TEST BANK for Family Health Care Nursing Theory, Practice, and Research 6th Edition by Joanna Kaakin

Chapter 1: Family Health Care Nursing: An Introduction Multiple Choice: 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.

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

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

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

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

6. 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

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

8. 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

9. 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

Multiple Response:

10. 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

Answers:

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?

Ans: 4 Page: 9

1.

2.

3.

4.

Feedback Family care is concerned with the experience of the family over time. It considers both the history and the future of the family group.

The physical absence of family members does not preclude the nurse from offering family care.

Family nursing is directed at families whose members are both healthy and ill regardless of the severity of the illness in the family member.

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.

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?

Ans: 4 Page: 16

1.

2.

3.

4.

Feedback An extended family is defined as two or more adult generations and one that includes grandparents and grandchildren living in the same household.

A cohabitation family type is defined as an unmarried couple sharing a household who are involved in an emotional and/or sexually intimate relationship.

A nuclear dyad is defined as a married couple with no children.

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.

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?

Ans: 1 Page: 5

1.

2.

3.

4.

Feedback 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.

The definition that a family is made up of people who share strong emotional ties is a psychological definition of a family.

The definition that a family is defined by blood ties, adoption, and marriage is a legal definition of a family.

The definition that a family is a group of people who live together with or without legal or biological ties is a sociological definition of a family.

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?

Ans: 3 Page: 9

1.

2.

3.

4.

Feedback The second approach to family nursing care centers on the assessment of all family members. The family nurse is interested in the way all the family members are individually affected by the health event of one family member. In this approach, all members of the family are in the foreground.

The third approach to care views the family as a system. The focus in this approach is on the family as a whole as the client; here, the family is viewed as an interactional system in which the whole is more than the sum of its parts. In other words, the interactions between family members become the target for the nursing interventions.

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.

The fourth approach to care looks at the family as a component of society, in which the family is viewed as one of many institutions in society, similar to health, educational,

religious, or economic institutions. The family is a basic or primary unit of society, and it is a part of the larger system of society.

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?

Ans: 3 Page: 13

1.

2.

3.

4.

Feedback As a counselor, the family nurse has a therapeutic role in helping individuals and families solve problems or change behavior.

As a care deliverer, the family nurse either delivers or supervises the care that families receive in various settings. To do this, the nurse must be a technical expert both in terms of knowledge and skill.

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

As an advocate the family nurse advocates for families and empowers family members to speak with their own voices, or the nurse speaks out for the family.

6. 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?

Ans: 1 Page: 14

1.

2.

3.

4.

Feedback 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.

As a researcher, the family nurse identifies practice problems and finds the best solution for dealing with these problems through the process of scientific investigation.

The family nurse is continually serving as a role model to other people, demonstrating positive health actions and strategies.

As a case manager the nurse coordinates and collaborates between a family and the health care system.

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?

Ans: 2 Page: 14

1.

2.

3.

4.

Feedback It is inappropriate to expect an ill client to attend a care conference.

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.

The spouse is not available. Telephoning in for the conference is not appropriate.

Providing the spouse with the outcomes of the meeting does not take the family’s needs into consideration and violates the purpose of the meeting.

8. 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?

Ans: 1 Page: 19

1.

2.

3.

4.

Feedback 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.

The economic function of the family is focused on providing the necessities of food, clothing, and shelter for the family members.

The health care function of the family is when the family learns how to maintain, protect, and restore health.

The family is the first and one of the most influential settings for socialization.

Families are the primary source of individual development and the primary setting in which children begin to acquire the beliefs, attitudes, values, and behaviors considered

appropriate to society. This situation does not demonstrate family socialization.

9. 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?

Ans: 2 Page: 23-24

1.

2.

3.

4.

Feedback Role strain occurs when the person lacks knowledge about performance of a role.

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.

Role ambiguity occurs when the person does not know what to do in a situation.

Role expectations occur when a person who is performing a role is expected to pick up additional responsibilities and incorporate them into the current role.

10. 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.

Ans: 2, 3, 5 Page: 6

1.

2.

3.

4.

5.

Feedback A healthy family fosters trust and respect instead of fostering suspicion.

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

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

A healthy family welcomes rituals and traditions but does not enforce participation in such family practices.

A trait common to healthy families is sharing leisure time.

. .

