Family Health Risks

1. A nurse was preparing for a home visit to a family where the mother had just been discharged from trauma care after being hit by a drunk driver. The nurse hoped the family was able to care for her. Which of the following comments from the husband would suggest an energized family?

a.
“I make most of the decisions so the kids don’t notice much difference.”
b.
“My daughter is pretty independent; she’s active in both sports and theater.”
c.
“My son is old enough to get a job and help pay all these medical bills.”
d.
“My wife taught our daughter how to cook simple meals.”

ANS: B

Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships (not if only the daughter is taught how to cook and only the son is expected to get a job), equal power structure (not if the husband makes all the decisions), and a high degree of autonomy by each member (kids know how to be flexible, because parents travel for business frequently).

DIF: Cognitive Level: Apply (Application) REF: p. 326

2. Using the Neuman Systems Model, which of the following questions would the nurse ask a client to assess physiological health?

a.
“What helps you to cope with situations involving your wife’s cancer?”
b.
“How has your child’s illness affected the behavior of your other children?”
c.
“Tell me about any illnesses your other family members have.”
d.
“Who do you turn to for support outside your immediate family?”

ANS: C

Physiological health involves issues related to physical wellness or illness. Other components of health in Neuman’s model include psychological health, sociocultural health, developmental health, and spiritual health.

DIF: Cognitive Level: Apply (Application) REF: p. 327

3. A nurse is working with a family member to reduce his health risk. Which of the following recommendations would most likely be made by the nurse?

a.
“Be sure to take a 30-minute walk each day.”
b.
“Call our office if you have any questions or concerns at all.”
c.
“Come back in 2 weeks for follow-up on your surgery.”
d.
“Continue to take the drug until it is gone, even if you’re feeling better earlier.”

ANS: A

The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. All the other options are treatment oriented rather than risk avoidance. Exercising for 30 minutes a day reduces the risk for many diseases.

DIF: Cognitive Level: Apply (Application) REF: p. 327

4. A nurse is appraising health risks. Which of the following questions would most likely be asked by the nurse?

a.
“Does your 4 year-old have a booster seat in the car?”
b.
“Have you noticed any physical problems as you go about your daily routine?”
c.
“What concerns do you have today?
d.
“Why did you decide to come in for a checkup?”

ANS: A

Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident.

DIF: Cognitive Level: Apply (Application) REF: p. 327

5. A nurse is conducting a health risk appraisal. Which of the following activities is the nurse assessing when using this tool?

a.
Health promotion activities
b.
Illness prevention activities
c.
Risk reduction activities
d.
Unhealthy activities

ANS: D

Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environment risk, and behavioral risk. Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.

DIF: Cognitive Level: Apply (Application) REF: p. 327

6. A nurse is implementing risk reduction interventions with a family. Which of the following questions is most important for the nurse to ask?

a.
“Did any of the hunters in your family kill a deer this year?”
b.
“How do you keep your rifles safe from curious children?”
c.
“Where do you shoot with your handguns?”
d.
“Where do you keep your rifles locked when it is not hunting season?”

ANS: C

Risk reduction is a complex process that requires knowledge of risks and families’ perceptions of the nature of the risk. In this situation the nurse was asking questions to determine the family’s perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 328

7. A nurse is completing a health risk appraisal with a client. Which of the following comments would cause the nurse to probe further to determine if the family is in crisis?

a.
“I can’t visit my husband in the hospital when I’m at work all day. How can I be sure he’s all right?”
b.
“My husband always handled our finances. Now that he’s gone, I’ll have to learn how to do this.”
c.
“I don’t know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children.”
d.
“What am I supposed to do now that everything we own is gone? Are there any agencies that can help me?”

ANS: C

A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. In three of the options, the survivor is considering the problem and trying to learn how to cope or seek resources to cope. Only in this option is the person overwhelmed and unable to conceive of how to cope.

DIF: Cognitive Level: Apply (Application) REF: p. 328

8. A nurse has completed health risk appraisals with several different families. Which of the following families would be of most concern to the nurse?

a.
An older couple who has just retired and sold their house, who talk about their new condo in a retirement community.
b.
Newlyweds who have been saving their money, who want to discuss birth control and family planning in preparation for future pregnancies.
c.
Parents who come with their child for his pre-kindergarten physical exam and want to be sure all the child’s immunizations are up to date.
d.
A woman who is very pleased with her new position at the hospital and wants to have her pre-employment exam and drug screen.

