CH 34 Family Interventions EXAM 1

4. Which documentation of family assessment indicates a healthy and functional family? a.Members provide mutual support. b.Power is distributed equally among all members. c.Members believe there are specific causes for events. d.Under stress, members turn inward and become enmeshed.

ANS: A Healthy families nurture and support their members, buffer against stress, and provide stability and cohesion. The distracters are unrelated or incorrect.

26. A 16-year-old wants to drive, but the parents will not allow it. A 14-year-old sibling was invited to several sleepovers, but the parents found reasons to deny permission. Both teens are annoyed because the parents buy clothes for them that are more suitable for younger children. The parents say, We dont want our kids to grow up too fast. Which term best describes this familys boundaries? a.Rigid b.Clear c.Enmeshed d.Differentiated

ANS: A Rigid boundaries are those that do not change or flex with changing circumstances, as indicated here by parents who are reluctant to revise their roles and expectations about their children as the children mature. Enmeshed boundaries are those that have failed to differentiate or develop individually; the family shares roles and thoughts to an excessive degree, without a healthy degree of individuality. Clear boundaries are not enmeshed; they are appropriate and well maintained.

23. Which comment by a mother during a family therapy session shows evidence of scapegoating? a.Our youngest child always starts arguments and upsets everyone else. b.We all express our feelings openly except when we think it might upset my husband. c.Our oldest child knows that my husband and I are doing all we can for the others. d.After my husband has been drinking, I have to get everyone up and ready for school.

ANS: A Scapegoating is blaming family problems on a member of the family who is not very powerful. The purpose of the blaming is to keep the focus off painful issues and off the blamers themselves. A double-bind message, such as We all express our feelings openly except when, involves giving instructions that are inherently contradictory or that place the person in a no-win situation. Our oldest child knows that is an example oftriangulation, wherein a third party is engaged to help stabilize an unstable pair within the family. A child assuming parental responsibilities (e.g., caring for siblings) because a parent fails to do so is an example of enabling.

17. Parents of a mentally ill teenager say, We have never known anyone who was mentally ill. We have no one to talk to because none of our friends understand the problems we are facing. Select the nurses most helpful intervention. a.Refer the parents to a support group. b.Build the parents self-concept as coping parents. c.Teach the parents techniques of therapeutic communication. d.Facilitate achievement of normal developmental tasks of the family.

ANS: A The need for support is evident. Referrals are made when working with families whose needs are unmet. A support group, such as through the National Alliance on Mentally Illness (NAMI), will provide the parents with support of others with similar experiences and with whom they can share feelings and experiences. The distracters are less relevant to providing a network of support.

2. A parent was recently hospitalized with severe depression. Family members say, Were falling apart. Nobody knows what to expect, who should make decisions, or how to keep the family together. Which interventions should the nurse use when working with this family? Select all that apply. a.Help the family set realistic expectations. b.Provide empathy, acceptance, and support. c.Empower the family by teaching problem solving. d.Negotiate role flexibility amongst family members. e.Focus planning on the family rather than on the patient.

ANS: A, B, C, D The correct answers address expressed needs of the family. The distracter is inappropriate.

3. Which situations are most likely to place severe, disabling stress on a family? Select all that apply. a.A parent needs long-term care after sustaining a severe brain injury. b.The youngest child in a family leaves for college in another state. c.A spouse is diagnosed with liver failure and needs a transplant. d.Parents of three children, aged 9, 7, and 2 years, get a divorce. e.A parent retires after working at the same job for 28 years.

ANS: A, C, D Major illnesses and divorce place severe, potentially disabling stress on families. The distracters identify normal milestones in a familys development.

1. A wife believes her husband is having an affair. Lately, he has been disinterested in romance and working late. The husband has an important, demanding project at work. The mother asks her teen, What have you noticed about your father? The teen later mentions this to the father, who says, Tell your mother that I cant deal with her insecurities right now. Family therapy should focus on: (select all that apply) a.identifying and reducing the cognitive distortion in each parents perceptions. b.confronting the family with the need for honest, direct, assertive communication. c.helping the parents find ways to cope more effectively with their stress and fears. d.supporting the teen to redirect the parents when they try to communicate through her. e.convincing the mother that her fear of an affair is due to her own insecurities and unfounded. f.helping the husband understand how others might misinterpret the changes in his behavior.

ANS: A, C, D, F Each parent is seeing the others behavior in a possibly distorted manner, which the nurse would explore and help the parents correct. The nurse would guide the parents to communicate more effectively, but confrontation would likely be non-therapeutic because it would increase the tension and triangulation. Since fear and anxiety contribute to triangulation, increasing the parents coping abilities as well as reducing anxiety and fear would be areas for intervention. Teaching the adolescent how to protect herself from triangulation, when done in conjunction with interventions to help the parents reduce this behavior, would be protective of the adolescent and would assist the parents in their efforts to change this pattern of communication. The nurse has no facts about whether or not the husband is having an affair; therefore, the nurse should not convince the wife that her fear is only due to her insecurities. Her fears may be well-founded. Helping the husband understand how his wife might see the changes in behavior differently can help him to respond helpfully instead of accusing her of being insecure.

8. An adult diagnosed with schizophrenia lives with elderly parents. The patient was recently hospitalized with acute psychosis. One parent is very anxious, and the other is ill because of the stress. Which nursing diagnosis is most applicable to this scenario? a.Ineffective family coping related to parental role conflict b.Caregiver role strain related to the stress of chronic illness c.Impaired parenting related to patients repeated hospitalizations d.Interrupted family processes related to relapse of acute psychosis

ANS: B Caregiver role strain refers to a caregivers felt or exhibited difficulty in performing a family caregiver role. In this case, one parent exhibits stress-related illness and the other exhibits increased anxiety. The other nursing diagnoses are not substantiated by the information given and are incorrectly formatted [one nursing diagnosis should not be the etiology for another].

. An adult recently diagnosed with AIDS is hospitalized with pneumonia. The patient and family are very anxious. Select the best outcome to add to the plan of care for this family. a.Describe the stages of the anticipatory grieving process. b.Identify and describe effective methods for coping with anxiety. c.Recognize ways dysfunctional communication is expressed in the family. d.Examine previously unexpressed feelings related to the patients sexuality.

ANS: B Desired outcomes might be set for the family as a whole or for individuals within the family. The outcome most closely associated with the anxiety that each member is experiencing is to focus on identifying and describing ways of coping with the anxiety. The other options are not appropriate at this time.

14. Parents of a teenager recently diagnosed with serious mental illness express dismay. One parent says, Our hopes for our childs future are ruined. We probably wont ever have grandchildren. The nurse will use interventions to assist with: a.denial. b.grieving. c.acting out. d.manipulation.

ANS: B Grief is a common reaction to having a family member diagnosed with mental illness. The grief stems from actual or potential losses, such as the familys ability to function, financial well-being, and altered future. Data do not support choosing any of the other options.

10. A parent is admitted to a chemical dependency treatment unit. The patients spouse and adolescent children participate in a family session. What is the most important aspect of this familys assessment? a.Spouses codependent behaviors b.Interactions among family members c.Patients reaction to the familys anger d.Childrens responses to the family sessions

ANS: B Interactions among all family members are the raw material for family problem solving. By observing interactions, the nurse can help the family make its own assessments of strengths and deficits. The other options are narrower in scope when compared with the correct option.

11. A parent is admitted to a chemical dependency treatment unit. The patients spouse and adolescent children attend a family session. Which initial assessment question should the nurse ask of family members? a.What changes are most important to you? b.How are feelings expressed in your family? c.What types of family education would benefit your family? d.Can you identify a long-term goal for improved functioning?

ANS: B It is important to understand family characteristics, particularly in a family under stress. Expression of feelings is an important aspect of assessment of the familys function (or dysfunction). The distracters relate more to outcome identification and planning interventions, both of which should be delayed until the assessment is complete.

3. When a nurse assesses a family, which family task has the highest priority for healthy family functioning? a.Allocation of family resources b.Physical maintenance and safety c.Maintenance of order and authority d.Reproduction of new family members

ANS: B Physical and safety needs have greater importance in Maslows hierarchy than other needs.