2-1

Chapter 2: Theoretical Foundations for the Nursing of Families

Multiple Choice:

1. 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

2. 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

3. 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

4. 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.

. .

2-2

5. 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

6. 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.

7. 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

Multiple Response:

8. 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.

9. 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

10. 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

2-3

. .

2-4

Answers:

1. 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?

Ans: 4 Page: 29 1.

2.

3.

4.

Feedback Theories construct hypotheses, or the question, “What is expected to happen?”

Theories in general explain what is happening; they provide answers to “How?” and “Why?” questions, help to interpret and make sense of complex phenomena, and predict what could happen in the future based on careful thought and study about what has happened in the past.

Theories are designed to make sense of the world by showing how one concept is related to another and how together they make a meaningful pattern that can predict the consequences of certain clusters of characteristics or events.

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

2. 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?

Ans: 2 Page: 29

1.

2.

3.

4.

Feedback System is not part of a theory.

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

Propositions are statements about the proposed relationship between two or more concepts.

A conceptual model is a set of general propositions that integrate concepts into meaningful configurations or patterns.

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

. .

2-5

Ans: 3 Page: 45-46

1.

2.

3.

4.

Feedback The health of individual members is analyzed according to the impact on the entire family unit.

The employment status of the parents is not a specific feature of family development theory.

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.

The children’s education is addressed after the family structure and life cycle stage is identified.

4. 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?

Ans: 1 Page: 47

1.

2.

3.

4.

Feedback 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.

Children leaving home to go to college would be an expected trajectory within the developmental model.

Children progressing through basic education would be an expected trajectory within the developmental model.

Children leaving home or “launching” is an expected trajectory within the developmental model.

5. 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?

Ans: 2

. .

2-6

Page: 49

1.

2.

3.

4.

Feedback Mesosystems are the relationships among major microsystems in which persons or families actively participate, such as families and schools, families and religion, and families with peers.

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

Microsystems are the settings in which individuals/families experience and create dayto-day reality. They are the places people inhabit, the people with whom they live, and the things they do together.

Macrosystems are the broad cultural attitudes, ideologies, or belief systems that influence institutional environments within a particular culture/subculture in which individuals/families live.

6. 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?

Ans: 2 Page: 49

1.

2.

3.

4.

Feedback Mesosystems and exosystems, within macrosystems, serve as blueprints.

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

The microsystem is the setting for day-to-day reality. It does not serve as a blueprint for the family’s development.

Chronosystems are time-related contexts that effect the other systems and are influenced by sociohistorical conditions.

7. 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?

Ans: 1

. .

2-7

Page: 49

1.

2.

3.

4.

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

The target population for any nursing theory is families with health problems.

The target population for any nursing theory is families with illness treatment.

The target population for a family social science theory is a “normal” family with an expected trajectory.

8. 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.

Ans: 1, 2, 4, 5 Page: 39-40

1.

2.

3.

4.

5.

Feedback 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.

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.

The concept that families develop and change over time is a concept associated with family development theories.

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.

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.

. .

2-8

9. 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.

Ans: 2, 5 Page: 43

1.

2.

3.

4.

5.

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

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.

Normative refers to a predictable change that occurs within a family based on expected developmental steps.

Conflicting is not a term or concept related to family development theory.

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

10. 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.

Ans: 1, 3, 4, 5 Page: 34-35

1.

2.

3.

4.

5.

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

Determining normative and nonnormative events is an action completed when following a family development and life cycle theory.

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

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

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.

. .

3-1

Chapter 3: Family Demography: Continuity and Change in North American Families

Multiple Choice:

1. The nurse prepares to assess a female client who is 25 years old. What should the nurse most likely expect when assessing this client’s family structure?

1. Attends college 2. Married with one child 3. Lives with a sexual partner 4. Lives at home with parents

2. Immigration rates increased after the Immigration and Naturalization Act was amended in 1965. Which observation demonstrates the greatest impact of this act to the practicing nurse?

1. There will be fewer clients from outside of the United States.

2. Chinese interpreters will be needed most often.

3. A large number of clients will be considered undocumented immigrants.

4. Refugees will have access to health care through resettlement programs.

3. The nurse learns that a middle-aged client lives alone. What should the nurse consider when planning this client’s care?

1. A transfer to a skilled facility is required.

2. There is no one to help with care needs at home.

3. The client has the finances to purchase necessary supplies.

4. The client’s health insurance covers home care.

4. The nurse learns that an older female client lives alone. Which statement best explains the reason for this client’s living arrangement?

