Prep U: Ch 4: Health of the Individual, Family, & the Community

The nursing student asks the instructor to explain what a community is. Which statement by the instructor would be inappropriate?

"Communities have few effects on the health of the individuals that live there." explanation: The health of the residents of a community is affected by several factors, including the social support systems, the community health structure, environmental factors, and types of agencies providing assistance for those in need of shelter, housing, and food. The other three statements are true

What is an example of a community risk factor?

Children are kept inside on a sunny day due to a lack of recreational opportunities. explanation: A key component of the question is the term community. The most basic definition of a community is a specific population or group of people living in the same geographic area under similar regulations and having common values, interests, and needs. The only option above that addresses community is the one in which children are kept inside the home on a sunny summer day because of a lack of recreational opportunities. The other options are focused on individuals, which is not the direction of the question.

Who is responsible for the client's care?

Client explanation: The ideal goal of healthcare is for individuals to be responsible for their own health.

The parents of a blended family have a baby boy age six months who is due for immunizations. The clinic closest to their home has recently closed, and they feel intimidated by the prospect of going to the large, university hospital near their home. Which type of factor is the primary influence on this aspect of the family's health?

Community health care structure explanation: The size, location, and services of health care offerings in a geographical area are components of the community health care structure and its influence on health. Family functioning, lifestyle, and economic considerations are not primary influences on the family's actions.

The nurse is assessing the family structure of the client. The family household comprises two parents, three children, and one grandparent. The nurse recognizes that this is a(n):

extended family. explanation: An extended family is composed of family members, including aunts, uncles, and grandparents, who live in close geographic proximity to one another. A traditional family consists of two parents and their children. A blended family is formed when parents bring unrelated children from previous relationships together to form a new family. Unmarried individuals who choose to live together for a variety of reasons form a cohabiting family.

An adolescent informs the nurse of a desire to learn about birth control. What response by the nurse would gather additional data?

"Would you like to tell me more?" explanation: The nurse requires additional information from adolescents prior to arriving at conclusions. The nurse should engage the client's request rather than deferring the matter to the parents. An open ended question such as "Would you like to tell me more?" is more likely to generate discussion than a blunt yes/no question about sexual activity. The nurse would require more information before making a medical referral.

A new graduate nurse asks a nurse manager working at the community health center, "I've heard people talk about community health nursing and community-based nursing. Is there a difference?" Which response by the nurse manager would be appropriate?

"Community health nursing involves care for entire populations whereas community-based nursing focuses on individuals and families in that population." explanation: In contrast to community health nursing, which focuses on whole populations within a community, community-based nursing is centered on the health care needs of individuals and families. Nurses practicing community-based nursing provide interventions to manage acute or chronic health problems, promote health, and facilitate self-care. Nursing care provided within a community must be culturally competent and family centered.

A nurse is assessing a family with adolescents. The family consists of a father, mother, a 13-year-old son, a 14-year-old son from a previous marriage, and a 16-year-old daughter. Which statement by the parents would lead the nurse to suspect a potential risk factor for altered health with this family?

"Our 16-year-old just seems to butt heads with us at every turn." explanation: The statement about the daughter butting heads with the parents may suggest a conflict among family members and thus a risk factor for altered health. Being assertive (not aggressive), being able to problem-solve, and having open communication about sexually transmitted infections promote family health.

A nurse is caring for a client newly diagnosed with diabetes mellitus and developing a holistic plan of care. For this plan of care to be successful, it must what?

Address the disease but also incorporate the mind, body, and spirit. explanation: A holistic plan of care seeks to balance and integrate the use of crisis medicine, advanced technology, and the mind, body, and spirit, which are incorporated though the use of the nursing process. Taking into account the cost of care is only one facet of a holistic picture. Connecting families, friends, and the environment is important, but mind, body, and spirit define holism. A holistic plan of care may provide a connection between medicine and nursing, but it does not define it.

The nurse is explaining the expected developmental tasks of a typical family with adolescents. Which of the following would be incorrect for the nurse to include?

