Family Dynamics EAQ
The parents of an 11-year-old child with a terminal illness appear overwhelmed and anxious. What is the best response by the nurse? 1 Explaining the diagnosis in a variety of ways 2 Encouraging the parents to express their feelings 3 Recommending that the parents talk with other parents 4 Offering assurance that surgery will probably correct the problem
2 Encouraging the parents to express their feelings The parents need to express and work through their feelings before they can move forward with other coping strategies. Explanation of the diagnosis is not focused on the needs of the parents at this time. Participation in a support group may eventually be suggested; however, this is not the priority at this time. Assuring the parents that surgery will correct the problem is false reassurance; there is no guarantee that the surgery will be successful.
A 44-year-old client has been unable to function since her husband asked for a divorce 2 weeks ago. She is brought to the crisis intervention center by a friend. What type of crisis is this situation? 1 Social 2 Situational 3 Maturational 4 Developmental
2 Situational Situational crises involve an unanticipated loss, such as a divorce, that is threatening to the client. Social crises involve multiple losses such as those occurring during major disasters. Maturational crises occur in response to stress experienced as one struggles with developmental tasks. Developmental (maturational) crises are associated with developmental tasks; divorce is not a developmental task.
After her child's visit to the pediatrician a mother tells the nurse that she is concerned that an antidepressant has been prescribed for her adolescent son. What is the best response by the nurse? 1 "Tell me more about what's bothering you." 2 "You need to speak with the doctor about your concern." 3 "Are you sure it's not a medication for attention deficit disorder?" 4 "Didn't the doctor tell you why your son needs an antidepressant?"
1 "Tell me more about what's bothering you." Reflecting the parent's feelings provides an opportunity for further exploration. It is the nurse's responsibility to assess the mother's concerns before planning further interventions. Implying that either the health care provider or the mother is wrong is a nontherapeutic response. Implying that the mother didn't listen or understand is a judgmental, nontherapeutic response.
A nurse understands the stages of parental adjustment that follow the birth of an at-risk infant who is in the neonatal intensive care unit. To better plan nursing care, the nurse bases observations and assessments on the recognition that the: 1 Parents should be encouraged to visit their newborn within a day of birth 2 Mother should not see the infant until she has completed the necessary grief work 3 Mother should be reunited with her infant as soon as possible to enhance adjustment 4 Nurse should wait until the parents ask to see their newborn before suggesting a visit
3 Mother should be reunited with her infant as soon as possible to enhance adjustment The mother should be reunited with her newborn at the first opportunity after she is emotionally prepared. There is no magic about the first 24 hours; some mothers are too ill, or both parents may be too frightened, to see their baby that soon. Grief work will go on for an extended period and has no relationship to when the infant is seen. Some parents may be too frightened to ask to see their baby ; the nurse can prepare the parents and then suggest a visit.
An infant is born with a bilateral cleft palate. Plans are made to begin reconstruction immediately. What nursing intervention should be included to promote parent-infant attachment? 1 Demonstrating positive acceptance of the infant 2 Placing the infant in a nursery away from view of the general public 3 Explaining to the parents that the infant will look normal after the surgery 4 Encouraging the parents to limit contact with the infant until after the surgery
Demonstrating positive acceptance of the infant By demonstrating acceptance of the infant, without regard for the defect, the nurse acts as a role model for the parents, thereby encouraging their acceptance. Infants with cleft palates can remain in the newborn nursery; they should not be hidden. Telling the parents that the child will look normal after surgery is false reassurance; it does not promote parent-infant attachment behaviors. Encouraging the parents to limit contact will delay attachment; the parents should be encouraged to have frequent contact with their infant.