1. Older adult women are more likely to prefer living alone when compared with men.

2. Older adult women are more financially secure and able to live alone when compared with men.

3. Older adult women tend not to get along with their adult children, and therefore have no choice but to live alone.

..

3-2

4. Older adult women live longer than men, and therefore find themselves outliving their spouse or partner and living alone.

5. The nurse prepares an educational program on the living arrangements of young adults for a community health fair. What should the nurse explain as an important difference between the young adults of today and those of previous generations?

1. Young adults are marrying younger today than before.

2. Young adults are entering the military more than before.

3. Young adults are spending more years living with their parents than before.

4. Young adults are entering the workforce at younger ages than before.

6. The nurse notes that a young female client lives in a homeless shelter with her children. Which characteristic is most likely associated with this client?

1. Widowhood 2. Never married 3. Divorced from a spouse 4. Separated from a spouse

7. The nurse learns that a client is in a cohabitation living arrangement. What should this information indicate to the nurse?

1. Higher risk for divorce if the couple marries 2. Financial inability to obtain needed health care 3. Children are at a higher risk for behavioral problems 4. Health care decisions can be made on behalf of each other

8. When considering nursing care of families today, how will changing demographics affect the nurse’s approach to care?

1. Adult children will provide primary care for aging parents.

2. Fathers are not involved with the health care of their children.

3. More fathers are awarded the custody of children after a divorce.

4. More children live in nontraditional families, which negatively affects their well-being

..

3-3

9. The nurse notes that a preadolescent male with same-sex parents is scheduled for a wellness examination. Which of the following should the nurse keep in mind when caring for this client?

1. Most likely this client is less psychologically developed than his peers.

2. Most likely this client is less emotionally developed than his peers.

3. Most likely this client is at greater risk for emotional distress.

4. Most likely this client is cognitively delayed in school performance.

Multiple Response:

10. The community health nurse notes a large number of cohabitation households in the community. Which statement could explain the reason for this? Select all that apply.

1. Wider availability of reliable birth control 2. Increased uncertainty about the stability of marriage 3. Easier to separate when compared with a married relationship 4. Loss of stigma associated with cohabitation and sexual relations outside of marriage 5. Desire to express that unmarried cohabitation is different from the life of married couples

11. Which characteristic should the nurse remember when caring for a single mother? Select all that apply.

1. Less likely to be able to pay for care 2. More likely to seek health care services 3. More likely to fill out health care forms correctly 4. Less likely to understand care instructions 5. Less likely to communicate effectively with nurses and doctors

12. During a community fair presentation, a participant asks why health care costs continue to increase in the United States. How should the nurse respond? Select all that apply.

1. Rising incomes 2. Insurance coverage fees 3. Care of children in poverty 4. Changes in medical technology 5. Increased use of pharmaceuticals

. .

3-4

Answers:

1. The nurse prepares to assess a female client who is 25 years old. What should the nurse most likely expect when assessing this client’s family structure?

Ans: 3 Page: 53 1.

2.

Feedback A 25-year-old client has most likely completed a college education.

A young woman reaching adulthood in the first decades of the 21st century is not likely to marry before her 27th birthday.

3.

Cohabitation among opposite- and same-sex couples continues to rise in North America. Therefore, the nurse should expect that this client lives with a sexual partner.

4.

A young woman today may move in and out of her parents’ home several times; however, because this varies, this assessment finding would not be expected.

2. Immigration rates increased after the Immigration and Naturalization Act was amended in 1965. Which observation demonstrates the greatest impact of this act to the practicing nurse?

Ans: 4 Page: 59

1.

2.

3.

4.

Feedback Immigration to the United States increased to an average of 900,000 persons per year in the 1990s and to 1 million in 2014.

Estimates based on U.S. American Community Survey data reveal that 60 million people older than age 5 speak a language other than English at home, the most common being Spanish.

Undocumented immigrants are ineligible for any type of federal public benefits including welfare, Social Security, and health services such as Medicaid and Medicare.

Undocumented immigrants are less likely to seek care for themselves or for their children, even when their children are citizens, for fear of detection and deportation.

In the United States and Canada, immigration laws provide refugees with resettlement assistance including temporary health care services.

..

