NU309 PrepU Chapter 3

Blended family or Stepfamily

A remarried family with a child under 18 years of age who is the biological child of one of the parents and was born before the remarriage

A nurse is preparing to assess a family that recently went through a divorce. The family now consists of a 40-year-old female, her 16-year-old son, and 5-year-old daughter. The mother will continue as the primary wage earner with her current employment and has full custody of the children. Which action should the nurse prioritize with this family? A. Assess the son for emotional trauma. B. Assess the daughter for emotional trauma. C. Educate the mother on community supports. D. Educate the mother on the risks of intimate partner violence.

A. Assess the son for emotional trauma.

The nurse is completing a family history. The nurse decides to begin with the assessment of the family of orientation and then progress to an assessment of the family of procreation. When moving to the assessment of the family of procreation, what question will the nurse ask? A. Do you have a significant other or any children? B. Can you tell me about your stepmother's health? C. How many full siblings are in the family unit? D. Is your stepbrother from your father's previous marriage?

A. Do you have a significant other or any children? (The nurse is beginning with questions related to the family of orientation. These include questions related to the family the client was born into. Questions relating to the client, parents, and siblings are appropriate to complete the information. Questions related to stepparents and stepsiblings are related to family structure. They are members of a blended family structure. When the nurse begins questioning about the family of procreation, the nurse would include questions related to the client's spouse or significant other and any children.)

A 16-year-old adolescent whose weight is classified as obese is about to be discharged. The adolescent tells the nurse that they do not liking being obese and that the kids at school make fun of them. What is the most important thing the nurse should encourage the adolescent to do to lose weight? A. Exercise for 30 minutes each day. B. Decrease the amount of sugar in the diet by one-half. C. Allow your parents to be supportive throughout the process. D. Get an after-school job that you enjoy.

A. Exercise for 30 minutes each day. (The nurse will encourage the adolescent to perform regular daily exercise. The exercise can start off by walking for 30 minutes then increase to include more strenuous exercises such as jumping rope, running, or cycling. The plan needs to be easy to complete and allow for flexibility. The hope is that, once a specific routine is established, the adolescent will make a lifestyle change. Reducing sugar is also very important in the diet but other factors such as portion size and caloric intake also are important components of weight loss. Support is important in the weight-loss journey. Peers are very important to an adolescent because they spend a good deal of time with their peers. An after-school job is helpful for self-esteem and independence, which is a developmental task of adolescence, but working a job is not related specifically to weight loss.)

A 4-year-old adopted child has begun to ask questions about when she was born. Which suggestions by the clinic nurse would be considered the most appropriate answer for this child related to her birth? Select all that apply. A. Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. B. Tell the child that her biological mom could not care for her after birth because she was HIV positive. C. Inform the child that her biological mom was in prison and would not be able to care for her for a long time. D. Explain that her biological mom could not care for her so she was given away. E. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them.

A. Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. E. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them. (At least by 4 years, children are old enough to fully understand the story of their adoption: they grew inside the body of another woman who, because she could not care for them after they were born, gave them to the adopting parents to raise and love. It is important for parents not to criticize a birth mother as part of the explanation because children need to know, for their own self-esteem, that their birth parents were good people and they were capable of being loved by them, but things just did not work out that way. At age 4, children do not understand HIV status, not being able to provide for the needs of an infant, or prison terms.)

The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based? A. The family is the constant in the child's life and the primary source of strength. B. The care provider is the constant in the child's life and the primary source of strength. C. The child must be prepared to be his or her own source of strength during times of crisis. D. The wishes of the family should direct the nursing care plan for the child.

A. The family is the constant in the child's life and the primary source of strength. (Family-centered care involves a partnership between the child, family, and health care providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own health care needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.)

A gay couple is considering adopting a newborn and they want to know the long-term outcomes for children in gay families. What is the best response by the nurse? A. Their psychological health is similar to children of heterosexual parents. B. Their social relationships are usually more strained. C. This type of adoption is not recommended for a newborn. D. There is lack of evidence on how this will impact the children.

A. Their psychological health is similar to children of heterosexual parents. (Research has shown that children of gay and lesbian parents do not differ from children of heterosexual parents in terms of psychological health and social relationships.)

A 7-year-old child with asthma has missed enough days of school to be considered truant. The school nurse does an assessment of the family and learns that one parent is in another city all week for work, the other parent leaves for work early each morning and returns home late in the evening, and the maternal grandparent takes care of the child. Which question(s) will be helpful in assessing the child's health needs? Select all that apply. A. Who is in charge of the child's asthma management? B. Who makes sure the child takes the medications every day? C. What kind of work does the parent in another city do? D. How old is the grandparent? E. Who is the primary contact person for the school nurse?