The parents of a gifted 4-year-old notice that their child has been showing signs of rebellion and acting out. One important thing to teach the parents about gifted children is: 1 They need boundaries like any other child 2 Intense emotions require an outlet, not punishment 3 All discipline models approval of physical aggression 4 Gifted children should be allowed to freely express themselves
1 They need boundaries like any other child Gifted children need discipline like any other child to feel loved and safe. Punishment is appropriate for behavior that is unsafe or falls outside set boundaries. Discipline appropriately applied does not lead to physical aggression. Free expression does not mean overstepping the boundaries of appropriate behavior.
During data collection, the nurse finds that a preschool-age child is stressed about the family relocating to a different city. The nurse tells the parents about ways to reduce the child's stress during the transition. What is the best approach the parents can take to help their child cope with the transition? 1 Delaying the move 2 Allowing the child to rest 3 Distracting the child from the topic 4 Explaining what the child can expect
4 Explaining what the child can expect The parents should prepare the child for relocation by explaining what he or she should expect from the move. The child can be prepared to accept the change without the need for a major change in plans such as delaying the move. Allowing the child to rest and distracting the child from the topic may provide momentary relaxation, but is not the proper long-term strategy to reduce stress by adequately preparing the child for the change.
A client with dementia and a percutaneous endoscopic gastrostomy (PEG) tube is being cared for at home. Which action provides evidence that a family member is effectively managing the client's care? 1 Empty feeding bag stays attached to the tubing. 2 Tube is flushed with air after medication is given. 3 Replacement of the tube is done on a weekly basis. 4 Head of the bed remains elevated after the feeding.
4 Head of the bed remains elevated after the feeding. The client's upper body must be elevated to prevent aspiration and promote digestion. Attaching the empty feeding bag to the tubing is not necessary. The end of the gastrostomy tube just needs to be covered. The tube is flushed with water, not air, before and after food or medication is given; excess air in the gastrointestinal tract can cause abdominal distention and cramping. Because the tube was inserted by a surgical procedure, it is replaced only when a problem is identified, and usually only by the health care provider.
A client at 16 weeks' gestation arrives at the prenatal clinic for a routine visit. During the examination the nurse notes bruises on the client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm: 1 Domestic abuse 2 Hydatidiform mole 3 Excessive exercise 4 Thrombocytopenic purpura
1 Domestic abuse Domestic abuse is likely to intensify during pregnancy, and attacks are usually directed toward the pregnant woman's abdomen. A hydatidiform mole manifests as an unusually enlarged uterus for gestational age accompanied by hypertension, nausea and vomiting, and vaginal bleeding, not bruises on the face and abdomen. Excessive exercise may cause cardiovascular or pulmonary problems. It will not result in bruising. Thrombocytopenic purpura and other bleeding disorders manifest as bruises and petechiae on many areas of the body's surface, not just the face and abdomen.
After being shown to the parents, a preterm male newborn weighing 3 lb 15 oz (1500 g) is moved to the neonatal intensive care unit. What should the nurse's plan for parental visits include? 1 Taking them to visit their son as soon as possible 2 Securing a prescription for them to be allowed to visit their son 3 Determining whether their son's condition is satisfactory before taking them to see him 4 Discouraging them from being involved with their son until his prognosis is established
1 Taking them to visit their son as soon as possible The development of attachment between parents and infant is an important psychological goal and should be facilitated. The decision to visit is the nurse's responsibility and does not require a practitioner's permission. It is important for parents to develop a relationship with the ill newborn even if the prognosis is unfavorable.
A nurse determines that the information about falling down the stairs given by a parent suspected of child abuse contradicts the information given by the child. What should the nurse say to the parent? 1 "Tell me again how your child fell down the stairs." 2 "Your child says the stairs did not cause this injury." 3 "Did you do anything to cause this injury to your child?" 4 "Why don't you tell me what really happened to your child?"
1 "Tell me again how your child fell down the stairs." The nurse needs additional information to investigate the contradictory responses. The response "Your child says the stairs did not cause this injury." will put the parent on the defensive and may increase the child's risk for additional abuse. The response "Did you do anything to cause this injury to your child?" requires a yes or no response and will limit further discussion; it may also precipitate a defensive response. The response "Why don't you tell me what really happened to your child?" is judgmental, will interfere with further communication, and may precipitate a defensive response.