3-5

3. The nurse learns that a middle-aged client lives alone. What should the nurse consider when planning this client’s care?

Ans: 2 Page: 61

1.

2.

3.

4.

Feedback There is no evidence to support that the client will need to be transferred to a skilled facility for assistance with care.

The proportion of households with just one person in the United States more than doubled from 13% to 27% between 1960 and 2012. This means that fewer Americans live with family members who can help care for them when they are ill or injured. In Canada, single-person households are the fastest growing type of household and projections indicate this trend will continue well into the 21st century.

The scenario does not support the assumption that the client has the resources to pay for necessary supplies. Living alone does not mean that the person has extra finances.

There is no information about the client’s health plan coverage. Home care may or may not be required.

4. The nurse learns that an older female client lives alone. Which statement best explains the reason for this client’s living arrangement?

Ans: 4 Page: 61

1.

2.

3.

4.

Feedback Older women do not prefer to live alone. This living arrangement is most likely because the male spouse has passed away and the older woman is widowed.

Older women have fewer financial resources than men.

Geography and size of the family impact an older woman’s ability or desire to live with adult children.

A woman is likely to spend more years living alone after a spouse dies than will a man because life expectancy is about 3 years longer for an older woman than for an older man, and because women usually marry men older than themselves. Therefore, older American women are nearly twice as likely as men to be living alone.

. .

3-6

5. The nurse prepares an educational program on the living arrangements of young adults for a community health fair. What should the nurse explain as an important difference between the young adults of today and those of previous generations?

Ans: 3 Page: 63

1.

2.

3.

4.

Feedback Today marriage is delayed. In 2015, 54% of women aged 25 to 29 in the United States and 67% of men in the same age group had never been married.

There is no evidence to support that the number of young adults entering the military is greater than before.

American parents often take in their children after they return from the military or school, or when they are between jobs. Today, leaving and returning home seems to be a common part of a successful transition to adulthood.

Entrance into the workforce occurs after completing high school or college.

6. The nurse notes that a young female client lives in a homeless shelter with her children. Which characteristic is most likely associated with this client?

Ans: 2 Page: 72

1.

2.

3.

4.

Feedback Based upon the client’s age, it is unlikely that the client is a widow.

Never-married single mothers are disadvantaged because they are younger, less educated, and less often employed than are divorced single mothers and married mothers. Single mothers often must curtail their work hours to care for the health and well-being of their children. Mothers who never-married are much less likely to get child support from the father than are mothers who are divorced or separated.

Most divorced mothers with custody of children younger than 21 receive some child support from the children’s father.

Women who are separated are more likely to receive financial support from the father of their children.

. .

3-7

7. The nurse learns that a client is in a cohabitation living arrangement. What should this information indicate to the nurse?

Ans: 2 Page: 65

1.

2.

3.

4.

Feedback There is no evidence to support a higher risk for divorce if the couple marries after cohabitating.

On average, cohabitating couples report poorer health and have lower incomes than do married couples. Although they are more likely to need health care services, they may be less likely to have the financial ability to secure them.

There is no evidence to support that children living in a cohabitating household have a higher risk for behavioral problems.

Because cohabitating relationships are not legally sanctioned in most states, partners may not have the right to make health care decisions on behalf of each other or of the other’s children.

8. When considering nursing care of families today, how will changing demographics affect the nurse’s approach to care?

Ans: 4 Page: 77

1.

2.

3.

4.

Feedback Because of geographical location and number of children, it is unlikely that an adult child will provide primary care for aging parents.

The new ideal father is a co-parent who is responsible for and involved in all aspects of his children’s care. Fathers spend more time caring for children when mothers are employed and when children are young.

Custody of children after a divorce is more likely to be awarded to the mother than to the father.

Similar to children growing up in single-parent families, children with stepparents have lower levels of well-being than children growing up with biological parents. It is not simply the presence of two parents, but the presence of two biological parents that seems to promote children’s healthy development.

. .

3-8

9. The nurse notes that a preadolescent male with same-sex parents is scheduled for a wellness examination. Which of the following should the nurse keep in mind when caring for this client?

Ans: 3 Page: 76

1.

2.

3.

4.

Feedback Studies have found that children of same-sex parents fare relatively as well, if not better, in psychological development.

Studies have found that children of same-sex parents fare relatively as well, if not better, in emotional development.

