ch 34 Family Interventions

A nurse is asking about the patient's family during an interview. Which statement made by the patient would indicate that the family has diffused boundaries? 1 "I am sure everybody in my family likes the food that I prefer to be cooked." 2 "I make sure that my children eat their breakfast before leaving for school." 3 "My spouse and I spend two hours every day helping our children study." 4 "I am the eldest member of the family and thus responsible for the financial security of the family."

1 "I am sure everybody in my family likes the food that I prefer to be cooked."

A nurse is performing a family assessment. Which question should the nurse ask the family members to assess the sociocultural variables of the family? Select all that apply. 1 "Which country do you belong to?" 2 "Are there any prevalent illnesses in your family in the past generations?" 3 "What is the highest academic degree that you have received?" 4 "How much is the annual income of the family?" 5 "Who is the decision-maker of the family?"

1 "Which country do you belong to?" 3 "What is the highest academic degree that you have received?" 4 "How much is the annual income of the family?"

A family consists of two parents and three school age children. In this family, the parents seek input from the children but make decisions regarding the children's activities. Each child receives an allowance and has a household chore weekly. How should the nurse interpret boundaries within this family? 1 Clear 2 Rigid 3 Blended 4 Enmeshed

1 Clear

What nursing interventions related to a drug regimen should the nurse provide to a patient being treated with psychotropic medications? Select all that apply. 1 Explain the purpose of the prescribed drugs. 2 Inform about the side effects of the drugs prescribed. 3 Inform about the desired medical effects of the drug. 4 Advise the family members to maintain rigid boundaries. 5 Avoid providing information regarding drugs to the family.

1 Explain the purpose of the prescribed drugs. 2 Inform about the side effects of the drugs prescribed. 3 Inform about the desired medical effects of the drug.

A tool to effectively uncover multigenerational issues in a family is the 1 Genogram 2 Focused interview 3 Family function checklist 4 Family assessment device

1 Genogram

Which approaches to family therapy are classified as insight-oriented? Select all that apply. 1 Psychodynamic 2 Cognitive-behavioral therapy 3 Experimental-existential 4 Family of origin 5 Structural 6 Strategic

1 Psychodynamic 3 Experimental-existential 4 Family of origin

Which statement helps explain why being sensitive to the patient's cultural and religious issues can be a challenge for the nurse? Select all that apply. 1 Religious beliefs tend to be matters of "faith," not of "fact." 2 Changing beliefs is a very time consuming and difficult task. 3 A nurse's practice may involve contact with many differing cultures 4 The nurse and the patient may not share similar beliefs. 5 The nurse's focus must be on the patient and not personal selfreflection

1 Religious beliefs tend to be matters of "faith," not of "fact." 3 A nurse's practice may involve contact with many differing cultures 4 The nurse and the patient may not share similar beliefs.

A patient tells the nurse, "My family always blamed me for everything that went wrong even though my father could not keep a job because of his drinking." Which concept applies to this scenario? 1 Scapegoating 2 Triangulation 3 Multigenerational issues 4 Double bind communication

1 Scapegoating

The nurse is assessing a patient who is disturbed and has difficulty in building relationships with people. The patient says to the nurse, "I have always been like this. I don't feel like talking or sharing my feelings with anybody. Even my family members have been like this." What can the nurse interpret about the patient's family? 1 The family has developed rigid boundaries. 2 The family has disorganized management. 3 The family has very enmeshed boundaries. 4 The family has dysfunctional communication.

1 The family has developed rigid boundaries.

What should the nurse assess before referring a family for psychodynamic therapy? 1 The origin of the problems among the family members 2 The types of dysfunctional communication used by the family members 3 The extent of emotional attachment between the family members 4 The cultural beliefs associated with family in the family members

1 The origin of the problems among the family members

A nurse is assessing the caregivers of a patient who has recently been diagnosed with a serious psychiatric illness. The nurse believes that the family should be referred for family therapy. How would family therapy be beneficial for the family of the patient? Select all that apply. 1 They will know about the community resources that are useful for the patient. 2 They will know about the techniques to maintain basic health and hygiene. 3 They will be able to deal with the symptoms of the patient effectively. 4 They will know the drugs and their dosage required for the patient. 5 They will be able to accept the illness of the patient.

