Family midterm

Question 1

The nurse is transferring to a care area that focuses on family nursing practice. What should the nurse realize about this approach to care?

1. Interventions in family care address the future plans for the family.
2. Family members must be present before the implementation of family care.
3. Resources are placed to support an ill family member with the greatest chance for recovery.
4. The nurse and family together define the family and where therapeutic energy should be placed.

Answer 1

4. The nurse and family together define the family and where therapeutic energy should be placed.

The intervention that “family nurses must define with the family which persons constitute the family and where they will place their therapeutic energies” is an intervention used by family nurses to provide structure to working with families regardless of the theoretical underpinning of the nursing approach. This is an enduring idea that supports the practice of family nursing

Question 2

The nurse notes that a client has been previously married and participates in raising the current spouse’s children from a previous marriage. How should the nurse document this family type?

1. Extended
2. Cohabitation
3. Nuclear dyad
4. Reconstituted

Answer 2

4. Reconstituted

A reconstituted or blended family type is defined as an arrangement in which one or more of the parents was previously married and brings children from the previous marriage into the current marriage.

Question 3

The nurse prepares an in-service program on family nursing for new graduate employees. Which definition of family is the best one for the nurse to use?

1. Members of a family are self-defined
2. People who share strong emotional ties
3. A family is defined by blood ties, adoption, and marriage
4. A group of people who live together with or without legal or biological ties

Answer 3

1. Members of a family are self-defined.

The definition of family that is most inclusive and takes the individual family members into consideration is that the members of a family are self-defined

Question 4

The nurse prepares to assess a client whose family is being used as a resource. Which approach to family nursing care is the nurse implementing?

1. Family as client
2. Family as system
3. Family as context
4. Family as component of society

Answer 4

3. Family as context

The first approach to family nursing care focuses on the assessment and care of an individual client in which the family is the context. This is the traditional nursing focus, in which the individual is foreground and the family is background. The family serves as context for the individual as either a resource or a stressor to the individual’s health and illness.

Question 5

During a home visit the nurse teaches the client and family about actions to reduce the spread of infection between the family members. Which role is the nurse implementing?

1. Counselor
2. Care deliverer
3. Health teacher
4. Family advocate

Answer 5

3. Health teacher

The family nurse teaches about family wellness, illness, relations, and parenting.

Question 5

The nurse stays with a client who is having chemotherapy for the first time until the family arrives. Which role is the nurse implementing with the client?

1. Surrogate
2. Researcher
3. Role model
4. Case manager

Answer 5

1. Surrogate

The family nurse serves as a surrogate by substituting for another person, such as when he or she stays with the client until family arrives.

Question 6

The nurse observes parents discussing an adolescent’s plans for the weekend and setting boundaries to which the adolescent agrees. Which function did this family unit demonstrate?

1. Affective
2. Economic
3. Health care
4. Socialization

Answer 6

1. Affective

The affective function, one of the basic functions of family, is essential for creating a harmonic and stable environment, and optimal for healthy child development and for the satisfaction of all family members. Affective function has to do with the ways family members relate to one another and those outside the immediate family boundaries. Well-functioning families are able to maintain a consistent level of involvement with one another, yet at the same time not become too involved in each other’s lives.

Question 6

The adult daughter of an older client is expected to be at the client’s bedside yet personal family responsibilities are not being completed. Which family interactional process is the daughter experiencing?

1. Role strain
2. Role conflict
3. Role ambiguity
4. Role expectations

Answer 6

2. Role conflict

Role conflict occurs when expectations about familial roles are incompatible. The adult daughter needs to help an aging parent; however, she is also expected to maintain personal role functions.

Question 7

The spouse of a client with complex care needs is unavailable to attend a care conference at 2 p.m. What should the nurse do to support family nursing care?

1. Have the client attend in place of the spouse
2. Schedule the conference when the spouse is available
3. Ask the spouse to telephone in during the time of the conference
4. Provide the spouse with outcomes determined during the meeting

Answer 7

2. Schedule the conference when the spouse is available

One obstacle to family nursing practice is the hours for care. Because the spouse is not available during the scheduled meeting, the approach to overcome this obstacle is to schedule the meeting when the spouse can attend.

Question 8

The nurse prepares to assess a family during a home visit. Which traits should the nurse expect that demonstrate a healthy family? Select all that apply.

1. Develops suspicion among members
2. Exhibits a sense of shared responsibility
3. Admits to and seeks help with problems
4. Enforces participation in rituals and tradition
5. Shares leisure time

Answer 8

2. Exhibits a sense of shared responsibility

A trait common to healthy families is exhibiting a sense of shared responsibility.

3. Admits to and seeks help with problems

A trait common to healthy families is admitting to and seeking help with problems.

5. Shares leisure time

A trait common to healthy families is sharing leisure time.

Question 9

The nurse reviews potential theories to use as a guide for providing care to a family in the community. What should the nurse keep in mind as a major function of theory in family nursing?

1. Identifies a specific hypothesis
2. Answers “How?” or “Why?” questions
3. Examines how the concepts create a meaningful pattern
4. Improves nursing services provided to families

Answer 9

4. Improves nursing services provided to families.

The major function of theory in family nursing is to provide knowledge and understanding that improves nursing services to families

Question 10

The nurse reviews a theory for applicability to a family health situation. On which part of the theory should the nurse focus in order to understand the expected relationship between the theory’s concepts?

1. System
2. Hypothesis
3. Propositions
4. Conceptual model

Answer 10

2. Hypothesis

A hypothesis is a way of stating an expected relationship between concepts or an expected proposition.

Question 11

The nurse prepares to assess a family according to a family development theory. Which action will the nurse complete first during this assessment?

1. Health of individual members
2. Employment status of the parents
3. Family structure and life cycle stages
4. Education status of the children

Answer 11

3. Family structure and life cycle stages.

When conducting family assessments using the developmental model, nurses begin by determining the family structure and where this family falls in the family life cycle stages.

Question 12

The nurse is struggling with using a developmental model when assessing a family new to a community. Which data could explain the difficulty the nurse is having using this model?

1. The parental units are same-sexed.
2. The youngest son is beginning college.
3. The middle child is attending high school.
4. The oldest daughter has just gotten married.

Answer 12

1. The parental units are same-sexed.

A primary criticism of family development theory is that it best describes the trajectory of intact, two-parent, heterosexual nuclear families. It does not consider same-sex couples and normalizes one type of family while ignoring others.

Question 13

The nurse reviews the bioecological system theory before discussing this approach with a group of new graduate nurses. What should the nurse explain as the blueprint for the ecology of human and family development?

1. There is no one system that can serve as a blueprint.
2. Macrosystems contain mesosystems and exosystems.
3. The microsystem sets the stage for all future development.
4. Sociohistorical conditions determine developmental progress.

Answer 13

2. Macrosystems contain mesosystems and exosystems.

Mesosystems and exosystems are set within macrosystems, and together they are the “blueprints” for the ecology of human and family development.

Question 14

The nurse uses the bioecological system theory to assess a family. On which system should the nurse focus to determine the impact of the mother’s change in employment?

1. Mesosystem
2. Exosystem
3. Microsystem
4. Macrosystem

Answer 14

2. Exosystem

An exosystem is an external environment that influences an individual and family indirectly such as the effect of job experience on family life.

Question 15

The nurse selects the family systems theory as a guide for providing care to a family. Which concept of this theory should the nurse use to maintain the stability of this family? Select all that apply.

1. The whole is more than the sum of its parts.
2. All parts of the system are interconnected.
3. Families develop and change over time.
4. Systems can be organized into subsystems.
5. There is a boundary between the system and the environment.

