Chapter 15: Family Assessment and Interventions

A psychiatric-mental health nurse has received an in-service education about defense mechanisms. Which statement made by the nurse regarding defense mechanisms would indicate a need for further teaching?

"Defense mechanisms indicate that the client is in a problematic mental state."

The nurse is using a directive role when asking a client which question?

"Are you thinking about hurting someone else right now?"

A psychiatric-mental health nurse has created a genogram for a family and is reviewing it with them. One of the family members asks, "What do the vertical lines mean?" Which response by the nurse would be most appropriate?

"The vertical lines are used to connect parents and children."

A family's genogram reveals that two family members have struggled with issues involving alcohol use. When intervening with the family, which question would be most appropriate for the nurse to ask?

"How did the alcohol problems of these family members affect others in the family?"

A nurse is caring for a client with depression. The client says that the client cannot stop thinking about the client's dead spouse. Which self-disclosure example given by the nurse is most appropriate?

"I can understand your situation; my cousin lost a spouse a few months ago."

A nurse has interactions with several clients throughout the day. The nurse would require a formal setting for discussion for which client?

A client with difficulty maintaining boundaries

During the initial interview, a nurse-therapist has created a genogram on a whiteboard utilizing the input of the family members. What is an advantage of using genograms in family therapy?

A concise diagram of family relationships is produced, including significant information.

In viewing the stages of the family life cycle, those families in later life undergo which emotional transition?

Accepting the shifting of generational roles

The nurse-therapist's priority when implementing a genogram is to ...

Assess how a family has functioned both in the past and currently

The nurse is caring for adult client that has a history of being neglected. Which role of the nurse is most likely to create difficulty for the nurse-client relationship if the client confuses physical care with intimacy and sexual interest?

Caregiver

Acting in a family therapist role is relatively new for psychiatric-mental health nurses. Which of the following describes an appropriate intervention for a nurse who is functioning in this capacity?

Conduct family assessments and draw genograms.

The nurse therapist is setting goals for a family in therapy. One goal is for the family to adopt a healthy family structure. Which would be an appropriate outcome criterion for this goal?

Conflicts are resolved in a rational manner

A nurse knows that rapport has been established when the client begins to do what action? Select all that apply.

Develops a sense of sharing. Displays decreased anxiety and feels comfortable in the presence of the nurse.

A psychiatric-mental health nurse is assessing a family's development. The nurse would assess change in which area? Select all that apply.

Employment Acculturation Severe illness Geographic location Migration

A psychiatric-mental health nurse is assessing a family. The family consists of a husband, age 68, a wife, age 61, a son, age 32, his wife, age 32, their two children, ages 4 and 1 with a third child on the way, and a daughter, age 24. The son, his wife and children live about 20 minutes away from the parents. The daughter lives about 30 minutes away but works near the parents' home. The husband has had multiple health issues over the past 5 years requiring numerous hospitalizations, emergency department visits, surgeries, and health care provider visits. The husband is semi-retired. The wife continues to work full time and is the primary breadwinner for the household. The nurse would identify this family is in which phase of the family life cycle?

Families in late middle age

A nurse is reviewing a genogram created for a family. When evaluating the information, which aspect would the nurse review first?

Family composition

A nursing instructor is teaching a class on empathy. The instructor determines that the class needs additional education when the students identify that empathy involves what?

Feeling the same emotions that the client is feeling at a given time

Which graphical representation should the nurse use to document the family composition?

Genogram

The nurse observes the parent of a child client holding the child close on the lap during the initial assessment. Which distance zone is the parent exhibiting for people who mutually desire personal contact?

Intimate

A client is discussing the client's problems at the workplace. Which nonverbal cues would indicate that the nurse is attentive to the client? Select all that apply.

Leaning toward the client Maintaining eye contact with the client

A nurse is assessing a family. During the assessment, the husband reports that he doesn't feel like his wife and he are close. He says, "She seems so distant with me. The wife responds, "I'm not distant. This is how my mother and father were." The nurse interprets these statements as suggesting which concept?

Multigenerational transmission process

A psychiatric-mental health nurse is using the Transitional Relationship Model as a strategy for developing therapeutic relationships. When applying this model, the nurse understands that it is based on the works of which theorist?

Peplau

A nurse analyzes the results of the family assessment. Which characteristics of family boundaries should the nurse recognize as promoting the emotional health of the family?

Permeable

A nurse recently began working with a client in the community. The client arrived 15 minutes late for the last appointment and did not show up for today's scheduled appointment, despite confirming the day before. How should the nurse best interpret this client's behavior?

The client is testing the parameters of the relationship.

A psychiatric-mental health nurse is assisting a family and providing counseling. When intervening with this family, which concept would be most important for the nurse to keep in mind?

The focus should be on problem-solving.

A client expresses worry about the client's child's aggressive behavior. The nurse says "You are in a very challenging situation. Your child's aggressive behavior is very stressful for you, is this correct?" What does this nurse's statement indicate?

The nurse is empathizing with the client.

A psychiatric-mental health is involved in a deteriorating nurse-client relationship. Which phase would the nurse and client experience first?

Withholding

The nurse is analyzing a genogram of a large family. Included in most family genograms are the ...

ages of the members.

The manager is reviewing the implementation of the Transitional Relationship Model (TRM) on a care area. Which data should the manager identify that supports the successful implementation of this model? Select all that apply.

discharge of clients 5 days earlier than in the past number of readmissions down 6% over the last 2 months

A mental health facility is planning to implement the transitional relationship model. Which intention will the organization emphasize when communicating this strategy with the nursing staff?

eases the transition from hospital to community

The Calgary family assessment model and the Calgary family intervention model are dimensional frameworks that conceptualize the family into categories of structural, developmental, and ...

functional.

Horizontal lines in a genogram represent ...

marriages.

Some families not only survive the day-to-day stresses of caring for a family member with a serious mental health problem but also seem to grow stronger and healthier. This is example of:

resilience.

The nurse plans family interventions for an adult client who is diagnosed with schizophrenia and lives with the parents. The parents have confided in the nurse that they are experiencing extreme fatigue due to needing to closely monitor their child's medication regimen. Which is the best intervention to include in the updated family plan of care?

self-care activities

The nurse is meeting a client for the first time. Which action should the nurse take to establish a rapport with this client? Select all that apply.

shaking the client's hand when greeting asking the client to further explain a recurring symptom remaining neutral when the client states a lack of faith in medical care

The nurse is playing a game of cards with a client and sharing a story about a recent date. The client and nurse are laughing about how the date went and the nurse asks whether they should pursue a second date. This interaction could be considered what type of relationship?

social

Family members are often reluctant to discuss the mental disorders of other family members because of ...

stigma associated with mental illness.

A client diagnosed with an anxiety disorder feels anxious about leaving their house. Which type of therapy would the nurse recommend for the client?

telemedicine services

An advanced practice nurse has chosen to apply motivational interviewing (MI) in the care of a client who will transition back to the community from inpatient treatment. The nurse should begin to apply this method by:

validating the client's ability to make decisions and effect change.

A client with a mental health condition lives in a rural area. Which approach would the nurse consider as an option for this client's care?

virtual interactions using telehealth technology