Mental Health Ch. 35_Family Interventions

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." A double bind is created when the verbal and nonverbal messages are incongruent, leaving the listener confused or trapped ("damned if he does and damned if he doesn't"). None of the other options present such a confused message.REF: 626; Box 35-2

What is the primary function of the nurse generalist in caring for families? a. Assessing the amount of stress on the system b. Conducting private family therapy sessions c. Prescribing psychobiological intervention d. Determining the new skills the family needs

a. Assessing the amount of stress on the system An important function of a nurse generalist is to assess cues from various family members that indicate the degree and amount of stress the family system is experiencing and report these so that appropriate interventions may be made in a timely manner by a qualified counselor. The remaining options are outside the scope of practice of a psychiatric nurse generalist.REF: 628-629

A family consists of a husband, a wife, their three children, and the wife's mother. This family form is referred to using which term? a. Extended b. Dyadic c. Blended d. Indwelling

a. Extended An extended family (multigenerational) is a composite of three or more generations. None of the other options refer to this family composition.REF: 622

Which assessment tool is highly effective in uncovering multigenerational issues in a family? a. Genogram b. Focused interview c. Family function checklist d. Family assessment device

a. Genogram A genogram maps family structure and family information for at least three generations. It graphically depicts relational patterns and multigenerational issues. Demographics, sociocultural context, and critical events can be noted. While helpful, none of the remaining options focus on multigenerational issues.REF: 627

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 what type of communication? a. Manipulative b. Scapegoating c. Generalizing d. Placating

a. Manipulative One example of manipulation occurs when a family member makes a request with strings attached so that the other person has difficulty refusing. This example is not associated with any of the other options.REF: 624; Box 35-1

At the first therapy session the family's father 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 the focus of which family dynamic behavior? a. Scapegoating b. Boundaries resisting c. Differentiation d. Multigenerational transition.

a. Scapegoating A scapegoat is the person others blame for the family's distress. Those blaming the scapegoat are usually trying to keep the focus off their own painful issues and problems. The parents seem to be scapegoating the younger son. The information presented does not support any of the other options.REF: 626; Box 35-2

A 26-year-old client diagnosed with schizophrenia is having difficulty adjusting to the community after hospitalization. His family is dismayed by his poor hygiene and avolition. Which intervention should the nurse suggest? a. The client attending a psychoeducational group b. Close supervision of the client by the family c. Encourage the family to ignore all symptoms except delusions. d. Suggest group home living for the client in order to avoid family burnout.

a. The client attending a psychoeducational group Psychoeducation can help the family learn to accept the illness of a family member, learn to deal effectively with symptoms, and understand medications. None of the other options provide a realistic, effective intervention to manage this client's socialization and self-care issues.REF: 624-625

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 The term nuclear family refers to parents and the children under the parents' care.REF: 622

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 does not want to move. The client has engaged in which form of dysfunction family dynamics? a. Triangulation b. Enmeshment c. A double bind d. Diffuse boundaries

a. Triangulation Triangulation occurs when a two-person relationship is under stress and one person draws in a third person to stabilize the system by forming a coalition.REF: 626; Box 35-2

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 is demonstrating which boundary issue a. Clear b. Diffused c. Disengaged d. Inflexible

b. Diffused A common phenomenon within families with diffuse boundaries is that individuals expect other members of the family to know what they are thinking. The described conversation is not reflective of any of the other options.REF: 626; Box 35-2

What term best describes a family dynamic where boundaries are not clear and whose members are overinvolved with each other? a. Clear boundaries b. Enmeshment c. Scapegoating d. Rigid boundaries

b. Enmeshment When boundaries are diffuse, individuals tend to become "enmeshed." As a consequence, it is not clear who is in charge, who is responsible for decisions, and who has permission to act or take charge; family members are often overinvolved with each other. Clear boundaries are adaptive and healthy. They are well understood by all members of the family and give family members a sense of "I-ness" and also "we-ness." Scapegoating refers to a situation in which one member of the family is seen as the cause of all the problems. Rigid boundaries are characterized by the consistent adherence to rules and roles—some apparent and some less so—no matter what.DIF: Cognitive Level: Understand (Comprehension)REF: Box 35-2TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