Answer 15

1. The whole is more than the sum of its parts.

The second concept of the family systems theory is that the whole is more than the sum of its parts. This means that the family as a whole is composed of more than the individual lives of family members. It goes beyond parents and children as separate entities. Families are not just relationships between the parent-child but are all relationships seen together.

2. All parts of the system are interconnected.

The first concept of the family systems theory is that all parts of the system are interconnected. This means that whatever influences one part of the system influences all parts of the system.

4. Systems can be organized into subsystems.

The fourth concept in the family systems theory is that systems can be further organized into subsystems. These subsystems identify relationships between family members and are used to create interventions specific to the needs of those members.

5. There is a boundary between the system and the environment.

The third concept is that all systems have some form of boundary between the system and the environment. Boundaries are physical or abstract imaginary lines that families use as barriers or filters to control the impact of stressors on the family system.

Question 15

The nurse works in an environment in which a family therapy theory serves as the model for assessing and planning care. Which data should the nurse expect when assessing the family?

1. Pathology
2. Health problem
3. Illness treatment
4. Normal trajectory

Answer 15

1. Pathology

The target population for family therapy theories is families with pathology or troubled families.

Question 16

The nurse learns that the father of a family passed away at age 41. How should the nurse classify this family event in relation to family development theory? Select all that apply.

1. On time
2. Off time
3. Normative
4. Conflicting
5. Nonnormative

Answer 16

2. Off time

Off time refers to a family transition within family development theory. It is considered to be “off time” when a family unit experiences something that is against a societal norm such as having children before being married.

5. Nonnormative

Nonnormative refers to a change in a family that occurs out of sequence or is caused by an illness or other family event.

Question 17

The nurse notes that the community health clinic has added a section for “family” on the assessment form. Which definition is most likely being used for “family”?

1. Biologically related members
2. Anyone who lives in the same residence
3. Anyone who the client says is the family
4. Two or more people living together related by birth, marriage, or adoption

Answer 17

4. Two or more people living together related by birth, marriage, or adoption

The U.S. Census Bureau defines a family as two or more people living together and who are related by birth, marriage, or adoption.

Question 18

The nurse prepares to employ the family systems theory to assess a family. Which actions will the nurse complete during this assessment? Select all that apply.

1. Complete a family ecomap
2. Determine normative and nonnormative events
3. Complete a family genogram
4. Conduct family member care-planning sessions
5. Collect data on the family and individual members

Answer 18

1. Complete a family ecomap

A family ecomap is completed to see how individuals and the family relate to the community around them.

3. Complete a family genogram

A family genogram is completed to understand patterns and relationships over several generations over time.

4. Conduct family member care-planning sessions

Care-planning sessions are held to address the needs of individual members and the family as a whole.

5. Collect data on the family and individual members

Assessment questions relate to the interaction between the individual and the family, and the interaction between the family and the community in which the family lives.

Question 19

The nurse provides care in the women and children’s shelter twice a week. What characteristic of the child should the nurse consider when providing care?

1. Educationally equal to children living in a permanent home
2. Educationally inferior to children living in a permanent home
3. Emotionally advanced to children living in a permanent home
4. Emotionally inferior to children living in a permanent home

Answer 19

2. Educationally inferior to children living in a permanent home

Homeless children are more likely to repeat a grade in school.

Question 20

The nurse learns that a child being seen in the community clinic has health coverage through the State Children’s Health Insurance Program (CHIP). What does this coverage indicate to the nurse?

1. The child has a chronic disability.
2. The child receives special education.
3. The child is being raised in a single-parent family.
4. The child has no insurance and is not eligible for Medicaid.

Answer 20

4. The child has no insurance and is not eligible for Medicaid.

CHIP was enacted in 1997 to address the lack of health insurance coverage for children who do not qualify for Medicaid.

Question 21

The nurse prepares a presentation on health disparities for the city council. What should the nurse identify as the social determinant contributing to health disparities?

1. Poverty
2. Housing
3. Education
4. Food security

Answer 21

1. Poverty

Poverty is likely the most fundamental social determinant contributing to health disparities.

Question 22

The nurse learns that a client with a chronic health problem has not been taking medication as prescribed. Which social issue should the nurse consider as a potential reason for this client’s nonadherence to treatment? 1. Racism 2. Isolation 3. Health literacy 4. Social exclusion

Answer 22

3. Health literacy Because the client is not taking the medication as prescribed, health literacy should be considered. Understanding the directions to take the medication and frequency would be contingent upon health literacy.

Question 23

The nurse works in a community health clinic that has lesbian, gay, bisexual, and transgender (LGBT) clients. Which policy-related stigma or barriers should the nurse be aware of when caring for these clients? Select all that apply. 1. Reduced use of alcohol and tobacco 2. Increased use of health insurance benefits 3. More likely to delay accessing health services 4. Less likely to receive preventive screenings such as mammograms 5. Higher rates of prostitution and substance use among adolescents

Answer 23

3. More likely to delay accessing health services Because of systemic and policy-related stigma and barriers, these individuals are far more likely to delay accessing health care. 4. Less likely to receive preventive screenings such as mammograms Because of systemic and policy-related stigma and barriers, these individuals are less likely to receive preventive screens such as mammograms. 5. Higher rates of prostitution and substance use among adolescents Families with LGBT youth are particularly vulnerable and experience significant family life challenges related to stigma and acceptance. As such, LGBT adolescents experience much higher rates of prostitution and substance use.

Question 24

The nurse prepares an educational seminar on family policy for a community health fair. Which areas should the nurse emphasize as affected by family policy? Select all that apply. 1. Health 2. Housing 3. Education 4. Transportation 5. Food and water

Answer 24

1. Health Family policies have been developed for the purpose of preventing health problems on a societal scale and include health. 2. Housing Family policies have been developed for the purpose of preventing health problems on a societal scale and include housing. 3. Education Family policies have been developed for the purpose of preventing health problems on a societal scale and include education. 5. Food and water Family policies have been developed for the purpose of preventing health problems on a societal scale and include food and water.

Question 25

The nurse refers to the determinants of health before assessing a family newly relocated to a community. Which should the nurse identify as behavioral determinants of health? Select all that apply. 1. Gender 2. Tobacco use 3. Ethnicity 4. Substance abuse 5. Physical activity

Answer 25

2. Tobacco use A behavioral determinant of health can be modified and includes tobacco use. 4. Substance abuse A behavioral determinant of health can be modified and includes substance abuse. 5. Physical activity A behavioral determinant of health can be modified and includes physical activity.

Question 26

The nurse notes that a large number of clients in the community health clinic have type 2 diabetes mellitus. What should the nurse consider as reasons for the number of people with this chronic illness? Select all that apply. 1. Lower income 2. Unhealthy diet 3. Lack of exercise 4. Use of public transportation 5. Inability to pay for medications

Answer 26

1. Lower income In a recent study, diabetes rates were four times higher among persons who live in a low-income neighborhood. 2. Unhealthy diet In a recent study, diabetes rates were four times higher among persons who live in a low-income neighborhood. Reasons for this include an unhealthy diet. 3. Lack of exercise In a recent study, diabetes rates were four times higher among persons who live in a low-income neighborhood. Reasons for this include lack of exercise. 5. Inability to pay for medications In a recent study, diabetes rates were four times higher among persons who live in a low-income neighborhood. Reasons for this include the inability to pay for medication.

