Final topics - Concept of Family
The nurse has been asked to review a hospital's written policies for the pediatric care unit. Hospital management is concerned that the current materials express an authoritarian attitude that is off-putting to families. The goal of the nurse's review is to recommend changes that promote openness and communicate appreciation for the role of families in the care of children. Which of the following statements meets this goal? A) "Parents are welcome to remain in their child's room overnight if they wish." B) "Hospital policies require that patients eat food prepared onsite." C) "Sibling visits are allowed between the hours of 8 a.m. and 6 p.m." D) "Comfort items from home are not permitted without the approval of the nursing staff."
A) "Parents are welcome to remain in their child's room overnight if they wish." Rationale: Words like policies, allowed, and not permitted imply that hospital personnel have authority over families in matters concerning their children. Words like guidelines, working together, and welcome communicate openness and appreciation for families in the care of their children.
The community nurse identifies that a family new to the community needs assistance with family dynamics and material resources. Which of the following should the nurse consider offering to the parents of this family to support their needs? Select all that apply. A) A list of free counseling services to assist with parental stress B) Hours of the local health clinic C) Location of the community library D) Location of the community co-op food bank E) Hours when the park is open
A) A list of free counseling services to assist with parental stress B) Hours of the local health clinic D) Location of the community co-op food bank Rationale: When working with families, nurses will often need to collaborate with other healthcare professionals. For families in need of counseling, financial assistance may be available. When making these recommendations, nurses should be aware of some stigmas surrounding therapy and counseling, and work to assure families of the potential benefits of these modes of care. Families facing economic challenges should be made aware of community resources, including wellness clinics and food banks. The hours for the library and the park would not help the family with the issues that the nurse observed.
A pediatric home healthcare nurse is making an initial visit to assess the parenting style of a family preparing to treat a child with medications to reduce hyperactivity. Which approach should the nurse use for this assessment? A) Ask the parents, "How do you handle situations that require limit setting?" B) Ask the child, "What rule is hardest for you to obey?" C) Observe the parent interacting with the child for 5 minutes. D) Ask the parents, "What are the house rules?"
A) Ask the parents, "How do you handle situations that require limit setting?" Rationale: Parental styles are best assessed while the family explains how it handles situations that require limit setting. A less complete picture of parenting style is obtained during a brief artificial observation. Asking the child which rule is hardest for him or her to follow will not give the nurse insight into parenting styles. Learning about rules is less helpful than is an explanation of enforcement efforts and success.
A nurse in an outpatient pediatric clinic notes that a preschool-aged child who was due to be seen is a no-show. The child is not up to date on vaccinations. Which action by the nurse is appropriate? A) Call the parents and encourage them to bring the child for recommended care. B) Speak firmly with the parents about the importance of being compliant. C) Notify the healthcare provider that the child's immunizations are no longer up to date. D) Plan to discuss the principles of health supervision at the next scheduled visit.
A) Call the parents and encourage them to bring the child for recommended care. Rationale: The nurse in the pediatric healthcare setting is responsible for reviewing the health supervision of the child. Partnering with the parents and encouraging the parents to follow health-supervision guidelines are the best strategies to use. Speaking firmly with the parents about compliance will alienate the parents at this time. A discussion of the principles of health supervision without an intervention at this visit would mean a delay in needed healthcare for the child in this example. Discussing with the healthcare provider that the immunizations are not up to date is not necessary in an outpatient clinic. Immunizations are given per schedule.
The nurse is assigned to care for a child in a spica cast for a fractured femur suffered in an automobile accident. The child's father was driving the car, which was badly damaged. In assessing the family, the nurse learns that the father just recently lost his job and the mother has been working through a "temp" agency. Which nursing diagnosis is most appropriate for this family? A) Compromised Family Coping related to the effects of multiple simultaneous stressors B) Interrupted Family Processes related to child with a significant disability requiring alteration in family functioning C) Caregiver Role Strain related to a child with a disability and the associated financial burden D) Impaired Social Interaction (parent and child) related to the lack of family or respite support
A) Compromised Family Coping related to the effects of multiple simultaneous stressors Rationale: Compromised Family Coping related to the effects of multiple simultaneous stressors best fits the multiple crises to which this family is responding. Lack of family or respite support was not mentioned in the scenario. The spica cast might result in an alteration in family functioning; however, fractures generally are not considered a significant long-term disability. The need for a spica cast is not considered a newly acquired disability.