ANS: A

Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. None of the other options represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences.

DIF: Cognitive Level: Apply (Application) REF: pp. 329-330

9. Which of the following best describes a normative life event that can increase the risk for illness?

a.
A family is involved in a motor vehicle crash.
b.
A group of teens experiment with recreational drugs.
c.
A woman is pregnant with her first child.
d.
The family wage earner is laid off from his job.

ANS: C

Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of

eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The events listed in the other options are not normative life events.

DIF: Cognitive Level: Apply (Application) REF: pp. 329-330

10. A nurse is drawing a genogram. Which of the following would the nurse use to demonstrate a marriage relationship between two individuals?

a.
A broken line
b.
A dashed line
c.
A solid line
d.
Two parallel lines

ANS: C

Marriage is indicated by a solid line on a genogram.

DIF: Cognitive Level: Apply (Application) REF: p. 330

11. Which of the following best describes the use of genomic health care?

a.
Assists with understanding family relationships
b.
Assists with determining familial health risks
c.
Useful in learning about environmental risk factors
d.
Useful in detecting risk for developing cancer

ANS: B

Genomic health care can give health care providers the tools that they need to use a person’s unique genomic information to design and prescribe the most effective treatment for each person and to help clients and families understand some of their health risks that are influenced by their genetic make-up. When nurses obtain a family history and learn about the illnesses and causes of death of biologically related family members, they can then learn about shared genes, environment and lifestyle behaviors that can increase a person’s risks for the same diseases that other family members experienced. Genomic health care is broader than detecting risk for developing cancer.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 332

12. Which of the following families is at high risk for health problems?

a.
A man agrees that he needs to eat better and exercise more but also expresses how busy he is at his job.
b.
A man knows that his grandfather, father, and older brother all died of cardiac disease.
c.
A man is currently unemployed and despairs about finding a position.
d.
A man expresses disappointment that, having been laid off as an executive, his new position pays only about two thirds of his original salary.

ANS: C

A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care.

DIF: Cognitive Level: Apply (Application) REF: p. 333

13. A home health nurse who is visiting a family for the first time asks, “Could we review your extended family and other persons or groups with whom you interact each week?” Which of the following provides the best rationale for the nurse asking this question?

a.
To assess the family’s environment and social resources and risks
b.
To communicate with relevant others as needed
c.
To determine financial assets available to the family in case of serious need
d.
To understand the extended family relationships

ANS: A

The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family’s connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family’s interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap.

DIF: Cognitive Level: Apply (Application) REF: p. 334

14. Which of the following clients would cause the nurse the most concern?

a.
The client who is currently unemployed but actively seeking a position and frequently walking from one interview to another
b.
The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods
c.
The client who is employed and often works 12 hours a day without moving from the computer desk
d.
The client who is employed but always leaves promptly at 5:00 to pick up the children from the day care center

ANS: C

Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesn’t move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease.

DIF: Cognitive Level: Apply (Application) REF: p. 334

15. An occupational health nurse is developing an educational program to address the importance of healthy personal health habits. Which of the following topics would be most important for the nurse to address?

a.
Avoidance of alcohol
b.
Regular physical exercise
c.
Daily consumption of calcium-rich foods
d.
Monthly self-breast and testicular exams

ANS: B

Many family health risks can be reduced by careful attention to diet, exercise, and stress management. Regular physical exercise is effective in promoting and maintaining health and in preventing disease. Physical activity can help to prevent obesity, diabetes, heart disease, cancer, osteoporosis, and depression. Avoidance of alcohol and daily consumption of calcium-rich foods are not recommendations for improving personal health habits.

DIF: Cognitive Level: Apply (Application) REF: p. 335

16. A home health nurse is about to visit a family at their home. However, the nurse is feeling uncomfortable about getting out of her car because a group of young adults across the street are drinking and fighting among themselves. Which of the following actions should be taken by the nurse?

a.
Call the agency and ask what she should do.
b.
Call the family, explain the situation, and try to reschedule.
c.
Fulfill the nurse’s commitment to the family and enter the home quickly.
d.
Drive away and notify the family from a safer location.

ANS: D

Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists. Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit.