Question 26

The nurse suspects that members of a community are being subjected to subtle acts of institutional racism. What did the nurse assess to make this determination? Select all that apply. 1. Waited to be seen by the clinic physician after others who arrived later were seen 2. Notified by the city that trash removal would occur on Mondays and Thursdays every week 3. Received notification of an increase in Medicaid benefits for members of the household 4. Had the water and electricity turned off by the landlord of an apartment because the children “make too much noise” 5. Overlooked for a job in a fast food restaurant even though open positions were posted and other people in the community were hired after the individual applied

Answer 26

1. Waited to be seen by the clinic physician after others who arrived later were seen Institutional racism refers to deferential access to resources and opportunities, including health. Waiting to be seen after everyone else was seen is an example of this type of racism. 4. Had the water and electricity turned off by the landlord of an apartment because the children “make too much noise” Unjustified utility shut-off indicates inadequate housing, which is an example of institutional racism. 5. Overlooked for a job in a fast food restaurant even though open positions were posted and other people in the community were hired after the individual applied Being hindered from achieving gainful employment is an example of institutional racism.

Question 27

The nurse desires to change health policy in a local community. Which action should the nurse take? Select all that apply. 1. Contact elected officials to lobby against harmful policies 2. Ensure resources are available for clients before discharge 3. Read articles to learn the process of making a policy into a law 4. Join a professional organization that supports change in family policies 5. Participate in community meetings where health policy is being challenged

Answer 27

1. Contact elected officials to lobby against harmful policies Specific strategies for nurses to get involved in influencing policy from micro- to exo-levels include contacting elected representatives regarding needed policies or changes to those that are harmful. 2. Ensure resources are available for clients before discharge Specific strategies for nurses to get involved in influencing policy from micro- to exo-levels include making sure needed resources are available for clients before discharge. 4. Join a professional organization that supports change in family policies Specific strategies for nurses to get involved in influencing policy from micro- to exo-levels include joining professional associations and advocating for needed family policies. 5. Participate in community meetings where health policy is being challenged Specific strategies for nurses to get involved in influencing policy from micro- to exo-levels include joining community advocacy groups.

Question 28

The nurse prepares to assess a family, which includes several members with chronic health problems. Which definition of assessment will the nurse use when meeting with this family? 1. The use of an instrument to quantify a particular family attribute 2. The use of a tool to collect family information within 15 minutes 3. The collection of subjective and objective data that begins upon first contact with the family 4. The process of assigning numbers or symbols to variables to assist nurses in measuring family member characteristics

Answer 28

3. The collection of subjective and objective data that begins upon first contact with the family Data collection, which is the first part of assessment, involves both subjective and objective family information that is obtained through direct observation, examination, or in consultation with other health care providers. In all cases, family assessment begins from the first moment that the family is referred to the nurse.

Question 29

The nurse plans to use a family genogram during a family assessment. What assessment information does this tool provide? 1. Tension between family members 2. Multigenerational patterns and health conditions 3. Communication patterns among family members 4. Relationships between family members and the community

Answer 29

2. Multigenerational patterns and health conditions The family genogram is a format for drawing a family tree that records information about family members and their relationships during at least three generations.

Question 30

The nurse meets with a family to complete a genogram. How many generations should the nurse ask the family members about? 1. One 2. Two 3. Three 4. Four

Answer 30

3. Three The family genogram is a format for drawing a family tree that records information about family members and their relationships during at least three generations.

Question 31

The nurse begins to assess a family. What best describes the family story? 1. The analysis of outcomes 2. The gathering of data from a variety of sources to see the whole picture of the family experience 3. The process of establishing intervention plans 4. The clustering of data into meaningful groups, identifying pertinent relationships between variables

Answer 31

2. The gathering of data from a variety of sources to see the whole picture of the family experience The family story is created by gathering data from a variety of sources to see the whole picture of the family experience.

Question 32

The nurse refers to the Family Reasoning Web when caring for a family. What is the purpose of this tool? 1. Diagrams family members across three generations 2. Diagrams relationship within and external to the immediate family 3. Provides comprehensive data about family structure, development, and function 4. Organizes data into family categories

Answer 32

4. Organizes data into family categories The Family Reasoning Web is an organizational tool to help analyze the family story by clustering individual pieces of data into meaningful family categories. This systematic approach to collecting and analyzing information helps structure the information collection process to ensure the inclusion of important pieces of information.

Question 33

The nurse reviews the Calgary Family Assessment Model (CFAM). What does this model blend? 1. Nursing and family therapy 2. Medicine and nursing 3. Nursing and social work 4. Nursing and ecology

Answer 33

1. Nursing and family therapy The CFAM blends nursing and family therapy concepts that are grounded in systems theory, cybernetics, communication theory, change theory, and a biology of recognition.

Question 33

The nurse prepares to use the Family Assessment and Intervention Model when assessing a family. What is this model based on? 1. Orem’s Self-Care Theory 2. Neuman Systems Model of Health Care 3. Rogers’ Theory of Unitary Human Beings 4. Bronfenbrenner’s Bioecological Systems Theory

Answer 33

2. Neuman Systems Model of Health Care The Family Assessment and Intervention Model is based on Neuman’s health care systems model.

Question 34

The nurse reviews a genogram completed for a family new to a community. What information will the genogram provide? Select all that apply. 1. The types of possible support systems for extended family members 2. A quick snapshot of the family members from an intergenerational perspective 3. The types of social support to the immediate nuclear family 4. Information on the health status of family members in the immediate and extended family 5. The family unit in relation to the larger community in which it is embedded

Answer 34

2. A quick snapshot of the family members from an intergenerational perspective A genogram provides a quick snapshot of the family members from an intergenerational perspective. 4. Information on the health status of family members in the immediate and extended family A genogram provides information on the health status of family members in the immediate and extended family.

Question 34

In which of the following ways does an ecomap help in the assessment of a family? Select all that apply. 1. Pinpoints health conditions 2. Analyzes multigenerational patterns 3. Highlights tension among family members 4. Includes pets and non-blood family members 5. Identifies the relationship between family members and the community

Answer 34

3. Highlights tension among family members An ecogram highlights tension among family members. 5. Identifies the relationship between family members and the community An ecogram identifies the relationship between family members and the community.

Question 35

The nurse learns that a family is moving and will no longer be able to meet with the nurse for continuing care. What should the nurse do as this relationship is terminated? Select all that apply. 1. Write a therapeutic letter 2. Schedule a summary meeting 3. Ask the physician to write a letter 4. Encourage the family to keep in touch 5. Refer to resources in the new community

Answer 35

1. Write a therapeutic letter A therapeutic letter should be written by the nurse after the summary meeting. 2. Schedule a summary meeting Strategies when closing the relationship include a summary evaluation meeting where the family and nurse put formal closure to the relationship. 4. Encourage the family to keep in touch Strategies when closing the relationship include extending invitations to the family for follow-up. 5. Refer to resources in the new community Strategies when closing the relationship include making referrals when appropriate.

Question 36

The nurse plans to use the Family Assessment and Intervention Model. What is the purpose of this model? Select all that apply. 1. Health promotion 2. Family change strategies 3. Restoration of family stability and family functioning 4. Family reaction and instability at lines of defense and resistance 5. Large amount of information that may not relate to the family problem

Answer 36

1. Health promotion The Family Assessment and Intervention Model is used for health promotion. 3. Restoration of family stability and family functioning The Family Assessment and Intervention Model is used for the restoration of family stability and family functioning. 4. Family reaction and instability at lines of defense and resistance The Family Assessment and Intervention Model is used for family reaction and instability at lines of defense and resistance

Question 37

Delete

Answer 37

Delete

Question 38

The nurse prepares to use the Calgary Family Assessment Model (CFAM) to assess a family. Which categories of assessment questions will the nurse use? Select all that apply. 1. Process 2. Function 3. Structure 4. Development 5. Evolution of change

Answer 38

2. Function The assessment questions that accompany the model are organized into three major categories that include function. 3. Structure The assessment questions that accompany the model are organized into three major categories that include structure. 4. Development The assessment questions that accompany the model are organized into three major categories that include development.