1 They will know about the community resources that are useful for the patient. 3 They will be able to deal with the symptoms of the patient effectively. 5 They will be able to accept the illness of the patient.

The nurse is counseling a couple who are planning to get divorced. The wife states "This man never listens to what I say and treats me unfairly." The husband tells the nurse "Can you please tell me how long we need to stay?" What should be the nurse's response? 1 "I will not take much of your time." 2 "I would like to listen to your wife." 3 "You cannot interrupt in this way." 4 "Ask this question to someone else."

2 "I would like to listen to your wife."

The nurse demonstrates an understanding of effective data collection when interviewing a patient regarding a family history when planning which intervention? 1 Basing the assessment on a universally accepted definition of family. 2 Constructing a genogram as a basis for documenting the information gathered. 3 Recognizing that the Family Apgar tool is used for assessing single parent families. 4 Gathering information on at least four generations of the patient's family members.

2 Constructing a genogram as a basis for documenting the information gathered.

The nurse is working with a family whose boundaries are not clear and whose members are over-involved with each other. What term is used to describe this type of family dynamic? 1 Clear boundaries 2 Enmeshment 3 Scapegoating 4 Rigid boundaries

2 Enmeshment

Which service is a staff level registered nurse prepared to offer to a family? 1 Conduct private family therapy sessions 2 Explain to a family the purpose of a prescribed medication 3 Help family members express conflict through psychodrama 4 Lead problem solving for complex disordered family relationships

2 Explain to a family the purpose of a prescribed medication

A nurse is speaking to a couple in a plastic surgeon's office. One spouse wants to get a facelift procedure. The husband seems to be disapproving and has fears regarding complications related to the surgery. The husband tells the wife, "Do whatever you like." Which type of dysfunctional communication does this statement indicate? 1 Blaming 2 Placating 3 Distracting 4 Manipulating

2 Placating

The nurse is assessing a couple who are getting a divorce. The nurse finds that the husband and the wife are giving fake reasons for the divorce. What should the nurse do in this situation? 1 Explain about the consequences of getting divorced. 2 Refrain from giving any family therapy to the couple. 3 Speak to the parents of the couple about the divorce. 4 Speak to the couple by making them both sit together.

2 Refrain from giving any family therapy to the couple.

The nurse is giving family therapy to a nuclear family in which both the parents are working. The nurse asks the parents to take time out from their busy schedules and make sure to spend time with the child. What would be the outcome if the parents follow the nurse's suggestion? 1 The child would be able to perform well academically. 2 The child would have good relationships with people. 3 The child would possess good problem-solving abilities. 4 The child would not have any psychological problems

2 The child would have good relationships with people.

Following an assessment of a couple who is unmarried and is cohabitating, the nurse concludes that the family is well-differentiated. What would have led the nurse to believe this? 1 The male partner is the primary decision-maker in this relationship. 2 The couple discusses their problems and makes joint decisions. 3 The male and female partners do not rely on each other for making decisions. 4 The male partner is completely dependent on the female partner for making decisions.

2 The couple discusses their problems and makes joint decisions.

The nurse administrator is observing the work of the nurse in a family counseling center. The nurse gets upset after talking to a couple who are planning to get divorced. The nurse feels very sorry for the wife and starts fighting with the husband in favor of the wife. What can the nurse administrator interpret from this? 1 The nurse is providing some justice for the wife 2 The nurse has become triangulated in the family 3 The nurse has become the scapegoat in the family 4 The nurse has developed a therapeutic relationship

2 The nurse has become triangulated in the family

Which evaluation data supports that the patient diagnosed with schizophrenia has benefited from his or her family's involvement in psychoeducational programming? 1 The patient is living with his or her parents. 2 The patient has not relapsed in three years. 3 The family is supplementing the patient's disability income. 4 The family provides the patient with transportation to a part-time job.