DIF: Cognitive Level: Apply (Application) REF: p. 338

17. A nurse arrives at a home at the appointment time established with the client over the phone. However, no one answers the door. Finally a child comes out and says, “My mom said she couldn’t see you and you should go away.” Which of the following actions should be taken by the nurse?

a.
Demand the child let the nurse into the home to talk to the mother.
b.
Interview the child as to how the family is doing.
c.
Leave a card with information on how to get in touch with the nurse .
d.
Point out that legally once an appointment has been made the mother needs to be seen.

ANS: C

The contact may be terminated as requested if the nurse determines that either the situation has been resolved or services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 338

18. A nurse is completing an initial home visit with a family. Which of the following actions should be taken first by the nurse?

a.
Assess the family and the home setting for both strengths and problems.
b.
Determine the family’s expectations of a home visit.
c.
Establish rapport between the nurse and the family.
d.
Engage in extended social interaction as would be expected from any guest.

ANS: C

With the exception of social interaction, all the tasks listed are important. The initial home visit includes the nurse’s self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the client’s expectations. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks.

DIF: Cognitive Level: Apply (Application) REF: pp. 338-339

19. A home health nurse is preparing to terminate the first home visit with teenage parents and their new baby. Which of the following actions will the nurse take before leaving?

a.
Determine the family’s willingness for another home visit
b.
Establish the purpose of the visit
c.
Review the family’s learning and other accomplishments of the visit
d.
Review the family record and reason for referral

ANS: C

During the termination phase, the nurse reviews the visit with the family, summarizes what has occurred and what has been accomplished, and may make plans for future visits. The other options listed occur during the pre-visit phase.

DIF: Cognitive Level: Apply (Application) REF: p. 340

20. During which phase of the home visit does the nurse document what was accomplished?

a.
Pre-visit phase
b.
In-home phase
c.
Termination phase
d.
Post-visit phase

ANS: D

A major task of the post-visit phase is documenting the visit and services provided.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 340

21. A nurse has just witnessed the signing of an agreement between two parents in which the parents pledge not to yell at each other in the presence of their children. Which of the following is being demonstrated through this action?

a.
Contracting
b.
Crisis intervention
c.
Empowerment
d.
Strategic planning

ANS: A

Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased.

DIF: Cognitive Level: Apply (Application) REF: p. 341

22. A nurse wants to empower the family of a mother who has been newly diagnosed with breast cancer. Which of the following actions would the nurse most likely take?

a.
Apply for emergency financial assistance on the family’s behalf.
b.
Arrange for community members to assist with child care.
c.
Invite the mother to join a cancer support group.
d.
Teach the family how to navigate the health care system.

ANS: D

Definitions of empowerment reflect three characteristics of the empowered family seeking help: access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. Approaches for helping individuals and families assume an active role in their health care should focus on empowering, rather than giving direct help.

DIF: Cognitive Level: Apply (Application) REF: pp. 341-342

23. A nurse has been successful in creating improvement in a family’s health. Which of the following characteristics is most likely displayed by the nurse?

a.
Skilled at recognizing and strengthening the family’s competencies
b.
Skilled at obtaining referrals and resources for the family
c.
Skilled at communication and interpersonal relationships
d.
Skilled at assessing and naming the family’s main problems

ANS: A

The nurse’s approach to the family should be positive and focused on competencies rather than on problems or deficits.

DIF: Cognitive Level: Apply (Application) REF: p. 342

24. Which of the following should be the initial consideration made by a nurse who is working with lesbian, gay, bisexual, and transgendered (LGBT) families?

a.
Understanding of same sex marriage laws within the state
b.
Understanding of personal feelings of working with members of this community
c.
Assessment of the family structure within the LGBT family
d.
Assessment of sexual orientation in a safe environment

ANS: B

Nurses have an ethical obligation to provide culturally competent care to LGBT families. Some nurses may feel a degree of discomfort discussing sexual orientation with their patients. However, it is important to overcome this barrier to care for LGBT families. Thus, nurses should provide a safe environment for patients to discuss their sexual orientation.

DIF: Cognitive Level: Apply (Application) REF: p. 342

25. A nurse notes that the community has an unusually high prevalence of sexually transmitted infections among teens. Which of the following best describes a secondary prevention action the nurse could take?

a.
Conducting a sexual behavior survey with the adolescents
b.
Establishing in-school education related to transmission of sexual infections
c.
Providing free condoms at schools and universities
d.
Providing follow-up educational programs for those diagnosed with an STI

ANS: A

Secondary prevention would include screening for risky behavior. Education and distribution of condoms are both primary prevention measures, and follow-up education for those diagnosed and being treated is tertiary to prevent further problems.

