Nursing Concepts Week 11
The nurse is teaching a 16-year-old unmarried client who has given birth. What is most important for the nurse to include when discussing care with the client and her extended family?
"Family members should become active in bonding with the infant" The nurse's instruction is that family members should become active in caring for, interacting with, and bonding with the infant. Children in adolescent families are at greater risk for health and social problems; however, this infant is currently a part of the mother's family. Parents in these families may be forced to stop their formal education and are more likely to be physically, developmentally, and financially unprepared to care for a child. The nurse understands this and encourages the extended family to provide support for the mother and infant in order to promote health. The nurse provides culturally competent care that includes promoting family competence and health, and being nonjudgmental, regardless of the type of family the client has. Integrating a new infant into any family comes with stressors. A family that is resilient can adapt and transform in response to stress.
The nurse is explaining how a family ecomap diagrams the family's relationships and interactions with the social networks in the community. Which statement by a family member indicates that further teaching is required?
**"The nurse will prepare the ecomap by observing our family in a social setting." The family ecomap reveals the individual family member's perceptions about their relationships with the family unit and other significant individuals and groups in their lives. The family members must give that information.
A 6-year-old client comes to the clinic for a wellness visit and the nurse gives the child a coloring book about fluoride. Which preventable health problem is the nurse most concerned about for this client?
**Dental caries Many diseases and negative health problems are preventable or minimized through lifestyle modifications. Use of fluoride has been shown to reduce dental decay, one of America's most prevalent health problems. Fluoride is used in the water supply, in toothpaste, as a supplement or it can be applied topically. There is a connection between oral health and heart health, but it probably would not be made with a normally well child client. Allergies are not prevented by the use of fluoride. Head lice are preventable by avoiding contact with someone or something already infected.
The nurse is performing a wellness assessment for a family with school-age children. Which assessment is important to identify the factors that contribute to the health of the family? (Select all that apply.)
**Family members who are in good health **How family members interact with one another **Neighborhood in which the family lives **How well the children are doing in school Assessment of a family's wellness considers the physical, social, emotional, spiritual, occupational, and intellectual well-being of family members individually and the unit as a whole. How children are developing intellectually, where the family lives, which family members are at risk for poor health outcomes, and the support the family members show for one another all impact on the well-being of the unit. The nurse empowers the family to set its own goals for family health.
The nurse is choosing multifaceted family assessment tools to use with a family composed of a newly married couple. Which assessment tool does the nurse discard as not applicable to thisfamily?
**HOME Inventory The HOME Inventory is designed to measure quality and quantity of stimulation and support in the home environment for ages birth to 15 years. It would not be used for a family of adults with no children. The Family Ecomap diagrams family interactions with each other and with the community. The Family APGAR assesses adaptability, partnership, growth, affection, and resolve within the family. The Friedman Family Assessment Tool examines the family in the larger context of the community in which the family lives.
Which outcome indicates that a client family may need additional assistance to achieve and maintain their health goals?
**The adolescent children have completed the agreed-upon chores once in a 4-week time period. Family health promotion enlists the support of all family members. The lifestyle choices of one family member affect the health and function of the family unit. Family noncooperation even in small things, such as agreed-upon chores of the children not being completed, will affect the emotional bond. Doing things together, such as preparing meals at home, selecting a family pet, and completing a Lamaze class, relieves stress and demonstrates cooperation so that the family can cope with larger issues successfully.
A new client brings her 3-year-old son to the community clinic for a measles-mumps-rubella (MMR) vaccination because without it he will not be allowed to enroll in a local daycare facility. The nurse sees an opportunity to provide this client with which health-promoting education?
**The importance of having all family members up to date on their immunizations A 3-year-old child should already have received the MMR immunization; this is a prime time to assess the family's vaccination history and provide education on the benefits of vaccinations as a primary tool in preventing illness and maintaining health. Some adults in the family may also need immunizations, such as flu vaccines or vaccines that they did not receive when they were young. The nurse can provide information regarding physicians and criteria for a good daycare facility, but this isn't the priority. Young children dislike the discomfort of injections; therefore, their cooperation is usually minimal.
Which description best depicts a binuclear family?
A family where there is co-parenting with children sharing time between families
The nurse is caring for a pediatric client with diabetes. The client's parents do not speak English. While incorporating elements of family-centered care into the plan for this client and the family, how can the nurse best teach them about home care?