19. Which scenario best illustrates scapegoating within a family? a.The identified patient sends messages of aggression to selected family members. b.Family members project problems of the family onto one particular family member. c.The identified patient threatens separation from the family to induce feelings of isolation and despair. d.Family members give the identified patient nonverbal messages that conflict with verbal messages.

ANS: B Scapegoating projects blame for family problems onto a member who is less powerful. The purpose of this projection is to distract from issues or dysfunctional behaviors in the members of the family.

12. A nurse interviews a homeless parent with two teenage children. To best assess the familys use of resources, the nurse should ask: a.Can you describe a problem your family has successfully resolved? b.What community agencies have you found helpful in the past? c.What aspect of being homeless is most frightening for you? d.Do you feel you have adequate resources to survive?

ANS: B The correct option asks about use of resources in an open, direct fashion. It will give information about choices the family has made regarding use of resources in the community. The other questions do not address prior use of resources or focus on other aspects of coping.

5. A 15-year-old is hospitalized after a suicide attempt. This adolescent lives with the mother, stepfather, and several siblings. When performing a family assessment, the nurse must first determine: a.how the family expresses and manages emotion. b.names and relationships of the familys members. c.the communication patterns between the patient and parents. d.the meaning that the patients suicide attempt has for family members.

ANS: B The identity of the members of the family is the most fundamental information and should be obtained first. Without this, the nurse cannot fully process the other responses.

13. Two divorced people plan to marry. The man has a teenager, and the woman has a toddler. This family will benefit most from: a. role-playing opportunities for conflict resolution regarding discipline. b.guidance about parenting children at two developmental levels. c.formal teaching about problem-solving skills. d.referral to a family therapist.

ANS: B The newly formed family will be coping with tasks associated with the stage of rearing preschool children and teenagers. These stages require different knowledge and skills. There is no evidence of a problem, so the distracters are not indicated.

25. A wife believes her husband is having an affair. Lately, he has been disinterested in romance and working late. The husband has an important, demanding project at work. The mother asks her teen, What have you noticed about your father? The teen later mentions this to the father, who says, Tell your mother that I cant deal with her insecurities right now. Which family dynamic is evident? a.Multigenerational dysfunction b.Triangulation c.Enmeshment d.Blaming

ANS: B Triangulation is a family dynamic wherein a pair relationship (usually the parents) is under stress and copes by drawing in a third person (usually a child) to align with one or the other members of the pair relationship.Multigenerational dysfunction is any dysfunction that exists within or across multiple generations of a family, such as child abuse or alcoholism. Blaming is distracting attention from ones own dysfunction or reducing ones own anxiety by blaming another person. Enmeshment refers to blurred family boundaries or blending together of the thoughts, feelings, or family roles of the individuals so that clear distinctions among members fail to emerge.

1. A married couple has two biologic children who live with them as well as a child from the wifes first marriage. What type of family is evident? a.Homogeneous b.Extended c.Blended d.Nuclear

ANS: C A blended family is made up of members from two or more unrelated families. It is not a nuclear family because a stepchild is present. It is not an extended family, because there are only two generations present. Homogeneous is not a family type.

2. A married couple has two children living in the home. Recently, the wifes mother moved in. This family should be assessed as: a.nuclear. b.blended. c.extended. d.alternative.

ANS: C An extended family has members from three or more generations living together. Nuclear family refers to a couple and their children. A blended family is one made up of members from two or more unrelated families. An alternative family can consist of a same-sex couple or an unmarried couple and children.

18. Select the best question for the nurse to ask to assess a familys ability to cope. a.What strengths does your family have? b.Do you think your family copes effectively? c.Describe how you successfully handled one family problem. d.How do you think the current family problem should be resolved?

ANS: C The correct option is the only statement addressing coping strategies used by the family. The distracters seek opinions or use closed-ended communication techniques.

24. Which example of behavior in a family system demonstrates double-bind communication? a.A mother tells her daughter, You make me so mad that sometimes I wish I had never had you. b.A teenager tells her father, You are treating me like a baby when you tell me I must be home by 10 PM on a school night. c.A son tells his mother, You worry too much about what might happen. Nothing has happened yet, so why worry? d.A wife tells her husband, You go ahead with your bowling trip. Try not to worry about me falling on my crutches while Im alone at home.