2 The patient has not relapsed in three years.

In which condition does a conflict between two people require a third person to resolve it? 1 Placating 2 Triangulation 3 Scapegoating 4 Family life cycle

2 Triangulation

Which family situation should the nurse assess as warranting a referral for family therapy? 1 A couple are having their first child. They say, "It's certainly going to be a change for us." 2 A husband and wife are sending a son off to college and planning their daughter's wedding. They say, "Soon we will be back to having an empty nest again." 3 A couple are having Difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope." 4 The parents of a blended family with five children ranging in age from 5 to 15 years say, "It's never quiet, but the disagreements eventually get worked out."

3 A couple are having Difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope."

During a family therapy session a wife states, "My husband is always angry. The children and I are always on edge. We can never relax." The nurse identifies the wife's communication technique as 1 Placating 2 Distracting 3 Generalizing 4 Manipulating

3 Generalizing

The nurse is assessing a single-parent family consisting of a parent and an adolescent. The parent recently lost a job and the adolescent is in high school. The adolescent tells the nurse that he wants to help the parent. Which nursing intervention would be helpful in preventing the family from having diffused boundaries? 1 Arrange for some financial resources for the family 2 Ask the adolescent to go and obtain a full-time job 3 Suggest resources that help the parent to get a job 4 Ask the father to stay away from the child for some time

3 Suggest resources that help the parent to get a job

The nurse is assessing a distressed couple who are having difficulty conceiving a child. The husband is willing to adopt a baby. The wife says to the nurse, "I want to undergo advanced treatments which could help me conceive. I don't care about the cost." The husband, though disagreeing, tells the wife "It's your wish." What is the reason for saying this? 1 The husband is supportive towards his wife. 2 The husband is trying to manipulate his wife. 3 The husband wants to keep peace with his wife. 4 The husband wants to try to distract his wife.

3 The husband wants to keep peace with his wife.

The nurse is preparing a care plan for a couple who are distressed as their child has been diagnosed with muscular dystrophy. What should be the primary goal of the therapy for this family? 1 To encourage the couple to share their feelings with each other 2 To clarify the rigid and enmeshed boundaries within the family 3 To provide information about the disease and its management 4 To promote healthy communication between the family members

3 To provide information about the disease and its management

A female adult says to the nurse, "I ended my relationship with my mother three years ago when she showed favoritism by giving my sister more money than she gave me." In a family genogram, how is the relationship between this mother and daughter depicted? 1 Square 2 Solid line 3 Zigzag line 4 Two slanted parallel lines

3 Zigzag line

During a family therapy session the mother says to her daughter, "I would like to know why you took the piece of pie that was left after dinner last night. You knew I wanted it." Later the father tells his daughter, "I know exactly why you did that." The nurse therapist should consider the possibility that the family has A. clear boundaries. B. diffuse boundaries. C. disengaged boundaries. D. no boundary problems.

B. diffuse boundaries.

Marnie is the nurse working with a family whose boundaries are not clear and whose members are overinvolved with each other. The term that describes this type of family dynamic is: A. clear boundaries. B. enmeshment. C. scapegoating. D. rigid boundaries.

B. enmeshment.

Grace wants to find out more about the Potter family and tells them she will do a genogram. Rhea asks what a genogram is. The best response would be: A. "A genogram will assess risk for mental illness in future generations." B. "A genogram is a tool used for deciding on the best type of therapy for your family." C. "A genogram will help me see your family structure, history, and current functioning." D. "A genogram will help us determine the cause of Jeremy's schizophrenia."

C. "A genogram will help me see your family structure, history, and current functioning."

Which family situation should the nurse assess as warranting a referral for family therapy? A. A couple are having their first child. They say, "It's certainly going to be a change for us." B. A husband and wife are sending a son off to college and planning their daughter's wedding. They say, "Soon we will be back to having an empty nest again." C. A couple are having difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope." D. The parents of a blended family with five children ranging in age from 5 to 15 years say, "It's never quiet, but the disagreements eventually get worked out."

