Roles and Relationships

1. The nurse defines a role as a(n):

a.
positive standard of behavior.
b.
accepted behavior standard.
c.
sexually linked standard.
d.
unchangeable standard.

ANS: B

A role is a socially accepted behavior standard; roles are not always positive or unchangeable.

DIF: Cognitive Level: Knowledge REF: 214 OBJ: 1

TOP: Role Definition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

2. The nurse is aware that the status of any role is based on:

a.
age.
b.
responsibility.
c.
society.
d.
health.

ANS: C

The society in which the role is assumed delegates the value or status of that role. In some societies, advanced age is valued and given high status; in others, advanced age is not given status and the role is negative.

DIF: Cognitive Level: Analysis REF: 214 OBJ: 1

TOP: Role Status KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

3. The nurse points out that a homogeneous society is one in which members:

a.
share a common cultural history.
b.
are diverse in role expectation.
c.
have conflicted role status.
d.
may choose or change role performance.

ANS: A

A homogeneous society is one that is simple and uncomplicated, in which all members share the same culture and role expectations.

DIF: Cognitive Level: Comprehension REF: 215 OBJ: 1

TOP: Homogeneous Society KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

4. The man who has the role of father, husband, professional businessman, son, and community leader may experience:

a.
role confusion.
b.
isolation.
c.
internal role conflict.
d.
diminished self-esteem.

ANS: C

The assumption of multiple roles results in conflicts because the individual roles require time and behavioral modes that may conflict with each other. For example, the behaviors that a self-directed businessman may find useful in running a successful business may conflict with being the obedient son or caring husband.

DIF: Cognitive Level: Analysis REF: 215 OBJ: 1

TOP: Internal Role Conflict KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

5. The nurse is aware that the older man who retires from his work and changes his role status will have fewer adjustment problems primarily on the basis of whether he:

a.
is financially secure.
b.
has other roles and relationships.
c.
is healthy.
d.
has a supportive family.

ANS: B

Other significant roles can take the place of the role of an employed worker. The fewer roles one has, the greater the impact of retirement. Finances, health, and family are important, but not as significant to the self-image as having other satisfying roles.

DIF: Cognitive Level: Application REF: 216 OBJ: 2

TOP: Impact of Retirement KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

6. The nurse assesses that although the college professor has retired, he still perceives himself as an educator and retains his academic title and professional association membership as a support to his:

a.
altered self-image.
b.
unchanged role as an educator.
c.
substitution for employment.
d.
habitual professional behavior.

ANS: A

The loss of the active teaching position is a threat to the self-image. The retention of his academic title and membership in his professional organization is a way of coping with his retirement status.

DIF: Cognitive Level: Analysis REF: 216 OBJ: 2

TOP: Impact of Retirement KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

7. The nurse identifies the older adult who is most likely to experience problems with role changes as the:

a.
65-year-old grandmother who cares for her grandchildren while the mother works.
b.
70-year-old retired business owner who comes to help his son run the business.
c.
75-year-old retired physician who volunteers at a medical screening clinic.
d.
80-year-old retired school administrator who takes educational foreign cruises several times a year.

ANS: B

The father who comes to work to “advise” his son is the most at risk for role conflict problems, because he has not completely given up his role as owner. This will conflict with his role as a father.

DIF: Cognitive Level: Analysis REF: 216 OBJ: 5

TOP: Impact of Retirement KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

8. The recently widowed 65-year-old man has told the nurse that he is so lost without his wife that he is planning to retire, sell his home, and move to a retirement village in another state. The nurse is aware that such a plan is:

a.
positive, because it represents a new beginning.
b.
positive, because it allows him more time to resolve his grief.
c.
risky, because he is giving up significant supports to his self-image and grief resolution process.
d.
negative, because he has not thought his plan through.

ANS: C

The decision is risky because loss of home, employment, and circle of friends as support puts his self-image at risk; so many useful roles are going to be given up. The nurse is not in a position to evaluate how well he has thought out his plan. More time to resolve grief and the launching of a “new beginning” without support may not be beneficial.

DIF: Cognitive Level: Analysis REF: 217 OBJ: 5

TOP: Loss of Spouse KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

9. The older adult asks the nurse what is meant by the term roleless role. The nurse explains that it refers to persons who perceive:

a.
that the roles that gave life meaning are gone.
b.
“old age” as freedom to design new roles and relationships.
c.
that roles must be maintained, regardless of their lack of significance.
d.
that roles can be altered to meet and diminish damage to the self-image.

