Unit 6 - Care of Family Ch. 3

39. 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.

ANS: A In the at-home hospice setting, family members must find a balance between direct caregiving activities and their own needs for personal time. The nurse must assess this to help the family avoid caregiver strain and resentment and to maintain roles necessary for family functioning. Ensuring the family understands the hospice concept and providing information are also important, but are not directly related to family functioning. The family may or may not need counseling.

5. 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

ANS: A, D, E The toddler is in a stage where rapid physical development occurs but coordination and judgment are lagging behind. Thus the toddler is prone to accidents and injury. The nurse should offer anticipatory guidance so the parents can keep their child safe. Development of personal values and ethics occurs in the school-age and adolescent stage. Impact of peer group increases in this stage as well.

40. 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

ANS: B Assimilation is the process whereby a family or individual loses its unique cultural identity and identifies more with the dominant culture. The teens appear to be assimilated. Acculturation is the changes in cultural patterns within a group to match those of the host society. Connectedness relates to with whom the family identifies and relates as a family unit. Lost children are often seen in substance-abusing families.

18. 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

ANS: C 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.

10. A nurse is assessing a family whose patriarch died recently. Using Kübler-Ross's stages of grieving, what stages should the nurse assess for? (Select all that apply.) A. Bargaining B. Dealing C. Denial D. Remorse E. Shock

ANS: A, C Kübler-Ross's stages of grieving include denial, anger, bargaining, and acceptance. Dealing is one of Rodebaugh's stages. Remorse is one of Epperson's stages. Shock is one of Harvey's phases.

31. 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

ANS: C Family-building activities are an extension of family rituals and center on recreation and leisure. They do contribute to family bonding, but the most specific answer is family building. Family activities are influenced by family beliefs.

27. 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

ANS: D A quantitative tool measures the frequency at which problems or behaviors occur. An ecomap is a tool that displays the outside systems used by the family. A genogram illustrates the family structures and compares generations within the same family. Qualitative tools measure the descriptions and depth of family experiences.

36. 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

ANS: B Systems theory looks at boundaries, balance and homeostasis, and subsystems. An important concern in the family whose member is diagnosed with a mental illness is social isolation, which is related to boundaries. Some families view mental illness as shameful and try to keep the information secret. The nurse should work to ensure the family understands the importance of healthy interaction with outside systems. Children's ages would be assessed using developmental theories.

2. 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

ANS: D 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.

32. 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

ANS: A The most effective goals are those that include the entire family. The entire family agrees upon the goals and commits to working on them.

6. 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? (Select all that apply.) 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

ANS: A, C, D, E The genogram may be used to highlight generational influences of behaviors, illnesses, vocational information, or any other pertinent information that provides a larger picture of patterns that exert influence on the family's current situation. The genogram should include at least three family generations and should list dates of births, divorces, deaths, stillbirths, and other pertinent elements of family information.

8. 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

ANS: C 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.

1. 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

ANS: A 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.

29. 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

ANS: A A strengths-and-problems list requires the family members to list their strengths as well as what each member brings to the group that is positive. The problems list helps the family prioritize problems to work on. By seeing this information in writing, the family members can capitalize on their strengths to work on the problems. It does demonstrate that each family has both strengths and problems, but that is not the main purpose. It does not force families to take responsibility, although it does encourage this. Its purpose is not to point out who has which problems.

19. 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."

ANS: A 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.

23. 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?"

ANS: A According to this family theory, birth order plays an important role in predicting certain patterns of behavior. Spouses who occupy the same birth order may have difficulty functioning together. In this case, both spouses probably are first-borns with a need for control. The other questions may yield helpful information as part of a thorough assessment, but are not related to this theory.

38. 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

ANS: A All options are important activities to keep the family engaged fully with the patient. However, for a patient who is critically ill, determining who makes medical decisions (and if there are advance directives) is crucial. The other actions can occur later.

33. 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.

