Deck 10: Family-Focused Care in Acute Settings

Question 1

Juanita was brought to the hospital by her daughter-in-law, Alejandra, who lives within a few miles of her in a remote area of the state. Juanita will be kept in a semi-private room for overnight observation and Alejandra plans to stay at Juanita's bedside for a couple of hours so she can find out what is going on before she leaves to check into a motel for the night. Juanita's nurse checks in on her patient and asks Alejandra what her relationship is to Juanita. Upon learning this information, what is the best response by the nurse?

A) I'm afraid that, due to HIPPA regulations, we have a hospital policy that we can only share information about the patient with Juanita's extended family such as her husband or children.
B) I'll need you to step out in the hallway so that I can talk to you about Juanita's medical status; it's an issue of confidentiality and we need to protect personal health information.
C) I'll need to check with Juanita to make sure it's okay if I discuss her medical status with you.
D) I'm sorry, but due to HIPPA regulations, we can't have visitors stay at the bedside when the patient is not in a private room.

Answer 1

I'll need to check with Juanita to make sure it's okay if I discuss her medical status with you.

Question 2

Often, the admission of a family member to the hospital creates conflict and stress for family members. This is the case for the White family, who ask the nurse caring for an elderly family member multiple questions and for explanations about their father's recent admission to the hospital for pancreatitis. Which of the following environmental factors is supportive of family-focused nursing care?

A) Prior family priorities and routines assist the health-care team to concentrate on the family's perceptions of priorities of care.
B) Multiple questions suggest that family members are not absorbing the information that is being provided to them; they need to be provided with more online resources to use at times that are convenient for them.
C) The family is likely to be disagreeing with one another about what should be happening with the care of their father; the nurse should seek out a key family member to discuss concerns rather than meeting with the entire family.
D) Information needs to be given in understandable language, with the use of pictures drawn to illustrate concepts starting at the time of admission to the hospital.

Answer 2

Prior family priorities and routines assist the health-care team to concentrate on the family's perceptions of priorities of care.
Information needs to be given in understandable language, with the use of pictures drawn to illustrate concepts starting at the time of admission to the hospital.

Question 3

Which of the following statements is the best rationale for allowing a family member to be present during cardiopulmonary resuscitation of another family member?

A) The inclusion of the family will improve the public image of nurses.
B) Inclusion of family members reduces the need for the nurse to constantly update them on patient progress.
C) The inclusion of family members reduces both patient and family distress.
D) The inclusion of family will improve the overall efficiency of the healthcare team.

Answer 3

The inclusion of family members reduces both patient and family distress.

Question 4

Which of the following concepts is important to the provision of family-centered nursing care in the acute care setting?

A) A planned hospitalization helps to clarify family roles and unifies families.
B) During hospitalization, families are often challenged by the need to make adjustments in family routines.
C) Deliberate adherence to typical family routines during hospitalization reduces the uncertainty experienced by family members.
D) Exposure to an ill family member in the acute care setting is stressful and family time should be limited.

Question 5

Family members of critically ill hospitalized adults often have a well-defined, predictable set of needs. Which of the following are accurate representations of these needs?

A) Being able to take breaks in order to return home for rest and healthy meals
B) Remaining near to the patient in order to maintain the familial relationship
C) Being kept informed about decisions being made for the family by the health-care team
D) Being given time to make decisions

Question 6

You are caring for a 58-year-old woman who had a bilateral mastectomy 48 hours ago. When you meet the patient she tells you that her husband will not attend the discharge teaching meeting as planned. She also mentions that he has not been to the hospital since the surgery. Which of the following responses by the nurse practicing family-focused care is most appropriate?

A) Can you tell me more about your family and how your hospitalization has affected them?
B) We may be able to reschedule the meeting-I'll check with the discharge planner.
C) Did the admitting nurse create a genogram of your family?-it might help if I took a look at it.
D) Will you be able to manage your care alone at home, or is there someone else I should call?

Question 7

Kathy is the parent of 13-year-old Meg, who has cerebral palsy. In the medical record, it is noted that in a previous hospitalization Kathy complained that Meg was forced to wear an oxygenation saturation monitor although the physician had said it was not needed. After you introduce yourself as the nurse, which of the following statements might best help build a positive nurse-family partnership?

A) I understand that you were upset about the monitor during the last hospitalization, but every patient has to wear it.
B) I know that you were upset during the last hospitalization. We will not use the monitor if the physician does not believe it is needed.
C) Is there some way we can help Meg better comply with wearing the monitor during this hospitalization?
D) Parents are often upset during hospitalizations. Fatigue reduces your patience for hospital routine.

Question 8

You are a nurse caring for a patient who is having a GI bleed. You say to his wife: It is so fortunate that you brought him to the emergency room. You were right in thinking that he needed immediate medical attention. This is a therapeutic statement for which of the following reasons?

