Health of the Individual, Family, and Community (PrepU)

The nurse is conducting a family assessment of a traditional family. Which assessment data cue describes the socioeconomic status of the family?

The father is an engineer and the mother is an elementary school teacher. (The occupations of the parents provide financial support for the family and contribute to the socioeconomic status of the family. Affiliation with a religious organization can be a source of social support during stressful times, which can promote adaptive coping for the family. Cultural and religious activities of the family define values and beliefs important to family members. Recreational activities, such as vacationing together, promote interaction of family members.)

A family assessment of a father, mother, and four children has suggested the presence of several risk factors. Which aspect of the family's structure and function would be considered a psychosocial risk factor?

The parents have a tumultuous relationship, with frequent separations in the past. (Conflict is an example of a psychosocial risk factor. Chemical dependency is considered a lifestyle risk factor, whereas a lack of adequate housing is an environmental risk factor. Lack of electricity is an economic risk factor.)

The nurse assesses a client who is postoperative day 1 following a total abdominal hysterectomy. Assessment data includes blood pressure (BP) 150/88 mm Hg, heart rate (HR) 100 beats/min, respiratory rate (RR) 22 breaths/min with a pain scale of 8 on a scale of 1 to 10. The abdominal dressing is clean, dry, and intact. The client's prescriptions indicate ambulation today. Which is the priority nursing action?

Medicate the client for pain as prescribed by the health care provider. (The nurse is likely to use Maslow's hierarchy of needs as a tool for setting priorities for client care. Using this tool, the nurse considers the client's physical needs, such as managing pain, as a priority in this situation.)

A nurse in a wellness center is presenting a class on integrating holistic therapies with traditional health care. The nurse talks about the trend in health care to treat each client in a manner that reconnects the total being. Which would best be considered a holistic approach to health?

Physical, emotional, and spiritual well-being (approach to health reconnects the mind and body, which are treated separately in traditional approaches. The connection of physical, emotional, and spiritual well-being must be understood and considered when providing health care.)

Which intervention performed by the nurse is most appropriate for assisting a client in meeting safety and security needs based on Maslow's hierarchy of needs?

Providing the mother the phone number for the poison control center (The nurse is meeting safety needs by providing a mother with the phone number for the poison control center. Cutting up food and opening drink containers for the client would meet the most basic need for food.)

According to Archer, what are the three general types of communities?

Emotional, structural, and functional

Duvall's family life cycle

Family life cycle: sequence of changes in family composition, roles, relationships, and developmental tasks

Socialization function

In this function the family teaches values, attitudes, and provides feedback, and with the function of reproduction the family produces and raises children.

A nurse is assessing a family and observes that the family demonstrates behaviors that assist its members in establishing their identities. The nurse interprets this behavior as fulfilling which family function?

Affective (The affective and coping functions of the family provide emotional comfort to family members and help members establish their identity and maintain it in times of stress. Physically, the family provides a safe, comfortable environment necessary for growth, development, and rest or recuperation. Economically, the family provides financial aid to family members and also helps meet society's needs. Through socialization, the family teaches; transmits beliefs, values, attitudes, and coping mechanisms; provides feedback; and guides problem solving.)

A nurse is assessing a family with adolescents. The family consists of a father, mother, a 13-year-old son, a 14-year-old son from a previous marriage, and a 16-year-old daughter. Which statement by the parents would lead the nurse to suspect a potential risk factor for altered health with this family?

"Our 16-year-old just seems to butt heads with us at every turn." (The statement about the daughter butting heads with the parents may suggest a conflict among family members and thus a risk factor for altered health.)

The nurse is explaining the expected developmental tasks of a typical family with adolescents. Which of the following would be incorrect for the nurse to include?

Adjustment to retirement (Developmental tasks for families with adolescents and young adults include balancing teenagers' freedom with responsibility, maintaining supportive home base, and strengthening marital relationships.)

When providing care to a client, the nurse prioritizes the client's needs. Which intervention would the nurse employ to meet the client's physiologic needs?