Adjustment to retirement explanation: Developmental tasks for families with adolescents and young adults include balancing teenagers' freedom with responsibility, maintaining supportive home base, and strengthening marital relationships. Adjusting to retirement is a developmental task for families with older adults.

A nursing student's parents are both physicians. The nursing instructor may feel the student has

Been socialized in healthcare explanation: Socialization happens by the process of living and experiencing in family and society. If the student comes from a family of healthcare professionals, this too is part of the socialization process.

The charge nurse is assigning client care for the upcoming shift. Which is the priority evaluation when performing this task?

Determine the level and intensity of client care needed according to physical and psychosocial factors. explanation: Level and intensity of client care based on physical and psychosocial factors is the priority evaluation when using Maslow's hierarchy of needs. While the other options may impact staffing, these are not the priority when making client care assignments.

Which theorist supports the developmental framework of family assessment?

Duvall explanation: Duvall supports the developmental framework of family function. Minuchin, Satir, and Bowen are nurses whose family nursing theory is based on systems theory.

According to Archer, what are the three general types of communities?

Emotional, structural, and functional explanation: Archer described three general types of communities: emotional, structural, and functional.

The nurse is assessing a family parented by a 60-year-old grandmother and three school-age grandchildren. The nurse is aware that which problem may occur in a single-parent family at a greater level than in other types of families?

Increased financial concerns explanation: Many single-parent families are headed by women. Single parents often have special problems and needs, including financial concerns and role shifts (i.e., having the roles of both parents). Single-parent families are not less knowledgeable about child safety than other family types, nor is there a higher incidence of child abuse, neglect, or conflict among family members.

The nurse assesses a client who is postoperative day 1 following a total abdominal hysterectomy. Assessment data includes BP 150/88 mm Hg, HR 100/bpm, RR 22/min with a pain scale of 8 out of 1-10. The abdominal dressing in clean, dry, and intact. The client's orders indicate ambulation today. Which is the priority nursing action?

Medicate the client for pain. explanation: The nurse is likely to use Maslow's hierarchy of needs as a tool for setting priorities for client care. Using this tool, the nurse considers the client's physical needs, such as managing pain, as a priority in this situation. The nurse addresses other needs, such as assisting the client with ambulation, after the client's health condition stabilizes. There is no need to contact the healthcare provider about condition unless vital signs do not improve following the management of the client's pain. Removing the abdominal dressing is not indicated.

A nurse is implementing interventions that focus on protecting a client from physical and emotional harm. Which category of needs is the nurse addressing?

Safety and security explanation: Safety and security needs have both physical and emotional components. Physical safety and security means being protected from potential or actual harm. Emotional safety and security involves trusting others and being free of fear, anxiety, and apprehension. Physiologic needs are the most basic in the hierarchy and the most essential to life. They must be met at least minimally to maintain life. Love and belonging needs include the understanding and acceptance of others in both giving and receiving love, and the feeling of belonging to groups such as families, peers, friends, a neighborhood, and a community. Self-esteem needs include the need for a person to feel good about himself or herself, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishments.

A nurse is working at a community clinic that serves mostly families with young children. What would be a priority intervention for clients in this developmental stage?

Setting up parenting classes explanation: Duvall (1977) identified critical family developmental tasks and stages in a family life cycle. Duvall's theory, based on Erikson's theory of psychosocial development, states that all families have certain basic tasks for survival and continuity as well as specific tasks related to developmental stages throughout the life of the family. The question asks about a community clinic that serves mostly families with young children and the priority intervention for clients in this developmental stage. Setting up parenting classes is the only answer that addresses the stated developmental stage. Families with adolescents and young adults would be at the appropriate developmental stage for providing sex education and alcohol/drug information. The community clinic would not focus on screening for congenital defects.

The nurse is assessing the communication style of the client. Communication is an example of which dimension of the individual?

Sociocultural dimension explanation: Communication is essential for interaction with others and is an example of the sociocultural dimension. The physical dimension incudes physiological health and nutrition. Housing and community are examples of the environmental dimension. The emotional dimension includes fear, sadness, loneliness, and acceptance of self.