ANS: A All the outcomes show some positive resolution, but the most optimal response is the parents and teen jointly planning the parents' nights out. This shows collaboration, communication, and mutual respect. In the end, everyone's needs are taken into consideration, and the teen will be more willing to adapt the current role to include watching the siblings. Consistent consequences delivered without anger is a hallmark of healthy discipline. The teen is taking responsibility when he or she acknowledges that the forgetting occurs on purpose. The lines of communication are open when the teen is allowed to verbalize feelings.

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

ANS: A 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.

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

ANS: A 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.

25. 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.

ANS: A Consistency in setting and enforcing rules is critical. Consequences should be delivered immediately, without anger, and consistently. The father's disciplining the child without getting mad is demonstrating that goals have been (or are being) met. The other options do not show consistent, calm, immediate consequences.

30. 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.

ANS: A Culture affects the roles family members assume during times of illness, pregnancy and childbirth, and death. The best option is to ask the woman what role men in her culture play during pregnancy and childbirth. This can open a discussion of how the woman is coping and if she is getting enough support, either from her mate or friends and family. Asking why the man doesn't seem involved is judgmental. Encouraging the man to participate may not be desired by the woman and may be seen as an intrusion by the man. The nurse could research the culture but this would not lead to a discussion until the next visit. It is also important to be aware that there are variations in how people of the same culture behave and believe.

14. 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

ANS: A 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.

8. 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? (Select all that apply.) 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

ANS: A, B, C, D Sometimes families are in special need of nursing intervention due to situational or developmental crises that go beyond the family's internal resources. Developmental crises occur as part of expected growth events that can take place during any developmental stage of the family or its individual members and include such situations as being displaced, hospitalization of a family member, domestic violence, and serious depression. Childbirth is a normal event that does not generally require special nursing intervention unless complications occur.

3. 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? (Select all that apply.) 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

ANS: A, B, C, E Many social pressures have negative effects on the health of our families. Some of these trends include the economic situation, HIV and AIDS in women and children who are vulnerable due to barriers to health care, a loss of resources in schools, and an increase in all types of violence. As a group, adult males do not have restricted access to health care.

4. 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.

ANS: A, C, D, E Family systems theory considers family boundaries (how the family interacts with the outside world) and looks at interaction among all the members, as the family unit itself is considered more important than the individuals within it. Boundaries can also be assessed in part by determining if there are family secrets or taboos (closed boundaries) or if information is shared too freely (open boundaries). Developmental stages of the family are not considered in family systems theory, but are part of Duvall's family developmental stages and theory.

2. 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? (Select all that apply.) 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

ANS: A, C, D, E In the 1950s and 1960s, families were father-dominated and nuclear in structure and shows focused on problems that were simple and easily solved. In the 1960s and 1970s, the trend was toward blended families (with widowhood being the reason for remarriage) that were mostly in an upper-income bracket. In the 1980s and 1990s, social issues such as class and politics became popular. The shows may not have shown resolution of the problem at hand, but emphasized the closeness of the family unit. In the 1990s, shows brought increased awareness of the challenges facing families dealing with a host of problems such as alcoholism, poverty, and abuse. In the new millennium, shows present alternative and extended family formats.

1. 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? (Select all that apply.) 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.

ANS: A, D, E The patient's family should be welcomed into nursing experiences. The family is a rich source of support and information about the patient. The patient will have to reintegrate into the family upon discharge. The patient's family represents the context from which he or she comes. Families may or may not have to assume the caregiving role. It is stereotypical to assume that families will interfere in patient care.

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

ANS: B 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.

28. 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

ANS: B A genogram is a diagram of at least three generations that illustrates the present family structures and compares past generations with the present ones. To determine the prevalence of this inherited disorder in the family, the nurse would use a symbol to denote each family member with this disease. An ecomap displays the outside systems with which the family interacts. A problem list helps family members identify difficulties or negative characteristics. A quantitative tool assesses the frequency of a behavior or problem. A genogram has a quantitative influence, as it documents how many people in the family have the characteristic being studied, but a genogram is more specific.

17. 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.

ANS: B 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.

16. 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

ANS: B 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.