A nuclear family consists of married parents, a 16-year-old daughter, and a 19-year-old son recently diagnosed with schizophrenia. The rest of the family is bewildered with his symptoms and express that they feel lost in knowing how to deal with things. Which of the following approaches to family therapy should the nurse implement at this time to provide support and give information to the family that will help them cope with their son's illness? a. Insight-oriented family therapy b. Psychoeducational family therapy c. Behavioral family therapy d. Multigenerational family therapy

b. Psychoeducational family therapy The primary goal of psychoeducational family therapy is the sharing of mental health care information. This helps family members better understand their member's illness, prodromal symptoms (symptoms that may appear before a full relapse), medications needed to help reduce the symptoms, and more. Psychoeducational family meetings allow feelings to be shared and strategies for dealing with these feelings to be developed. Insight-oriented therapy focuses on developing increased self-awareness, other awareness, and family awareness among family members. Behavioral family therapy focuses on changing behaviors of family members to influence overall patterns of family interactions. The last option is a distractor and is incorrect.DIF: Cognitive Level: Analyze (Analysis)REF: page 13TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

The nurse wants to assess a family's rational patterns by creating their genogram. Which statement best describes the purpose of such an analysis? 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." By creating a genogram, nurses and therapists are able to map the family structure and record family information that reflects both history and current functioning. The other options do not describe the function of a genogram.DIF: Cognitive Level: Analyze (Analysis)REF: page 19TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

Which family situation should the nurse assess as warranting a referral for family therapy? a. A couple is 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 is 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 is having difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope." The family in option C is the only family system clearly expressing an unmanageable degree of stress. The other systems may be undergoing stress but have not expressed distress.REF: 622

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 using which term? a. Placating b. Distracting c. Generalizing d. Manipulating

c. Generalizing Generalization involves making global statements using "always" and "never" when dealing with problematic family issues. Generalization allows the speaker to avoid dealing with specific examples. None of the other options describes the provided conversation.REF: 624; Box 35-1

The family that consists of a married mother and father and three biological children all living together is referred to using which term? a. Blended family b. Cohabitating family c. Nuclear family d. Other family

c. Nuclear family A nuclear family consists of one or more children who live with married parents who are the biological or adoptive parents to all the children. Blended family refers to one or more children living with a biological or adoptive parent and an unrelated stepparent who are married to each other. Cohabitating family refers to one or more children living with a biological or adoptive parent and an unrelated adult who are cohabitating. "Other" refers to one or more children living with related or unrelated adults who are not biological or adoptive parents. This includes children living with grandparents and foster families.DIF: Cognitive Level: Remember (Knowledge)REF: page 4TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

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 Family stress is often the greatest at times of serious illness, death, or divorce. While the other options can produce levels of stress, none are as stressful as coping with a family member's chronic illness.REF: 627

The members of a family openly tell each other what they are thinking and feeling. A nurse listening to their interchanges would assess their communication using which term? a. Generalizing b. Double-bind c. Disengaged d. Healthy

d. Healthy Healthy communication is exemplified by being clear and direct in saying what you want and need. The other terms are used to describe some form of dysfunctional communication.REF: 623

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." Which nursing diagnosis should be given priority? a. Deficient knowledge b. Parental role conflict c. Defensive coping d. Relational problems

d. Relational problems This discourse concerns relational problems related to a mental disorder, a generic medical condition, or a sibling relational problem. No data suggests the other diagnoses.REF: 628; Box 35-3

A nurse works with a nuclear family that includes an adult child diagnosed with schizophrenia. The child's mother confides that she and her husband "have not been getting along well." She states that her teenage daughter provides much support to her and claims that "she doesn't really like her dad much anymore and doesn't talk to him." The nurse suspects that the family is experiencing which family dysfunctional dynamic? a. Emotional abuse b. Neglect c. Boundary blurring d. Triangulation

d. Triangulation Triangulation refers to a family "triangle" of three. When the tension in a dyad (two people) builds, a third person (child, friend, or parent) may be brought in by one of the members. This third person of the dyad serves to help lower the tension by solving the crisis or offering understanding. Family triangles may create emotional instability in the long run and are not optimal for dealing with problems in an open and direct way. There is nothing that indicates abuse. There is nothing to indicate neglect. Boundary blurring occurs when boundaries are diffuse, or unclear.DIF: Cognitive Level: Analyze (Analysis)REF: page 15TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity