Ch 20 Family Health
The current school year is now over, and the school health nurse spends time summarizing the records of all the children who had come into the school health office during the past school year. Which of the following best explains the rationale for this action? a. Because analysis can help establish priorities for future health programs b. Because annual reports are expected by the school board c. Because it's very personally rewarding to see all the help one has given throughout the year d. Because the nurse has to justify the school health office budget for each year
A. Because analysis can help establish priorities for future health programs Community health nurses (CHNs) are employed in ambulatory care centers, occupational health and school sites, housing complexes, day care programs, residential treatment and substance abuse programs, and other official and nonofficial agencies. At each of these sites, CHNs meet families and can assess and intervene at the family and community levels The challenge is to focus not only on individual students but extend practice to the whole school community of children. Fiscal constraints hold the nurse accountable for the best delegation of scarce resources. In times of limited budgets, the school health nurse, on the basis of the most frequent problems presented in the office, can draw conclusions as to what are the major health needs of children in the community. On the basis of those conclusions, health programs can be planned to maximize health promotion and disease prevention in the school.
Which of the following is an appropriate conclusion to draw from research based on network therapy theory? a. Nurses can help at-risk populations access or build support systems. b. Problems in our health care system are worsened by specialization and fragmentation. c. Social class places limitations on access to health care. d. The family is culturally anchored in American beliefs.
A. Nurses can help at-risk populations access or build support systems Network therapy theory involves changing the network of families, be it extended family or friends, who tend to maintain a dysfunctional status quo in the nuclear family. The nurse can help the family replace or expand their network with other resources from the wider system that would be able to provide more support and enhance family functioning
Which of the following best describes what is meant by cohabitation? a. A living arrangement in which one adult is employed and the other is unemployed b. A living arrangement in which an unmarried couple in a long-term relationship lives together c. A living arrangement between two members of the same sex d. A living arrangement between two single mothers with children
B. A living arrangement in which an unmarried couple in a long-term relationship lives together The most comprehensive definition of cohabitation is a living arrangement in which an unmarried couple live together in a long-term relationship that resembles a marriage. One of the key aspects of this definition is the long-term relationship which is not mentioned in the other definitions.
When making a home visit, a nurse is usually expected to focus attention on the ill family member. But whom would the nurse possibly focus on instead? a. The children who are being affected by the stress of the situation b. The ill family member's primary caregiver c. The spouse of the ill family member d. The neighbors of the family who may be able to help
B. The ill family member's primary caregiver Changes in family patterns, fears, emotional responses, and expectations of individual family members can be assessed in the family interview. Special needs of the primary caretaker (i.e., often the spouse, daughter, or daughter-in-law) must be assessed
Which of the following is a major barrier to a nurse caring for the family as a whole? a. Families often don't want to know what is wrong with their loved one. b. Nurses don't know how to care for families. c. Reimbursement is paid only for services given to an individual. d. The family often isn't available when the nurse is giving care.
C. Reimbursement is paid only for services given to an individual. As a result of the current era of cost containment, constraints on the community health nurse will increase. Reimbursement is almost entirely calculated for services rendered to the individual and thus is a major constraint toward moving toward planning care for the family as a unit.
Which of the following descriptions does NOT reflect a current definition of family? A. A social unit interacting with the larger society B. Individuals living together related by kinship, marriage, or choice C. Mother, father, and children interacting with extended family D. Two or more persons living together who share common interests
D. Two or more persons living together who share common interests Current families are diverse in composition and relationships and vary in reasons for living together. Formerly, families were defined by how closely they resembled the "nuclear family" of parents and children, but this is no longer the case. "Family" means any person or persons who play a significant role in an individual's life. DIF: Cognitive level: Knowledge REF: Page 382-383
The nurse has started to complete a family health tree. Which of the following questions would be most helpful as the nurse works with the family to promote their health? a. "Can you tell me the cause of death of your older relatives back several generations?" b. "Do you know of any chronic health problems any of your relatives or their spouses have had?" c. "What concerns do you have about your family's health?" d. "What do your family members do to keep in shape and handle stress?"