A hospital translator should be used Language barriers prevent therapeutic communication. It is not uncommon for children to be asked to interpret for the family; however, this practice exposes them to information they may not understand or know how to communicate. The preferred method for teaching home care is the hospital translator. Information written in English would not be useful for these parents.
The nurse is caring for a 10-year-old client with diabetes. The parents of the client do not speak English. How should the nurse best teach the client and family about home care?
An agency translator should be used. Language barriers prevent therapeutic communication that is necessary to providing culturally competent care. It is not uncommon for children to be asked to interpret for the family; however, this exposes them to information they may not understand or know how to communicate. The preferred method for teaching home care is the hospital/agency translator. Information written in the family's language might be useful, after verbal instruction is given.
Barry Fitch is a 14-year-old boy with a right leg fracture. He plays football and his parents express concern about when he'll be able to return to the sport. Barry is found to be hypertensive and his BMI is 30.The provider starts Barry on an antihypertensive medication. Which action by the nurse will be beneficial to the family unit?
Answering any questions the parents may have about their child's illnes Answering parents' questions; emphasizing the importance of healthy eating andexercise; and teaching about stress management are all clinical therapies for the family. Giving medical advice to the parents and suggesting a second opinion are outside the nurse's scope of practice.
The nurse is caring for 6-year-old Justin Sennet, who has come to the clinic for a physical. His father is impatient and speaks sharply to the child, who is walking around the examination room. The father mentions that his wife died 6 months ago. What is important for the nurse to include during this interview?
Assessing for signs of complicated grief The nurse's approach would be to assess how the family is coping with its loss in order to prevent abuse and trauma and promote family competence following this major family alteration. The nurse would assess for signs of complicated or traumatic grief and family violence. It could be appropriate to provide information about therapy and support groups, teach about healthy coping strategies, and facilitate referrals to counselors and other professional resources. Parenting style, emotional availability, family communication patterns, discipline, and limit setting are factors that impact family development; these are at play in this parent-child interaction, and would be noted in the nurse's assessment.
The nurse is caring for a 7-year-old child diagnosed with type 1 diabetes. The client is the only child in a two-parent nuclear family. The parents of this client would most likely be working on which developmental tasks in the family life cycle? (Select all that apply.)
Being involved in child's sports, school, or clubs Managing increased time commitments The parents of a 7-year-old child would be working through Stage IV (family with school-age children). Developmental tasks at this stage of family development are facilitating peer relations, and maintaining family dynamics while adjusting to outside influences. At this stage of family development, parents are involved with school-related activities, sports, and clubs, and managing external influences of friends. Learning to manage parenting tasks and responsibilities occurs in Stage II (childbearing). Looking to retirement occurs in Stage VII (middle-aged parents).
Callie Washington is a newly divorced mother who relocated to the town where her parents live. She was able to find a job working the night shift. At a wellness visit for her 4-year-old daughter, Callie asks the nurse about daycare providers in the area who provide services at night. Which is the best intervention for the nurse to offer to this family?
Commend the client for being willing to make hard sacrifices in order to be financially independent. Single-parent families with young children are at risk for health alterations because these families often live in poverty. The nurse can support and encourage the strength evidenced by the desire to be financially self-sufficient, while keeping in mind the goal of family wellness. The nurse helps the family head to explore additional resources available to her, using questions to direct her thinking rather than providing answers to difficult problems. Some social services resources, as well as community support groups, may be available. The nurse may encourage discussion about the possibility of the family supplying nighttime child care, which would ensure that her child is in a safe environment while the parent is at work.
Gemma Frank is a 30-year-old woman who has recently started hemodialysis treatments. Her boyfriend and their 6-year-old daughter are very supportive. She has been able to keep her job as a CPA because the office will work with her schedule. Which intervention will the nurse implement to help this family prevent impaired coping?
Connecting the family with appropriate supportive resources, including counselors and sources of financial assistance Connecting the family with appropriate supportive resources, including counselors and sources of financial assistance, can help prevent ineffective coping. Advising the family about the challenges ahead is also helpful. It is important to incorporate culturally important customs into the client's care. Talking about the illness as a family should not be avoided, as it can be extremely beneficial.