Question 39

The nurse reviews assessment data before creating a family plan of care. Which definition of family health promotion should the nurse keep in mind when selecting interventions for this family? 1. Having resources to pay for medical bills 2. Living in a location where health resources are readily available 3. Planning for retirement and achieving a quality and dignified death 4. Improving or maintaining the physical, social, emotional, and spiritual well-being of the family

Answer 39

4. Improving or maintaining the physical, social, emotional, and spiritual well-being of the family Family health promotion has been defined as the process by which families work to improve or maintain the physical, social, emotional, and spiritual well-being of the family unit and its members.

Question 40

The nurse is assessing the rituals that a family follows. Which definition of a family ritual should the nurse use when identifying these activities? 1. Process of family members learning to do things together 2. Repetitive pattern of formal behavior around a specific event that is repeated 3. Process of getting the family members back together after a conflict 4. Action that the family takes to keep the family heritage and history

Answer 40

2. Repetitive pattern of formal behavior around a specific event that is repeated Family ritual is a repetitive pattern of prescribed formal behavior pertaining to some specific event, occasion, or situation that tends to be repeated over and over again.

Question 41

The nurse prepares information about internal and external influencers of family health. Which should the nurse use as an example of an external influencer? 1. Child care 2. Marital dyad 3. Chronic illness 4. Sibling subsystems

Answer 41

1. Child care The external factors are divided into societal and community-level factors. The community level is the configuration of social spheres that contribute to child health. These social spheres include day-care institutions.

Question 42

A health care system is planning to implement telehealth in all facilities. Which outcome should the nurse expect when this approach to care is fully implemented? 1. Reduced incidences of chronic disease development 2. Improved health care access, quality, and efficiency 3. Decreased time for diagnosing health problems 4. Elimination of the need for face-to-face interactions with care providers

Answer 42

2. Improved health care access, quality, and efficiency Telehealth has the potential to improve health care access, quality, and efficiency.

Question 43

Which factor(s) should the nurse identify as influencing the promotion of a family’s health? Select all that apply. 1. Being a role model 2. Teaching self-care behavior 3. Supporting family member during illness 4. Focusing primarily on younger family members 5. Providing care for members across the life course

Answer 43

1. Being a role model Families are primarily responsible for being a role model for health teaching and care. 2. Teaching self-care behavior Families are primarily responsible for teaching self-care and wellness behavior. 3. Supporting family member during illness Families are primarily responsible for supporting each other during illness. 5. Providing care for members across the life course Families are primarily responsible for providing care for members across their life course.

Question 44

The nurse reviews the Healthy People 2020 guidelines before preparing an educational seminar on healthy families for a community health fair. Which Healthy People 2020 goal should the nurse include in this presentation? Select all that apply. 1. Prevent substance abuse 2. Eliminate health disparities 3. Prevent diseases and disorders 4. Provide universal medical insurance for all 5. Increase the quality and years of a healthy life

Answer 44

2. Eliminate health disparities One goal of Healthy People 2020 is to eliminate health disparities. 5. Increase the quality and years of a healthy life One goal of Healthy People 2020 is to increase the quality and years of life.

Question 45

The nurse reviews data collected during a family assessment. Which trait of a healthy family should the nurse identify as being present in this family? Select all that apply. 1. Exhibits a sense of humor 2. Attends religious services weekly 3. Shares family rituals and traditions 4. Demonstrates adaptability to change 5. Communicates and listens to all family members

Answer 45

1. Exhibits a sense of humor Exhibiting a sense of humor indicates appreciation and affection between the family members. 3. Shares family rituals and traditions Sharing family rituals and traditions is a characteristic of the family spending time together. 4. Demonstrates adaptability to change Demonstrating adaptability to change is a characteristic of the family’s ability to deal with stress. 5. Communicates and listens to all family members Communicating and listening to all family members indicates positive family communication.

Question 46

The nurse uses the Family Health Promotion model as a guide when caring for community family members. Which health-related influences should the nurse keep in mind when following this model? Select all that apply. 1. Family systems patterns 2. Family size and structure 3. Family’s definition of health 4. Perceived family health status 5. Family health socialization patterns

Answer 46

3. Family’s definition of health According to the Family Health Promotion model, health-related influences include the family’s definition of “health.” 4. Perceived family health status According to the Family Health Promotion model, health-related influences include perceived family health status. 5. Family health socialization patterns According to the Family Health Promotion model, health-related influences include family health socialization patterns.

Question 47

Family empowerment is a process, outcome, and intervention. On what should the nurse focus when assisting a family to become more empowered? Select all that apply. 1. Providing information 2. Problem-solving for the family 3. Encouraging family participation in goal setting 4. Providing encouragement and support 5. Using strategies to increase family strength

Answer 47

1. Providing information When empowering a family, the nurse collaborates with the family and provides information. 3. Encouraging family participation in goal setting The primary emphasis in family empowerment is the involvement of the family in goal setting. 4. Providing encouragement and support When empowering a family, the nurse collaborates with the family and provides encouragement and support. 5. Using strategies to increase family strength When empowering a family, the nurse collaborates with the family and uses strategies to help the family make lifestyle changes to increase family strength.

Question 48

The school nurse is aware of several students who live in a home with a biological mother and a cohabitating stepfather. What problems should the nurse assess in these students? Select all that apply. 1. Delinquency 2. Lower grades 3. Behavior problems 4. Lack of college expectations 5. Irregular breakfast consumption

Answer 48

1. Delinquency Children residing in cohabitating stepfather families experience higher rates of delinquency than teenagers living with two married biological parents. 2. Lower grades Children residing in cohabitating stepfather families experience lower grades than teenagers living with two married biological parents. 3. Behavior problems Children residing in cohabitating stepfather families experience more behavioral problems than teenagers living with two married biological parents. 4. Lack of college expectations Children residing in cohabitating stepfather families experience greater lack of college expectations than teenagers living with two married biological parents.

Question 49

The nurse is planning care for a family facing a health crisis in one of the members. Which action should the nurse take to promote spirituality and increase the resiliency of this family? Select all that apply. 1. Clarify ambiguity 2. Create and hold a sacred space 3. Encourage routine expression of spirituality 4. Help make meaning of the adverse experience 5. Be fully present to demonstrate compassion

Answer 49

1. Clarify ambiguity A specific action that the nurse can use to promote spirituality and increase family resiliency is to clarify ambiguity. 2. Create and hold a sacred space A specific action that the nurse can use to promote spirituality and increase family resiliency is to create and hold a sacred space. 4. Help make meaning of the adverse experience A specific action that the nurse can use to promote spirituality and increase family resiliency is to help make meaning of an adverse experience. 5. Be fully present to demonstrate compassion A specific action that the nurse can use to promote spirituality and increase family resiliency is to provide compassionate witnessing by being fully present.

Question 50

The nurse prepares to implement a care contract for a family. In which order should the nurse implement the components of the contract? All choices must be used. 1. Develop a plan 2. Evaluate the outcomes 3. Assign responsibilities 4. Determine the time frame 5. Modify, renegotiate, or terminate the contract 6. Set the goal, environmental planning, and reinforcement 7. Complete a family assessment of wellness and identify areas for improvement

Answer 50

Ans: 7, 6, 1, 3, 4, 2, 5 7. Complete a family assessment of wellness and identify areas for improvement The nurse begins by completing a family assessment of wellness including the identification of areas to improve. 6. Set the goal, environmental planning, and reinforcement Next, the family sets goals for the contract. 1. Develop a plan Third, the plan is written, identifying actions to achieve the goal. 3. Assign responsibilities Assigning responsibilities identifies the individuals responsible for and included in the actions. 4. Determine the time frame Determination of time frame means the frequency for the actions to be performed. 2. Evaluate the outcomes Evaluate the outcomes means the plan is reviewed, on a scheduled basis, for adherence and achievement of the identified goal. 5. Modify, renegotiate, or terminate the contract The final step of modifying, renegotiating, or terminating the contract occurs in the future and helps the family identify if any changes or modifications to the plan need to be altered in order to achieve the goal.