D. "What do your family members do to keep in shape and handle stress?" The family health tree is based on the genogram of the current generations—that is, parents, their children, and their own parents. Spouses and past generations aren't included. The family health tree provides a mechanism for recording the family's medical and health histories. The nurse should note causes of death of deceased family members, genetically linked diseases, and lifestyle-related risk factors (i.e., by asking what family members do to "handle stress" and "keep in shape"). The family health tree can be used in planning positive familial influences on risk factors such as diet, exercise, coping with stress, or pressure to have a physical examination
What has research suggested is a barrier to college students eating healthy? a. Lack of access to an exercise facility b. Lack of access to a primary care provider c. Lack of knowledge of the benefits of healthy eating d. Lack of knowledge related to food preparation
D. Lack of knowledge related to food prep Young adults, though identified as underinsured and having limited access to primary care, are identified as a group knowledgeable about the benefits of healthy eating. This age group (20-31) has been identified in numerous national surveys to not regularly engage in healthy eating habits especially eating below the recommended daily servings of fruits and vegetables and a diet high in fast foods. Earlier studies among college students identified the following barriers: cost, stress, lack of knowledge related to food preparation, and peer influence and lack of time to balance busy lives.
Which of the following best describes what proportion of children live in a single-parent family? a. Fewer than 10% b. 11%-15% c. 16%-20% d. 21%-26% e. More than 30%
E. More than 30% In 2012, 34% of all U.S. children lived in single-parent homes
Which of the following definitions of family would be the most useful for the nurse practicing in the community? a. A group of persons with shared convictions b. A social unit interacting with the larger society c. People descended from a common ancestor d. Persons related either by blood or by legal contract (marriage) e. Whoever the family says is in their family
E. Whoever the family says is in their family Although some believe even these definitions are too narrow, the widest definitions are "the members of the family are self-defined" and "the family is who they say they are."
A client provides information regarding medical and health history. This is an example of which of the following assessment tools? Genogram Family health tree Ecomap Ancestry mapping tool
Family health tree A family health tree provides a mechanism for recording the family's medical and health histories. The genogram is a tool that helps the nurse outlines the family's structure. The ecomap is used to depict a family's linkages to their suprasystems. Option D is not an assessment tool used by the community health nurse. DIF: Cognitive level: Knowledge REF: Page 392
Which of the following best describe why it is crucial that nurses who focus on the care of individual patients also be able to work with families? (Select all that apply.) a. Anytime a person is ill, his or her whole family is affected. b. By understanding the family, understanding of the individual is improved. c. Families often are very demanding if they feel their loved one isn't receiving the best care possible. d. Individuals depend on their families for care and support. e. Most important decisions are made by families as a whole, not individuals. f. Risks caused by genetics or environment affect the whole family, not just the individual.
A, B, D, F Reasons that it is important for nurses to work with families include that the family is a resource in giving care to its members and working together on health promotion and wellness activities; any dysfunction (illness, injury, separation) that affects one family member will affect the whole family; the nurse can often identify a health problem that involves risks for the entire family. Finally, understanding the whole family helps the nurse understand and provide more holistic care to the individual.
Which of the following factors make family nursing particularly challenging? (Select all that apply.) a. The health care system primarily focuses on care of individuals. b. Insurance reimbursement focuses on illness care and treatment of individuals. c. Family members are not always consistent in what they tell the nurse. d. More variables to be considered when completing an assessment e. Number of chronic comorbidities f. Most theories focus on intervention with individuals.
A, B, F Families have challenging health care needs that are not usually addressed by the health care system. Instead, the health care system most frequently addresses the individual. Traditionally, nursing has relied heavily, if not solely, on theoretical frameworks from the disciplines of psychology or social psychology, which target individuals.