A. Who is in charge of the child's asthma management? B. Who makes sure the child takes the medications every day? E. Who is the primary contact person for the school nurse? (It is important for the nurse to determine who is managing the child's chronic disease (symptoms and medications) and who in the family is the contact person. Although the nurse may have general concerns about the grandparent's ability to properly care for the child, the goal would be to assess what the grandparent understands about the disease and treatment without making assumptions based solely on age. The occupations of the parents do not directly impact the child's health care needs.)

A 2-year-old child has been diagnosed with leukemia. The child has been admitted to the hospital for the initiation of treatment. The family appears overwhelmed with the new diagnosis, and describe themselves as being "in a state of shock." In working with the family, a plan of care is established around which priority? A. altered family coping related to new illness of the child B. altered family processes related to hospitalization of the child C. financial strain risk related to the cost of the child's treatment D. altered family function related to shifting dynamics and roles of family members

A. altered family coping related to new illness of the child (The nurse is correct to assess the family situation and select a priority to develop a plan of care. All of the options could be priorities at different times in the treatment process. Because it is known that the family is not coping well with this new diagnosis and hospitalization, that is the priority to develop a plan of care. All the other options imply situations that are potential consequences of this change in the family.)

A community health nurse who works with migrant workers instructs the group that their children are in danger of which of the following? Select all that apply. A. intestinal parasites B. low socioeconomic status C. lack of immunizations D. consistent health care E. easily accessible health care

A. intestinal parasites B. low socioeconomic status C. lack of immunizations (Families of immigrants or migrant farm workers can have difficulty finding consistent health care because of seasonal movement. Children from these families may also be at high risk for intestinal parasites, low socioeconomic status, and lack of immunizations.)

The nurse is counseling a family with two school-age children. The parents state, "What a difference I see in the kids developmentally especially since they are now going to school." Which area(s) will the nurse emphasize as a goal for the family? Select all that apply. A. routine health assessments to promote child health B. greater independence through loosening of ties C. socialization experiences through sports and hobbies D. safety through prevention of unintentional injuries E. meaningful school experience through focus on learning over a lifetime

A. routine health assessments to promote child health C. socialization experiences through sports and hobbies E. meaningful school experience through focus on learning over a lifetime (The nurse is correct to counsel parents on changes that they will see in their children and priority goals for the parents to work toward. For the family with a school-age child, goals focus on promoting child health through immunizations, dental care, and routine health assessments; promoting child safety related to home and automobiles; encouraging socialization experiences outside the home such as sports participation, music lessons, or hobbies; and encouraging a meaningful school experience to make learning a lifetime endeavor, not merely the 13 years (K to 12) a child attends school. Greater independence through loosening parental ties would be a goal for the family with an adolescent. Prevention of unintentional injuries would be a goal for the family with a preschool-age child.)

Family function

Activities and roles family members carry out

Define appropriate actions of the adolescent within the developmental stage of the age group

Appropriate for the teen to prefer spending time with friends over family. At this time, the family must now loosen ties to allow adolescents more freedom and prepare them for life on their own.

Important framework for the nurse to use when assessing the response of each child to the divorce

Assessing each child individually from the perspective of his or her developmental stage allows for the planning of interventions suitable to each child. Each of the other three frameworks addresses family dynamics rather than the specific needs of the children.

The nurse is preparing to do an altered family function risk assessment on a client. Which question should the nurse ask first? A. "What is the general sleep pattern in your family?" B. "What are the potential sources of stress in your family?" C. "Tell me about your family's eating habits?" D. "Are you able to cope with family health problems?" E. "How would each member describe this family?"

B. "What are the potential sources of stress in your family?" (History taking to identify areas of risk or potential problems requires both open-ended and focused questioning. Questions related to potential sources of stress in the areas of roles, finances, lifestyle, previous experience, and general health are crucial. Follow a general question, such as "What are the potential sources of stress in your family?", with more specific questions.)