Question 51

The nurse provides care to a client who is experiencing an acute illness. What information about family-centered care should the nurse keep in mind when planning this client’s care? 1. Visiting hours should be strictly enforced. 2. Care conferences serve little purpose. 3. Families influence client recovery. 4. Discharge planning begins when the client stabilizes.

Answer 51

3. Families influence client recovery. Family members and significant others of critically ill patients are integral to the recovery of their loved ones. Their involvement in providing care brings them together and assists in helping the patient feel comfortable in an unaccustomed setting, such as an acute care setting.

Question 52

What should the nurse consider when determining the degree of family involvement in discharge planning? 1. Current advance directive for the client 2. Family’s education and information needs 3. A family letter stating expectations for discharge 4. Legal advice provided by an attorney during the discharge meeting

Answer 52

2. Family’s education and information needs Because families are key members of the health care team and will be the primary providers of care once the patient leaves the acute setting, addressing the family’s educational and information needs is a critical part of the discharge process.

Question 53

How should the nurse categorize a family who is willing to discuss withdrawal of treatment, has good communication with other family members, uses facts and family wishes to make decisions, and is able to identify a time and date to withdraw treatment? 1. Struggling 2. Progressing 3. Maintaining 4. Accommodating

Answer 53

2. Progressing A progressing family has good communication with each other and the extended family. Facts are mostly used to support the wishes of the family member. There is a planned date and time of withdrawal.

Question 54

For which reason might a nurse experience role ambiguity when caring for a critically ill client and the family? 1. Deciding whether to eliminate the family’s worries or provide emotional support 2. Weighing the biomedical technical model of care against the holistic nursing model of care 3. Asking to withhold information from the health care provider until test results are confirmed 4. Balancing the professional relationship and the more personal relationship the family seeks with the nurse

Answer 54

1. Deciding whether to eliminate the family’s worries or provide emotional support Role ambiguity is when nurses find themselves with an unrealistic role expectation. The nurses believed that it was their responsibility to “make it right” or to “take away the family members’ worries” rather than to provide emotional support for families dealing with the uncertainty of outcome for a family member in the ICU.

Question 55

What type of communication from nurses do families find as being the most helpful? 1. Brief 2. Honest 3. Vague 4. Limited

Answer 55

2. Honest Families find the most helpful communication from nurses as being honest.

Question 56

The nurse notes that a client has an advance directive stating that no cardiopulmonary resuscitation (CPR) should be performed if the heart stops. Which type of prescription should the nurse expect to be placed on this client’s medical record? 1. All but CPR 2. Do not resuscitate (DNR) 3. Comfort measures only 4. No extraordinary measures

Answer 56

2. Do not resuscitate (DNR) A do not resuscitate (DNR) order is a request not to have cardiopulmonary resuscitation in the event one’s heart stops. This order may or may not be part of an advance directive or living will. A physician can put this order in a client’s chart for that person.

Question 57

What research information should the nurse manager use as evidence to increase the amount of family involvement in the care of a hospitalized client? 1. Increases the cost of care 2. Causes poor outcomes 3. Increases family stress 4. Improves outcomes

Answer 57

4. Improves outcomes Families help their loved ones in the hospital in many ways that improve client outcomes, decrease recovery time, increase reports of comfort, and decrease the length of the hospital stay.

Question 58

A family accompanies a client to the hospital for treatment of an acute illness. Which characteristic is likely to increase the degree of family stress? Select all that apply. 1. Feeling alone 2. Being unsure of their role 3. Feeling chaos and loss of control 4. Neglecting personal health needs 5. Being comforted by staff interventions

Answer 58

1. Feeling alone Clients and families often feel alone when entering an acute care setting. 2. Being unsure of their role Families are often unsure of their role in an acute care setting. 3. Feeling chaos and loss of control Family members may also have feelings of chaos and loss of control because of extreme uncertainty related to an acute admission of a family member. 4. Neglecting personal health needs Family caregivers will focus attention on the critically ill family member and often pay little attention to their own health.

Question 59

Nurses can anticipate which family reaction as a family member is transferred from intensive care to the regular medical–surgical care area? Select all that apply. 1. Confusion 2. Vulnerability 3. Ambivalence 4. Abandonment 5. Unimportance

Answer 59

2. Vulnerability Families describe experiencing vulnerability when they had to accept their new responsibility as a different kind of family caregiver within the hospital setting. Their sense of vulnerability was found to be the most intense of these family emotions. 3. Ambivalence Families express being caught between the extremes of feeling relieved and happy their loved ones were better, and families’ fears and doubts regarding if their loved ones were well enough to leave the ICU. 4. Abandonment Families feel abandonment when the transfer is abrupt and not planned. 5. Unimportance Families report having a feeling of unimportance because of the different staffing ratio on the medical–surgical unit.

Question 60

A client is newly admitted to the intensive care unit for an acute illness. Which of the following family needs do the client’s family require during this time? Select all that apply. 1. Comfort 2. Teaching 3. Proximity 4. Assurance 5. Information

Answer 60

1. Comfort Comfort is the fourth dimension of family need as identified through the Critical Care Family Needs Inventory. 3. Proximity Proximity is the third dimension of family need as identified through the Critical Care Family Needs Inventory. 4. Assurance Assurance is the first dimension of family need as identified through the Critical Care Family Needs Inventory. 5. Information Information is the second dimension of family need as identified through the Critical Care Family Needs Inventory.

Question 61

What factor should be considered when determining hospital visiting policies? Select all that apply. 1. Client preference 2. Family preference 3. Nursing care needs 4. Visitor health status 5. Location of waiting room

Answer 61

1. Client preference The client’s request or need to see family should be taken into consideration. 2. Family preference The family’s request or need to see the ill family member should be taken into consideration. 3. Nursing care needs The treatments or routine care activities that should be performed confidentially and privately should be taken into consideration. 4. Visitor health status The American Association of Critical-Care Nurses (AACN) suggests that there are times when family visits should be restricted such as when a visitor has a communicable disease.

Question 62

Which of the following are considered advantages to the family being present during resuscitative efforts? Select all that apply. 1. Not disrupting client care 2. Talking to the client and saying good-bye 3. Ensuring appropriate care is provided 4. Providing spiritual support to the client 5. Offering emotional comfort to the client

Answer 62

1. Not disrupting client care An increasing number of critical care units (CCUs) and emergency departments allow family members to choose to remain present at the patient’s bedside during cardiopulmonary resuscitation (CPR). This is based on research findings that demonstrate that family presence does not disrupt client care. 2. Talking to the client and saying good-bye During resuscitative efforts, families have an opportunity to talk with the client and say good-bye. 4. Providing spiritual support to the client Family members appreciate the option of being present during resuscitation as it allows them to take an active role in helping their loved one through a difficult time while providing spiritual support. 5. Offering emotional comfort to the client Family members appreciate the option of being present during resuscitation as it allows them to take an active role in helping their loved one through a difficult time while providing emotional comfort.