Sons of same-sex couples are more likely to experience disapproval from their peers and face greater homophobic teasing than girls. Boys may be at greater risk of experiencing emotional distress.

Studies have found that children of same-sex parents fare relatively as well, if not better, in school performance.

10. The community health nurse notes a large number of cohabitation households in the community. Which statement could explain the reason for this? Select all that apply.

Ans: 1, 2, 3, 4 Page: 64

1.

2.

3.

4.

5.

Feedback Research has shown that one reason for the increase in cohabitation is the availability of reliable birth control.

Considering the increase in divorce rates, there is greater uncertainty about the stability of marriage. If a marriage is not successful, the parties suffer through a lengthy and difficult divorce.

If a relationship between a cohabitating couple is not successful, one can simply move out.

Research has shown that the stigma associated with cohabitation and sexual relations outside of marriage has eroded.

There is no evidence to suggest that people cohabitate because of the desire to make a statement that unmarried cohabitation is different from married life.

. .

3-9

11. Which characteristic should the nurse remember when caring for a single mother? Select all that apply.

Ans: 1, 4, 5 Page: 73-74

1.

2.

3.

4.

5.

Feedback In the United States, single mothers are more likely to be poor and uninsured, making it more likely they will not be able to pay for it.

In the United States, single mothers are more likely to be poor and uninsured, making it less likely they will seek health care services.

Single mothers today are younger and less educated than they were a few decades ago.

This presents problems because these mothers have more difficulty filling out health care forms correctly.

Single mothers today are younger and less educated than they were a few decades ago.

This presents problems because these mothers are less likely to understand their care instructions.

Single mothers today are younger and less educated than they were a few decades ago.

This presents problems because these mothers are less likely to communicate effectively with nurses and doctors.

12. During a community fair presentation, a participant asks why health care costs continue to increase in the United States. How should the nurse respond? Select all that apply.

Ans: 1, 4, 5 Page: 59

1.

2.

3.

4.

Feedback A major cause of increased health expenditures in industrialized countries is rising incomes.

Insurance coverage fees are not identified as a reason for the increase in health care costs.

Providing care to children in poverty is not identified as a reason for the increase in health care costs.

A major cause of increased health expenditures in industrialized countries is changes in medical technology.

. .

3-10 5.

A major cause of increased health expenditures in industrialized countries is increased use of pharmaceuticals.

. .

4-1

Chapter 4: Family Policy: The Intersection of Family Policies, Health Disparities, and Health Care Policies

Multiple Choice:

1. 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

2. 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

3. 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.

4. 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

. .

4-2

3. Education 4. Food security

5. 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

Multiple Response:

6. 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

7. 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

..

4-3

8. 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

9. 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

10. 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

11. 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

. .

4-4

Answers:

1. 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”?

Ans: 4 Page: 86 1.

2.

3.

4.

Feedback The definition of family includes people related by marriage and adoption in addition to biologically related members.

Even though people may live in the same residence, that does not mean they are considered a family in the United States.

Even if the client says someone is family, he or she is not automatically considered part of a family in the United States.

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

2. 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?

Ans: 2 Page: 90-91

1.

2.

3.

4.

Feedback Homeless children are more likely to have learning disabilities.

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

There is no information to support the emotional development of a child who is homeless.

There is no information to support the emotional development of a child who is homeless.

3. 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?

Ans: 4

. .

4-5

Page: 100

1.

2.

3.

4.

Feedback Illness or disability is not used as a determinant for participation in the CHIP program.

The child’s education needs are not used to determine participation in the CHIP program.

The child’s family structure is not used to determine participation in the CHIP program.

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

4. 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?

Ans: 1 Page: 90

1.

2.

3.

4.

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

Poverty influences other social determinants that have a negative impact on family health, such as housing.

Poverty influences other social determinants that have a negative impact on family health, such as education.

Poverty influences other social determinants that have a negative impact on family health, such as food security.

5. 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?

Ans: 3 Page: 95 Feedback

. .

4-6 1.

2.

3.

4.

There is no evidence to suggest that this client’s lack of adherence is because of racism.

There is no evidence to suggest that isolation is causing this client’s lack of adherence.

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.

There is no evidence to suggest that social exclusion is causing this client’s lack of adherence.

6. 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.

Ans: 1, 2, 3, 5 Page: 87

1.

2.

3.

4.

5.

Feedback Family policies have been developed for the purpose of preventing health problems on a societal scale and include health.