After 5 years of unprotected intercourse, a childless couple comes to the fertility clinic. The husband tells the nurse that his parents have promised to make a down payment on a house for them if his wife gets pregnant this year. What is the nurse's best response to this comment? 1 "This must be very difficult for you with this added pressure." 2 "Having a child is a decision you should make without your parents' input." 3 "You're lucky. It's nice that your parents are making such a generous offer." 4 "Five years without a pregnancy is a long time. You were right to come to the fertility clinic."
1 "This must be very difficult for you with this added pressure." Stating that the situation must be difficult encourages the clients to verbalize their feelings. The clients are not seeking advice concerning their relationship with their parents; the focus should be on them. Stating that five years without a pregnancy is a long time is an insensitive statement and cuts off further communication.
A client who is scheduled to have a hysterectomy starts to sob and says, "I told my husband that after this operation, I'll be only half a woman. He told me not to worry, but I know that he was just putting up a front." How should the nurse respond? 1 "It's frightening to think that your husband rejects you as a woman." 2 "You think this operation will affect how your husband feels about you as his wife." 3 "Try not to worry about it right now. The most important thing is for you to get well." 4 "I'll try to have your surgery postponed. You both need time to adjust to the effects of a hysterectomy."
2 "You think this operation will affect how your husband feels about you as his wife." Stating that the client thinks that the operation will affect how her husband feels about her as his wife reflects and verbalizes the client's feelings in a nonjudgmental way. The husband did not indicate feelings of rejection; the client's perception is altered by her own feelings. Telling the client not to worry about it right now demonstrates a lack of acceptance of the client's feelings and cuts off communication. Such feelings are common and must be verbalized; surgery should not be postponed.
Which finding indicates an 8-year-old is a latchkey child? 1 The child stays with a single parent. 2 The child has a large group of friends. 3 The child is dependent on adults for his needs. 4 The child is unsupervised at home after school.
4 The child is unsupervised at home after school. Latchkey children are those who remain unsupervised after school hours. Staying with a single parent does not mean that the child is a latchkey child; a single parent may also be available to supervise the child. Latchkey children may not have many friends, as activities outside the home may be curtailed. All children, and not just the latchkey children, are dependent on adults to an extent for their needs.
An older client who lost a spouse 20 years ago comes to the community health center with a vague list of complaints and a brief life history. The couple's only child died at birth. The client lives alone and is able to perform all the activities of daily living. The client has had an active social life in the past but has outlived many friends and family members. What is an important question for the nurse to ask when taking this client's health history? 1 "Are you all alone?" 2 "How did your son die?" 3 "Do you still miss your spouse?" 4 "How do you feel about your life now?"
4 "How do you feel about your life now?" The answer to "How do you feel about your life now?" will provide the nurse with an idea of the client's hopes and frustrations without being threatening or probing. "Are you all alone?" is probing and provides little information for the nurse to use in planning care. "How did your son die?" and "Do you still miss your spouse?" are both probing, disregard the client's present situation, and provide little information for the nurse to use in planning care.
A 7-year-old boy is brought to the clinic by the mother, who tells the nurse that her child has been having trouble in school, has difficulty concentrating, and is falling behind in schoolwork since she and her husband separated 6 months ago. The mother reports that lately her child has not been eating dinner, and she often hears him crying when he is alone. What basis for these behaviors should the nurse consider? 1 The child feels different from his classmates. 2 The child will be happier living with the father. 3 The child is working through feelings of shame. 4 The child may be blaming himself for his parents' breakup.
4 The child may be blaming himself for his parents' breakup. Children usually blame themselves for their parents' marital problems, believing that they are the reason that a parent leaves. No data are presented to indicate that the child feels different from his peers, that he will be happier living with his father, or that he is working through feelings of shame.