Question 63

A client is recently admitted to a medical–surgical care area. Which action should the nurse take to help reduce the family’s stress? Select all that apply. 1. Clarify information 2. Facilitate family conference 3. Provide time for the family to visit 4. Recognize the uniqueness of the family 5. Identify one person to provide information

Answer 63

1. Clarify information Families in acute care settings reported numerous stressors and changes in their family environment, and are often desperately in need of support. Nurses are in a position to provide support by clarifying information. 2. Facilitate family conference Families in acute care settings reported numerous stressors and changes in their family environment, and are often desperately in need of support. Nurses are in a position to provide support by facilitating family conferences when necessary. 3. Provide time for the family to visit Families in acute care settings reported numerous stressors and changes in their family environment, and are often desperately in need of support. Nurses are in a position to provide support by providing time for the family to visit. 4. Recognize the uniqueness of the family Families in acute care settings reported numerous stressors and changes in their family environment, and are often desperately in need of support. Nurses are in a position to provide support by recognizing the uniqueness of the family.

Question 64

Which emotion might a family experience when a family member is in the intensive care unit (ICU)? Select all that apply. 1. Fear 2. Peace 3. Relief 4. Sadness 5. Helplessness

Answer 64

1. Fear Emotional stress rises when a family member is acutely ill and families suffer with the client during illness and treatment. They have feelings of fear. 4. Sadness Emotional stress rises when a family member is acutely ill and families suffer with the client during illness and treatment. They have feelings of sadness. 5. Helplessness Emotional stress rises when a family member is acutely ill and families suffer with the client during illness and treatment. They have feelings of helplessness.

Question 65

The nurse cares for a client with a life-threatening illness. Which need should the nurse address with this client’s family? Select all that apply. 1. Providing visiting hours 2. Giving reassurance 3. Offering realistic hope 4. Conveying honest answers 5. Assessing the level of anxiety

Answer 65

2. Giving reassurance The American Association of Critical-Care Nurses’ (AACN) Essentials of Critical Care Nursing identified evidence-based practice areas to assess the family’s needs and resources in order to develop interventions that optimize the family’s impact on the patient and the interactions with the health care team. Areas for family interventions include giving reassurance. 3. Offering realistic hope The American Association of Critical-Care Nurses’ (AACN) Essentials of Critical Care Nursing identified evidence-based practice areas to assess the family’s needs and resources in order to develop interventions that optimize the family’s impact on the patient and the interactions with the health care team. Areas for family interventions include offering realistic hope. 4. Conveying honest answers The American Association of Critical-Care Nurses’ (AACN) Essentials of Critical Care Nursing identified evidence-based practice areas to assess the family’s needs and resources in order to develop interventions that optimize the family’s impact on the patient and the interactions with the health care team. Areas for family interventions include giving honest answers. 5. Assessing the level of anxiety The American Association of Critical-Care Nurses’ (AACN) Essentials of Critical Care Nursing identified evidence-based practice areas to assess the family’s needs and resources in order to develop interventions that optimize the family’s impact on the patient and the interactions with the health care team. Areas for family interventions include assessing level of anxiety.

Question 66

The nurse is including the family of a 32-year-old client in her interview. What is the rationale for including the family of this adult in the interview? A. The client will become debilitated and need the family to provide care. B. The client’s illness impacts the entire family. C. The family will need to support the client as he heals. D. The family has information the nurse practitioner needs about the client.

Answer 66

B. The client’s illness impacts the entire family. When a client is ill, the entire family is impacted and should be considered in the assessment and intervention.

Question 67

The nurse is explaining the focus of family nursing assessment and intervention to the family members. She explains that which are the interacting parts of reciprocity? A. Parents, children, and health-care providers B. Nurses, physicians, and clients C. Health, illness, and family D. Men, women, and children

Answer 67

C. Health, illness, and family The interacting parts of reciprocity are the family and its interaction with health and illness.

Question 68

The nursing instructor is explaining family systems nursing. Which of these theories is not synthesized into family systems nursing? A. Cybernetics B. Change C. Family therapy D. Informatics

Answer 68

D. Informatics Informatics theory is not synthesized into family systems nursing.

Question 69

Nurses collaborate with many professionals to care for their clients. Which professional would be most concerned with the emotional ties within the family? A. An economist B. A sociologist C. A psychologist D. A psychiatrist

Answer 69

C. A psychologist A psychologist would be most concerned with the emotional ties within the family.

Question 70

5. The nurse has just graduated with a bachelor’s degree in nursing (BSN). Which is the least accurate statement about her scope of practice? A. She primarily views the family as a client rather than a context. B. She is considered a nurse generalist. C. She focuses on family interaction and reciprocity. D. She predominately conceptualizes the family as a unit of care.

Answer 70

A. She primarily views the family as a client rather than a context. Nurses with a BSN usually view the family as a context, rather than a client.

Question 71

The Calgary Family Assessment Model (CFAM) is a multidimensional framework consisting of three major categories. Which is not one of these categories? A. Developmental B. Functional C. Foundational D. Structural

Answer 71

C. Foundational Foundational is not one of the categories of the CFAM

Question 72

Based on what the nurse knows about the Calgary Family Intervention Model (CFIM), which of these would be the best response to the family? A. “Let’s let the client begin first.” B. “I have much experience in handling family matters of this type.” C. “That appears to be a great strength in this family.” D. “This method is rooted in modernism.”

Answer 72

C. “That appears to be a great strength in this family.” The CFIM is a strengths-based model.

Question 73

The client asks the nurse why the nurse uses the term intervention, yet the physician always uses the term diagnosis. Which is the best explanation of the difference? A. “Interventions are interactional in nature. They occur in a relationship.” B. “Intervention is a nursing term, whereas diagnosis is reserved for medicine.” C. “We are from different disciplines, so we use different vocabulary.” D. “They mean the same thing.”

Answer 73

A. “Interventions are interactional in nature. They occur in a relationship.” Interventions are interactions between the nurse and the client.

Question 74

The nurse decides to visit the family of a client with attention deficit-hyperactivity disorder (ADHD). This intervention is most important for families with children with this diagnosis for which reason? A. They are more prone to have cluttered and messy homes. B. They are more likely to abuse their children. C. There is more interpersonal conflict in these homes. D. There are more safety risks in these homes.

Answer 74

C. There is more interpersonal conflict in these homes. There is evidence that families with a child with ADHD have more interpersonal conflict.

Question 75

The nurse is preparing to transition an elderly client to another level of care. Which is the least important priority? A. Providing timely communication to the family and caregiving team B. Involving the client and caregiver in establishing goals C. Educating the family about resources and levels of care D. Notifying the insurance company of the change

Answer 75

D. Notifying the insurance company of the change This is a family responsibility.

Question 76

The nurse finds that more of her clients are asking for applications and Web sites to promote health. What would be a barrier to the use of applications and Web sites for most clients? A. Electronic accessibility B. Culture and literacy needs C. Available at all times D. Web site flexibility

Answer 76

B. Culture and literacy needs Culture and literacy needs may be a barrier unless these are taken into consideration when developing the application or Web site.

Question 77

The nurse is determining the need for a family intervention. Which would be the lowest priority? A. A child being bullied on social media B. An elderly client receiving a terminal diagnosis C. The birth of a child D. A child making the soccer team

Answer 77

D. A child making the soccer team Although it might disrupt the family schedule a bit, it is not as disruptive to the family as the other situations.

Question 77

12. What is the best way to determine when the next appointment should be scheduled? A. Ask the family members how many meetings they believe it will take to resolve the problem. B. Schedule the next session and determine after each session how many more are needed. C. The insurance company will determine a reasonable amount. D. Offer the same time on the same day of the week each week to develop a habit.

Answer 77

A. Ask the family members how many meetings they believe it will take to resolve the problem. The family is the best judge of how many sessions will be needed.

Question 78

The nurse is surprised that the family does not want an intervention. Which would be an unusual reason for a family not to want an intervention? A. The nurse works for the state department of social services. B. The nurse once dated a member of the family. C. The nurse works at the hospital where one of the family members is being admitted. D. The client is moving to another state.