The nurse educator is teaching a group of students about health promotion and disease prevention. Which nursing activities promote health and health maintenance? Select all that apply. A) Helping a mother determine a daily feeding schedule for her infant B) Teaching a school-age child how to use dental floss C) Teaching parents how to perform pulmonary drainage and cupping on their ill child D) Treating a child diagnosed with pneumonia E) Administering the flu vaccine for an infant who is 9 months of age
A) Helping a mother determine a daily feeding schedule for her infant B) Teaching a school-age child how to use dental floss E) Administering the flu vaccine for an infant who is 9 months of age Rationale: Administering flu vaccines, discussing feeding schedules, and instructing children about the use of dental floss are all health promotion and/or maintenance topics. Treatment of pneumonia would not be a topic for health promotion and maintenance, as pneumonia is an acute illness. Teaching parents how to perform pulmonary drainage and cupping on their ill child is not considered health promotion and maintenance because it is treatment for acute illness.
Which of the following most accurately describes the family burden associated with mental illness? A) It is the overall level of distress experienced as a result of the mental illness. B) It is the pattern of negative attitudes that lead people to fear individuals with mental illness. C) It is the measurable or quantifiable impacts of mental illness on the family. D) It is the assessment that visualizes the way the family interacts with the community.
A) It is the overall level of distress experienced as a result of the mental illness. Rationale: Family burden is the overall level of distress experienced in the family as a result of the mental illness. Stigma is the pattern of negative attitudes that lead people to fear and discriminate against individuals with mental illness and their families. Objective burdens are a type of family burden that is measurable or quantifiable. An ecomap is an assessment tool that helps nurses visualize how the family unit interacts with the external community environment.
A client with a bipolar disorder arrives at the emergency department disheveled, arguing with family members. The nurse recognizes that the family is suffering from an objective family burden. To which of the following is this burden related? A) The client's symptomatic behaviors B) Family conflict C) Anger D) Caregiving problems
A) The client's symptomatic behaviors Rationale: The objective family burden is related to the actual, identifiable family problems associated with an individual's mental illness. One burden the family must manage relates to symptomatic behaviors. Deficit behaviors of their loved ones-such as lack of motivation, difficulty in completing tasks, isolation from others, inability to manage money, poor grooming and personal care, and poor eating and sleeping behavior-can be of great concern to families. Intrusive or acting-out behaviors-such as lack of consideration for others, excessive arguing, conflicts with neighbors and friends, damaging material possessions, inappropriate sexual behavior, suicide attempts, substance abuse, and violent outbursts-are very disturbing to family members. The family may be experiencing caregiving problems, fear, or family conflict, but these arise from the client's symptomatic behaviors.
The nurse is caring for a client who is hospitalized with pneumonia. Which of the following will the nurse assess when determining the impact of the illness on the family? Select all that apply. A) The duration of the illness B) The effect of the illness on future family functioning C) The cause of the illness D) The meaning of the illness to the family E) The financial impact of the illness
A) The duration of the illness B) The effect of the illness on future family functioning D) The meaning of the illness to the family E) The financial impact of the illness Rationale: The impact on the family is assessed by the duration of the illness as well as its effect on the family finances and functioning. Other factors include residual effects of the illness, meaning of the illness to the family, and its significance to family systems. The cause of the illness is not a factor that determines the impact on the family.
The nurse is meeting with the family of a 16-year-old patient who was recently diagnosed with depression. His younger sister states that she finds the patient's behavior distressing, as well as the way in which her parents respond to the behavior. She also states that she is tired from doing many of her brother's chores for him because he can't or won't do them himself. What type of family burden is the patient's sister experiencing? A) A low level of subjective burden B) A high level of subjective burden C) A low level of objective burden D) A high level of objective burden
B) A high level of subjective burden Rationale: Subjective burden refers to a family member's perception of what is burdensome. In this case, the sister feels that the brother's behavior, the parents' response, and her need to complete his chores is highly burdensome. Objective burdens are those that are measurable, such as cost of care; none of the burdens the sister feels are measurable.
The nurse is evaluating the success of wellness care provided to a new family in the community. Which observations by the nurse indicate that care has been successful? Select all that apply. A) The children are observed eating doughnuts for breakfast. B) All family members have up-to-date immunizations. C) The family spends every Saturday afternoon participating in physical activities. D) The youngest child squints when reading school work. E) The oldest child does not wash his hands before eating.
B) All family members have up-to-date immunizations. C) The family spends every Saturday afternoon participating in physical activities. Rationale: Evaluation of care is based on the family's progress toward goals and outcomes mutually determined by the family and nurse. Examples of achieved outcomes include the following: family members demonstrate more frequent engagement in activities that involve the entire family unit, each family member is up to date with all vaccinations, and individual family members report a decrease in or cessation of behaviors associated with adverse health conditions and disease. Eating doughnuts for breakfast could indicate poor nutrition. Squinting when reading indicates the need for a vision assessment. And not washing hands before eating could lead to the ingestion of a microorganism that could cause disease.