The nurse is assessing a client diagnosed with early-onset Alzheimer's disease. The spouse states that it is making them uncomfortable to be the sole care provider due to the degree of lifestyle changes that will be required. Which factors will be a priority issue when assessing for a risk of caregiver role strain? Select all that apply.

Past history of poor relationship between caregiver and care receiver Inexperience with giving care to others Caregiver as the spouse explanation: Illness may precipitate a health crisis in a family. If a family member's illness is serious, the roles and responsibilities of other family members change. The caregiver is the spouse, the spouse's inexperience with care giving to others, and the past history of then poor relationship between the caregiver and the care receiver, are factors for Risk for Caregiver Strain. The caregiver's apprehension about possible institutionalization of the care receiver, the inability to complete care giving tasks, and not having respite or recreation resources for the caregiver are factors related to Actual Caregiver Strain.

During the nurse's admission interview the client says, "I don't get too much rest because I am in nursing school and work full time to support myself and my kids." The nurse classifies this statement as an issue at which level of Maslow's basic needs?

Physiologic explanation: Rest is a basic physiologic need, because it allows time for the body to rejuvenate and be free of stress. Lack of sleep and rest may become a safety issue if not addressed. Love and belonging is related to acceptance in a group. Self-esteem is related to how one sees one's self.

Parents raising two school-aged children incorporate their religious beliefs into the family's daily life. The family's beliefs regarding religion include dietary considerations, worship practices, attitudes, and values. This is an example of which function of the family?

Socialization explanation: Through socialization, the family teaches; transmits beliefs, values, attitudes, and coping mechanisms; provides feedback; and guides problem solving. Incorporating religious beliefs, values, and attitudes is an example of socialization. Physical functions of the family include providing a safe, comfortable environment necessary for growth and development, rest, and recuperation. The reproductive function of the family is raising children. The affective and coping function of the family involves providing emotional comfort to family members.

A nurse is caring for a 78-year-old client who has been hospitalized following a stroke. Which nursing action has the highest priority for this client?

Measuring the client's intake and output during recovery explanation: According to Maslow's hierarchy of basic human needs, physiologic (Level 1) needs, such as maintaining fluid balance, are of the highest priority, so measuring the client's intake and output during recovery is the nursing priority in this case. Ensuring that the client has family and friends visit addresses a Level 3 (love and belonging) need. Helping the client fill out an advanced directive form addresses a Level 4 (self-esteem) need. Finding a safe environment for the client on discharge addresses a Level 2 need (safety and security).

The nurse is admitting a 38-year-old client to the oncology unit whose religious background is different from the nurse's own. The nurse is assessing how the client's religion may affect the client's health care needs. Which question by the nurse is the best way to consider the client's religious practices in the plan of care?

"What can we do to help you meet any religious needs you may have?" explanation: The nurse should always respect the client's religious beliefs and ask whether the client has any religious needs that may affect health care. Comparing the client's beliefs with those of the nurse is inappropriate. Asking general questions about the client's religion would not identify other aspects of religion that might affect health care. A too-narrow focus on only dietary restrictions or specific medical treatments will not give the nurse enough information to develop an inclusive plan of care.

A nurse has the Petty Family as a client, who consists of a wife, husband, and their 4-year-old daughter. The husband has been unemployed for 8 months, and they lost their apartment. The family has been staying in neighborhood shelters and, on occasion, with the husband's father for a night or two. When evaluating this family, the nurse identifies this family as which type?

A homeless family explanation: This family is homeless, which is considered a nontraditional family. A multigenerational family is one in which several generations or age groups live together in the same household. A blended family is formed when parents bring unrelated children from previous relationships together to form a new family, and an extended family consists of a relative, such as aunts, uncles, and grandparents, who live in close geographic proximity to each other.

A community is defined as a social group that may or may not share common geographic boundaries yet interact because of

Common interests explanation: Community is defined as a social group, whose members may or may not share common geographic boundaries, yet who interact because of common interests or shared values to meet the needs within a larger society. A community assessment allows the nurse the opportunity to understand the community. Members of a community may or may not have similar school districts, common economic interests, or common political beliefs.