-Assessing the client's skin color -Weighing the client -Promoting a high-fiber diet

The nurse is assessing a family parented by a 60-year-old grandmother and her three school-age grandchildren. The nurse is aware that which problem may occur in a single-parent family at a greater level than in other types of families? a) Lack of knowledge about child safety b) Increased financial concerns c) Child abuse and neglect d) Conflict between family members

b) Increased financial concerns - Many single parent families are headed by women. Single parents often have special problems and needs, including financial concerns and role shifts (i.e., having the roles of both parents). Single-parent families are not less knowledgeable about child safety than other family types, nor is there a higher incidence of child abuse, neglect, or conflict among family members.

A nurse is providing care to a client who is feeling lonely and isolated. In an effort to develop a trusting nurse-client relationship, the nurse exhibits a caring attitude, ensures the client's privacy, and spends time with the client to promote therapeutic communication. The nurse is meeting which category of client needs?

Love and belonging

The home health nurse is making an initial visit to a client's home. During the visit the nurse observes the mother cooking dinner, the father watching television with a child on the lap, and the grandmother in a rocking chair reading the Bible. The nurse recognizes this family structure as which of the following?

Extended family

A nurse is working as part of a group to address factors within the community affecting the health of the families in that community. Which area would the nurse identify as playing a role in contributing to altered health status?

-Limited number of institutions providing health care -Small number of recreational opportunities for adults and children -Overlapping of industrial zones with residential zones

A family that consists of two homosexual parents and three children living in the same house is an example of which type of family?

Nuclear family

The Nuclear Family

This family is also known as the traditional family and is composed of two parents and their children. The parents might be heterosexual or homosexual, are often married or in a committed relationship.

An Extended Family

This type of family includes aunts, uncles, and grandparents.

A single-parent family

This type of family involves one parent and may be the result of marital separation or divorce, the death of a spouse, or the parent never having been married.

Physical function

This type of function provides a safe, comfortable environment necessary for growth and development.

The nurse on the elective surgery floor receives a report that describes the client's abdominal wound dressing as having a moderate amount of yellowish and bloody drainage on it and a very foul smell. In planning for a dressing change, it is most important for the nurse to perform which action?

Wash the nurse's hands before and after the dressing change. (Physical safety and security mean being protected from potential or actual harm. The abdominal dressing with a foul smell indicates the presence of bacteria. It is most important for the nurse to prevent the spread of infection to the nurse and others and to protect the client. Proper hand washing before and after the dressing change to prevent the spread of infection is a nursing activity that will meet these physical safety needs.)

The charge nurse is assigning client care for the upcoming shift. Which is the priority evaluation when performing this task? a) Determine the level and intensity of client care needed according to physical and psychosocial factors. b) Consider the educational level and experience of the nursing staff. c) Calculate the number of staff scheduled to work the oncoming shift. d) Examine the departmental budget to determine the financial consequences of staffing patterns.

a) Determine the level and intensity of client care needed according to physical and psychosocial factors. - Level and intensity of client care based on physical and psychosocial factors is the priority evaluation when using Maslow's hierarchy of needs. While the other options may impact staffing, these are not the priority when making client care assignments.

A nurse is caring for an adolescent who has just lost a leg in a motor vehicle accident. Which human need would the nurse most likely need to address? a) Love and belonging needs b) Safety and security needs c) Self-actualization needs d) Self-esteem needs

d) Self-esteem needs - The options listed are stages of Maslow's hierarchy of needs. The adolescent would have issues and concerns in the self-esteem stage. Self-esteem needs would include fear, sadness, loneliness, and accepting self; all would be appropriate with this client. Love and belonging would focus on the sociocultural aspect and would include areas such as relationships with others, communication with others, support systems, being part of a community, and feeling loved by others. Safety and security would focus on the environmental aspect and would include areas such as housing and community/ neighborhood to name a few. Self-actualization needs are in the intellectual and spiritual dimension and would include areas such as thinking, learning, decision making, values, beliefs, and helping others.

A Blended Family

This type of family is also a traditional family formed when parents bring unrelated children from previous relationships together to form a new family.

Duvall's theory

Theory: Identified critical family development tasks and stages in the family life cycle. Based on Erikson's theory of psychosocial development States that all families have certain basic tasks for survival and continuity and specific tasks related to the sequential stages of development throughout the life of the family. If the family does not meet certain developmental tasks, societal disapproval may lead to intervention of CPS, social services, welfare agencies, police departments, or health departments. The successful mastery of of each developmental stage is important to the family's adaptation and growth through successive stages. Family development theory (theory of 8 successive stages) - INDIVIDUAL WITHIN THE CONTEXT OF NORMS - based on traditional, nuclear, intact family - doesn't take into account families whose life cycles exemplify alternative development sequences (divorce, single-parent, stepfamilies)

Economical function

This type of function provides financial aid to family members.