A nurse was creating an ecomap for a family, which consisted of a 3-year-old girl, an 8-year-old boy, and their mother. Which of the following questions would be useful for the nurse to ask? a. "Are you involved with any groups or resources in the community?" b. "Can you tell me about your extended family wherever they live?" c. "Have you thought about what would happen if you needed help?" d. "What were the causes of death for your older family members?"
A. "Are you involved with any groups or resources in the community?" The ecomap is another classic tool that is used to depict a family's linkages to their suprasystems. The nurse can note people, institutions, and agencies significant to the family with some notations as to the nature of the ties that exist. Knowing what resources the family is currently able to assess will help the nurse know what resources to suggest to the family
A nurse asked of a family, "Could each of you tell me what you typically do during the week?" Which of the following would the nurse most likely say to follow up such an open-ended question? a. "Could you tell me about what you do at your job?" b. "Do you believe those choices are the best use of your free time?" c. "How do you feel about those activities?" d. "Is there anything you would like to do differently?"
A. "Could you tell me about what you do at your job?" Both of these questions pertain to data collection for the family health tree. The family health tree can be used in planning positive familial influences on risk factors such as diet, exercise, coping with stress, or pressure to have a physical examination.
A young son was so physically fidgety that his mother was seriously embarrassed by his inability to be quiet and involved in the interview. Which of the following comments by the nurse would be the most helpful? a. "Isn't it marvelous how much energy your son has?" b. "Is there something your son could be doing for you that would use some of that energy?" c. "Is your son always so fidgety? Have you discussed his behavior with his pediatrician?" d. "Why don't you let your son go to his room until we're finished?"
A. "Isn't it marvelous how much energy your son has?" Sending the son to his room might be seen as punitive and would remove him from being informed about interventions planned and decisions made. A compliment reinforces family strengths and tends to further progress toward open trusting relationships. The comment took a flaw (physically fidgeting) and reframed it as an asset (high energy)
Which of the following characteristics is demonstrated by healthy or energized families? (Select all that apply.) A. Communication is appropriate and clear. B. Support and respect are evident and appreciated. C. Roles are static and change only in times of crisis. D. Common beliefs and values are shared. E. Members play and share leisure time appropriately.
A. Communication is appropriate and clear. B. Support and respect are evident and appreciated. D. Common beliefs and values are shared. E. Members play and share leisure time appropriately. Healthy or energized families communicate, support, teach values, share a religious core, have flexible roles and power, engage in family decision making, foster responsibility and service to family and community, have a sense of humor and play, and grow from problem solving. DIF: Cognitive level: Knowledge REF: Page 389-390
Which of the following theoretical approaches would be most useful to the nurse who wants to improve patient-provider communication and address the gap between what providers discuss and what families want to know about? a. Ecological framework b. Network therapy theory c. The Kentucky Partnership model d. Transaction model
A. Ecological framework The ecological framework is a blend of systems and developmental theory with an individual's understanding of his or her environment. Kogan and others investigated parent-health care provider discussions of family and community health risks during well-child examinations, as well as the gaps in issues discussed by the practitioner and the information the parent desired. The results indicate the need for better communication and education between health care providers and clients.
A nurse asked a family if they'd work with her to create a family genogram. The mother asked, "Why would you want to know so much about our family?" Which of the following would be the most appropriate response by the nurse? a. "A genogram helps you see how some problems run in families. Your children will need to know this." b. "If you're willing to share, we can discuss family history and possibly some hereditary health issues." c. "Please be assured you don't have to answer any question you don't want to answer." d. "Why would you want to keep your family members secret? Is there some problem?"
B. "If you're willing to share, we can discuss family history and possibly some hereditary health issues." A genogram is an excellent opening to the discussion of family history and possible hereditary health problems. It may also point to a need for health education. Some families may be sensitive to the sharing of such information, but obviously any patient can answer with however much or little he or she wishes to share
Which of the following questions is crucial to ask very early in a family interview? a. "Do you see any way this problem could have been avoided—so future problems could be prevented?" b. "What do you all, as a family hope to achieve during your time with me?" c. "What would you like me to do for you today?" d. "Would you like to know my perception of what our goals together should be?"