Family policies have been developed for the purpose of preventing health problems on a societal scale and include housing.

Family policies have been developed for the purpose of preventing health problems on a societal scale and include education.

Family policies have been developed for the purpose of preventing health problems on a societal scale but do not address issues with transportation.

Family policies have been developed for the purpose of preventing health problems on a societal scale and include food and water.

7. 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.

Ans: 3, 4, 5 Page: 93

1.

Feedback Because of systemic and policy-related stigma and barriers, these individuals experience greater alcohol and tobacco use.

. .

4-7 2.

3.

4.

5.

Because of systemic and policy-related stigma and barriers, these individuals experience significant differences in health-seeking and health-promoting behaviors.

Because of systemic and policy-related stigma and barriers, these individuals are far more likely to delay accessing health care.

Because of systemic and policy-related stigma and barriers, these individuals are less likely to receive preventive screens such as mammograms.

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.

8. 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.

Ans: 2, 4, 5 Page: 84

1.

2.

3.

4.

5.

Feedback A social determinant of health cannot be modified in the same way as a behavioral determinant and includes gender.

A behavioral determinant of health can be modified and includes tobacco use.

A social determinant of health cannot be modified in the same way as a behavioral determinant and includes ethnicity.

A behavioral determinant of health can be modified and includes substance abuse.

A behavioral determinant of health can be modified and includes physical activity.

9. 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.

Ans: 1, 4, 5 Page: 88

1.

2.

3.

Feedback 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.

Increasing the frequency of trash removal ensures a healthy environment and does not demonstrate institutional racism.

Receiving notice of an increase in Medicaid benefits increases health care opportunities and

. .

4-8

4.

5.

does not demonstrate institutional racism.

Unjustified utility shut-off indicates inadequate housing, which is an example of institutional racism.

Being hindered from achieving gainful employment is an example of institutional racism.

10. 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.

Ans: 1, 2, 3, 5 Page: 92

1.

2.

3.

4.

5.

Feedback In a recent study, diabetes rates were four times higher among persons who live in a lowincome neighborhood.

In a recent study, diabetes rates were four times higher among persons who live in a lowincome neighborhood. Reasons for this include an unhealthy diet.

In a recent study, diabetes rates were four times higher among persons who live in a lowincome neighborhood. Reasons for this include lack of exercise.

Although a recent study indicated that diabetes rates were four times higher among persons who live in a low-income neighborhood, the use of public transportation is not linked to this disease.

In a recent study, diabetes rates were four times higher among persons who live in a lowincome neighborhood. Reasons for this include the inability to pay for medication.

11. The nurse desires to change health policy in a local community. Which action should the nurse take? Select all that apply.

Ans: 1, 2, 4, 5 Page: 107-108

1.

2.

3.

4.

5.

Feedback 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.

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.

Reading how to make a policy into a law is not a strategy identified to influence policy from the micro- to the exo-level.

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.

Specific strategies for nurses to get involved in influencing policy from micro- to exo-levels include joining community advocacy groups.

. .

4-9

. .

5-1

Chapter 5: Family Nursing Assessment and Intervention

Multiple Choice:

1. 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

2. 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

3. 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

4. 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

..

5-2

4. The clustering of data into meaningful groups, identifying pertinent relationships between variables

5. 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

6. 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

7. 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

Multiple Response:

8. 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

. .

5-3

5. Identifies the relationship between family members and the community

9. 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

10. 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

11. 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

12. Which of the following are characteristics of the Friedman Family Assessment Model? Select all that apply.

1. Family is an open system 2. Views families as subsystems of the wider society 3. Identifies family conflicts and patterns of violence 4. Focuses on family structure, function, and relationships 5. Used when the family-in-community is the setting for care

. .

5-4

13. 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

. .

5-5

Answers:

1. 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?

Ans: 3 Page: 117 1.

2.

3.

4.

Feedback An assessment is not an instrument that quantifies a particular family attribute.

There are various assessment tools available to the nurse; however, a time limit is not associated with the completion of the assessment.

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.

Assessment is not the process of assigning numbers or symbols to variables in order to measure family member characteristics.

2. The nurse plans to use a family genogram during a family assessment. What assessment information does this tool provide?

Ans: 2 Page: 127

1.

2.

3.

4.

Feedback The genogram does not identify tension between family members.

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.