A client is diagnosed with diabetes mellitus. He has been in the hospital several times since the diagnosis 2 years ago. His wife tells the nurse that she is exhausted, and that they have both gained weight and withdrawn from social activities since his diagnosis. Which of the following are appropriate nursing actions? (Select all that apply.)
Educating the client and family about healthy eating habits Providing resources for family counseling Teaching the client and family about healthy forms of stress management Discussing with the client and family the benefits of exercise for stress relief and health Teaching families about stress management; giving resources for family counseling; and discussing healthy eating habits and the benefits of exercise are all appropriate interventions. It is not appropriate for the nurse to promote a specific product or service.
The nurse is doing an assessment addressing the interaction of members of the family. Which level of family cohesion describes a family where family members cannot develop a separateidentity?
Enmeshed
Six-year-old Celine Toussaint has been diagnosed with sickle cell disease. She comes to the clinic with her grandparents and parents for follow-up care. In the assessment interview, the parents mention that they are both looking for work. Which nursing intervention would be appropriate for this family?
Facilitate connections with community resources This family is at risk because of stressors related to serious illness and financial issues. The appropriate nursing intervention would be to facilitate connections with community resources that could address the family's immediate needs for employment. Intergenerational family support may be a major strength of thisfamily, which the nurse would encourage. Family ecomaps and genograms are tools that nurses use in their assessments, not nursing interventions.
A nurse is caring for a 5-year-old client from an intergenerational family with 75-year-old grandparents who have provided care since the parents went to prison. Which factor, affecting the families' ability to cope with a young child, should the nurse consider when planning care?
Family concerns that focus on maintaining functioning In order to plan care for the client, the nurse must understand the implications of care giving for the aging grandparents. As well as caring for a young child from a Stage II or IV family, the grandparents are in a Stage VIII family. Among the grandparents' concerns is maintaining function during the aging process, especially since they are caring for a young child. The plan of care must include interventions that comprehensively address family needs. Family role assignment, decision making, and procedures the child will undergo do not directly affect the family's ability to cope.
A family comes to the hospital for the father's preoperative visit. The nurse notes that the mother and children let the father answer all questions posed to family members. What should the nurse consider as she prepares the plan of care for this family?
Family has rigid flexibility The deferral of all family members to the father may indicate rigid family flexibility. A family with rigid flexibility demonstrates very low flexibility for change in the family's leadership, relationships, and rules. Low flexibility may impair the family's resiliency; its ability to respond productively to stress through adaptation and change during the father's illness and recovery. Family communication in high functioning families demonstrates self-disclosure in their communication patterns, where family members share personal feelings about themselves and others. Families with diffuse boundaries demonstrate very open contact with each other and outside systems. The nurse does not observe those behaviors in this family.
Which statement about family health promotion is an incorrect description?
Family health promotion principles are designed primarily to guide families who are raising young children.
Which factors place the family system at risk of alterations in function? (Select all that apply.)
Family member quitting job Medical bills Physical or mental illness in a family member Caregiver strain
The nurse has arranged a HOME Inventory with a client's family that includes small children. How should the nurse administer the HOME Inventory? (Select all that apply.)
Family members are encouraged to act normally during the interview and observation. The parent should be interviewed in a quiet place free from distractions. The Inventory should take about 45 dash -90 minutes. The atmosphere should be relaxed and informal. Responsiveness of the parent to the child is observed. The HOME Inventory assesses the home environment of families with children of all ages. The nurse observes parental responsiveness and acceptance, home learning environment, and physical environment of the home. The atmosphere must be relaxed and informal so that family members can act in their normal way. Since the objective is to observe interaction of parent and child, the parent is not separated from the child for an interview.
The nurse is planning discharge care for a 10-year-old child with an asthma exacerbation. Which roles in the binuclear family unit of the child should the nurse identify before teaching canbegin? (Select all that apply.)
Financial decision maker for the child Legal guardian of the child Medical decision maker for the child Family members take on different roles within the family. The decision maker in the family may not be the primary provider or caregiver, or the working parent. The nurse must identify thelegal, medical, and financial decision maker for each family when planning care for a child.
The nurse is caring for a 5-year-old client diagnosed with cancer. Which factors affecting a family's ability to cope should the nurse consider when planning care (Select all that apply.)
