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.

Accepted Answer

According to family systems theory,each family system contains boundaries that affect how the outside world interacts with the family.Families that have recently immigrated to the United States might have closed boundaries and may only be receptive to health information provided by extended family members or members of their community.Establishing a lay health educator program in which community members can be taught health information with the intent of delivering it to their communities would be a good way to work with these families while respecting their boundaries.Regularly occurring health events might improve the nurse's standing in the community.Written information may or may not be helpful; many refugees are illiterate in their native languages and some languages do not have a written form.Establishing relationships within the community is advisable,but does not go far enough to solve the problem.

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

Accepted Answer

Most definitions of family require at least two people who self-define as being part of that family.Thus,a single individual cannot be a family.A family of choice is the family adopted through marriage or cohabitation.A family of origin includes the individuals who reared the person of interest.A nuclear family consists of a male partner,a female partner,and their children.

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

Accepted Answer

Caregiver strain occurs when the main caregiver becomes overwhelmed and feels "underhelped" regarding the tasks concerned with the care of the family member.In this situation,mounting bitterness and withdrawal from other family members may cause caregivers to push away any potential helpers.

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

Accepted Answer

An enabler is a common role in families with addictions.The enabler makes excuses for the addicted person's behavior.The patient's behavior allows the spouse to continue with the addiction without being held accountable.

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.

Accepted Answer

According to group theory,groups evolve through the distinct stages of forming,storming,norming,performing,and adjourning.Storming often occurs when a group that has recently formed notices differences in members,leading to chaos or confusion.This couple is in this stage.At this point,the nurse's best action is to reassure the woman and help her brainstorm ways of working together cooperatively,which might include forming rules or procedures that both parties agree to follow.Asking about their early relationship does not give the woman information that will help the present situation.Warning the patient about the negative effects of stress on her unborn baby sounds judgmental and threatening.A referral for counseling might be needed at a future date.

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

Accepted Answer

During the school-aged and adolescent/teenage developmental stage,personal values are shaped and clarified and ethical development occurs.This stage provides the optimal opportunity for teaching about drugs,sex,and health promotion.

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.

Accepted Answer

In family developmental theory,the age of the child determines the stage the family is in.If there is more than one child,the family is probably in multiple developmental stages at the same time.The family is probably in a combination of beginning families,preschool,school-aged and adolescent,and launching stages.The competing priorities of all of these stages pave the way for chaos.Without further information,the nurse cannot conclude that economic stressors or communication problems are the root cause of the issue.Simply concluding that the family has too many children is judgmental and does not leave any room for interventions.

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.

Accepted Answer

Effective tools for families include ways to enhance family performance.One very effective tool is to put the family first in this very chaotic world.Giving up some activities in order to eat dinner together shows the family is putting the unit as a whole first over individual desires.This is the opposite of children being in multiple activities,which often cuts into family time and can be disruptive.Communication should be guided by the desire to understand the other first,then to be understood.A strong desire for the children's success does not guarantee successful family functioning.

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

Accepted Answer

A commune is a group of men,women,and children all living together.Families with relatives beyond the nuclear family are called extended families.Kinship care provided to children constitutes a no-parent family.An unmarried man and woman living together is called cohabitation.

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

Accepted Answer

Developmental theory has as its core the idea that every person moves through developmental stages with tasks that must be mastered before they can move on to the next stage.Family developmental theory assumes the same progression for families as a unit.Duvall's theory identifies eight family stages.The nurse using Duvall's family developmental theory must first assess the stage the family is in,because teaching and all other interventions must be tailored to that stage.Only tailoring the teaching to specific needs does not necessarily require assessment of the family using a developmental approach.Determining how the family interacts with society is more in line with systems theory.Observing roles is part of structural-functional theory.

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

Accepted Answer

A family consists of two or more members who self-identify as a "family" and interact and depend on one another socially,emotionally,and financially.Because the patient self-identifies the friend as "like a sister," the patient and friend consider themselves a family.

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.

Accepted Answer

According to structural-functional theory,each person in a family unit occupies a specific role.Sometimes roles are shared.A problem can occur when one member of the family is unable to fill his or her role and no one else is doing it.That appears to be the situation here.The nurse should assess what roles each family member plays and assist them to see how they can fulfill the role formerly held by the patient.The family may need financial resources if the patient was the breadwinner.There is no need to conduct an environmental assessment,as it does not appear that any family member is in danger.The family may or may not need counseling at this time.

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

Accepted Answer

The structural-functional theory focuses on the outcomes,not the processes,within the family.The nurse using this theory would assess if the family goals are being met.Communication patterns are critical to communication theory.Processes are important to family developmental theory,and boundaries are important in family systems theory.

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

Accepted Answer

According to Bowen,triangulation occurs when a dyad (the sisters)focuses on a third person who draws attention away from their conflicts.The homemaker is serving this function in this family.Bowen's theory looks at family problems that are rooted in family processes,such as communication.Relationship building and rituals are not part of this theory.

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."

Accepted Answer

According to communication theory,verbal and nonverbal messages should be congruent.A verbal "no" accompanied by nodding the head "yes" is sending inconsistent messages.Messages should be clear,so explaining things in many different ways would not be recommended.Good communicators determine if the listener has understood.Good communication demonstrates love and support clearly,but the advice to not yell is vague and seems to send the message that yelling at an older child would be more acceptable.

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

Accepted Answer

Families should fulfill five functions: physical needs,economic needs,reproductive needs,affective and coping needs,and socialization needs.A child with poor social skills probably (but not necessarily)comes from a family that is not fulfilling the child's socialization needs.Assuming that the child has an emotional or mental illness without further assessment is unhelpful.Assuming that the family is lower income,is poorly educated,and has poor job skills is stereotypical.

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.

Accepted Answer

Family systems theory recognizes that changes in one member of a family affect every other member of the family.In order for the family to function effectively,all members need to adapt to the major changes in one of the members.Making lists and assigning chores are simple tasks that might help with organization,but this does not go far enough in solving the problem.The family may or may not need a referral for counseling.Simply telling the family members a fact does not give them enough information to adapt.

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

Accepted Answer

Structural-functional theory focuses on the functioning of the family and the roles assumed by each family member to promote family function.Necessary roles include provider,housekeeper,child caregiver,socializer,sexual partner,therapist,recreational organizer,and kinship member.The therapist role is assumed when one family member expresses concern for another's health or emotional well-being.The aunt does not appear to be the primary caregiver (child-caregiver role).There is no indication that the aunt fills the socializer role by organizing family social activities.The kinship role includes maintaining family and social ties by things like remembering important dates,and the aunt does not appear to function in that role either.

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.

Accepted Answer

This child's presentation is suspicious.If child abuse is suspected,the nurse should question the child privately.In all situations the nurse is legally obligated to report the abuse to the proper investigating agency.

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

Accepted Answer

An adult child who still lives at home is either using home base as a temporary arrangement while continuing education or as a "nonaction" until more permanent ties have been established elsewhere.With the parent's frustration and anxiety,this situation of incomplete launching needs to be addressed.The first suggestion should be about vocational assessment and training for the adult child.There is no indication the patient needs anger management,a parenting workshop,or marriage counseling.

Quiz 3: The Evolving Family

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

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 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?

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

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

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

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

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?