Homework Lance
1. The following people enter the health clinic together: an unmarried man and his year-old son, an unmarried woman with a year-old daughter, and the man’s married brother, who is separated from his wife. During the assessment it is determined that both men work and contribute to the household, where all of them live. Which of the following best describes the “family”?
a.
The group consists of three families: the man and his son, the woman and her daughter, and the brother, who is married even though he and his wife are separated.
b.
There are two families involved: first, the unmarried man and woman and their two children, and second, the brother, who is married even though he and his wife are separated.
c.
There is no family here, only three adults sharing resources between themselves and two biologically related children.
d.
The family includes whoever the adults state are family members.
ANS: D
Nurses working with families should ask an adult member to identify all those considered to be family members and then include those members in health care planning. A “family” may range from the traditional nuclear model with extended family to such “postmodern” family structures as single-parent families, stepfamilies, same-gender families, and families consisting of friends.
DIF: Cognitive Level: Apply (Application) REF: p. 307
2. The nurse in community health needs to conduct a family assessment within a commune but is uncertain how to proceed because family lines appear blurred. The best way to determine the family of a mother and her child is to ask the woman which of the following questions?
a.
“How many children do you have, and who is the father of each?”
b.
“Is there a register of families who are members of this commune?”
c.
“Tell me about your significant other.”
d.
“Who are the members of your and your child’s family?”
ANS: D
The members of a family are self-defined. The family includes whoever the woman says are family members. The nurse should include all those members in health care planning.
DIF: Cognitive Level: Apply (Application) REF: p. 307
3. In taking a family history, the nurse in community health finds that this is the second marriage for the previously divorced parents and that the male partner is the stepparent to the oldest child. For which of the following aspects of the family assessment is data being gathered?
a.
Dynamics
b.
Function
c.
Structure
d.
System
ANS: C
Family structure refers to the characteristics and demographics (gender, age, number) of individual members who make up the family. Structure defines the roles and the positions of family members.
DIF: Cognitive Level: Apply (Application) REF: p. 308
4. Which of the following statements best explains why family functions and structures create unique challenges in family nursing?
a.
Function and structure change over time.
b.
Function and structure do not apply to all family units.
c.
Some clients do not have families.
d.
Traditional families are rare in society.
ANS: A
The functions that families serve evolve and change over time. Some become more important and others less so. Family structures also change over time. The great speed with which changes in family structure, values, and relationships are occurring makes working with families at the beginning of the twenty-first century exciting and challenging.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 308
5. A nurse is working with a family who is confronting major challenges to their health. Which of the following approaches would be most helpful for the nurse to use?
a.
Allowing the family to be noncompliant
b.
Building on the family’s strengths and resilience
c.
Labeling the family as resistant
d.
Recognizing that the family is dysfunctional
ANS: B
The labels of dysfunctional, noncompliant, resistant, or unmotivated all denote families who are not functioning well; however, such labels do not create an environment conducive for positive family change and intervention and should not be used. Families are neither all good nor all bad; families have both strengths and difficulties and have seeds of resilience. Recognizing the family’s strengths gives the nurse assets on which to draw in planning care.
DIF: Cognitive Level: Apply (Application) REF: pp. 309-310
6. The nurse is told that a healthy, functional family consisting of a 25-year-old man and a 24-year-old woman, who are expecting their first child, would appreciate a nurse coming to their apartment for anticipatory guidance in preparing themselves and their apartment for the baby. Based on that statement, which of the following assumptions can the nurse safely make about the family?
a.
The family is lacking a strong support system.
b.
The family’s basic needs are being met.
c.
The couple’s in-laws are unavailable to share their expertise about child care.
d.
The married couple is excited about their first baby.
ANS: B
In functional, healthy, or resilient families, the basic survival needs are met. Healthy families exist based on attachment and affection. There is nothing in the example to suggest that they are married, that their income is low, or that they lack other resources or support systems.
DIF: Cognitive Level: Apply (Application) REF: p. 309
7. A nurse focuses on the care of the individual while viewing the client’s family as a background resource or possible stressor. Which of the following conceptualizations of family does this nurse’s view represent?
a.
Client
b.
Component of society
c.
Context
d.
System
ANS: C
Family as the context, or structure, has a traditional focus that places the individual first and the family second. In the “family as context” concept, the family serves as either a resource or a stressor to individual health and illness.
DIF: Cognitive Level: Apply (Application) REF: p. 310
8. A nurse asks a family member, “What has changed between you and your spouse since your child’s head injury?” Which of the following focuses of the family is the nurse assessing?
a.
The context
b.
The client
c.
A system
d.