ANS: A

The concept of the roleless role defines persons who view roles that were meaningful to them, such as spouse, parent, friend, or active worker, are gone.

DIF: Cognitive Level: Application REF: 217 OBJ: 4

TOP: Roleless Role KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

10. The nurse recognizes that the bereaved widow has entered the searching and yearning stage of grief when she exhibits:

a.
renewed interest in social activities.
b.
signs of depression.
c.
making plans for the future.
d.
denial of the loss of her husband.

ANS: B

Depressive behavior is a cardinal indicator of the searching and yearning phase of grief.

DIF: Cognitive Level: Application REF: 218, Table 12-1

OBJ: 5 TOP: Stages of Grief

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

11. When the home health nurse suggests a grief resolution group to the older woman who was widowed 6 months ago, the widow furiously states, “I don’t want or need any help! I want my husband back!” The nurse recognizes this behavior as being characteristic of the grief stage of:

a.
shock.
b.
searching.
c.
disorientation.
d.
reorganization.

ANS: C

The stage of disorientation is characterized by resistance to seeking help and irritability.

DIF: Cognitive Level: Application REF: 218, Table 12-1

OBJ: 5 TOP: Grief Stages KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

12. The nurse is concerned about the 80-year-old man who is exhibiting behaviors characteristic of dysfunctional grieving, such as verbalizing _____ after the death of his wife.

a.
despair 3 months
b.
guilt and self-doubt 4 months
c.
a sense of disorganization 6 months
d.
a sense of depression and despair 1 year

ANS: D

Sense of depression and despair after 1 year of bereavement may indicate dysfunctional grief.

DIF: Cognitive Level: Analysis REF: 218, Table 12-1

OBJ: 5 TOP: Dysfunctional Grieving

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

13. The home health nurse helps a grieving widow to start grief resolution by:

a.
distracting her with social conversation.
b.
encouraging her to verbalize her grief.
c.
pointing out behaviors that are not helpful to grief resolution.
d.
focusing on her loneliness and loss.

ANS: B

Verbalization, acknowledgment, and confrontation of grief initiate problem solving for grief resolution. Encouraging the widow to focus on the negative aspects of loss and loneliness reinforce negative ideation. Pointing out behaviors that are not helpful and distraction with social conversation are not directed at grief resolution.

DIF: Cognitive Level: Application REF: 219 OBJ: 7

TOP: Grief Resolution KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

14. Nurses may find dealing with grieving persons difficult because nurses:

a.
avoid discussing sources of grief.
b.
believe that intervention is usually not helpful.
c.
have their own unresolved grief.
d.
believe that grief is personal and should be dealt with independently.

ANS: A

The natural desire to avoid grieving persons and reluctance to intervene cause nurses problems with helping grieving patients.

DIF: Cognitive Level: Comprehension REF: 219 OBJ: 7

TOP: Intervention for Grief Resolution KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

15. The long-term care facility nurse can promote social contact and interaction most effectively by:

a.
making a telephone available for family contact.
b.
posting a list of activities on the bulletin board.
c.
telling the patient about social rooms in the facility.
d.
accompanying the patient to a craft activity.

ANS: D

The proactive intervention combines the best of all interventions: one-on-one contact, showing interest, and providing support to the patient.

DIF: Cognitive Level: Knowledge REF: 220 OBJ: 7

TOP: Encouraging Social Interaction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

16. A 59-year-old construction worker living with his divorced son and 9-year-old grandson was admitted to the hospital 3 days ago with a massive heart attack. His son is out of town on a business trip and has been unable to visit him. His grandson had to go stay with a friend. The social worker tells the nurse that the son stated he will not be able to care for his father when he gets out of the hospital and does not know how he will afford the skilled nursing facility. The most appropriate nursing diagnosis is:

a.
impaired social interaction
b.
dysfunctional grieving
c.
social isolation
d.
interrupted family process

ANS: D

The family process has been interrupted due to a change in the patient’s health. There has been a change in the roles and relationship with the son. The patient is now dependent on the son.

DIF: Cognitive Level: Analysis REF: 220 OBJ: 6

TOP: Interrupted Family Process KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

17. Which stage of grief usually resolves after approximately 2 weeks?

a.
Disorientation
b.
Shock and numbness
c.
Reorganization
d.
Searching and yearning

ANS: B

The stage of grieving known as shock and numbness usually resolves within the first 2 weeks.