B. "What do you all, as a family hope to achieve during your time with me?" Therapeutic questions are key questions that the nurse uses to facilitate the interview. One important basic theme is to determine the family's expectations of the interview or home visit.
A nurse is completing a first assessment interview with a family after entering the family's apartment for the first time. Which of the following would be crucial for the nurse to remember? a. Analyze the power relationships before focusing on needed information b. Be on best behavior with manners and courtesy, starting with a self-introduction c. Determine as soon as possible who makes decisions within the family d. Evaluate the safety of the immediate environment for self and the family
B. Be on best behavior with manners and courtesy, starting with a self-introduction Manners are common social behaviors that set the tone for the interview and begin the development of a therapeutic relationship. The nurse introduces himself or herself by name and title and always addresses the client and family members by name (i.e., Mr., Mrs., or Ms., unless otherwise directed by client).
Which of the following best describes why a nurse would ask about the meals of all family members, rather than focus on a nutritional history for the post-myocardial infarction patient? a. It is assumed that all family members eat the same food at the same time each day. b. Lifestyle choices among family members are usually consistent. c. Many parents eat whatever their children don't rather than throw away good food, so the nurse should know what the children eat. d. The nurse was afraid to assume that whoever cooked would only prepare one meal for everyone to share.
B. Lifestyle choices among family members are usually consistent. The family remains the focus because families experience similar risk factors (i.e., physiological, behavioral, and environmental). Family health practices influence lifestyle habits among family members. Consequently, although family members may or may not eat together, they will have a tendency to make similar choices.
A nurse needed to help a child who was not behaving consistently with the requirements of the new preschool program that began that fall. Which of the following actions would be most appropriate for the nurse to perform? a. Meet with the child each day to let the child have a safe play environment without the regular program frustrations b. Meet with the child's parents to discuss how their parenting may need to change to help improve their child's behavior at school c. Meet with the child's teacher to brainstorm ways to help the child cope with school requirements d. Point out to the child that if behavior doesn't improve, the child won't be able to play with all the other children at the school
B. Meet with the child's parents to discuss how their parenting may need to change to help improve their child's behavior at school The teacher can be assumed to be an expert in dealing with small children. If the problem is defined as a child not behaving within expectations, the most effective approach would be to discuss with the parents how to help the child. Systems theory provides direction in understanding how health care providers can expand family capacity by changing parenting and therefore changing child behaviors.
A family agreed to bring all the children in to the clinic at one time to begin to catch up on the children's immunizations, but they didn't keep their appointment. Which of the following conclusions by the nurse would be most accurate? a. Obtaining immunizations might have been the nurse's goal, not the family's. b. Some barrier or restraint interfered with the family's ability to come. c. The family had other, more important priorities. d. The nurse didn't adequately emphasize the importance of obtaining immunizations.
B. Some barrier or restraint interfered with the family's ability to come. Families most frequently served by the community health nurse are disadvantaged in that they are unable to buy health care from the private sector. However, constraints to obtaining needed health and social services are well documented and may come from characteristics of health and social services rather than individual family limitations. The nurse should note those constraints that prevent full use of the resource such as hours of service, distance and transportation, availability of interpreters, and criteria for receiving services
A 36-year-old woman had diabetes diagnosed at a free health-screening program at a large employer. Which of the following should be emphasized by the nurse when helping the woman make an appointment at the diabetic clinic for follow-up testing and treatment? a. "Bring a food diary of everything you've eaten for one week with you to the appointment to help with future meal planning." b. "It's really not that hard to learn how to inject insulin, and it really doesn't hurt." c. "Please encourage all your family members, including your parents, to be tested for diabetes as well." d. "They'll teach you how to manage your meals and medications to stay healthy."