The nurse is collecting data on a few children at the community health care center. Which child is most likely at high risk for injury and delinquent behavior? A. Lives with low income, single mother works long hours B. Lives with mother and stepfather after parent's divorce C. The child lives with adopted parents. D. Lives with two working parents and eight older siblings.
A. Lives with low income, single mother works long hours Single-parent families often lack adequate access to childcare when the parent is working, which gives rise to latchkey children who spend a great deal of time at home alone and are often at higher risk for injury and delinquency. Although there are many family circumstances that may create latchkey conditions for a child, living with a stepparent or adopted parents is not a typical indicator of a latchkey child. A child with a large number of older siblings is more likely to have a great deal of family support and supervision.
A 6-year-old child has been wetting the bed at night since the birth of a baby brother. What defense mechanism is the child using to cope with the stress of accepting a new family member? 1 Regression 2 Repression 3 Dissociation 4 Displacement
1 Regression Regression is the return to an earlier and more comfortable developmental level. Repression is the unconscious and involuntary forgetting of painful ideas, events, or conflicts. Dissociation is the unconscious separation of painful feelings and emotions from an unacceptable idea, situation, or object. Displacement is discharging pent-up feelings to a less threatening object or person.
The wife of a client who has completed alcohol detoxification relates that she is concerned about her husband's behavior if he starts drinking again. She says, "When the drinking starts it really disrupts my family, and I'm not sure how to handle it." What is the best response by the nurse? 1 "Include your husband in the family's activities even when he's been drinking." 2 "Attend Al-Anon meetings and avoid assuming responsibility for your husband's behavior." 3 "Search the house regularly for hidden alcohol and accompany your husband outside the home." 4 "Help your husband avoid embarrassment by making excuses for him when it's impossible for him to function."
2 "Attend Al-Anon meetings and avoid assuming responsibility for your husband's behavior." Encouraging the wife to attend Al-Anon and to stop making excuses for the husband supports the family of the addicted individual and allows the family to continue on with life by reducing their guilt. Including the husband in the family's activities even when he has been drinking will be impossible to accomplish; the wife has stated that the drinking disrupts the family. Telling the wife to search the house regularly for hidden alcohol and to accompany her husband outside the home places the burden for preventing drinking on the family and will produce feelings of resentment and guilt. The husband must assume responsibility for his behavior resulting from the drinking. Telling the woman to help her husband avoid embarrassment by making excuses for him when it's impossible for him to function is enabling behavior, which does not help the abuser or the family.
A nurse is working with a couple and their two children. The 14-year-old son has been in trouble at school because of truancy and poor grades. The 16-year-old daughter is quiet and withdrawn and refuses to talk to her parents. The parents have had severe marital problems for the past 10 years. The priority nursing concern at this time is how the: 1 Parents can set limits on their children's behavior 2 Couple's marital problems are affecting their children 3 Son's behavior in school will impair his relationships with peers 4 Daughter's withdrawn behavior limits her ability to talk with her friends
2 Couple's marital problems are affecting their children The parents' ongoing marital problems appear to have interfered with their parental roles, resulting in their children's behavioral problems. At this time the children need support, not limits. The son's and daughter's behaviors are not the priority nursing concern because there are no data to support these assumptions.
The nurse is obtaining the history of a client in the third trimester who is visiting the prenatal clinic for the first time. She tells the nurse she has two toddlers at home, that their father abandoned the family last month, and that she doesn't know what to do. The nurse concludes that the client is: 1 Angry that the father has left 2 Overwhelmed by the situation 3 Ambivalent about her pregnancy 4 Denying the reality of her pregnancy
2 Overwhelmed by the situation Because of the difficult home situation, this client is experiencing multiple stressors that could cause difficulty with coping. There is no information to support the conclusion that the client is angry or that she is ambivalent about the pregnancy. The client is attending the prenatal clinic, which indicates that she is aware of reality and is not in denial.