C. A couple are having difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope."

At what point would the nurse expect a family to demonstrate the greatest dislocation in the family life cycle? A. When the couple is deciding whether to have children B. When the first child enters school C. When a member is diagnosed with multiple sclerosis D. When the couple renegotiates the marital system as a dyad

C. When a member is diagnosed with multiple sclerosis

The family function that helps define the roles of family members and allows for differences among members is A. communication. B. management. C. clarity. D. socialization

C. clarity

During a family therapy session a wife states, "My husband is always angry.The children and I are always on edge. We can never relax." The nurse identifies the wife's communication technique as A. placating. B. distracting. C. generalizing. D. manipulating.

C. generalizing.

The client, who is the eldest son in a family in which the father was an alcoholic and the mother was an enabler, drinks heavily and has married a woman who never complains about his drinking. This scenario suggests a A. double bind. B. sociocultural issue. C. multigenerational issue. D. stage in the family life cycle.

C. multigenerational issue.

The family that consists of a married mother and father and three biological children all living together is referred to as a(n): A. blended family. B. cohabitating family. C. nuclear family. D. other.

C. nuclear family.

The members of a family openly tell each other what they are thinking and feeling. A nurse listening to their interchanges would assess them as using A. generalizing communication. B. double-bind communication. C. disengaged communication. D. healthy communication.

D. healthy communication.

During family therapy the family's youngest daughter says, "They care more about my sister because she's older and gets straight As in school." The nursing diagnosis with priority focuses on A. deficient knowledge. B. parental role conflict. C. defensive coping. D. relational problems.

D. relational problems.

An important means of promoting good self-esteem in children is A. for the mother to assume the role of placator to avoid family confrontations. B. to tightly define roles and establish individual responsibility for most functions. C. to establish closed boundaries to provide structure. D. to communicate validation of individual worth.

D. to communicate validation of individual worth.

As Grace continues to work with the family, Rhea confides that she and her husband Todd have not been getting along well. She states that daughter Jasmine provides much support to her, and that Jasmine "doesn't really like her dad much anymore and doesn't talk to him." Grace suspects: A. emotional abuse. B. neglect. C. boundary blurring. D. triangulation.

D. triangulation.

Which assessment question demonstrates an understanding of the indicators of family stress? Select all that apply. 1 "Are you experiencing any suicidal thoughts?" 2 "How long have you and your partner been together?" 3 "Are you able to identify what events trigger your anxiety?" 4 "Do you understand the importance of being actively involved in your treatment plan?" 5 "Can you tell me more about these problems you are having with muscle pain and insomnia?"

1 "Are you experiencing any suicidal thoughts?" 3 "Are you able to identify what events trigger your anxiety?" 4 "Do you understand the importance of being actively involved in your treatment plan?" 5 "Can you tell me more about these problems you are having with muscle pain and insomnia?"

Which statement made by a family member of an individual recently diagnosed with schizophrenia supports the nurse's assessment that the family will respond well to care strategies that support the competence model of care? 1 "How long will it be before the patient will need to be cared for by others?" 2 "Is the patient's illness chronic or does he or she have a chance of getting well again?" 3 "My mother will be devastated to hear that my brother is mentally ill." 4 "Our brother is family and we will be there to support him in every way we can."

4 "Our brother is family and we will be there to support him in every way we can."

An eight-year-old child tells the nurse, "I learned to mow the grass when I was six years old. My father drinks so much that he never mows it and I want our home to look as nice as the other homes in our neighborhood." Which nursing diagnosis is most applicable to this scenario? 1 Defensive coping 2 Caregiver role strain 3 Parental role conflict 4 Dysfunctional family processes

4 Dysfunctional family processes

In which condition is the least powerful person in the family blamed for another family member's distress? 1 Blaming 2 Distracting 3 Triangulation 4 Scapegoating

4 Scapegoating

A middle-aged father tells the nurse "I live with my wife and three children. Two children always listen to me and do whatever I say. The third child never listens to us and does whatever he wants. I am fed up. I don't know what to do with this kid." What makes the nurse feel that the family needs intervention? 1 The child displays socially unacceptable behavior. 2 The child is not mature enough to do things his way. 3 The parents are overly protective towards the child. 4 The parents expect the child to behave their way.

