Chapter 19 - Family Nursing (QUESTIONS)
An older adult with two grown children is being discharged home and will need insulin injections and some assistance with activities of daily living. The patient's son lives within 5 km of the patient's home. The daughter tells the nurse that she doesn't know how to handle her parent's and her own children's needs. What should be the nurse's initial response? a. Work with the family in supporting caregivers. b. Tell the daughter to look into nursing home placement immediately. c. Arrange for the patient to remain in the medical centre. d. Make beneficial decisions for the family on how to manage the care at home.
ANS: A Feedback A The nurse must consider supporting family caregivers in order to develop better communication and problem solving for families. Building relationships for successful caregiving will improve care for the patient. B Nursing home placement should not be the nurse's initial response to caregiver strain. C Arranging for the patient to remain in the medical centre is not always feasible and does not address the problem of caregiver strain. It should not be the nurse's initial response in this situation. D The nurse should not make decisions for the family but rather should work with the family to problem solve.
Which dimension of the family assessment includes assessing the whole situation or background relevant to the family? a. Structural b. Functional c. Instrumental d. Developmental
ANS: A Feedback A The structural dimension of the family assessment includes the context, which means assessing the whole situation or background relevant to the family. B Assessing the whole situation or background relevant to the family is not part of the functional category of family assessment. C Assessing the whole situation or background relevant to the family is not part of the instrumental subcategory of family assessment. D Assessing the whole situation or background relevant to the family is not part of the developmental category of family assessment.
Which of the following two subcategories compose a functional assessment? a. History and physical assessment b. Instrumental and expressive functioning c. Developmental and emotional assessment d. Family functioning and use of defence mechanisms
ANS: B Feedback A History and physical assessment are not the two subcategories that compose a functional assessment. B A functional assessment is composed of instrumental and expressive functioning. C Developmental and emotional assessments are not the two categories that compose a functional assessment. D Family functioning and use of defence mechanisms are not the two subcategories that compose a functional assessment.
Mrs. Lily is talking about her recent chronic diagnosis and how it has affected her emotionally, intellectually, socially, and spiritually. The nurse knows that this is referred to as which of the following? a. Reflection b. Illness narrative c. Comprehensive honesty d. Complete life review
ANS: B Feedback A Reflection does not refer to a patient's story of how illness affects his or her whole being, including emotional, intellectual, social, and spiritual components. B An illness narrative is a patient's story of how illness affects his or her whole being, including emotional, intellectual, social, and spiritual components. C Comprehensive honesty does not refer to a patient's story of how illness affects his or her whole being, including emotional, intellectual, social, and spiritual components. D A complete life review does not refer to is a patient's story of how illness affects his or her whole being, including emotional, intellectual, social, and spiritual components.
The Calgary Family Assessment Model focuses on three major categories of family life, including structural and developmental dimensions. What is the third dimension? a. Expressive b. Functional c. Instrumental d. Attachments
ANS: B Feedback A The expressive category is a subcategory of the functional dimension. B The third dimension that the Calgary Family Assessment Model focuses on is the functional dimension. C The instrumental category is a subcategory of the functional dimension. D The attachment category is a subcategory of the developmental dimension.
When working with families, the nurse may view the family either as context or patient. Which one of the following examples demonstrates the view of the family as context? a. The family's ability to support the patient's dietary and recreational needs b. The patient's ability to understand and manage his or her own dietary needs c. The family's demands on the patient based on his or her role performance d. The adjustment of the patient and family to changes in diet and exercise
ANS: B Feedback A The family's ability to support the patient's dietary and recreational needs demonstrates the view of the family as patient. B When the nurse views the family as context, the primary focus is on the health and development of an individual member existing within the patient's family. The patient's ability to understand and manage his or her own dietary needs demonstrates the view of the family as context. C The family's demands on the patient based on his or her role performance demonstrates the view of the family as patient. D The adjustment of the patient and family to changes in diet and exercise demonstrates the view of the family as patient. Nursing practice that focuses on family as patient is also known as family systems nursing.
What is the nurse's ultimate goal when offering interventions to families? a. Suggesting new coping measures b. Increasing the family's autonomy in solving their own problems c. Providing families with specific guidelines on how to manage their time and resources more effectively d. Referring families to the appropriate support system
ANS: B Feedback A The nurse will assist the family to identify coping mechanisms that have been successful in the past and to explore with them new coping mechanisms with them. The intervention is collaborative, and the patient is encouraged to make his or her own decisions. The ultimate goal is to empower families. B The ultimate goal when offering interventions to the family is to help family members discover solutions that reduce or alleviate emotional, physical, and spiritual suffering. The nurse's role is to guide the family in problem solving. C The nurse collaborates with the family to identify appropriate approaches to time and resource management. The ultimate goal is to empower families. D At times the nurse may need to refer families to community resources when family functioning is impaired. The ultimate goal is to empower families.
Which of the following terms is given to a conversational statement emphasizing family strengths and abilities? a. Linear b. Circular c. Commendation d. Normalization
ANS: C Feedback A Linear is a type of question. B Circular is a type of question. C A commendation is a conversational statement emphasizing family strengths and abilities. D Normalization is not the term given to a conversational statement emphasizing family strengths and abilities.
The nurse is identifying a sketch of which of the following when he or she creates a family's ecomap? a. The region where the family resides b. The most influential health determinants on the family's health c. The family's contact with those outside the family d. The family structure and relevant information about family members
ANS: C Feedback A The ecomap does not provide geographic details. B Health determinants are not identified in the ecomap. C An ecomap is a sketch of the family's contact with those outside the family. The family members who share the household are depicted in the centre of the ecomap, and various important extended family members or larger systems are sketched in to show their relationship to the family. D The genogram provides a sketch of the family structure.