The nurse overhears a school-age client tearfully telling his mother about an incident on the playground in which another child pushed him down and threw dirt at him. The boy's mother takes him on her lap, hugs him, and explains that if it happens again he should firmly but politely ask the child to stop. If that does not work, he should walk away from the child. If the child continues to pursue him, he should find an adult to intervene. Which of the following family roles is the boy's mother assuming in this interaction? A) Maintaining the continuity of society by transmitting knowledge and beliefs to children B) Caring, nurturing, and educating children C) Receiving and giving love D) Meeting the protection and economic support needs of family members
B) Caring, nurturing, and educating children Rationale: Caring, nurturing and educating children involves teaching children how to get along in the world; by sharing conflict resolution strategies with her son, the mother is doing just that. While the interaction also shows the mother expressing love for her child by taking him on her lap and hugging him, that is not its primary focus. Maintaining continuity of society involves the transmission of customs and traditions on a cultural level. Protection and economic support involve meeting physical needs for shelter and nutrition.
During a follow-up home visit, the nurse is evaluating the success of a family's ability to use internal resources to cope with the illness of a family member. Which observations by the nurse indicate that internal resources are being accessed? Select all that apply. A) Next-door neighbor helping with family chores B) Effective communication pattern C) Skill in providing care to the ill family member D) Church members stopping by with groceries E) Center for Aging picking up the family member to take her to a physician's appointment
B) Effective communication pattern C) Skill in providing care to the ill family member Rationale: External support systems promote coping and adaption and include friends, religious affiliations, and community resources. Internal resources include effective communication patterns and knowledge or skills to assist in the family problem-solving process.
During a home visit, the nurse determines that care interventions are needed to address alcohol and substance abuse by family members. Which interventions should the nurse consider when planning care for this family? Select all that apply. A) Suggest grief counseling. B) Evaluate family members' potential for being a danger to self or others. C) Suggest engaging in educational activities. D) Be alert to behaviors that indicate sibling jealousy. E) Recommend community resources to assist with substance abuse behavior.
B) Evaluate family members' potential for being a danger to self or others. E) Recommend community resources to assist with substance abuse behavior. Rationale: For the family with alcohol or substance abuse, the nurse should evaluate family members' potential for being a danger to self or others and recommend community resources to family members to help with substance abuse behaviors. Grief counseling would be appropriate for the family who has suffered a loss of a family member. Educational activities and being alert to sibling jealousy would be appropriate for the antepartum or postpartum family.
A nurse is caring for a preschool-age client who was admitted for dehydration. The child lives with the parents and maternal grandparents. In which of the following types of family does this child reside? A) Blended family B) Extended family C) Two-career family D) Nuclear family
B) Extended family Rationale: In some cultures and as people live longer, more than two generations may live together in an extended setting. A two-career family is one where both partners are employed. A blended family occurs when existing family units join together to form new families. A nuclear family is viewed as an autonomous unit in which both parents reside in the home.
The nurse is creating a plan of care for the family of a client with a terminal illness. Which aspects of this family's care should the nurse emphasize when creating this plan? Select all that apply. A) Instructing on medication administration B) Guiding to determine realistic goals C) Identifying strategies to enhance family functioning D) Suggesting that cultural practices be minimized at this time E) Focusing on the client's health needs as a priority
B) Guiding to determine realistic goals C) Identifying strategies to enhance family functioning Rationale: Nursing care includes assisting the family with planning realistic goals/outcomes and strategies that enhance family functioning, such as improving communication skills, and identifying and using support systems. Teaching medication administration is an intervention that would support the assimilation of the ill client back into the home and family environment. This action may or may not be needed at this time. The nursing care should incorporate cultural practices and not minimize them. The family's needs are as important as those of the client and need to be addressed by the nurse.
The community nurse is planning a wellness seminar for families in an urban community. Which resources should the nurse consider obtaining to support these families' needs? Select all that apply. A) Emergency first responder personnel B) Information about community healthcare providers C) Individuals who provide mental health services D) Law enforcement officials E) Nutritionists
B) Information about community healthcare providers C) Individuals who provide mental health services E) Nutritionists Rationale: Wellness promotion is an essential aspect of family health and focuses on increasing healthy behaviors and optimizing lifestyle choices. Educating clients and facilitating appropriate referrals to nutritionists and community service providers will not only improve the family's quality of life, but also reduce the risk of illness. Depending on the needs of the client, nurses may collaborate with a variety of healthcare providers and professionals, including physicians, counselors, social workers, and mental health specialists. Ambulance first responders and law enforcement personnel will not necessarily support the goal of the wellness program.