C. "Please encourage all your family members, including your parents, to be tested for diabetes as well." Although the nurse might make any of these comments, it is particularly important that the rest of the family also get tested. Any problem that affects one or more family members probably affects other family members and the family as a whole. Commonalities in risk factors and diseases shared by family members can lead to case finding within the family. Because families often choose similar foods and engage in similar lifestyle behaviors, they all are at similar risk for problems such as diabetes. The earlier the diagnosis and treatment, the more likely it is that secondary problems can be avoided.
A nurse was teaching a class on good hygiene at a local day care center when one child volunteered, "I have two mommies." Which of the following would be the most appropriate response by the nurse? a. "Don't tell anyone; that's a secret." b. "That's nice—why did you share that?" c. "Yes, some children have two mommies, some have a mommy and a daddy, and some just have daddies. Some people only have one grown-up to love them." d. "Which mommy is your real mommy?"
C. "Yes, some children have two mommies, some have a mommy and a daddy, and some just have daddies. Some people only have one grown-up to love them." The Human Rights Campaign (2009) urges that health professions acknowledge all types of families including gay, lesbian, and even grandparents as heads of family.
Beyond gathering needed information for future interventions, which of the following purposes is served when the nurse interviews the family? a. Assessing the safety of the immediate environment before further planning can be done b. Establishing a process for the nurse and the family to make decisions c. Engaging in focused planned conversation, which has healing potential in itself d. Focusing on giving compliments to make the family feel good about themselves
C. Engaging in focused planned conversation, which has healing potential in itself The second key element in the interview is the therapeutic conversation. This type of conversation is focused and planned and engages the family. The nurse must listen and remember that even one sentence has the potential to heal or help a family member. Every encounter, whether brief or extended, has "healing potential."
Which of the following are examples of the internal structure of the family? a. Ethnicity and race b. Extended family members c. Gender and rank order of birth d. Social class and religion
C. Gender and rank order of birth Internal structure of the family refers to such items as family composition, gender, rank order (by age and sex), subsystems through which the family functions, and boundaries or who is in and who is not in the family system. Extended family members are part of the external structure.
Each evening, a newly disabled man becomes angry when his wife, just home from her new full-time job, does not have dinner on the table at 6 PM. Which of the following actions would be most appropriate for the nurse to take? a. Allow the wife to express her frustration and anger to you b. Explain to the husband that he is going to have to begin learning how to cook c. Help all family members recognize that long-time roles are being changed and change is uncomfortable for everyone d. Suggest to the children who are old enough that they prepare some simple meals during the week with the mother doing the fancy cooking only on weekends
C. Help all family members recognize that long-time roles are being changed and change is uncomfortable for everyone Roles refer to established patterns of behavior for a family. It takes other family members to keep a person in a particular role. Traditional roles are being challenged and are evolving with economic changes. Formal roles may come into conflict with roles set by family members. The husband has major life changes to which to adjust, as do all the other family members. His anger is a symptom of the painfulness of major life changes. The nurse can help the family members recognize the problem in preparation for addressing the issues.
Which of the following statements best describes how a family can meet the needs of society? a. By living and existing in the wider community b. By meeting the needs of the individual family members c. Through procreation and socialization d. Through productivity seen in employment positions
C. Through procreation and socialization The family fulfills two important purposes. The first is to meet the needs of society, and the second is to meet the needs of individual family members. The family meets the needs of society through procreation and socialization of family members.
A mother says to the nurse, "I know I should be feeling an empty nest sadness now that our youngest has left for college—but mainly I'm dying to turn his room into my craft room. Do you think that's normal for a mom? I really do love my kids." Which of the following would be the most appropriate response by the nurse? a. "Hmm, that is unusual. Would you like me to make an appointment with a psychologist for you?" b. "Maybe you've always wanted to be an artist and now you can, so enjoy the feeling—and the room!" c. "You're probably trying to put a positive spin on the situation to keep feelings of sadness at bay." d. "Very normal; you've launched your family and now you can devote attention to your own life and preferences—such as crafts." e. "Would you like to talk about how you feel?"