The nurse is caring for a family of five which includes 2 parents, a 3-year-old, 9-year-old, and a 16-year-old. The parents state a concern that their 16-year-old is anxious to drive to be able to do activities more independently. Which goal does the nurse correctly state that the family needs to work toward at this time? A. preventing unintentional injuries B. providing freedom while promoting safety C. encouraging adult decision-making D. encouraging meaningful school activities

B. providing freedom while promoting safety (The nurse is most correct to focus on the area where the family has a concern. Because the firstborn encounters different developmental stages first, it is appropriate for teaching and goal development to focus on the primary concern and new developmental stage. In the adolescent, a primary goal is to loosen ties enough to allow them more freedom while still remaining safe. Preventing unintentional injuries is a goal in the preschool years. Encouraging adult decision-making is focused after 20 years old. Meaningful school activities are a goal of the school-aged years.)

While assessing a family to identify who will be responsible for the child's care, the nurse notes indications of altered family functioning. Which family statement(s) causes concern? Select all that apply. A. "You know I love you but I do not agree with the decision." B. "My teenage step-brother will be home until the babysitter arrives." C. "I have not spoken to that side of the family since Dad died." D. "I will not take my blood sugar every morning. I have to get ready for work." E. "This is the way we are used to running the house. I do not want to change."

C. "I have not spoken to that side of the family since Dad died." D. "I will not take my blood sugar every morning. I have to get ready for work." E. "This is the way we are used to running the house. I do not want to change." (Altered family functioning may be noted by an inability to express or accept emotions, a lack of respect or support for other family members, and an inability to adapt to change. In addition, members may verbalize feelings of inadequacy, guilt, anxiety, failure, helplessness, and powerlessness. Noncompliance with treatment may be a manifestation of denial or refusal to acknowledge a problem's existence. Stating that a person does not agree with a decision is common and expresses that individual's point of view. It may be appropriate for an adolescent to stay with a child until the babysitter arrives. Not speaking to family members, refusing to complete care, and not wanting to change are causes for concern.)

The nurse telephones the parent of three young children to see why they did not attend the scheduled appointment today. The parent answers the phone and states, "Oh my goodness, I just cannot keep everything straight." Which nursing suggestion may be helpful for this parent? A. Have appointments documented in a variety of places throughout the house. B. Have one person in the family be responsible to get the children to their appointments. C. Place a central bulletin board to enhance communication throughout the family. D. Allow family and friends to assist with the care of the children.

C. Place a central bulletin board to enhance communication throughout the family. (The nurse will suggest a bulletin board where all important dates and times are placed. This enhances communication and allows for a place to check daily activities. It also helps to decrease overscheduling by placing the day into manageable activities. Documenting in a variety of places can be confusing and allow for mistakes. Having one person maintain the schedule may be overwhelming for that person and may disrupt family communication. It is also stressful to be the one responsible for all appointments. It is nice to have family and friend support but organization is still needed.)

The nurse is providing discharge teaching for an 8-year-old child after admission with an asthma exacerbation. The child is accompanied by a parent who does not speak the dominant language. How will the nurse complete the discharge teaching? Select all that apply. A. Request that the family bring a friend who is bilingual to assist with discharge teaching interpretation. B. Focus on the interpreter during the conversation and allow them to fully convey any expression or emotion from the child and parent. C. Speak clearly using short sentences and provide pauses for interpretation and responses. D. Ask the client and family to provide return demonstration of inhaler use to ensure understanding. E. When providing written discharge or follow-up information, ask the interpreter to translate in the family's language.

C. Speak clearly using short sentences and provide pauses for interpretation and responses. D. Ask the client and family to provide return demonstration of inhaler use to ensure understanding. E. When providing written discharge or follow-up information, ask the interpreter to translate in the family's language. (The nurse should use a professional interpreter and not a family friend for all care and procedures. When working with the interpreter, the nurse should focus on the client/family, not the interpreter to see the client's expressions. The interpreter can also translate written materials for the family. Asking the family to provide a return demonstration will assess their understanding.)

A couple with infertility has decided to adopt an infant and receive a call several months later that an infant is available. The social worker gives them the history of the biological mom, a teenager who tried to conceal her pregnancy by dieting and taking laxatives. However, at 26 weeks' gestation, the teenager shared her pregnancy with the family and received prenatal care. Given this history, the couple should be counseled to observe the infant for which possible abnormality? A. potential eating disorder as a teenager B. excess swelling related to kidney problems C. abnormal neurologic development D. risk for autism following immunizations

C. abnormal neurologic development (If the birth mother of an adopted child ate inadequately or received little prenatal care, for example, the adopted child is at a higher than normal risk for abnormal neurologic development. The risk for development of kidney problems or eating disorders would be the same as any other child. There is no proof that immunizations cause autism. The risk for autism would be the same as any other child.)