The nurse is reviewing the genogram for a patient recently diagnosed with mental illness. The genogram shows a history for mental health in the patient's parents' generation, but no history for mental health in previous generations. Which of the following should the nurse understand about this lack of history? A) Information from previous generations is not relevant to mental health. B) Older generations may not willingly volunteer mental health information. C) Mental illness was uncommon three or more generations ago. D) Only information from a patient's parents and siblings is included in a genogram.
B) Older generations may not willingly volunteer mental health information. Rationale: A family genogram is helpful in collecting information, as detailed health histories should incorporate data regarding the patient's parents, siblings, grandparents, and even great-grandparents if information is available. If aunts, uncles, or cousins have had any health concerns, these should be noted as well. When assessing a family's history of mental illness, nurses should be aware that many individuals from older generations may not volunteer knowledge about their mental illness.
The nurse is observing a family counseling session that is focusing on the family members' communication patterns. Which observation indicates that there are existing or potential problems with family communication? A) All members are participating in the discussion equally. B) A few of the members just sit and listen. C) Disagreements are ignored by the family leader. D) The verbal communication is congruent with the nonverbal messages.
C) Disagreements are ignored by the family leader. Rationale: An authoritarian setting is one in which one or more members set firm, nonnegotiable limits and other members may be cautious in expressing their feelings because of power struggles, hostility, or anger. Nurses should pay special attention to who does the talking for the family, which members are silent, how disagreements are handled, and how well the members listen to one another and encourage the participation of others. Nonverbal communication is important because it gives valuable clues about what people are feeling. Even though some members are more vocal, at least all are participating in the discussion. Verbal communication should be congruent with nonverbal cues. Listening is an art, and not all members of a family need to speak in the same setting.
The nurse is caring for a client who was involved in a car accident. The client's spouse was killed in the accident. The couple has two teenage children. Which statement explains how this tragedy will be approached by the family? A) The family feels that their place in the community has been eliminated. B) Family members may become detached from extended family. C) Family disorganization may occur. D) The family may withdraw into seclusion during the grief process.
C) Family disorganization may occur. Rationale: The death of a family member often has a profound effect on the whole family—especially if the deceased was the head of the family. Family disorganization would be common, but as the family begins to recover, a new sense of normalcy develops and the family reintegrates its roles and functions. Families need support from extended family members, their community, and spiritual advisers. The other options are not considered normal patterns of family grieving, and the nurse should be alert for problems that may develop if these are present.
A cohesive nuclear family has one kindergarten-aged child. The mother works from home and is the primary caregiver for the child. The father is required to travel a lot for work. Currently, the father is on an out-of-town project that will last for 6 months. He is home on the weekends, but gone the rest of the week. The nurse understands that family cohesion in this family is likely to become: A) disengaged triadic between all three members. B) cohesive dyadic between the mother and father. C) cohesive dyadic between the mother and child. D) cohesive triadic between all three members.
C) cohesive dyadic between the mother and child. Rationale: The family relationship is already cohesive and will likely remain so. However, with the father absent, the dynamics will likely become dyadic (two-person) between the mother and child as they come to depend on each other more. The mother and child will become less dependent on the father, making triadic (three-person) dynamics less likely. Similarly, the mother is less likely to have a strong dyadic relationship with the father during this time.
The nurse at a gerontologist's office works with many older adult clients who are cared for by family members. Which care provider is best described as belonging to the "sandwich generation?" A) A 72-year-old retired man who cares for his wife and the couple's pets B) A 21-year-old man who cares for two grandparents between college classes C) A 55-year-old single man who cares for his mother and maintains her home D) A 40-year-old married woman who cares for her mother and her two teenage children
D) A 40-year-old married woman who cares for her mother and her two teenage children Rationale: Adults who care for their own children and one or more of their own aging parents belong to a group that has come to be known as the "sandwich generation." This group faces an incredible amount of stress trying to meet the diverse needs of young children and adolescents as well as aging parents.
A nuclear family has three children-an infant who is 18 months old, a preschooler who is 4 years old, and a first grader who is 7 years old. According to Duvall's eight-stage family life cycle, what is this family's current stage? A) Stage I B) Stage II C) Stage III D) Stage IV
D) Stage IV Rationale: The oldest child serves as a marker for the family's developmental stage. In this case, the family is in stage IV, which is characterized by having school-aged children. Stage I is a couple that does not yet have children, stage II is a family whose oldest child is up to 30 months of age, and stage III is a family whose oldest child is in preschool.
The nurse is determining psychosocial risk factors for a family prior to planning care. Which assessment tool should the nurse use when initially screening families for these health risks? A) The Friedman Family Assessment Tool B) The Family Ecomap C) The Home Observation for Measurement of the Environment (HOME) D) The Family APGAR
D) The Family APGAR Rationale: The Family APGAR is a quick five-item questionnaire that may be used as an initial screening tool for family assessment. All other choices are family assessment tools but are not appropriate for initial family assessments.