Financial resources of the family Strength of the family structure Ability to seek services A child's illness or hospitalization can create stressful events for the child and family. The family's ability to cope depends on the strength of the family structure, its ability to successfully seekservices, its support system, and available resources. The country of origin of the family does not directly affect the ability to cope with a child's illness. The number of dependents living at home and family size do not directly affect the family's ability to cope with a child's illness.
The nurse is caring for a 32-year-old client, a partner in a gay marriage, who has just given birth. What does the nurse understand about this family that will affect the plan of care?
Frustrations about infant care are normal. As part of the nursing interventions, the nurse will facilitate the integration of the infant by helping these parents recognize that frustrations about infant care are normal, and encouraging bonding with and care for the infant by both parents. Homosexual adults form gay and lesbian families with goals of caring and commitment, the same as heterosexual couples do. Children in gay and lesbian families have been found to have the same advantages and expectations for development, adjustment and health as children in heterosexual families. Gay and lesbian parents can effectively provide supportive and healthy environments for their children. All families have coping strategies that help them deal with stress and change, which should be encouraged.
The nurse has been assessing a family that includes young parents and their three children. The mother has dark circles around her eyes, looks disheveled, and appears tired. Which intervention by the nurse would be appropriate for this family?
Giving a referral to appropriate community resources and/or counseling Family health and wellness is a collaborative effort, and this family is in need of assistance, which is a priority. The nurse can call on support from social workers, counselors, specialists, and whatever potential resources meet the client's needs. A therapeutic relationship with the family is one characterized by empathy and trust, and will develop as the nurse interviews and provides appropriate referrals for the young family. The nurse always offers wellness-promoting options without judgment. The Friedman Family Assessment Tool would be used in the home at a later date.
The home health nurse makes a visit to the apartment of 66-year-old Carla Morris, a client with rheumatoid arthritis who is recently widowed. Carla remarks that since her husband died, she is not motivated to cook nutritious meals that only she will eat. The nurse would ask Carla whether she is keeping her appointments with which healthcare provider?
Grief counselor Families with older adults are at the developmental stage at which the death of a spouse is common. They often need assistance to deal with their grief, which can lead to depression. Poor nutrition and lack of exercise can result from the underlying problem of depression; the client is not motivated to do what they may already know. The family consisting of older adults needs coping mechanisms to adjust to aging, living alone, and the chronic illness that aging often brings. Even when physical ailments are treated, a family's wellness is at risk if the client's emotional, social, spiritual, and intellectual health is not addressed.
The nurse is caring for a 3-year-old client. The client and the family are immigrants. When assessing the client, the nurse finds that the child has not had immunizations. Which is the best action of the nurse?
Identify reasons and beliefs that may be preventing immunization The nurse should first assess why the parents have not had the child immunized, which could include the family's cultural practices. The nurse must ensure that immigrant families or clients with views that differ from those of the mainstream culture are aware of the rules and laws governing the care and protection of children against preventable diseases. The first step is to identify why the child has not been immunized; then the family can be educated to promote immunization. Immunizations are given only when parents consent to vaccinations. The nurse cannot administer vaccinations without permission. By respecting the parents' decision without investigating the reasons they have chosen not to vaccinate their child is not appropriate to providing holistic care.
The nurse is caring for a preschool-age client and family who are immigrants. When assessing the client, the nurse finds that the child has not had immunizations. As the nurse is incorporating family-centered care into her practice, what is the initial action?
Identifying beliefs that are preventing the child from receiving immunizations Cultural practices detrimental to a child's growth and development, safety, or basic needs must be addressed first. The nurse must ensure that immigrant families or clients with views that differ from those of the mainstream culture are aware of the rules and laws governing the care and protection of children in the United States. The first step is to identify the reason the child has not been immunized. Doing so will assist the nurse in planning and delivering further education to promote immunization. Immunizations are given only when parents consent to vaccinations. The nurse cannot administer vaccinations without permission. By respecting the parents' decision without investigating the reasons they have chosen not to vaccinate theirchild, the nurse is not providing holistic care.
The nurse is caring for a client with an exacerbation of multiple sclerosis. Her husband confides that the stress of caring for her, in addition to their small children, has caused him to start smoking again after having quit many years ago. Knowing which information will alert the nurse to enhance the husband's coping skills?
