Chapter 10. Intervention With Families

A clinic nurse is caring for a 40-year-old client who lives with his parents. One parent continues to do the client's laundry and provides spending money. Which family dynamic does the nurse recognize in this situation? 1. Taking over 2. Communicating indirectly 3. Belittling feelings 4. Making assumptions

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A couple is in counseling related to their dysfunctional relationship. Their child has recently made a suicide gesture. The nurse should recognize that this might be an example of which family system concept? 1. Triangulation 2. Pseudohostility 3. Double-bind communication 4. Pseudomutuality

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An instructor is teaching about differentiated parent and adult child relationships. Students are instructed to give an example of a well-differentiated parent and adult child relationship. Which student example meets the instructor requirement? 1. An adult child considers, but is not governed by, the advice of his or her parents. 2. An adult child appears to listen to, but ignores, the advice of his or her parents. 3. An adult child respects and is governed by the wishes of his or her parents. 4. An adult child never requests advice or feedback from his or her parents.

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In defiance of parental wishes, a teenager succumbs to peer pressure and gets a tattoo. According to Bowen's family systems theory, how should the community health nurse interpret the teenager's action? 1. The teenager is attempting to differentiate self. 2. The teenager is triangulating self. 3. The teenager is cutting self off emotionally. 4. The teenager is exhibiting antisocial traits.

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The nurse is using the nursing process to develop a teaching plan for a multigenerational family household. Which statement best describes how a genogram would facilitate a teaching plan? 1. The genogram would provide an overall picture of the life of the family over several generations. 2. The genogram would provide influences for the development of predictable personality characteristics. 3. The genogram would provide a conceptual view of a societal emotional support system for the family during crises. 4. The genogram would provide guidelines for boundary setting with prevention of excessive interference.

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A nursing instructor is teaching about the importance of healthy family member expectations for newly blended families. Which student statement indicates a need for further instruction? 1. "Healthy family member expectations should be flexible." 2. "Healthy family member expectations should be conforming." 3. "Healthy family member expectations should be individual." 4. "Healthy family member expectations should be realistic."

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During family counseling, a husband tells his wife to spend more time with the family, and she responds by stating, "Okay, I'll turn in my resignation tomorrow." The husband replies, "I knew it! You've always been a quitter!" How should the nurse interpret the husband's statement? 1. The husband is expressing emotional cutoff. 2. The husband is expressing double-bind communication. 3. The husband is expressing indirect messages. 4. The husband is expressing avoidance behaviors.

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A 30-year-old client seeking therapy states, "My parent cries when she is not included in all my social activities and thinks of my friends as her own." Which of the following indicates the nurse's description of this family's boundaries? 1. The boundaries are rigid. 2. The boundaries are restructured. 3. The boundaries are enmeshed. 4. The boundaries are disengaged.

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A client is angry because her spouse has forgotten their anniversary. The following week, the client is still unwilling to discuss this with her spouse because she is afraid she will lose control. How should the nurse interpret this client's means of coping with anger? 1. Coping by attacking 2. Coping by surrendering 3. Coping by avoiding 4. Coping by belittling

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A fatherless 11-year-old African American girl lives with her grandmother after the death of her mother. Her older stepbrother is very involved in her life. How should the community health nurse view this family constellation, and why? 1. Abnormal; the grandmother should be concerned with issues other than childrearing. 2. Abnormal; a two-parent household is the most advantageous arrangement. 3. Normal; this is an example of a cultural variation that exists in the family life cycle. 4. Normal; older adults make better parenting figures due to life experiences.

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A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home? 1. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present. 2. The grandparental subsystem is not successfully managing separation from the parental subsystem. 3. Extended family living arrangements are common in some cultures. 4. The nuclear family living arrangement is the preferred environment for childrearing.

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An adolescent, his mother, and his soon-to-be stepfather have been in counseling with the nurse. Which statement by the nurse fosters positive relationships within this new family structure? 1. "Stepchildren should be consistently disciplined by only one parent." 2. "It is most important to give your full attention to the child's adjustment since it is most difficult for them." 3. "Keeping the lines of communication open between everyone in the family is important in establishing healthy relationships." 4. "Children need to decide who will be their disciplinarian because this new situation will be stressful."

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During family counseling a child states, "I just want to surf like other kids. Mom says it's okay, but Dad says I'm too young." The mother allows surfing when the father is absent. In the structural model of family therapy, what family interactional pattern should the nurse recognize? 1. Multigenerational transmission 2. Disengagement 3. Mother-child subsystem 4. Emotional cutoff

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In a family that is in the life cycle stage "family with adolescents," which changes must occur for the family to proceed developmentally? 1. Making adjustments within the marital system to meet the responsibilities of parenthood 2. Establishing a new identity as a couple by realigning relationships with extended family 3. Redefining the level of dependence so that adolescents are provided with greater autonomy 4. Reestablishing the bond of the dyadic marital relationship and eventual death of parents

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A client states, "I work full-time and take care of the kids and the house. I just do so much that it is difficult for me to have time for myself!" Which statement is an example of reframing by the nurse? 1. "You need to stop doing so much." 2. "It sounds like you are feeling overwhelmed." 3. "Self-care is very important." 4. "You have a very full life."

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A couple has been married for 20 years. They argue constantly, belittle feelings, and continuously contradict each other. During a therapy session, the nurse documents "marital schism." Which of the following is the meaning of the nurse's documentation? 1. The couple has a compatible marriage relationship. 2. The husband has a dominant relationship over the wife. 3. The couple has an enmeshed relationship. 4. The couple has an incompatible marriage relationship.

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A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly stated, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? 1. The mother is withholding supportive messages. 2. The mother is making denigrating remarks. 3. The mother is communicating indirectly. 4. The mother is using double-bind communication.

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A nurse enters an inpatient room and finds the family disagreeing about the client's living arrangements after discharge. Which information should the nurse provide when teaching techniques to resolve family conflicts? 1. All family members should use past incidents to make their point. 2. One family member should act as a gatekeeper to avoid family confrontation. 3. One family member should act as a compromiser to preserve harmony in the family. 4. All family members should respect differing opinions and negotiate a compromise.

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During family counseling a spouse states, "Every time my partner and I discuss child discipline, we get into shouting matches." The nurse instructs the couple to shout at each other for 2 weeks on Tuesdays and Thursdays for 30 minutes. Which intervention is the nurse using? 1. Reframing 2. Restructuring the family 3. Expressive psychotherapy 4. Paradoxical intervention

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