Which of the following communication patterns between father and child reflects circular communication? a. The father and child are engaged in a game of catch. b. The father uses rewards to encourage the child to go to bed. c. The father comforts the crying child. d. The child disobeys his father.
ANS: C Feedback A The example of the father and child being engaged in a game of catch is not an example of circular communication. It reflects a subsystem (structural assessment) of father and child; it reflects a relationship within the family. B The example of the father using rewards to encourage the child to go to bed is not an example of circular communication. It illustrates how influence (expressive functioning) is used to affect or control another person's behaviour. Influence can be classified as instrumental (e.g., using privileges to reward good behaviour), psychological (e.g., giving praise or admonishment), or corporal (e.g., hugging or hitting). C Circular communication refers to communication between family members that is reciprocal; that is, each person influences the behaviour of the other. An example is when a parent comforts a child because the child cries. Because the parent responds to the child, the child feels safe and secure. D The example of the child disobeying his father is not an example of circular communication. Rather, it is an example of a boundary.
The nurse is observing for the signs of a healthy family. While assessing a healthy family, what would the nurse expect to find? a. Change is viewed as detrimental to family processes. b. A passive response exists to stressors. c. The structure is flexible enough to adapt to crises. d. Minimal influence is exerted on the environment.
ANS: C Feedback A The healthy family is able to integrate the need for stability with the need for growth and change. It does not view change as detrimental to family processes. B The healthy family demonstrates control over the environment and does not passively respond to stressors. C A healthy family has a flexible structure that allows adaptable performance of tasks and acceptance of help from outside the family system. The structure is flexible enough to allow adaptability but not so flexible that the family lacks cohesiveness and a sense of stability. D The healthy family exerts influence on the immediate environment of home, neighbourhood, and school.
Mr. Casey is an 86-year-old diabetic who requires daily insulin injections. He lives with his daughter and her husband. Which of the following questions assesses instrumental functioning? a. "Mr. Casey, how do you think your daughter feels about your refusing to take your insulin?" b. "What do you feel has aggravated your difficulty in controlling the diabetes?" c. "Mr. Casey, who is responsible for administering your insulin injections?" d. "How will you deal with hypoglycemic reactions?"
ANS: C Feedback A The question, "How do you think your daughter feels about your refusing to take your insulin?", explores expressive functioning, more specifically emotional communication. B The question, "What do you feel has aggravated your difficulty in controlling the diabetes?", explores the patient's beliefs within the category of expressive functioning. C Instrumental functioning includes all normal activities of daily living, such as preparing meals, eating, sleeping, and attending to health needs. For families with health problems, these activities may include administration of medications. D The question, "How will you deal with hypoglycemic reactions?", evaluates the family's ability to problem solve; problem solving falls under the expressive functioning category.
In assessing the family, how should the nurse define "family"? a. Identifying those members who are related biologically b. Applying one of the family forms that are recognized by society c. Referring to family forms that social scientists and legislators have identified d. Accepting that "family" is defined by individuals
ANS: D Feedback A Biological relationship is one of the many types or forms of family that define family. Different definitions have resulted in heated debates among social scientists and legislators. The nurse must realize that families are as diverse as the individuals that compose them and that their various definitions must be respected. B A socially recognized form of the family is only one of the many family types or forms. Different definitions have resulted in heated debates among social scientists and legislators. The nurse must realize that families are as diverse as the individuals that compose them and that their various definitions must be respected. C A family form that is identified by social scientists and legislators is only one of the many ways of defining a family. Different definitions have resulted in heated debates among social scientists and legislators. The nurse must realize that families are as diverse as the individuals that compose them and that their various definitions must be respected. D The nurse must think of "family" as defined by each individual. The nurse can think of family as a set of relationships that the patient identifies as family or as a network of individuals who influence each other's lives, whether or not there are actual biological or legal ties. In other words, the family is each person's definition of whom or what constitutes it.
The nurse suspects that there is physical abuse present after visiting an older patient in her home. She has been receiving care from her family for several months. In recognition of the pattern of family violence, which of the following does the nurse know is true? a. Mental illness is a major cause of abuse. b. Abuse is primarily seen in lower income families. c. Spouses are the most frequent abusers. d. Family members and family caregivers are the most frequent abusers of older adults.
ANS: D Feedback A Mental illness may increase the incidence of abuse within the family but is not the major cause of abuse. B Abuse occurs across all social classes. C Spouses are classified as family members, but the most frequent abusers of older adults are family members and family caregivers, and this includes all caregivers. D Family members and family caregivers are the most frequent abusers of older adults. Caregiving can be stressful, causing a decline in the health of the caregiver and care receiver, and leading to the development of abusive relationships.
In the structural assessment of the family, the nurse determines which one of the following? a. How household tasks are shared among the family members b. The stage of life at which the family finds itself presently c. The emotional links between family dyads d. Which factors influence the roles and behaviours within the family
ANS: D Feedback A The sharing of household tasks can be assessed in the functional assessment, more precisely instrumental functioning. B In the developmental assessment, the nurse will assess the phase of the family's developmental life cycle. C The emotional ties between family dyads can be assessed under subsystems (structural assessment) and also under alliances and coalitions (expressive functioning). D In the structural assessment, the nurse identifies birth order, gender, and distance in age between siblings, since these may influence roles and behaviours within the family.