A parent who is visiting a hospitalized adolescent gets into an argument with the adolescent. Leaving the adolescent's room in tears, the parent meets the nurse and relates the argument, saying, "I can't believe I got so angry that I could have hit her." What is the most therapeutic response by the nurse? 1 "Teenagers really can drive you to distraction." 2 "Bring a surprise for her next time. It'll make you both feel better." 3 "Sometimes we find it difficult to live up to our own expectations of ourselves." 4 "You can't compare yourself to an abusive parent—after all, you didn't beat your child."
3 "Sometimes we find it difficult to live up to our own expectations of ourselves." The response "Sometimes we find it difficult to live up to our own expectations of ourselves" is the best response because it reflects the feelings being expressed at this time. "Teenagers really can drive you to distraction" avoids the real issue. Telling the parent to bring a surprise for the adolescent on the next visit does not address the real concern; the parent's argument may have been justified, and the child's behavior should not be rewarded. The response "You can't compare yourself to an abusive parent—after all, you didn't beat your child" avoids the issue; the parent may fear that next time control will be lost and abuse will occur.
Which family has at least one step-parent and step-sibling? 1 Nuclear family 2 Extended family 3 Blended family 4 Traditional nuclear family
3 Blended family The blended family includes at least one step-parent who is the spouse of a child's biological parent, but is not the child's biological parent. It also includes a step-sibling or half-sibling who does not share one common biological parent. The nuclear family is composed of two parents and their children, in which the parent-child relationship and sibling ties may be biological, step, adoptive, or foster. The extended family includes at least one parent, one or more children, and one or more relatives or nonrelatives other than a parent or sibling. Parent-child relationships may be biological, step, adoptive, or foster in an extended family. The traditional nuclear family consists of married couples and their biological children.
The parents of a critically ill 7-year-old child constantly blame each other for their child's illness. What parental response suggests that the nurse's intervention has been successful? 1 The father brings the child expensive gifts. 2 The parents promise the child a trip to an amusement park. 3 The parents make an appointment with a family counselor. 4 The mother assumes the blame for ignoring the child's complaints.
3 The parents make an appointment with a family counselor. The parents need the assistance of a professional in exploring their feelings and their family relationships. Bringing gifts is an attempt to relieve guilt feelings; the father may still feel responsible for the child's illness. The promise of a special trip may help the parents relieve their guilt feelings. The mother's assumption of the martyr role may help relieve the anxiety caused by feelings of guilt.
The nurse discusses discipline with parents of a 4-year-old child. Which parental statement regarding time-out reflects an appropriate application of this method of discipline? 1 "I send her to her room for misbehaving." 2 "We limit time-out to 20 minutes per incident." 3 "Putting him in a dark closet for time-out is very effective." 4 "I explain the reason for the time-out before and after disciplining him."
4 "I explain the reason for the time-out before and after disciplining him." Explaining the reason for the time-out before and after time-out reinforces the child's association of time-out with the undesirable behavior, allowing the child to work to control those behaviors. Sending the child to the bedroom may result in the child's associating bedtime with punishment or may be ineffective if the child is happy playing in the bedroom. Time-out should be limited to 1 minute per year of age, so a time-out for a 4-year-old should be limited to 4minutes. Putting a child in a dark closet will create fear and may damage the child's trust of the parents as a source of safety. Even if this approach is effective, the short-term benefit is not worth the long-term risk.
A client is dying. Hesitatingly, his wife says to the nurse, "I'd like to tell him how much I love him, but I don't want to upset him." Which is the best response by the nurse? 1 "You must keep up a strong appearance for him." 2 "I think he'd have difficulty dealing with that now." 3 "Don't you think he knows that without your telling him?" 4 "Why don't you share your feelings with him while you can?"