Inadequate coping function can lead to unhealthy choices and increase the risk of premature mortality in caregivers. The high stress associated with a family member's illness can lead to health problems and early mortality for the caregiver, especially if he chooses unhealthy habits. Though the cost of cigarettes is not inconsiderable and the client may be distressed by his smoking, these are not the most important considerations for this family. The nurse, while compassionate in regard to the family's stress, should not encourage smoking as a stress reliever.
The nurse has been assessing the parents and small children of a family who are all moderately overweight. Which is the nurse's goal when promoting wellness in this client family?
Monitor the goals of the family to ensure that they are reasonable and attainable. Empower the client to improve the health of the family now and reduce the risk of disease later. Your answer is correct. Identify the problem behaviors and unhealthy lifestyle habits of individuals in the family. Promote the use of all available community healthcare resources. The nurse educates clients about how to increase healthy behaviors and make appropriate lifestyle changes where they are needed. This empowers the client to make decisions to improve personal health and the health of the family unit. Client goals are unique and personal and are determined by the client, not the nurse. Although the nurse educates the client about available healthcare resources, it is the client's decision whether or not to take those suggestions. Identifying problem areas is one step in promoting wellness in a family, but it is not the goal.
During a health history interview with a family, the nurse is concerned that a 12-year-old client is experiencing signs of grief reaction. What information from the family would cause the nurse to suspect this condition?
Nurse observes a family alteration. An alteration in the family, loss of a family member because of death or divorce, could result in a grief reaction, which could manifest in the interview as depression, anger, or anxiety. Communication patterns that include family members listening, speaking, self-disclosing, and tracking, and family flexibility are characteristic of high functioning families. Grief may manifest in weight loss, headaches, sleeplessness and other symptoms, but the nurse would observe that after the health history interview, during the physical examination of family members that would follow.
For the family of a client with severe mental illness, family burden is the overall level of distress experienced. If a client is acting out by arguing excessively, displaying inappropriate sexualbehavior, or causing damage to the property of others, this is an example of which type of distress?
Objective family burden Objective family burden is related to symptomatic behaviors of the client; providing care for the client; and dealing with the social stigma of mental illness. Subjective family burden is defined as the psychological distress of the family members in relation to the objective burden. Stigma involves the negative attitudes and belief that lead people to fear, reject, avoid, and discriminate against people with mental illness. Being a caregiver is a role that the family may have to assume when caring for a client with severe mental illness. This is not a type of distress.
Which risk factor for developing health problems may be experienced by an individual or a family? (Select all that apply.)
Poverty Family history of disease Dangerous neighborhood Stressful job
The nurse is caring for a 10-year-old client diagnosed with diabetes mellitus. Which assessment findings for this client and family members are teaching opportunities for the nurse? (Select all that apply.)
Poverty-related stress Family members with BMI above 30 A family with a history of diabetes, body mass indices above 30 (indicates obesity), that is experiencing poverty-related stress needs education from the nurse about nutrition and its relationship to disease, as well as referrals to community resources that may be able to assist the family with needed food, medical care, and financial assistance. Parental structuring, an aspect of emotional availability, is the ability of parents to support the child's learning and inquiries without overwhelming the child's autonomy. A genogram is a map of gender, showing lines of descent through the generations of a family.
Seven-year-old Jermaine Cast has a serious, but not life-threatening, illness. He will need to be kept home from school for a 2-month course of treatment. His parents both work and neither parent has a lot of vacation time. What is the most important information the nurse can give the parents?
Provide information regarding Family and Medical Leave Act Nurses should educate the parents about the Family and Medical Leave Act of1993, so each could take time without pay to be able to be home with the child after they have exhausted their vacation or sick time. It is always helpful to discuss coping strategies with parents under stress, but it is not the most important information the nurse could offer in this situation. Day care is an appropriate place for preschool-age children while their parents are at work, but is not usually equipped to take care of a child with a serious health issue. Free clinics, or sliding fee clinics are helpful for many uninsured people but would not resolve a need for months of care for a sick child, nor is there evidence that this is an issue for this family.
The nurse is planning care of a 10-year-old child with an asthma exacerbation whose parents are currently unemployed. Which interventions are the best for the nurse to pursue for thisfamily? (Select all that apply.)