D. "Very normal; you've launched your family and now you can devote attention to your own life and preferences—such as crafts." To assess the family, the community health nurse must comprehend developmental phases and the struggles that families experience while going through them. The mother is recognizing the stage of launching family that occurs when the youngest child leaves home. The development requirement of this stage of life includes establishment of independent identities for parents—such as focusing on becoming a crafts person.
A man had been in an extended-care facility for five weeks and was now home. His wife tells the nurse, "He's trying to take up where he left off but we've adapted to not having him home. He keeps thinking things will be just as they were when he left, but they aren't." Which of the following would be the most appropriate response by the nurse? a. "Are the changes making him uncomfortable or are the rest of you uncomfortable?" b. "Do you want me to talk to him and try to explain?" c. "How can we make things as they were before he left?" d. "You all adapted to running the house without him; it will be challenging now to adapt back."
D. "You all adapted to running the house without him; it will be challenging now to adapt back." Family functional assessment, or how family members behave toward one another, is divided into two categories. The first is instrumental functioning, which refers to routine activities of daily living. This area takes on important meaning for the family when one member of the family becomes ill or disabled and changes were made. When the family member is better, the family must again adapt to changes, even if the change is to return to the original mode of functioning. It will help the family to be able to recognize the problem; labeling it makes it more manageable.
Which of the following best describes an unexpected result of the decrease in funding to traditional public and private forms of health care? a. Emergency departments where patients can't be turned away are overwhelmed with patients needing nonemergency care. b. Grants are increasingly being requested to pay for care. c. More people don't receive needed health care in a timely manner. d. Programs are developed as a result of community efforts
D. Programs are developed as a result of community efforts Most of the choices are expected consequences of decreased funding. What is unexpected is the increase in the number and type of models being created, as traditional public and private models of health care decline because of funding and shrinking resources. The programs develop in part as the result of community efforts.
Record data demonstrated that there were a very large number of children in the school district whose insurance plan was the Children's Health Insurance Program (CHIP). Which of the following conclusions would be accurate for the nurse to make? a. There are a large number of parents who know how to abuse government programs. b. There are a large number of homeless families. c. There are a large number of unemployed poverty-stricken families. d. There are a large number of working, low-income parents.
D. There are a large number of working, low-income parents CHIP has greatly increased access to health care for many low-income children. The majority of these children live in families with working, low-income parents.
A family came in to discuss a problem with one of their children. Which of the following family behaviors would be concerning to the nurse? a. Each family member made supportive comments about each other. b. Every Sunday the family attends religious services together. c. Family members made humorous comments about their life together. d. The family seemed to rather quickly determine priorities for action. e. The family wanted the nurse to decide what they should do.
E. The family wanted the nurse to decide what they should do. Traits of a healthy family include open communication, ability to establish priorities, being supportive of each other, sharing a religious core, having a sense of humor, and knowing when to seek help. However, healthy families also engage in decision making and do not want others to make decisions for them.
Family interviewing requires the community health nurse to understand or develop specific skills. All of the following demonstrate appropriate family interviewing skills or techniques except: introducing oneself by name and addressing the client appropriately, such as "Mr. Jones." planning the focus for the family visit in advance and engaging all family members present during the home visit. establishing the nursing goals based exclusively on the physician's orders. including time to identify family strengths and commend the family on these during the family assessment.
establishing the nursing goals based exclusively on the physician's orders. Family interviewing skills include social skills (manners), therapeutic conversations, use of tools such as the genogram or ecomap, use of therapeutic questions, and commending family and individual strengths. Assessment, goals, and interventions are completed and planned in collaboration with the family. DIF: Cognitive level: Knowledge REF: Pages 385-386