A component of society
ANS: C
When the focus is on the family as a system, the family is viewed as an interactional system in which the whole is more than the sum of its parts. The approach simultaneously focuses on individual members and the family as a whole at the same time. The interactions between family members are the target for nursing interventions.
DIF: Cognitive Level: Apply (Application) REF: p. 310
9. Which of the following theories views the family as a whole with boundaries that are affected by the environment?
a.
Family developmental theory
b.
Structural-functional theory
c.
Family role theory
d.
Family systems theory
ANS: D
The theory that views the family as a whole with boundaries that are affected by the environment is the family systems theory.
DIF: Cognitive Level: Remember (Knowledge) REF: pp. 310-312
10. A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the family life cycle. Which theory is being applied?
a.
Family systems
b.
Structural-functional
c.
Family developmental
d.
Interactionist
ANS: C
The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle.
DIF: Cognitive Level: Apply (Application) REF: pp. 312-313
11. A new mother is a full-time college student who lives with her parents, because the baby’s father has been imprisoned related to theft and drug abuse. The infant’s grandmother, although also employed, cares for the child while the young mother attends classes. Which of the following theoretical frameworks would be most helpful to the nurse when assessing this family’s needs?
a.
Developmental
b.
Interactional
c.
Structure-function
d.
Systems
ANS: A
Developmental theory explains and predicts the changes that occur to humans or groups over time. Achievement of family developmental tasks helps individual members accomplish their tasks. In this case the new mother has tasks, whereas her parents have temporarily interrupted their progress in response to their daughter’s (and grandchild’s) needs.
DIF: Cognitive Level: Analyze (Analysis) REF: pp. 313-314
12. A nurse considers how the environment outside of the family influences the development of a child when planning care for a family. Which of the following theories is being used by the nurse?
a.
Bioecological systems theory
b.
Family systems approach
c.
Family developmental theory
d.
Interactionist theory
ANS: A
The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time.
DIF: Cognitive Level: Apply (Application) REF: p. 314
13. A nurse is in the termination phase of the nurse-family relationship. Which of the following strategies would the nurse most likely implement?
a.
Increasing sessions with the nurse
b.
Making referrals when appropriate
c.
Providing a formative evaluation of the relationship
d.
Refusing additional communication with the family
ANS: B
It also includes decreasing contact with the nurse, extending invitations to the family for follow-up, and a summative evaluation meeting for formal closure.
DIF: Cognitive Level: Apply (Application) REF: p. 318
14. A nurse is making an appointment with a family for a nursing visit. Which of the following describes a potential barrier the nurse may encounter?
a.
The assessment cannot be done unless the extended family is present.
b.
It may be difficult to find a convenient time for all family members to be present.
c.
Nurses have limited time to do home visits.
d.
Families are often scattered over a large area, making access difficult.
ANS: B
It is important to encourage all family members to attend the meeting. However, it can be difficult to find a convenient time for all family members to attend. Many times late afternoon or evening appointments are necessary to accommodate the needs of the family.
DIF: Cognitive Level: Apply (Application) REF: p. 315
15. Which of the following factors must be considered before deciding on an appropriate plan of action?
a.
Family agrees to the nurse’s plan.
b.
Family is capable of the required actions.
c.
Family will learn better coping skills from the nurse’s plan.
d.
Nurse has informed family how to complete the required actions.
ANS: B
Family theorists stress that any intervention plan must be developed in collaboration with the family, using and enhancing family strengths and increasing independence of family members. The plan cannot be the nurse’s choice alone. Further, the plan must be within the information and skill level of the family, and the family must be committed to the plan and have adequate resources available to implement the plan.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 317
16. Which of the following terms refers to government actions that have a direct or indirect effect on families?
a.
Family funding
b.
Family legislation
c.
Family planning
d.
Family policy
ANS: D
Government actions that have a direct or indirect effect on families are called family policy.
DIF: Cognitive Level: Remember (Knowledge) REF: p. 320
17. A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions is the nurse most likely to take?
a.
Resigning from employment, but retaining health insurance
b.
Sharing family information with colleagues
c.
Providing Medicaid to a family who cannot afford health insurance
d.
Taking a defined time off of work for family events without fear of job loss
ANS: D
The Family Medical Leave legislation allows for a family member to take a defined amount of leave for family events, such as births and deaths, without fear of losing his or her job.
DIF: Cognitive Level: Apply (Application) REF: p. 320
18. A nurse is conducting a family assessment. Which of the following behaviors would the nurse recognize as suggestive of a family with problems?
a.
Before eating, the family prayed, expressing gratitude for their blessings.
b.