Nuclear family

Consists of a married couple and their immediate biological children

Cohabitation family

Couple is not married

The nurse is completing a family assessment. Which is the best interview question to determine the type of family in which a pediatric client resides? A. "In which country or state are you originally from and do you visit family often?" B. "How do you split up the home duties between the members of your family?" C. "When you consider someone to be family, who do you include?" D. "How many family members reside in your home and what are their ages?"

D. "How many family members reside in your home and what are their ages?" (When assessing the type of family during an interview with the client, the nurse documents the ages and relationships of family members within the home. It is best to directly ask this question to obtain accurate information. Asking the country or state of origin and how often they see family members may provide information on cultural background and potential closeness of the family. Asking who is considered "family" expands to include people outside the home. Splitting up home duties may not include all members who reside in the home, such as an infant.)

Students are reviewing information about family structures and functions. They demonstrate understanding of the information when they identify which of the following as true? A. The functions of a family in each family are identical. B. Married couples in families with children have been increasing since the year 2000. C. The intergenerational family is the traditional U.S. family structure. D. Despite changes in family structure, the nuclear family is still prominent.

D. Despite changes in family structure, the nuclear family is still prominent. (In the 21st century, family structures are more varied than in the past. The small, traditional family unit known as the nuclear family remains prominent. The functions of each family differ but do exist to meet some common goals. From 1970 to 2007, married couples in families with children decreased from 93% to 71%. The traditional U.S. family structure is the nuclear family but other structures are common today.)

The nurse is preparing to discuss birthing options with a 25-year-old female who is in a low-risk pregnancy with one older child. Which option will be best for the nurse to recommend for this client? A. Home setting C. Birthing center D. Hospital E. Any birthing settings

E. Any birthing settings (When a woman is low-risk and has no known medical needs, birth location is the choice of the mother. Home births attended with certified nurse midwives are less likely to have complications and require interventions. Birthing centers are an option for an alternative birth setting, and hospitals are required birth locations for women with potential needs or complications. The nurse should present the advantages and disadvantages of each option and allow the client to make the decision.)

Secondary prevention

Early detection and treatment of adverse health conditions (page 58)

Family of procreation

Family one establishes

Family of orientation

Family one is born into

Communal family

Group of adults who live together to attain an ideological goal

Socialization of family members

Includes being certain that children feel part of the family and are learning appropriate ways to interact with people outside the family, such as teachers, neighbors, or police. The family has an open communication system among family members and community members.

Maintenance of order

Includes establishing family values, establishing rules about expected family responsibilities and roles, and enforcing common regulations for family members, such as using "time-out" for toddlers. Healthy families: members know the family rules and respect and follow them; Dysfunctional families: the nurse may see a flagrant disregard of rules.

Allocation of resources

Involves determining which family needs will be met and their order of priority, including material goods as well as affection and space. Healthy families: there is justification, consistency, and fairness in the distribution. In many families, resources are limited (e.g., no one has new shoes).

Problem-solving role

Is determined based on whom the family relies on to provide the solution to problems

The problem solver

Looking at problems and helping come to solutions.

Dyad family

Only two adults, without children

Family-centered care

Partnership between the child, family, and health care providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own health care needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.

Gatekeeper role

Person in the family who determines what information will be released from the family or what new information can be introduced

Primary prevention

Preventing a disease or condition before it occurs (Page 58)

Nurturer

Primary caregiver to children or others in the family with challenges

When working with the family of a school-age child, the nurse should focus the assessment on...

Promoting children's health through immunizations, dental care, and routine health assessments; Promoting child safety related to home and automobiles; Encouraging socialization experiences outside the home such as sports participation, music lessons, or hobbies; Encouraging a meaningful school experience to make learning a lifetime concern.

Tertiary prevention

Reduce or limit the progression of a disease or condition (Page 58)

Binuclear family

Refers to the familial structure of joint custody families

Extended family

Several generations of the family, including the immediate nuclear family, grandparents, and other relatives such as aunts, uncles, and cousins

The steps of client and family education

Similar to the steps of the nursing process: the nurse must assess, diagnosis, plan, implement, and evaluate. Part of the evaluation process is to document all actions taken and outcomes achieved.

Financial manager role

Supervises the family finances

Strengths considered to be part of living in a single-parent environment

The adolescent may be self-reliant and independent in completing needed care.

Which question is appropriate for the nurse to use when obtaining information about the family's structure and function?

The question about the primary decision-maker reflects the family structure and function

The 2 functions a family serves in relation to society

To reproduce and to socialize offspring

Family structure

Who its members are