Answer 78

C. The nurse works at the hospital where one of the family members is being admitted. If a family member is being admitted to the hospital, it would be appropriate for a staff member of the hospital to intervene with them.

Question 79

The nurse is reviewing charts to determine which family needs a family intervention. Which would be the least appropriate? A. A family member dies after a long, terminal disease. B. An adolescent strives to make the cheerleading team to please her sick mother. C. A child begins doing poorly in school. D. A young adult returns home after a long stay in a drug rehabilitation facility.

Answer 79

B. An adolescent strives to make the cheerleading team to please her sick mother. This adolescent is showing strength and achieving goals. Family intervention is not as important in this case.

Question 80

The nurse is talking with the client and her partner during the initial assessment. She asks the client if there have been any losses of family members. The client tearfully replies that their 15-year-old dog died 3 weeks ago. The nurse will record this information in which subsection of the structural section of the Calgary Family Assessment Model? A. Gender B. Subsystems C. Rank order D. Family composition

Answer 80

D. Family composition The family is who they say they are, and it is important to note changes in family composition.

Question 81

The nurse is investigating how racial identity may influence the health beliefs and behaviors of a new client who recently immigrated from Africa. Which of the following questions is most appropriate to ask? A. “Thinking about your overall health, what do I need to understand in order to be most helpful to you?” B. “What health strengths and challenges do you face due to race?” C. “Tell me about your family’s traditional practices when it comes to illness.” D. “Is there a difference between how your family defines your illness and how the health-care system defines your illness?”

Answer 81

A. “Thinking about your overall health, what do I need to understand in order to be most helpful to you?” Racial identity, privilege, and oppression influence health beliefs and behaviors.

Question 81

2. The nurse is reflecting on her conversation with a client, a 17-year-old high school senior. The client revealed that when she is anxious about her decision to attend a college several hours away from home, she often talks to her grandmother. She is worried about how her younger brothers and sister will cope with her absence, but her grandmother encourages her to “spread her wings” and enjoy her time at college. In which of the following subsections does this conversation belong? A. Family composition B. Boundaries C. Rank order D. External structure

Answer 81

B. Boundaries Boundaries describe the way the family interacts.

Question 82

The nurse is caring for the family of a deceased car accident victim as they gather in the waiting room of the emergency room. Which of the following questions is most important to ask? A. “What spiritual or cultural needs do you have at this time?” B. “How did your loved one’s job as an executive impact the family?” C. “With the loss of the breadwinner, what challenges will you face in affording your medications?” D. “How do you define health?”

Answer 82

"What spiritual or cultural needs do you have at this time?" Assessing the family's spiritual and cultural needs is most important during periods of extreme and life-altering events.

Question 83

The nurse is giving an end-of-shift report. She explains how the family interacts with the community, focusing on the family’s contact with those outside the family. Which of the following is an appropriate diagram for this information? A. Social assessment B. Genogram C. Ecomap D. Cultural assessment

Answer 83

C. Ecomap The ecomap is a diagram of the family’s contact with those outside the family.

Question 84

The nurse is caring for a client who has been diagnosed with hypertension. The client reveals that his son just started taking medication to lower his cholesterol, his mother had a stroke at 72, his father died of a heart attack at 57, and his grandfather died of a heart attack at 52. He has a very close relationship with his mom, who lives with him so that he can take care of her. The nurse plans to create a diagram of the family dynamics. Which of the following is most appropriate? A. Genogram B. Ecomap C. Structural assessment D. Developmental assessment

Answer 84

A. Genogram A genogram diagrams the family’s internal structure and relations. It contains at least three generations and may contain some health information. The purpose of the genogram is to give a visual overview of the fami

Question 85

The nurse is caring for a married couple who are rebuilding their home after it was destroyed by a hurricane. The nurse assesses how the couple’s unique family experiences have shaped their family. Which of the following best describes what the nurse is assessing? A. Family life cycle B. Family development C. Multicontextual life cycle D. The stages and tasks the family must face

Answer 85

B. Family development Family development is the unique path one particular family experiences.

Question 86

Which of the following questions is appropriate for the nurse to ask to assess how the family is coping with the new situation? A. “When you look back over your life, what aspects have you enjoyed the most?” B. “As your attachment to your ex-husband changed, what changes did you notice in your children?” C. “What has given you the most happiness in life?” D. “What advice do you have for new stepfamilies?”

Answer 86

B. “As your attachment to your ex-husband changed, what changes did you notice in your children?” Positive coping strategies assist the family to build constructive and mutually supportive relationships.

Question 86

The nurse is caring for a 93-year-old resident at the extended-care facility. The client enjoys talking about his family. He had eight siblings and was married to his wife for 62 years until she died of cancer. Of their four living children, only his oldest daughter comes to visit once a month. The other children do not live close by and rarely visit or call. The client admits that he wishes his children would visit more often because he has so much he wants to tell them. The nurse knows the client is facing which task in the “families near the end of life” stage of the middle-class North American family life cycle? A. Maintaining functioning despite physical decline B. Dealing with the disabilities and death of elderly parents C. Beginning shift toward joint caring for older generation D. Dealing with loss of spouse, siblings, and other peers and preparation for death

Answer 86

D. Dealing with loss of spouse, siblings, and other peers and preparation for death Dealing with the loss of a spouse, siblings, and other peers and preparation for death occurs during the “families near the end of life” stage. The client is concerned about the opportunity to pass on the learning in his life to his children.

Question 86

The nurse is finishing discharge instructions for a client and her newborn. The client and her husband have three children at home, ages 3 to 12. During the conversation, the nurse asks, “How do you balance caring for the children and time with your spouse, and how do you think this will change with the new baby?” This question is most likely an example of assessing which of the following? A. Attachment in a middle-class North American family in stage three of the family life cycle B. Attachment in a middle-class North American family in stage one of the family life cycle C. Attachment in an adoptive family life cycle D. Attachment in an LGBQITT relationship

Answer 86

A. Attachment in a middle-class North American family in stage three of the family life cycle Asking about the time a couple spends together is an example of assessing attachment within a family with young children.

Question 87

The nurse is caring for an 8-year-old client who has been diagnosed with diabetes mellitus type 1. The nurse assesses how the client and his parents are doing with his new insulin regimen that includes self-administering of insulin injections. Which of the following best describes what the nurse is assessing? A. Instrumental functioning B. Expressive functioning C. Structural assessment D. Developmental assessment

Answer 87

A. Instrumental functioning Instrumental functioning is the ability of the family to function in the daily activities of life, such as self-administering insulin

Question 88

The nurse is interviewing a young gay couple, in their 20s, who have recently “come out” to both sets of parents. Whereas one man’s parents were accepting, the other man’s parents are struggling with acceptance. As they work to deal with the core issues of coupling, what other concerns should the nurse address? A. Illness of aging parents B. Issues related to adoption C. Issues of oppression and privilege D. Issues of ethnicity and religion

Answer 88

C. Issues of oppression and privilege The nurse should take an oppression-sensitive approach with the couple, assisting them to deal with similarities and differences.

Question 88

The nurse is assessing the expressive functioning of a family whose 12-year-old daughter, Jan, was recently involved in a motor vehicle accident that has left her wheelchair bound. Which of the following questions is most appropriate to assess the circular communication in the family? A. “When Jan gets dressed in the morning, whose role is it to help?” B. “How can you tell when Mom is stressed over caring for Jan?” C. “Who has Jan’s illness caused the most distress for in the family?” D. “When Jan is frustrated with her inability to go upstairs and yells at you, how does it make you feel?”

Answer 88

D. “When Jan is frustrated with her inability to go upstairs and yells at you, how does it make you feel?” Circular communication is reciprocal communication between family members.