During family play, jokes and laughter were heard.
c.
Each person had a private room with a door for alone time.
d.
Most of the conversation was between the father and the eldest daughter.
ANS: D
Evidence of healthy families can be seen in a variety of observations, including open communication among all members, mutual play with humor, balanced interactions among all members, expressions of a religious core or other value system, and each member being allowed some privacy.
DIF: Cognitive Level: Apply (Application) REF: p. 309
19. The hospital-based nurse has worked with a client at some length regarding appropriate diet. Based on the family systems theory, which of the following will most likely occur when the client returns home?
a.
The family member who prepares food will probably suggest the newly discharged member eat the meals everyone in the family enjoys.
b.
The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole.
c.
The family member who prepares food will probably prepare meals based on the diet plan for all the family.
d.
The family member who prepares food will probably prepare special meals for the newly discharged member.
ANS: B
Family systems typically maintain stable patterns, although families do change constantly in response to stresses. Change in one part of the family affects the total system. It is not realistic to expect the whole family to change eating patterns immediately based on the needs of one family member. However, if family members are supportive, they will want to try to help the ill member. Because of the rapid change and stress in American society, preparing different sets of meals is not very realistic. Therefore, the member who prepares the meals will probably compromise by trying to meet the ill member’s needs without making drastic changes in the overall eating patterns of the family.
DIF: Cognitive Level: Analyze (Analysis) REF: pp. 312-313
20. A nurse has just met a family and is being doing their family assessment. Which of the following actions should the nurse take before engaging in self-disclosure?
a.
Confirm the reason for the assessment.
b.
Demonstrate culture awareness.
c.
Take time to build trust.
d.
Understand the family dynamics.
ANS: C
Assessment is interactive. As you are evaluating families, they are evaluating you. Too much disclosure during the early contacts between the family and nurse may scare the family away. Slow the process down, and take time to build trust.
DIF: Cognitive Level: Apply (Application) REF: p. 315
21. A nurse is completing a tertiary prevention activity in a predominantly poor community, where eating clay (pica) is a common practice. Which of the following actions would the nurse most likely take?
a.
Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients.
b.
Initiate early intervention in the school system through education programs designed to focus on healthy food choices.
c.
Provide laboratory testing and physical assessments to assess for nutritional deficits resulting from clay intake.
d.
Survey families in the community to determine whether they eat clay and how much clay they eat.
ANS: A
Tertiary prevention is undertaken to prevent additional health problems when a problem has occurred. Early intervention in the school system is an example of primary prevention. Lab testing and surveying families are screening activities to determine whether a problem is present and to catch it in the early phases; such screening activities are representative of secondary prevention.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 309
MULTIPLE RESPONSE
1. A nurse requests to meet a newly referred family in their home. Which of the following best explains the rationale for this request? (Select all that apply.)
a.
The nurse can assess the family environment.
b.
The family will feel more comfortable.
c.
Families typically welcome others into their home.
d.
More family members can typically be involved.
ANS: A, B, D
Advantages to meeting in the family home include the fact that it allows the nurse to see the everyday family environment and observe typical family interactions. Also, more family members can be present, and families are often more comfortable in their own environment. However, a disadvantage to meeting in the family’s home is that family members may view this as an intrusion into the only place they feel safe from outside observation; thus, the nurse must be highly skilled in guiding the interactions and setting limits.
DIF: Cognitive Level: Apply (Application) REF: p. 315
2. In comparison with traditional norms, which family functions have become increasingly important in modern American society? (Select all that apply.)
a.
Conferring appropriate social status
b.
Educating the younger members
c.
Ensuring physical and mental health
d.
Fostering interpersonal relationships and support
ANS: C, D
Historically, families have had several functions including financial survival, reproduction, protection from hostile forces, and enculturation, including religious faith, education, conferring social status. Today, however, the more important functions are fostering relationships (emphasizing how people get along and their level of satisfaction) and promoting physical and mental health.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 307
3. Which of the following must be firmly established before beginning a family assessment? (Select all that apply.)
a.
Why the data are needed
b.
How best to interview each individual in the family
c.
The most convenient time for you to visit the family
d.
The rationale or purpose of the visit
ANS: A, C, D
Assessment of families requires an organized plan, including the purpose of seeing the family, which family members can be present, what you are assessing and why, and how will you obtain the necessary data. It can be assumed that the nurse would already know agency policies. It is more informative to interview the family as a whole so that you can observe family interaction (rather than focusing on interviewing each individual). Therefore, the preferred time to visit is when most family members will be available. Similarly, it is more informative to see the family in their home setting than to establish a different site for the visit.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 316
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