Referral to social services experts Referral to community wellness clinics Reassuring the family of the potential benefits of pursuing the nurse's collaborative interventions Nurses often need to collaborate with other professionals to help clients regain or maintain health. The nurse's collaborators may include social services experts, community free wellness clinics, food banks, and other community organizations that can meet the family's needs. The nurse teaches the family the value of these resources to their child's and family's health and encourages them to follow through on securing support. Identification of areas of knowledge deficiency in cultural competence and avoiding assumptions or judgments about clients are part of the nurse's own professional development and practice, not a nursing intervention for a client.
The nurse is caring for a man with polycystic kidney disease who will begin peritoneal dialysis the following week. The nurse will implement which of the following actions as part of the nursing care plan to prevent impaired family function? (Select all that apply.)
Referring the client and his partner to an insurance specialist to discuss their plan and his coverage Scheduling a family conference to evaluate the client's home and readiness of his partner to help with dialysis Giving the client and his partner information about a local dialysis support group that meets every month Educating the client and his partner about the pros and cons of this modality of treatment and the potential challenges they will face The nurse can enhance family coping by advising family members of upcoming challenges; educating them about treatments and resources; and apprising them of community and financial sources of help. Encouraging them to enlist family support is beneficial.
When developing a family plan of care for a pediatric client with a chronic health condition, which areas require an in-depth assessment of all family members? (Select all that apply.)
Religious preferences Culture and social practices Socioeconomic status A family plan of care requires in-depth assessment of all family members, including their health history, socioeconomic status, religion, culture, nutrition, and social habits and practices. Medication schedules and education/intelligence levels do not need to be assessed unless the nurse becomes aware of a problem in this area.
The nurse learns that a client with school-age children is also her mother's caregiver. The client tells the nurse, cannot meet everyone's demands anymore. Which is the most appropriate diagnosis for this client?
Sandwich generation syndrome Adjusting to outside influences Risk for situational low self-esteem Your answer is correct. Readjustment of marital relationship A nurse who is assessing an adult family member who cares for both her own children and an aging parent may diagnose any one of several conditions including, but not limited to, ineffective self-health management, interrupted family processes, compromised family coping, or risk for situational low self-esteem. Adults in this group are known as open double quote "The Sandwich Generation, close double quote " which is not a nursing diagnosis. Families in Stage IV of the family life cycle must adjust to outside influences as children start school. Spouses in Stage VI of the family life cycle readjust their marital relationship as the family launches young adults.
Which are factors that shape family development? (Select all that apply.)
Sibling relationships Resiliency Boundaries Parenting style
The family of a client diagnosed with schizophrenia shows the nurse some information they have obtained from the Internet and asks whether there are any local support groups they can attend. They also have a list of questions to ask the provider about the client's diagnosis. The nurse realizes that this family is in which stage of family response (family recovery)?
Stage 2—recognition and acceptance Stage 1 is when family members may notice the individual's erratic behavior and often deny that anything is wrong. In Stage 2, families begin searching for information and accept the diagnosis. Stage 3 describes how families learn coping strategies and become competent in providing care for the client. The final stage is one of personal and political advocacy.
A 51-year-old client has recently found work after being laid off for 5 months. He and his wife had been making good progress with smoking cessation but he has regressed. He requests a referral to a smoking cessation clinic. Which other health promotion suggestion might the nurse make? (Select all that apply.)
Starting a plan of moderate exercise Using relaxation techniques Eating a healthier diet For a family with middle-age adults who are in the process of planning for retirement, losing a job can be a major cause of stress. Moderate exercise, healthy eating, and relaxation techniques can help manage stress. Each individual who is making beneficial health changes is different and may need a form of care different from that of another family member. The client is already striving to quit smoking and has a job. There is no evidence the job is stressful.
The father of an adolescent client diagnosed with severe mental illness confides in the nurse that he is stressed and frustrated. The father is having difficulty managing the consequences of his son's behavior as he has broken into neighbors' homes and stolen items, and recently wrecked the family car. The father also tells the nurse that he is ashamed of his son's behavior because the family's friends are not inviting them to visit and seem to be avoiding them. Based on the father's statements, which issues are being experienced by this family? (Select all that apply.)
