."
B) "It's hard to decide how much food to buy because we don't know where he's eating."
C) "My son is gone a lot of the time, so we really don't notice that he moved back in."
D) "We have agreed not to have a curfew as long as we know when he will be home."

Question 37

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?

A) Ecomap
B) Genogram
C) Qualitative
D) Quantitative

Question 38

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

A) Can use their strengths to work on identified priority problems
B) Demonstrates that each family has both strengths and problems
C) Forces people to be accountable and take responsibility for problems
D) Lets families see which members have problems affecting them

Question 39

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?

A) Adapt to role changes positively within 2 months.
B) Divide up household duties between spouses more evenly.
C) Express feelings using "I" statements within 1 month.
D) Learn to discuss anger and other negative emotions.

Question 40

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?

A) "Do you feel safe at home or is someone hurting you there?"
B) "Does your sister always bring you and your sibling to school?"
C) "Have you ever seen your parents drinking a lot or using drugs?"
D) "Why aren't your parents available to bring you to school?"

Question 41

A nurse is explaining to a student why it is so important to consider the entire family as the patient.What explanation for this is best?

A) Families are a rich source of information and support.
B) Families will have to take over the caregiving role at home.
C) If they are not included, families tend to interfere in care.
D) The patient has to reintegrate into the family upon discharge.
E) The patient's background context includes the family.

Question 42

A nurse using family systems theory to work with patients and their families would do which of the following?

A) Assess how school, work, and church impact the family.
B) Describe the developmental stage the family is in.
C) Determine if there are any family secrets or taboos.
D) Listen to how information is shared with providers.
E) Observe how family members interact with each other.

Question 43

The nurse assesses the communication in a family that includes a single mother,a teenage son and daughter,and a grandmother.During the family interview,the daughter answers many questions while the son and mother are quiet and the grandmother is absent.What conclusions can the nurse make about this family?

A) The communication patterns are healthy.
B) The daughter may have a lot of power.
C) The grandmother does not want to be involved.
D) The grandmother may have little power.
E) The mother and son may have a coalition.

Question 44

A nurse assessing a family includes which components in the assessment?

A) Dietary habits
B) Family size and structure
C) Parenting style
D) Religious affiliation
E) Socioeconomic status

Question 45

The nurse explains to the student that television and movies have often portrayed families in certain ways,depending on the decade.Which of the following statements about this trend are correct?

A) 1950s-1960s: nuclear family, simple issues, father dominated
B) 1960s-1970s: extended families, lower income, divorced parents
C) 1980s-1990s: exploring social issues, stressed family closeness
D) 1990s: single parents, social issues including poverty and abuse
E) New millennium: alternative family structures, extended family

Question 46

The clinic nurse keeps resource numbers and contacts for assistance with situations in which family members may potentially require assistance to restore balance and function to the family.These developmental crises may include which of the following situations?

A) Home fire requiring a lengthy hotel stay
B) Hospitalization of a family member
C) Identification of domestic violence
D) Postpartum depression in a young family
E) The anticipated birth of a new baby

Question 47

A nurse is assessing a family whose patriarch died recently.Using Kübler-Ross's stages of grieving,what stages should the nurse assess for?

A) Bargaining
B) Dealing
C) Denial
D) Remorse
E) Shock

Question 48

A nurse working in the community understands that health is often affected by social stressors.Which of the following are examples of societal pressures having a negative impact on the health of today's families?

A) Economic trends affecting access to health care
B) Increased HIV/AIDS in women and children
C) Loss of resources in public schools
D) Restricted health-care access for adult males
E) Violence and increased teen suicides

Question 49

The nurse using developmental theory offers anticipatory guidance on preventing injuries to the family of a preschooler.What concepts guide this information?

A) Coordination lagging behind activity
B) Development of personal values and ethics
C) Impact of friends and peer group
D) Poor judgment about safety risks
E) Toddler's increasing physical abilities

Question 50

The family nurse completes a genogram map when conducting a family assessment.Appropriate information the nurse should include in the genogram map includes which of the following?

A) Congenital diseases in the family
B) Country of origin for family members
C) Dates of birth for all family members
D) Dates of divorce and deaths for family members
E) Three or more generations