A 44-year-old client is being treated for dehydration in an acute care hospital. The nurse determines that the rehydration treatment is working by assessing which values?

Urine output of 1500 mL in 24 hours (A balance between intake and elimination of fluids is an essential physiological need. Disruption in the water balance in the body results in either dehydration or edema. Measuring the fluid intake and output can determine the client's hydration status. A 24-hour urine output of 1500 mL is normal (range 1000 to 3000 mL/day) and indicates sufficient fluid intake to produce a normal urine output.)

Which items represent lifestyle risk factors for altered family health? Select all that apply. a) Inadequate childcare resources b) Insufficient financial resources c) Ingestion of high-fat foods d) Smoking by the parents e) Inadequate dental hygiene

c) Ingestion of high-fat foods d) Smoking by the parents e) Inadequate dental hygiene - Lifestyle risk factors include ingestion of high-fat foods, smoking by the parents, and inadequate dental hygiene. Inadequate childcare resources is a psychosocial risk factor, whereas insufficient financial resources is an environmental risk factor.

Which are stressors that affect the health of the family? a) Many job opportunities with adequate income b) Family members who live in the same geographic location c) Public transportation present throughout the community d) Inadequate childcare services

d) Inadequate childcare services - Inadequate childcare services is a major stressor for many families. Communities that offer many job opportunities tend to have low unemployment. Families that have adequate income to meet the needs of the family tend to have higher health. Public transportation facilitates access to health care. Other family members who live nearby are a source of support.

The epidemiology nurse finds a lower occurrence of influenza cases in a section of a large metropolitan city. Further research reveals higher influenza immunization rates in that section of the city. The nurse determines which probable cause for this occurrence? a) Immunizations are given at no cost in the area. b) Persons living in the area are better educated. c) Immunization has become a community norm. d) There are fewer tobacco users in this section of town.

c) Immunization has become a community norm. - The most probable cause for this occurrence is that immunization has become a community norm. People tend to do what others in their community do. Free or low-cost immunizations are given in many areas without increasing the immunization rate. Education has little to do with immunization or vaccination rates. Tobacco use may complicate course of illness for those who contract influenza but is not likely to positively impact immunization rates.

A client says, "I live in a small community on the northwest side of the city." Why does the nurse consider it significant that the client reports living in a community rather than a neighborhood?

Community indicates people who share similar characteristics. (Communities are thought to contain persons who share similar characteristics, whether it be social interaction, cultural or ethnic ties, or geographic area. Communities may be larger or smaller that a geographic neighborhood and are not defined by geography. Communities exist because they meet basic human needs.)

Friedman and associates identified the importance of family-centered nursing care, based on four rationales.

First, the family is composed of interdependent members who affect one another. If some form of illness occurs in one member, all other members become part of the illness. Second, a strong relationship exists between the family and the health status of its members; therefore, the role of the family is essential in every level of nursing care. The third rationale is that the level of health of the family and, in turn, each member can be significantly improved through health-promotion activities. Finally, illness of one family member may suggest the possibility of the same problem in other members; through assessment and intervention, the nurse can assist in improving the health status of all members.

A nurse is caring for an adolescent who has just lost a leg in a motor vehicle accident. Which human need would the nurse most likely need to address?

Self-esteem needs (The options listed are stages of Maslow's hierarchy of needs. The adolescent would have issues and concerns in the self-esteem stage. Self-esteem needs would include fear, sadness, loneliness, and accepting self; all would be appropriate with this client.)

A nurse is assessing a family with adolescents. The family consists of a father, mother, a 13-year-old son, a 14-year-old son from a previous marriage, and a 16-year-old daughter. Which statement by the parents would lead the nurse to suspect a potential risk factor for altered health with this family? a) "Our 16-year-old just seems to butt heads with us at every turn." b) "We've taught our kids to be assertive when appropriate." c) "All of us have faced problems along the way but we've worked them out." d) "We've encouraged our kids to talk to us about sex and sexually transmitted infections."

a) "Our 16-year-old just seems to butt heads with us at every turn." - The statement about the daughter butting heads with the parents may suggest a conflict among family members and thus a risk factor for altered health. Being assertive (not aggressive), being able to problem-solve, and having open communication about sexually transmitted infections promote family health.