Stigmatization objective family burden subjective family burden Objective family burden describes family problems as a result of the mental illness, such as the client's acting out and causing damage to property and other symptomatic behavior. Stigmatization refers to the collection of negative beliefs and reactions of others that lead them to discriminate against someone with mental illness. Subjective family burden is defined as the psychological distress of the family in response to the objective burden. Family recovery and friend support are not related to this assessment.
The nurse is caring for a young client with severe mental illness. The mother of the client confides that she is overwhelmed with frustration and hopelessness. She states that her daughter was a straight-A student before she started 'acting out' prior to her diagnosis. She states, She probably won't be able to finish medical school now. I don't know what she'll do. The nurse realizes that the mother is exhibiting which type of distress?
Subjective family burden Subjective family burden describes the psychological distress of the family members in relation to the objective burden. They experience anxiety, frustration, and hopelessness as they mourn the loss of their dreams and expectations of the individual who is mentally ill. Stigma and family recovery describe different processes.
Which actions help prevent family unit alterations in the presence of physical or mental illness? (Select all that apply.)
Talking about the illness as a family Going to family counseling Accepting the illness
The family of a client with a genetic disorder initiates an online support group for families of other individuals with this syndrome. They show the nurse their website and ask for feedback. Based on the family's behaviors, which conclusion by the nurse is the most appropriate?
The family is in the final stage of family recovery The final stage of family recovery is personal and political advocacy, which may include educating others about a specific illness. This family is not exhibiting signs of subjective family burden or being stigmatized. They have moved past Stage 1 of family recovery, which describes discovery and denial.
Three generations of the Cho family live together. When they complete their Family APGAR questionnaires, the nurse notes that the response of each individual is very different from those of the other family members. How may this information be interpreted by the nurse?
The family may need more support to cope with the demands of daily life, family function, and their health maintenance needs. The Family APGAR helps to measure family adaptability, partnership, growth, affection, and resolve. It can identify where the family needs help and also where the family is strong. Widely varying answers among family members could indicate a lack of cohesiveness in the family that warrants more help to deal with the demands of everyday life. Lack of family function affects the health of individuals in the family and the family unit as a whole. The family members complete the questionnaire independently without discussion. The form is simple and careful instructions are provided. The family should have some commonality in their answers if functioning appropriately.
Which factors affect a family's ability to manage the stress of an individual's illness? (Select all that apply).
The family's ability to be flexible The family's coping skills The family's communication skills The family's support system
The nurse is caring for a client with Guillain-Barré syndrome. She is on a ventilator; and though she is expected to make a full recovery, the provider has told the family that it will take some time. One evening, the client's husband comes to visit; he smells strongly of alcohol and he is slurring his words. Which conclusion by the nurse explains the husband's actions?
The high stress and inadequate coping function of the husband may have led him to unhealthy choices Caregiver stress is related to health problems for caregivers and can cause them to make such unhealthy choices as smoking and alcohol use. The nurse cannot reasonably deduce that the husband is not supportive; that the client's medical bills are causing stress; or that the husband is an alcoholic without further information.
The nurse is taking care of a 10-year-old client receiving chemotherapy who is experiencing nausea that is distressing the client and parents. Which intervention would be most appropriate in implementing a family- centered plan of care?
The nurse will teach distraction techniques to decrease symptoms. Interventions are selected because they are related to a specific goal that is shared by the family and healthcare team. All of the interventions mentioned can be effectively used with the client receiving chemotherapy; however, only one intervention (teaching distraction) addresses the goal of decreasing symptoms of nausea.
Tom Quincy is a 45-year-old man who recently suffered a stroke. He has marked left-side weakness. He works as a forklift operator and has a wife and two small children. When talking with Mr. Quincy and his wife, the nurse knows that which factor is most likely to cause impaired functioning of the family system?
The residual effects of Mr. Quincy's illness The residual effects of an illness help to determine the impact on the family unit. The long-term effects of the client's stroke are the most likely to impair the family's functioning. An extended social support system, the family's religious beliefs, and insurance that covers 100% of medical bills are positive factors and will not negatively impact the family system.
Which are clinical manifestations of impaired coping in the family system? (Select all that apply.)