DIF: Cognitive Level: Apply (Application) REF: p. 342

MULTIPLE RESPONSE

1. A family asks the nurse to please meet at their home rather than at the clinic. Which of the following best describes why the family prefers to meet in their home? (Select all that apply.)

a.
The family won’t have to travel.
b.
It is cheaper for the family because of reimbursement requirements.
c.
Meeting at home is much more convenient for the family.
d.
The nurse won’t be distracted by other clients or responsibilities.
e.
It would save money for the nurse and the clinic.

ANS: A, C

Advantages of a home visit include client convenience and client control, as well as the fact that it facilitates clients who are unable to travel, it allows more individualized services, and it provides a natural relaxed environment for discussion. However, home visits are expensive for the nurse and the nurse’s employer because of travel costs and the amount of time spent with just one family. Unfortunately, nurses can be distracted by other tasks regardless of setting. Home visits are cheaper for insurance companies, not for the family.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 337

2. Which of the following factor(s) may help determine how many home visits are made to a particular family? (Select all that apply.)

a.
Agency’s policies regarding eligibility for services
b.
Family’s feelings about the home visit and willingness to continue
c.
Nurse’s perception of the amount of time needed to complete required tasks
d.
Reimbursement policies of third-party payers

ANS: A, B, D

Although it is not unusual to have only one home visit with a family, often multiple visits are made. The frequency and intensity of home visits vary not only with the needs of the family but also with the eligibility of the family for services as defined by agency policies and priorities. Although the textbook does not directly discuss the issue, the family’s willingness to work with the nurse is a factor. Also, the nurse cannot make visits unless the agency is being reimbursed for the nurse’s time and expenses, so reimbursement policies of third-party payers are a major influence on the number of visits for which the family may be eligible. The nurse’s perception of the time needed to give quality care must unfortunately be secondary to other variables, which can control the time available.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 339

3. The nurse and the family have agreed on an ambitious goal to improve family functioning, but as the family later expresses with some dismay, they have not been able to change their behavior as easily and quickly as they had hoped. Which of the following must be remembered throughout this process? (Select all that apply.)

a.
A reassessment of resources should be done if the plan does not work.
b.
Individual family members must all be willing to make the plan their first priority.
c.
Goals must be realistic and feasible.
d.
Ongoing negotiation is central to the process.

ANS: C, D

In contracting, an important aspect is obtaining the family’s view of the situation and its needs and problems. Goals must be mutually set and realistic. A pitfall for nurses and clients who are new to contracting is to set overly ambitious goals. Because contracting is a process characterized by ongoing renegotiating, the goals are not static. The family’s inability to change “as easily and quickly as they had hoped” does not mean the plan is not workable—only that more time and effort may be necessary.

DIF: Cognitive Level: Apply (Application) REF: p. 341

4. A nurse enters a family’s home for the first time. Which of the following goals should the nurse have? (Select all that apply.)

a.
Assessing each family member in detail both physically and psychologically
b.
Collaborating with the family to establish goals and a plan for meeting them
c.
Determining the exact relationship between each member of the family
d.
Exploring the family’s perception of their problems and needs

ANS: B, D

During the beginning phase of the nurse-family interaction, three activities occur—mutual data collection and exploration of needs and problems; mutual establishment of goals; and mutual development of a plan.

DIF: Cognitive Level: Apply (Application) REF: p. 341

5. A nurse calls a family to arrange for the first home visit. Which of the following information should the nurse share with the family? (Select all that apply.)

a.
The reason for the visit
b.
Everything the nurse knows about the family
c.
How many visits will be planned
d.
The cost of the visit and how this may be paid

ANS: A, D

The nurse should include the reason for the visit, how or from whom the referral was obtained, and a brief summary of what is known about the family’s situation. The nurse should negotiate a time for the visit, preferably when most family members are available. Clients should be told the fee and possible methods of payment before the nurse assesses the family’s willingness for a home visit. If the family does not have a phone, mail can be used to share information.

DIF: Cognitive Level: Apply (Application) REF: pp. 337-338