Question 89

After 5 years of marriage, a client couple has experienced two miscarriages. The nurse is speaking to the wife after a recent positive pregnancy test. The wife is worried that the added financial and emotional stress may increase her husband’s drinking but is reluctant to discuss the issue with him. She feels that ignoring the issue will keep peace in the family. She says that she often avoids conversations that may lead to conflict. What category does her behavior fall under? A. Roles B. Nonverbal communication C. Problem solving D. Alliances and coalitions

Answer 89

A. Roles Roles are the established patterns of behavior for family members; a role is consistent behavior in a particular situation. The wife often avoids stressful conversations with her husband.

Question 90

The nurse completed the Calgary Family Assessment Model for a family and is now creating a plan of care. Which of the following statements is true regarding the Calgary Family Intervention Model (CFIM)? A. The CFIM focuses on improving deficits in the family. B. The CFIM identifies and corrects dysfunction. C. The CFIM does not focus on strengths. D. The CFIM emphasizes resilience in families.

Answer 90

D. The CFIM emphasizes resilience in families. The CFIM emphasizes family strengths and resilience.

Question 90

The nurse is constructing a genogram for a family. Which of the following should the nurse consider to construct a complete genogram that will most effectively help assess the family? A. Limit participation to two or three family members. B. Determine the priorities for the genogram. C. Genogram questions should be introduced only after the nurse has established a very close working relationship with the family. D. Children should be excluded from genogram questions.

Answer 90

B. Determine the priorities for the genogram. Determining the priorities first will help the nurse to focus on the family situation.

Question 91

As the nurse creates a plan of care for a family, she knows that which domain or domains in the Calgary Family Intervention Model (CFIM) focus on family functioning? A. Cognitive, behavioral, and affective B. Cognitive only C. Behavioral and affective D. Affective and cognitive

Answer 91

A. Cognitive, behavioral, and affective The CFIM emphasizes interventions aimed at promoting, improving, and sustaining family functioning in the cognitive, behavioral, and affective domains.

Question 92

A client, a 14-year-old girl, has recently been diagnosed with depression. Which of the following questions would the nurse ask to investigate the family’s perception of the client’s illness? A. “How does the client’s younger sister view her illness?” B. “Who in the family is most worried about the client’s health?” C. “When did you first notice a change in the client?” D. “How do you feel about the client’s diagnosis?”

Answer 92

C. “When did you first notice a change in the client?” This is an example of a linear question, used to inform the nurse about the family’s perception of the problem.

Question 92

The nurse is reviewing with a client how the client’s frequent drinking affects his two sons, aged 10 and 8. What type of question should the nurse ask? A. Behavior effect B. Hypothetical C. Difference D. Future oriented

Answer 92

A. Behavior effect Behavioral-effect questions seek answers on how the behavior of one member of the family affects the other members of the family.

Question 93

A family has been working on improving patterns of communication within the family and has made progress. The wife has begun voicing her concerns, and the husband listens and responds. Which of the following is the most appropriate nursing intervention at this time? A. Ask the wife how her view of time is different from the husband’s view of time. B. Ask the husband what would happen if the wife were no longer able to cook family meals. C. Ask the wife how she feels when the husband gets angry. D. Offer commendation

Answer 93

D. Offer commendation. Offering commendation emphasizes positive behavior patterns.

Question 93

A client, a 16-year-old boy, has recently started smoking. The nurse discusses the new habit with the client’s parents. Which domain of family functioning should be the nurse’s primary focus in addressing this concern with the client? A. Affective B. Behavioral C. Behavioral effect D. Cognitive

Answer 93

D. Cognitive The cognitive domain of family functioning focuses on interventions based on offering ideas, opinions, beliefs, information, or education for a particular health risk.

Question 94

Pauline, a 15-year-old girl, is the oldest sister of Kara and Sara, 9-year-old fraternal twins. Sara has acute lymphocytic leukemia and is currently undergoing treatment. Since the diagnosis, Pauline has avoided visiting Sara in the hospital or talking about her illness. Which of the following nursing interventions for Pauline is aimed at the behavioral domain? A. Acknowledging and validating Pauline’s emotions B. Encouraging Pauline’s inclusion in the caregiving for Sara by offering information about the disease, treatment, and prognosis and supporting Pauline’s efforts to engage with Sara C. Encouraging Pauline to share her experience as she faces Sara’s illness D. Commending Pauline for her strength during this difficult time for the family

Answer 94

B. Encouraging Pauline’s inclusion in the caregiving for Sara by offering information about the disease, treatment, and prognosis and supporting Pauline’s efforts to engage with Sara Offering support and information to Pauline may empower her to change her behavior toward Sara.

Question 95

A client, a 67-year-old wife, mother, and grandmother, has been diagnosed with terminal pancreatic cancer. The family members have been unable to communicate about the diagnosis and often sit at the client’s bedside in complete silence. Using the affective domain, what should be the nurse’s primary goal for this family? A. Share the treatment plan and prognosis with the family. B. Provide the family with a brochure that lists resources for additional information and support groups. C. Encourage the family to care for the client in shifts, to prevent caregiver burnout. D. Encourage the family members to listen to each other’s concerns and feelings.

Answer 95

D. Encourage the family members to listen to each other’s concerns and feelings. Helping family members to listen to each other’s concerns and feelings will elicit family support and is in the affective domain.

Question 96

The client, a 19-year-old college freshman, recently disclosed to her parents that she is in a lesbian relationship. The nurse on the campus asks the client how it makes her feel when her father refuses to meet her significant other. What type of question is this? A. A behavioral-effect question in the behavioral domain B. A behavioral-effect question in the affective domain C. A difference question in the affective domain D. A hypothetical question in the affective domain

Answer 96

B. A behavioral-effect question in the affective domain Asking how another family’s members behavior makes one feel is an example of a behavioral-effect question in the affective domain

Question 97

The nurse is preparing to offer commendation for a family who has made progress with their communication patterns toward one another. Which of the following is a recommendation that assists the nurse in offering commendation? A. Routinely include commendation at the end of the meeting. B. Offer commendation when there is any sign of evidence for it. C. Rely on the family to mention family strengths, and then offer warm commendation. D. Offer commendation by discussing family strengths in technical terms.

Answer 97

A. Routinely include commendation at the end of the meeting. Routinely closing a meeting with commendation ends the meeting on a positive note.

Question 97

The client, an 8-year-old boy in second grade, was recently diagnosed with attention deficit-hyperactivity disorder. Which of the following nursing interventions for the client’s parents is directed at the affective domain? A. Provide brochures with resources for the parents to cope with their son’s behavior. B. Encourage the parents to stop making excuses for their reactions to their son’s behavior. C. Assist the parents in putting together information for the client’s school about his diagnosis and treatment plan. D. Encourage the parents to discuss their feelings about their son’s behavior with one another.

Answer 97

D. Encourage the parents to discuss their feelings about their son’s behavior with one another. Sharing information with the school about the client’s diagnosis and treatment plan is in the cognitive domain.

Question 97

The client, a 15-month-old toddler, is being seen at the clinic today for a well-child checkup and routine vaccinations. During the visit, the client’s mom asks about the connection between autism and vaccinations. The nurse provides the mother with a verbal explanation and a brochure listing resources for additional information. In which domain does this nursing intervention belong? A. Affective B. Cognitive C. Behavioral D. Behavioral effect

Answer 97

B. Cognitive The cognitive domain focuses on providing the family with information and opinions

Question 98

The nurse is providing teaching to a family whose child was recently diagnosed with cystic fibrosis. When offering information, which of the following should the nurse avoid? A. Providing written information that is easy to read B. Providing information in medical terms to help the family understand words they will be hearing in the future C. Providing the family with information on support groups and resources D. Not becoming invested in the outcome

Answer 98

B.