A client says, "I live in a small community on the northwest side of the city." Why does the nurse consider it significant that the client reports living in a community rather than a neighborhood? a) Neighborhoods are, by definition, smaller units within a community. b) Community indicates people who share similar characteristics. c) Communities are defined by geography. d) Neighborhoods meet basic human needs, where communities do not.

b) Community indicates people who share similar characteristics. - Communities are thought to contain persons who share similar characteristics, whether it be social interaction, cultural or ethnic ties, or geographic area. Communities may be larger or smaller that a geographic neighborhood and are not defined by geography. Communities exist because they meet basic human needs.

A nurse in the emergency department assesses a 3-year-old child with a fractured femur, a hematoma on the back of the head, and multiple 1-cm round scabs and blisters on the upper back. The parents state that their child sustained the injuries by falling out of a high chair. What is the best action for the nurse to take?

Report the suspected child abuse to Child Protective Services. (The physical function of the family is to provide a safe environment necessary for growth and development. The child's injuries (a fractured femur with head injury and 1-cm round scabs and blisters on the upper back) suggest physical abuse by slamming the child into a wall while holding on to his leg, along with cigarette burns. All suspected cases of abuse must be reported to the appropriate agency or authority.)

Which statement is true regarding Friedman's theory of family-centered nursing care?

The role of the family is essential in every level of nursing practice.

A new graduate nurse asks a nurse manager working at the community health center, "I've heard people talk about community health nursing and community-based nursing. Is there a difference?" Which response by the nurse manager would be appropriate? a) "Community health nursing involves care for entire populations whereas community-based nursing focuses on individuals and families in that population." b) "There really isn't any difference between the two at all. Both terms are used to denote health care for all groups of people." c) "Community health nursing focuses primarily on providing care to people in their homes and living in a specific community." d) "Community health nursing emphasizes the need to address the cultural differences among the individuals and families in the community while community-based nursing does not."

a) "Community health nursing involves care for entire populations whereas community-based nursing focuses on individuals and families in that population." - In contrast to community health nursing, which focuses on whole populations within a community, community-based nursing is centered on the health care needs of individuals and families. Nurses practicing community-based nursing provide interventions to manage acute or chronic health problems, promote health, and facilitate self-care. Nursing care provided within a community must be culturally competent and family centered.

The nurse is explaining the expected developmental tasks of a typical family with adolescents. Which of the following would be incorrect for the nurse to include? a) Adjustment to retirement b) Maintain open communication c) Strengthen the marital relationship d) Maintain a supportive home environment

a) Adjustment to retirement - Developmental tasks for families with adolescents and young adults include balancing teenagers' freedom with responsibility, maintaining supportive home base, and strengthening marital relationships. Adjusting to retirement is a developmental task for families with older adults.

The nurse is conducting a family assessment of a traditional family. Which assessment data cue describes the socioeconomic status of the family? a) The father is an engineer and the mother is an elementary school teacher. b) The family celebrates Hanukkah and Passover with special meals. c) The family consults their rabbi and synagogue members during times of stress. d) The family members vacation together every year at a beach resort.

a) The father is an engineer and the mother is an elementary school teacher. - The occupations of the parents provide financial support for the family and contribute to the socioeconomic status of the family. Affiliation with a religious organization can be a source of social support during stressful times, which can promote adaptive coping for the family. Cultural and religious activities of the family define values and beliefs important to family members. Recreational activities, such as vacationing together, promote interaction of family members.

Which statement is true regarding Friedman's theory of family-centered nursing care? a) The role of the family is essential in every level of nursing practice. b) The family is composed of independent members who live and function individually. c) The focus on health should be directed at improving the health of the sickest member of the family. d) Illness of one family member strengthens the roles of the sick member in the family structure.

a) The role of the family is essential in every level of nursing practice. - Friedman and associates identified the importance of family-centered nursing care, based on four rationales. First, the family is composed of interdependent members who affect one another. If some form of illness occurs in one member, all other members become part of the illness. Second, a strong relationship exists between the family and the health status of its members; therefore, the role of the family is essential in every level of nursing care. The third rationale is that the level of health of the family and, in turn, each member can be significantly improved through health-promotion activities. Finally, illness of one family member may suggest the possibility of the same problem in other members; through assessment and intervention, the nurse can assist in improving the health status of all members.