A client says, "I live in a small community on the northwest side of the city." Why does the nurse consider it significant that the client reports living in a community rather than a neighborhood?

Community indicates people who share similar characteristics. explanation: Communities are thought to contain persons who share similar characteristics, whether it be social interaction, cultural or ethnic ties, or geographic area. Communities may be larger or smaller that a geographic neighborhood and are not defined by geography. Communities exist because they meet basic human needs.

A community-based nurse acts as a case manager for a small town about 60 miles from a major healthcare center. What is the most important factor of community-based nursing for this nurse to be knowledgeable about?

Community resources available to clients explanation: A community-based nurse must be knowledgeable about community resources available to clients as well as services provided by local agencies, eligibility requirements, and any possible charges for the services. The other answers are incorrect because they are not the most important factor for a community-based nurse to be knowledgeable about.

A nurse is developing a plan of care for a client to meet the client's self-actualization needs. The nurse would focus on which area as most important?

Emphasizing the client's strengths explanation: To help meet a client's self-actualization needs, the nurse focuses on the person's strengths and possibilities rather than on problems. Reducing fear would assist in meeting the client's safety and security needs. Promoting socialization would aid in meeting the client's love and belonging needs.

The home health nurse is making an initial visit to a client's home. During the visit the nurse observes the mother cooking dinner, the father watching television with a child on the lap, and the grandmother in a rocking chair reading the Bible. The nurse recognizes this family structure as which of the following?

Extended family explanation: The extended family is composed of two parents, their children, and relatives (such as aunts or grandparents) living in the same household. The blended family is a family formed when parents bring unrelated children from previous relationships together. Single-parent families have only one parent, and the nuclear family consists of two parents and their children.

The nurse in the adolescent in-patient psychiatric unit is interviewing the family of a 16-year-old client admitted for depression and threatened suicide. What assessment information is most essential for the nurse in determining the affective and coping function of the family?

Family patterns of communication explanation: The five major areas of family function are physical, economic, reproductive, affective and coping, and socialization. When assessing the family of a depressed client for affect and coping function, it is helpful for the nurse to be aware of the family's communication style. This information can help identify family difficulties and teaching points that could benefit the client and the family.

A nurse is working as part of a group to address factors within the community affecting the health of the families in that community. Which area would the nurse identify as playing a role in contributing to altered health status? Select all that apply.

Limited number of institutions providing health care Overlapping of industrial zones with residential zones Small number of recreational opportunities for adults and children explanation: Many community factors affect the health of residents. A healthy community enables people to maintain a high quality of life and productivity. For example, a healthy community offers access to health care services for all members of the community; has roads, schools, playgrounds, and other services to meet needs of the people in the community; and maintains a safe and healthy environment. Factors within the community that can affect health include the number and availability of health care institutions and services; zoning regulations separating residential and industrial areas; as well as air and water pollution and recreational opportunities. Limited numbers and availability of these would be considered risk factors for altered health. A high, not low, incidence of crime would be a risk factor for altered health.

A young couple who have been married less than a year are having difficulty with adjusting to parenting. What is a contributing factor to this level of maladjustment?

Limited time in learning to be a marital partner explanation: Tasks that the family does not complete at any one developmental stage can produce chronic difficulties as the family struggles to master tasks at the next stage. The couple is struggling due to them only being together married for less than a year and the difficulty of a having a child in this short time frame. Nothing in the stem alludes to the couple having issues with the stress of education, job, and parenting nor economic difficulties or involvement with significant others.

A nurse is providing care to a client who is feeling lonely and isolated. In an effort to develop a trusting nurse-client relationship, the nurse exhibits a caring attitude, ensures the client's privacy, and spends time with the client to promote therapeutic communication. The nurse is meeting which category of client needs?

Love and belonging explanation: People who believe that their love and belonging needs are unmet often feel lonely and isolated. The nurse addresses this by establishing a nurse-client relationship based on mutual understanding and trust (by demonstrating caring, encouraging communication, and respecting privacy). Physiologic needs are the most basic in the hierarchy of needs and the most essential to life. Safety and security needs have both physical and emotional components: physical safety and security means being protected from potential or actual harm; emotional safety and security involves trusting others and being free of fear, anxiety, and apprehension. Self-esteem needs include the need for a person to feel good about himself or herself, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishments.