DIF: Cognitive Level: Analysis REF: 218, Table 12-1

OBJ: 5 TOP: Grief Stages KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

18. Which stage of grief usually resolves after approximately 2 weeks to 4 months?

a.
Disorientation
b.
Shock and numbness
c.
Reorganization
d.
Searching and yearning

ANS: D

The stage of grieving known as searching and yearning usually resolves between 2 weeks and 4 months.

DIF: Cognitive Level: Analysis REF: 218, Table 12-1

OBJ: 5 TOP: Grief Stages KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

19. Which stage of grief usually resolves after approximately 4 to 7 months?

a.
Disorientation
b.
Shock and numbness
c.
Reorganization
d.
Searching and yearning

ANS: A

The stage of grieving known as disorientation usually resolves after 4 to 7 months.

DIF: Cognitive Level: Analysis REF: 218, Table 12-1

OBJ: 5 TOP: Grief Stages KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

20. Which stage of grief may last up to 2 years?

a.
Disorientation
b.
Shock and numbness
c.
Reorganization
d.
Searching and yearning

ANS: C

The stage of grieving known as reorganization may last up to 18 to 24 months.

DIF: Cognitive Level: Analysis REF: 218, Table 12-1

OBJ: 5 TOP: Grief Stages KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

21. The nurse knows that relationships in which many subcultures interact are described as:

a.
homogeneous.
b.
long term.
c.
impersonal.
d.
superficial.

ANS: A

Homogeneous is a term used to describe the members’ roles and their culture experience. Characteristics of a relationship include being short or long term, personal, impersonal, intimate, or superficial and are affected by role changes.

DIF: Cognitive Level: Comprehension REF: 215 OBJ: 1

TOP: Relationships KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

MULTIPLE RESPONSE

1. The nurse understands that role standards describe not only behavioral expectations but also expectations about role-appropriate __________. (Select all that apply.)

a.
housing
b.
clothing
c.
choice of vehicle
d.
family size
e.
support system

ANS: A, B, C, D

A support system is not a role-appropriate expectation. The other options are expected standards for a set role.

DIF: Cognitive Level: Comprehension REF: 214 OBJ: 1

TOP: Role Expectations KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

2. The nurse is aware that an older adult may become socially isolated related to the loss of __________. (Select all that apply.)

a.
a spouse
b.
friends to death or relocation
c.
health
d.
home
e.
culture

ANS: A, B, C, D

An individual’s culture does not have an influence on social isolation. Social isolation is related to the separation from family and friends, change in health, self-image, and financial limitations.

DIF: Cognitive Level: Knowledge REF: 217 OBJ: 5

TOP: Factors of Social Isolation KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

3. The nurse explains that grief is a normal response to the loss of __________. (Select all that apply.)

a.
loved ones
b.
professional roles
c.
dependence
d.
health
e.
relationships

ANS: A, B, D, E

The loss of independence, not dependence, is capable of stimulating a grief response that must be resolved in order to regain emotional equilibrium.

DIF: Cognitive Level: Knowledge REF: 217 OBJ: 5

TOP: Grief Response KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

4. The nurse reassures the grieving patient that ready sources of support are available from __________. (Select all that apply.)

a.
friends
b.
family
c.
self-help magazines
d.
support groups
e.
therapist

ANS: A, B, D, E

Friends, family, support groups, and therapy are all viable resources for grief resolution.

DIF: Cognitive Level: Knowledge REF: 219 OBJ: 7

TOP: Grief Resolution Resources KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

5. Methods that the nurse can use to assess dysfunctional grieving in the older adult include __________. (Select all that apply.)

a.
asking the patient to describe his or her relationship within the family
b.
observing the behavior of the patient when family members and friends come to visit
c.
asking questions about the patient’s profession and work history
d.
observing for changes in eating habits
e.
monitoring for changes in mental status

ANS: A, B, D, E

Asking questions related to profession and work history may reveal the patient’s role and perceived self-image. Questions aimed at their work relationships, feelings about retirement, and concerns over loss of a job will aid in assessing for dysfunctional grief. Patients may completely avoid their support systems, lose interest in activities, and be unable to concentrate.

DIF: Cognitive Level: Knowledge REF: 218 OBJ: 4

TOP: Dysfunctional Grief KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

COMPLETION

1. The nurse uses a diagram to depict __________, which is a term for interaction between different roles.

ANS: relationships

DIF: Cognitive Level: Comprehension REF: 214 OBJ: 1

TOP: Relationship Definition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

2. A society that has numerous subcultures with different or conflicting expectations is said to be a(n) __________ society.

ANS: heterogeneous

DIF: Cognitive Level: Knowledge REF: 215 OBJ: 1

TOP: Heterogeneous Society KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A