A 44-year-old client is being treated for dehydration in an acute care hospital. The nurse determines that the rehydration treatment is working by assessing which values? a) Urine output of 1500 mL in 24 hours b) An elevated hematocrit level c) An elevated urine specific gravity d) Oral intake of 1500 mL in 24 hours

a) Urine output of 1500 mL in 24 hours - A balance between intake and elimination of fluids is an essential physiological need. Disruption in the water balance in the body results in either dehydration or edema. Measuring the fluid intake and output can determine the client's hydration status. A 24-hour urine output of 1500 mL is normal (range 1000 to 3000 mL/day) and indicates sufficient fluid intake to produce a normal urine output. An elevated hematocrit and urine specific gravity indicate that the client is dehydrated. An oral intake alone is not an indicator of adequate hydration.

A home health nurse is visiting a family after the recent death of their matriarch. The nurse observes that the family is dressed in black, all of the mirrors are covered, and that the immediate family is sitting on square wooden boxes instead of chairs. The nurse asks what is happening, and is told, "We are Jewish, and the family is 'Sitting Shiva'." This family is fulfilling which family function?

affective and coping functions (This family exhibits the function of affective and coping by observing the ritual of "Sitting Shiva." By observing this Jewish, seven-day period of mourning for first-degree relatives (husband, wife, parent, or child) the family provides emotional comfort to family members, helps to establish their identity, and maintains it in times of stress.)

A nurse who is using Duvall's conceptual framework to assess a family with two parents and three children must first determine the

age of the oldest child. (Duvall's framework, essentially based on the individual life cycle, demonstrated that families move through a series of eight developmental stages. These stages are based on the developmental stage of the oldest child in the family, and they address marriage, childbearing, preschool years, school years, adolescent years, young adulthood, middle-aged parents whose children have left home, and aging parents.)

A community-based nurse acts as a case manager for a small town about 60 miles from a major healthcare center. What is the most important factor of community-based nursing for this nurse to be knowledgeable about? a) Eligibility requirements for services b) Community resources available to clients c) Transportation costs to the healthcare center d) Possible charges for any services provided

b) Community resources available to clients - A community-based nurse must be knowledgeable about community resources available to clients as well as services provided by local agencies, eligibility requirements, and any possible charges for the services. The other answers are incorrect because they are not the most important factor for a community-based nurse to be knowledgeable about.

A nurse is implementing interventions that focus on protecting a client from physical and emotional harm. Which category of needs is the nurse addressing? a) Physiologic b) Safety and security c) Love and belonging d) Self-esteem

b) Safety and security - Safety and security needs have both physical and emotional components. Physical safety and security means being protected from potential or actual harm. Emotional safety and security involves trusting others and being free of fear, anxiety, and apprehension. Physiologic needs are the most basic in the hierarchy and the most essential to life. They must be met at least minimally to maintain life. Love and belonging needs include the understanding and acceptance of others in both giving and receiving love, and the feeling of belonging to groups such as families, peers, friends, a neighborhood, and a community. Self-esteem needs include the need for a person to feel good about himself or herself, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishments.

A nurse is caring for a client newly diagnosed with diabetes mellitus and developing a holistic plan of care. For this plan of care to be successful, it must what? a) Take into account the cost of care. b) Connect families, friends, and the environment. c) Provide a connection between medicine and nursing. d) Address the disease but also incorporate the mind, body, and spirit.

d) Address the disease but also incorporate the mind, body, and spirit. - A holistic plan of care seeks to balance and integrate the use of crisis medicine, advanced technology, and the mind, body, and spirit, which are incorporated though the use of the nursing process. Taking into account the cost of care is only one facet of a holistic picture. Connecting families, friends, and the environment is important, but mind, body, and spirit define holism. A holistic plan of care may provide a connection between medicine and nursing, but it does not define it.