10. 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

ANS: B 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.

13. 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.

ANS: B 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.

37. 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?"

ANS: B In substance-abusing families, one child often takes the role as the responsible person, allowing the family to continue functioning. The fact that a sibling was bringing the children to school is a little unusual, and the nurse should assess the reason behind it. However, substance-abusing families often keep secrets for both social and legal reasons. The nurse should not ask directly about substance abuse, but rather open a line of discussion by introducing a nonthreatening question. There is no indication of abuse, so asking if the child is safe is not appropriate at this time. In a secret-keeping family, asking directly about drinking or drug use would most likely elicit a negative response. Asking "why" questions is confrontational.

9. A nurse assessing a family includes which components in the assessment? (Select all that apply.) A. Dietary habits B. Family size and structure C. Parenting style D. Religious affiliation E. Socioeconomic status

ANS: B, C, D, E A family assessment includes family size and structure; parenting style; and religious, cultural, and socioeconomic orientation. Dietary habits are not specifically assessed, although this information may be part of a cultural assessment.

7. 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? (Select all that apply.) 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.

ANS: B, D, E Communication theory asserts that patterns of communication within a family reveal much about the way the family functions, the structure of the family, the power base, decision making, affection, trust, and affiliation. Preliminary conclusions the nurse can make about this family are that the daughter may have a lot of power because she answers many questions without input from anyone else, the grandmother may not have much power because she is not even present, and the mother and son may have a coalition opposed to the daughter. The nurse will need to confirm these conclusions with further assessment. These communication patterns are not healthy. The nurse should not assume that the grandmother does not want to be involved but should assess the reason for her absence.

34. 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.

ANS: C A good goal or outcome is specific, measurable, and has a time element. The goal that best meets that description is expressing feelings using "I" statements within 1 month. Adapting to role changes is vague and not measurable. Dividing duties more evenly is not measurable and has no time element. Learning to discuss negative emotions does not mean using what is learned, so it is not as specific as the correct answer.

12. 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.

ANS: C 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.

11. 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.

ANS: C 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.

15. 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.

ANS: C 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.

35. 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.

ANS: C Safety is a priority concern in every family and all members should be made aware that the patient could have continued suicidal thoughts. If the siblings notice this, they should be taught to tell the parents immediately and could also be taught some effective communication to use. Looking for drugs or alcohol in the patient's room, encouraging medication use, and planning menus are all actions more appropriate for the parents.

5. 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.

ANS: C 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.

22. 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."

ANS: C This family is dysfunctional, but that does not go far enough to explain the situation. This behavior is known as triangulation, and occurs when a dyad diverts attention away from their problems and chooses instead to focus on a third party, in this case the nurse. Reassuring the student they will calm down is neither helpful nor accurate as the family members may choose to continue to lash out. Families often do get emotional, but again, this information is not really helpful.

26. 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.

ANS: C This is a difficult situation, but because the patient's wishes are known, the nurse has no choice other than to wait. In the emergency department, sometimes surgery is performed under the principle of implied consent (for instance, on an unconscious patient with no known family), but in this case, the patient has been clear as to her wishes, so doing that would be an ethics violation. The nurse must be careful to not be coercive. The nurse (and physician) would ensure that the patient understands the risks of waiting.

7. 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

ANS: D 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.

21. 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."

ANS: D According to group theory, a healthy family adjusts to changes in its structure by resetting roles and norms. In this family, a launched child has moved back in, disrupting the patterns established when he left. Agreeing to new rules and roles is a sign of adaptation. The other responses do not show adaptation to the new situation.

20. 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.

ANS: D 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.

24. 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.

ANS: D Children whose parents have a laissez-faire disciplinary style tend to be disrespectful, aggressive, and disobedient. A laissez-faire disciplinary style includes inconsistent use of discipline, allowing children (rather than the parents) control over the environment, few rules, and children making their own decisions rather than being guided by parents. The other options may be true, but without further assessment, the nurse cannot make those conclusions.

6. 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

ANS: D 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.