A) It is an open-ended question that encourages conversation.
B) It is circular questioning that focuses on relationships.
C) It commends the family member and empowers them in the situation.
D) It makes the family member feel that she has been heard.

Question 9

When nurses are trying to determine whether patients and families need more information, they often ask, Do you have any questions? Which of the following statements best explains why this approach is flawed?

A) Patients and families will ask questions without being invited, and this approach is too direct.
B) This approach presumes that the family and patient are not on the healthcare team and may be condescending.
C) The question asks patients to share private information, which is a violation of HIPPA guidelines.
D) Patients and families often don't know enough about a situation to know what questions to ask.

Question 10

You are caring for an eight-year-old who is in the emergency room with need for a closed-reduction of an arm fracture. The on-call orthopedic physician will be performing the procedure using conscious sedation. You are about to move the child to a different room to start an IV when the child's father asks you if you think that they should be seeking a second opinion. Because you know that families often feel the need to protect loved ones during hospitalization, what would your first response be to the parent?

A) Help the parent seek a second opinion by providing the name of another orthopedic surgeon.
B) Tell the parent that a second opinion might be confusing for them and that the room is ready for them to begin the procedure.
C) Review the procedure with the parent and assure them of the skill of the physician doing the procedure.
D) Ask the parent what has prompted them to ask this question of you and how you can be of most help to them at this time.

Question 11

Aiza is the wife of 52-year-old Hasan, who has been hospitalized for pneumonia. Aiza has spent the day by her husband's bedside and decides to leave his side to have dinner in the hospital cafeteria. When she returns to his room she finds Hasan is having difficulty breathing and notices that his oxygen saturation monitor is beeping and that the monitor is displaying 88% rather than the 94% it has been during the day. Aiza runs to get Hasan's nurse who is at a nearby computer charting. Which of the following statements made by Aiza best reflects the uncertainty of family illness?

A) Please, you need to come to my husband's room-I'm afraid that he is dying.
B) You need to come right now, I think that my husband needs some oxygen.
C) This happened last time he was in the hospital for the flu-I think you need to check on him right away.
D) I know I shouldn't have left for dinner-he gets so upset when I'm not at his side---he is probably having a hard time breathing because he is upset.

Question 12

Which of the following statements about the value of nurse-family meetings in the acute care setting is inaccurate?

A) Regular nurse-family meetings usually increase conflict between staff and family.
B) Regular family meetings help to improve care processes in the hospital.
C) Regular nurse-family meetings may enhance family decision-making.
D) Regular nurse-family meetings allow acknowledgement of family suffering.

Question 13

Which of the following statements made by a nursing student indicates the need for further education about family-focused nursing?

A) When family members are not well-supported during hospitalization, patients are often readmitted.
B) Families that are well-supported by nurses during hospitalization are more satisfied with their care.
C) While the individual patient is the focus during early hospitalization, the family should be included when things stabilize.
D) When nurses exclude family members from patient care, suffering may be magnified.

Question 14

Which of the following represents a barrier to the provision of family-focused nursing care in the acute care setting?

A) Nurse's beliefs that family members often interfere with the ability to provide quality care to the hospitalized family member
B) Family beliefs about the need to protect their hospitalized member by being involved with decisions about nursing care
C) Nurse's successful mastery of technology and electronic medical record allowing the nurse time to answer questions of family members
D) Nurse's focus on family involvement in discharge planning at the time of hospital admission

Question 15

The family of an 88-year-old man with an acute exacerbation of chronic obstructive lung disease is at his bedside. He is experiencing dyspnea and placement on a ventilator is suggested. The patient is DNR and does not want extreme measures taken, but is unable to speak for himself. One daughter supports placement on a ventilator while the other believes that it will only add to his suffering. Which of the following statements by a nurse might facilitate communication between these family members?

A) Can you tell me if he has ever been on a ventilator before, and how he responded to it then?
B) Given this confusion, maybe we should discuss his DNR status; I can go get the information we have on file.
C) I know that this is a difficult situation-perhaps you would like to talk with a clergy person to help in making the decision.
D) I'm sure that it is difficult seeing your father like this, can we spend a few minutes talking about your concerns at this time?

Question 16

Based on current research, which of the following statements about family presence in the acute care setting is accurate?

A) Visitation by family members should be unlimited in the acute care setting with the exception of the ICU.
B) Inclusion of family members in bedside rounds may cause miscommunication and family stress.
C) Inclusion of family members in bedside rounds improves patient/family satisfaction.
D) The inclusion of family members during resuscitation and invasive procedures is appropriate.

Question 17

Which of the following is an accurate statement about circular questions?

A) Circular questions often focus on family beliefs about acute illness.
B) Circular questions are primarily intended to commend family actions.
C) Circular questions may be open ended or yes-or-no questions.
D) The same circular questions should be used daily to ensure a consistent result.