ANS: D A double-bind communication is one that is inherently contradictory, that is, a comment that gives conflicting directions. In this case, the wife on crutches suggests that her husband should go bowling but then indicates that she will be at greater risk if he does, which in effect tells him go ahead and dont do it at the same time. This remark places the husband in a double bind, a situation in which no acceptable response exists. The distracters are clear, direct communications.

20. A parent became unemployed 6 months ago. The parent has subsequently been verbally abusive toward the spouse and oldest child. The child ran away twice, and the spouse has become depressed. What is the most appropriate nursing diagnosis for this family? a.Impaired parenting related to verbal abuse of oldest child b.Impaired social interaction related to disruption of family bonds c.Ineffective community coping related to fears about economic stability d.Disabled family coping related to insecurity secondary to loss of family income

ANS: D Disabled family coping refers to the behavior of a significant family member that disables his or her own capacity as well as anothers capacity to perform tasks essential to adaptation. The distracters are inaccurate because the stressors influence more than one individual.

21. A parent says, My son and I argue constantly since he started using drugs. When I talk to him about not using drugs, he tells me to stay out of his business. What is the nurses first most appropriate action? a.Educate the parent about stages of family development. b.Report the son to law enforcement authorities. c.Refer the son for substance abuse treatment. d.Make a referral for family therapy.

ANS: D Family therapy is indicated, and the nurse should provide a referral. Reporting the child to law enforcement would undermine trust and violate confidentiality. The other distracters may occur later.

16. A family expresses helplessness related to dealing with a mentally ill members odd behaviors, mood swings, and argumentativeness. An effective nursing intervention for this family would be to: a.express sympathy for their situation. b.involve local social service agencies. c.explain symptoms of relapse. d.role-play difficult situations.

ANS: D Helping a family learn to set limits and deal with difficult behaviors can often be accomplished by using role-playing situations, which give family members the opportunity to try new, more effective approaches. The other options would not provide learning opportunities.

15. Parents of a teenager recently diagnosed with serious mental illness express dismay. One parent says, Our child acts so strangely that we dont invite friends to our home. We quit taking vacations. Sometimes we dont get any sleep. Which nursing diagnosis best applies? a.Impaired parenting b.Dysfunctional grieving c.Impaired social interaction d.Interrupted family processes

ANS: D Interrupted family processes are evident in the face of disruptions in family functioning as a result of having a mentally ill member. Assessment data best support this diagnosis. Data are insufficient to support the other diagnoses.

22. Which scenario best demonstrates a healthy family? a.One parent takes care of children. The other parent earns income and maintains the home. b.A family has strict boundaries that require members to address problems within the family. c.A couple requires their adolescent children to attend church services 3 times a week. d.A couple renews their marital relationship after their children become adults.

ANS: D Revamping the marital relationship after children move out of the family of origin indicates the family is moving through its stages of development. Strict family boundaries or roles interfere with flexibility and use of outside resources. Adolescents should have some input into deciding their activities.

7. The parent of an adolescent diagnosed with mental illness asks the nurse, Why do you want to do a family assessment? My teenager is the patient, not the rest of us. Select the nurses best response. a.Family dysfunction might have caused the mental illness. b.Family members provide more accurate information than the patient. c.Family assessment is part of the protocol for care of all patients with mental illness. d.Every family members perception of events is different and adds to the total picture.

ANS: D The identified patient usually bears most of the family systems anxiety and may have come to the attention of parents, teachers, or law enforcement because of poor coping skills. The correct response helps the family understand that the opinions of each will be valued. It allows the nurse to assess individual coping and prepares the family for the experience of working together to set goals and solve problems. The other responses are either incorrect or evasive.

6. Which information is the nurse most likely to find when assessing the family of a patient with a serious mental illness? a.The family exhibits many characteristics of dysfunctional families. b.Several family members have serious problems with their physical health. c.Power in the family is maintained in the parental dyad and rarely delegated. d.Stress from living with a mentally ill member has challenged the familys function.

ANS: D The information almost universally obtained is that the family is under stress associated with having a mentally ill member. This stress lowers the familys level of functioning in at least one significant way. Stress does not necessarily mean the family has become dysfunctional.