Unhealthy lifestyle choices, smoking or substance abuse Changes in weight, gain or loss Withdrawal from social activities Depression or anxiety
A supervisor has asked a nurse to train new nursing staff in culturally competent care. Which information would the nurse include in the training? (Select all that apply.)
Variations in family structure Communication skills Cultures served by the nursing staff The nurse would include information about the cultures served locally by the healthcare organization, variations in family structure that nurses may encounter, and communications skills. In the training, the nurse would teach avoidance of judgments and assumptions, such as why nuclear families are superior to other family structures. The topic of why fathers and mothers should both participate in healthcare visits would be more appropriate for an educational program about facilitating the transition to parenthood.
You are conducting an assessment to create a family plan of care for 8-year-old Timothy Lopez. Which question is least appropriate for the nurse to ask his grandmother to help with developing your plan?
What medical treatments are they interested in? Asking what medical treatments interest the family is not a question that would provide information that could be incorporated in a family plan of care. Health beliefs of clients may include folklore and practices from different cultures. A family plan of care requires in-depth assessment of the immediate and extended family, as well as review and consideration of the following factors: health history, socioeconomic status, religion, culture, nutrition, and social habits and practices.
The nurse is conducting the assessment phase of the nursing process to create a family plan of care for 6-year-old Timothy Rodriguez. Which question is inappropriate to ask the parents when developing the plan of care?
Which medical treatments interest them Asking which medical treatments interest the parents is not a question that would provide information that could be incorporated in a family plan of care. A family plan of care requires in-depth assessment of the immediate and extended family, as well as review and consideration of the following factors: health history, socioeconomic status, religion, culture, nutrition, and social habits and practices.
The nurse is doing a focused assessment on a client with family health needs. Which is the most important assessment for the nurse to include in this initial visit? (Select all that apply.)
Work history Work function Positive lifestyle behaviors Aside from a client's physical health, family health depends on individual and family home environment, work environment, lifestyle choices, emotional health, and personal social relationships. Some work and living conditions create stress that the nurse can help the family address. Good health behaviors are encouraged, while the client is given education to eliminate or minimize risk from damaging health behaviors. The lack of family friends would be explored, but is not an essential part of the initial assessment for family health issues.
The parents of a school-age child are informed that the child has type 1 diabetes mellitus. The nurse knows which interventions may help to prevent impaired family coping? (Select all that apply.)
Working with a family counselor . Talking about the illness together as a family Teaching the family about challenges early in the process Learning about community resources and sources of financial assistance Successful coping can be achieved by the family's learning about challenges early in the process; talking together about the child's illness; working with a counselor; and learning about resources and financial assistance as indicated. Asking the provider to prescribe medications to the parents is not an appropriate nursing action.
Which resources can be most helpful to the nurse who is providing education to a group of clients about healthy lifestyle behaviors? (Select all that apply.)
a Nutritionists b Mental health specialists c Physicians d Educational programs (The nurse can draw on the nutritionist to teach healthy eating habits. Mental health workers can provide coping and stress reduction techniques. Physicians may refer a client or be involved in educating a client about healthy lifestyles. Educational programs can provide a structured environment for learning lifestyle changes. Ministers of faith may be important, but they are not part of healthy lifestyle behaviors.)
Which initial assessment data does the nurse collect to help identify a client's actual and potential health alterations?
d Psychosocial history with a physical examination (The individual and family psychosocial history along with physical examination is the initial step in assessing individual and family health. It may include, among other things, data on work history, family health history, history of emotional or mental imbalance, positive and negative lifestyle choices that impact health and disease prevention, current vital signs, and current physical symptoms or disorders. The other assessment tools are supplementary and may be used over time as a trusting relationship is built with the family.)
The nurse is providing an assessment of a family to determine a need for interventions. Which description is an indication of high functioning family communication?
Self-disclosure
The nurse is taking a family health history from a 24-year-old eastern European male client. The nurse will be alert to a health history that includes which race-specific genetically transmitteddisorder?
Tay-Sachs disease Some families have a history of certain diseases, and members of that family may be at risk because of gender and/or race. Tay-Sachs is a disease that occurs primarily in persons with an eastern European heritage. Sickle cell disease occurs primarily in persons with an African, South American, or Caribbean heritage. Osteoporosis occurs most frequently in women. Males are at risk for developing cardiovascular disease earlier than women, but the disease is not race-specific.