A nurse is caring for an adolescent who lost a leg in a motor vehicle accident. Which human need would the nurse most likely need to address?

Self-esteem needs explanation: The options listed are stages of Maslow's hierarchy of needs. The adolescent would have issues and concerns in the self-esteem stage. Self-esteem needs would include fear, sadness, loneliness, and accepting self; all would be appropriate with this client. Love and belonging would focus on the sociocultural aspect and would include areas such as relationships with others, communication with others, support systems, being part of a community, and feeling loved by others. Safety and security would focus on the environmental aspect and would include areas such as housing and community/ neighborhood to name a few. Self-actualization needs are in the intellectual and spiritual dimension and would include areas such as thinking, learning, decision making, values, beliefs, and helping others.

The nurse is conducting a family assessment of a traditional family. Which assessment data cue describes the socioeconomic status of the family?

The father is an engineer and the mother is an elementary school teacher. explanation: The occupations of the parents provide financial support for the family and contribute to the socioeconomic status of the family. Affiliation with a religious organization can be a source of social support during stressful times, which can promote adaptive coping for the family. Cultural and religious activities of the family define values and beliefs important to family members. Recreational activities, such as vacationing together, promote interaction of family members.

The home health nurse is making an initial assessment visit to a family that consists of two parents and twin 3-year-old boys. During the interview, the nurse is most concerned if the client makes which statement?

The father states, "I don't discuss money matters with my wife because I don't want her to worry." explanation: Effective and healthy families exhibit open communication among its members. Protecting the spouse from worry by not discussing money matters stifles communication and jeopardizes the family's affective and coping functions. It is appropriate for a father to provide emotional comfort to his son by allowing him to sit on his lap during the interview. Paying cash is an appropriate way to manage family finances. The mother is stating her personal belief about housework in a clear and open manner.

Which statement is true regarding Friedman's theory of family-centered nursing care?

The role of the family is essential in every level of nursing practice. explanation: Friedman and associates identified the importance of family-centered nursing care, based on four rationales. First, the family is composed of interdependent members who affect one another. If some form of illness occurs in one member, all other members become part of the illness. Second, a strong relationship exists between the family and the health status of its members; therefore, the role of the family is essential in every level of nursing care. The third rationale is that the level of health of the family and, in turn, each member can be significantly improved through health-promotion activities. Finally, illness of one family member may suggest the possibility of the same problem in other members; through assessment and intervention, the nurse can assist in improving the health status of all members.

A 44-year-old client is being treated for dehydration in an acute care hospital. The nurse determines that the rehydration treatment is working by assessing which values?

Urine output of 1500 mL in 24 hours explanation: A balance between intake and elimination of fluids is an essential physiological need. Disruption in the water balance in the body results in either dehydration or edema. Measuring the fluid intake and output can determine the client's hydration status. A 24-hour urine output of 1500 mL is normal (range 1000 to 3000 mL/day) and indicates sufficient fluid intake to produce a normal urine output. An elevated hematocrit and urine specific gravity indicate that the client is dehydrated. An oral intake alone is not an indicator of adequate hydration.

The nurse on the elective surgery floor receives a report that describes the client's abdominal wound dressing as having a moderate amount of yellowish and bloody drainage on it and a very foul smell. In planning for a dressing change, it is most important for the nurse to perform which action?

Wash the nurse's hands before and after the dressing change. explanation: Physical safety and security mean being protected from potential or actual harm. The abdominal dressing with a foul smell indicates the presence of bacteria. It is most important for the nurse to prevent the spread of infection to the nurse and others and to protect the client. Proper hand washing before and after the dressing change to prevent the spread of infection is a nursing activity that will meet these physical safety needs. Changing the abdominal dressing more frequently, applying extra gauze to absorb the wound drainage, or using sterile gloves to change the dressing will not prevent the spread of infection to other clients or staff.