4 "Why don't you share your feelings with him while you can?" It is difficult to work through a loss; however, encouraging the sharing of feelings helps both parties to feel better about having to let go. The response "You must keep up a strong appearance for him" impedes the work of acceptance of one's finality and the use of the remaining time to the best advantage. There is no evidence to suggest that the client cannot cope with these emotions; the response "I think he'd have difficulty dealing with that now" denies that this is a time for closeness and honesty. The response "Don't you think he knows that without your telling him?" is demeaning, closes off communication, and does not foster the expression of feelings.
The father of a child who is dying of cancer asks the nurse whether he should tell his 7-year-old son that his sister is dying. What is the most appropriate response by the nurse? 1 "He can't comprehend the real meaning of death, so don't tell him until the last minute." 2 "Your son probably fears separation most and wants to know that you will care for him, rather than what will happen to his sister." 3 "You should talk this over with your health care provider, who probably knows best what's happening in terms of your daughter's prognosis." 4 "Your son probably doesn't understand death as we do but fears it just the same. He should be told the truth to let him prepare for his sister's possible death."
4 "Your son probably doesn't understand death as we do but fears it just the same. He should be told the truth to let him prepare for his sister's possible death." Children of early school age are not yet able to comprehend death's universality and inevitability, but they still fear it, often personifying death as a "boogeyman" or "death angel." They need an opportunity to prepare for a coming death. At age 10 this child needs to know the seriousness of the illness and to understand that recovery may not be possible. Children younger than age 10 interpret death as separation and punishment; they fear this in addition to death itself. Telling the father to talk to the health care provider only avoids the question.
On a return visit to the fertility clinic a couple requests fertility drugs because, despite having a 28-day menstrual cycle and temperature readings that demonstrate an ovulatory pattern, the woman has been unable to conceive. What should the nurse explain to the couple? 1 A laparoscopy will be scheduled. 2 An endometrial biopsy will be required. 3 A fertility medication will be prescribed. 4 An examination of semen will be needed.
4 An examination of semen will be needed. Because the client has an ovulatory cyclic pattern, the infertility may be a result of a seminal factor; the partner's semen should be examined before more extensive studies or treatments are begun. A laparoscopy is an invasive procedure that may be needed after all noninvasive tests are completed and the cause of the infertility remains undetermined. An endometrial biopsy is an invasive procedure that may be needed after all noninvasive tests are completed and the cause of the infertility remains undetermined. After all diagnostic and treatment options are exhausted, a fertility medication may be prescribed if it is determined that the medication will enhance the probability of conception.
How should parents practice "time-out" with preschoolers? 1 By instructing the child to take a nap 2 By asking the child to study for an hour 3 By allowing the child to watch television 4 By encouraging quiet time alone without toys
4 By encouraging quiet time alone without toys Time-out is a way to discipline the child and is usually performed after misbehavior. The child is asked to be quiet and stay alone in a room without toys. This helps the child calm down and know that misbehavior may be punished. Instructing the child to take a nap is not an effective method for teaching good behavior. Likewise, asking a child at this age to study will not be effective. Watching television may help distract the child, but will not correct the child's behavior.
A nurse is assigned an adolescent who gave birth 12 hours ago. She continually talks on the phone to her friends and does not respond when her new baby cries. What is the best immediate intervention? 1 Calling social service for a consult 2 Calling the psychiatric team for an intervention 3 Calling her mother and having her speak with the client 4 Modeling appropriate behaviors that encourage infant bonding
4 Modeling appropriate behaviors that encourage infant bonding All women go through several phases of adapting to the role of mother. An adolescent may still need time to adjust to her new role, especially if she has just given birth in the past day. By modeling appropriate behavior, the nurse demonstrates appropriate maternal skills to the adolescent. This will assist her as she makes the transition into her new role as a mother. If this behavior continues and does not improving before discharge, social service may need to get involved, but a consult is not needed in this early phase. A psychiatric consult is not necessary because this is not a psychiatric illness. The adolescent's mother is an important part of the plan, especially if the adolescent is going home to her house, but the relationship between the two needs to be assessed to see what role she will play in this new mother-child relationship.