4 The parents expect the child to behave their way.

Which situation is the best example of a double bind? A. A wife sighs while telling her husband, "You can go out with the boys tonight if it's what you really want to do." B. A mother tells her son, "Under no circumstances will I give you permission to stay out after midnight." C. A roommate states, "I would prefer to have you call if you think you are going to be late for dinner." D. A man says, "I was surprised and delighted when my entry was chosen for an award."

A. A wife sighs while telling her husband, "You can go out with the boys tonight if it's what you really want to do."

The family consists of the husband and his wife, their four children, the wife's 21-year-old sister, and client's elderly aunt. Which members are considered the client's nuclear family? A. The parents and their four children B. The wife and her sister C. The husband and his aunt D. The four children and the wife's sister

A. The parents and their four children

A function of the entry-level staff nurse in caring for families is to A. assess the amount of stress on the system. Correct B. conduct private family therapy sessions. C. prescribe psychobiological intervention. D. determine the new skills the family needs.

A. assess the amount of stress on the system.

A 26-year-old client diagnosed with schizophrenia is having difficulty adjusting to his return to the community after hospitalization. His family is dismayed by his poor hygiene and avolition. A useful strategy for the nurse to suggest would be for family members to A. attend a psychoeducational group. B. closely supervise the client on a daily basis. C. learn to ignore all symptoms except delusions. D. take turns monitoring the client to avoid burnout.

A. attend a psychoeducational group.

At the first family therapy session the family tells the therapist that "We wouldn't have to be here if our younger son wasn't such a brat. He seems so different from our other son. We never had difficulty with him misbehaving." The other sibling offers "He gets upset pretty easily." The nurse should suspect that the younger son is A. being scapegoated. B. resisting boundaries. C. assuming the family management function. D. experiencing multigenerational transition.

A. being scapegoated.

The nurse who assesses a family as having enmeshed boundaries includes the care plan goal of "Family members will A. define individual beliefs and needs." B. form triangles to reduce anxiety." C. develop greater comfort with enmeshment." D. increase intrafamilial relational conflicts."

A. define individual beliefs and needs."

A family consists of a husband, a wife, their three children, and the wife's mother. This family form is called a(n) A. extended family. B. dyadic family. C. blended family. D. indwelling family.

A. extended family.

A highly useful tool to uncover multigenerational issues in a family is the A. genogram. B. focused interview. C. family function checklist. D. family assessment device.

A. genogram.

A girl is overheard saying to her brother, "If you stick up for me with mom and dad, I will forget I heard you planning to sneak out after they are asleep." This can be assessed as a type of communication called A. manipulative. B. scapegoating. C. generalizing. D. placating.

A. manipulative.

The client disagrees that her husband should seek a promotion since it will require the family to move. After she discusses the situation with their 12-year-old, the child tells her father she doesn't want to move. The client has engaged in A. triangulation. B. enmeshment. C. a double bind. D. diffuse boundaries.

A. triangulation.

Which technique would be least helpful in putting family members at ease as family therapy begins? A. Getting each member's view of the way the problem affects the family B. Focusing on the identified patient's views about the family problems C. Providing clear, understandable information to the family members D. Maintaining a neutral, nonjudgmental demeanor as members speak

B. Focusing on the identified patient's views about the family problems

Grace is the nurse working with the Potter family, which consists of married parents Todd and Rhea, 16-year-old Jasmine, and 19-year-old Jeremy, who has recently been diagnosed with schizophrenia. The rest of the family is bewildered with Jeremy's symptoms and express that they feel lost in knowing how to deal with things. Which of the following approaches to family therapy would Grace take at this time to provide support and give information to the family that will help them cope with Jeremy's illness? A. Insightoriented family therapy B. Psychoeducational family therapy C. Behavioral family therapy D. Multigenerational family therapy

B. Psychoeducational family therapy