The genogram does not identify communication patterns among family members.

The genogram does not identify relationships between family members and the community.

3. The nurse meets with a family to complete a genogram. How many generations should the nurse ask the family members about?

Ans: 3 Page: 127

. .

5-6

1.

2.

3.

4.

Feedback The genogram draws a family tree for three generations, not just one.

The genogram draws a family tree for three generations, not just two.

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.

The genogram draws a family tree for three generations, not four.

4. The nurse begins to assess a family. What best describes the family story?

Ans: 2 Page: 116

1.

2.

3.

4.

Feedback Analyzing outcomes occurs during the family evaluation.

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

The family intervention is the process of establishing intervention plans.

Clustering of data occurs during the analysis of the family story.

5. The nurse refers to the Family Reasoning Web when caring for a family. What is the purpose of this tool?

Ans: 4 Page: 133

1.

2.

3.

4.

Feedback A genogram diagrams family members across three generations.

An ecomap diagrams relationships within and external to the immediate family.

The family story provides comprehensive data about family structure, development, and function.

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.

. .

5-7

6. The nurse prepares to use the Family Assessment and Intervention Model when assessing a family. What is this model based on?

Ans: 2 Page: 121

1.

2.

3.

4.

Feedback The Family Assessment and Intervention Model is not based on Orem’s Self-Care Theory.

The Family Assessment and Intervention Model is based on Neuman’s health care systems model.

The Family Assessment and Intervention Model is not based on Rogers’ Theory of Unitary Human Beings.

The Family Assessment and Intervention Model is not based on Bronfenbrenner’s Bioecological Systems Theory.

7. The nurse reviews the Calgary Family Assessment Model (CFAM). What does this model blend?

Ans: 1 Page: 122

1.

2.

3.

4.

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

The CFAM does not blend medicine and nursing.

The CFAM does not blend nursing and social work.

The CFAM does not blend nursing and ecology.

8. In which of the following ways does an ecomap help in the assessment of a family? Select all that apply.

. .

5-8

Ans: 3, 5 Page: 128

1.

2.

3.

4.

5.

Feedback A genogram pinpoints health conditions.

A genogram analyzes multigenerational patterns.

An ecogram highlights tension among family members.

A genogram includes pets and non-blood family members.

An ecogram identifies the relationship between family members and the community.

9. The nurse reviews a genogram completed for a family new to a community. What information will the genogram provide? Select all that apply.

Ans: 2, 4 Page: 128

1.

2.

3.

4.

5.

Feedback A genogram does not provide the types of possible support systems for extended family members.

A genogram provides a quick snapshot of the family members from an intergenerational perspective.

An ecomap identifies types of social support to the immediate nuclear family.

An genogram provides information on the health status of family members in the immediate and extended family.

An ecomap identifies the family unit in relation to the larger community in which it is embedded.

10. 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.

Ans: 1, 2, 4, 5 Page: 141

1.

Feedback A therapeutic letter should be written by the nurse after the summary meeting.

. .

5-9 2.

3.

4.

5.

Strategies when closing the relationship include a summary evaluation meeting where the family and nurse put formal closure to the relationship.

The physician does not have the information to write a letter.

Strategies when closing the relationship include extending invitations to the family for follow-up.

Strategies when closing the relationship include making referrals when appropriate.

11. The nurse plans to use the Family Assessment and Intervention Model. What is the purpose of this model? Select all that apply.

Ans: 1, 3, 4 Page: 121

1.

2.

3.

4.

5.

Feedback The Family Assessment and Intervention Model is used for health promotion.

The Family Assessment and Intervention Model is not used for family change strategies.

The Family Assessment and Intervention Model is used for the restoration of family stability and family functioning.

The Family Assessment and Intervention Model is used for family reaction and instability at lines of defense and resistance.

Generating large quantities of data that may not relate to the problem is a characteristic of the Friedman Family Assessment Model.

12. Which of the following are characteristics of the Friedman Family Assessment Model? Select all that apply.

Ans: 1, 2, 4, 5 Page: 121 1.

2.

3.

4.

5.

Feedback The Friedman Family Assessment Model views families as an open system.

The Friedman Family Assessment Model views families as subsystems of the wider society.

The Friedman Family Assessment Model does not address family conflicts and patterns of violence.

The Friedman Family Assessment Model focuses on family structure, function, and relationships.

The Friedman Family Assessment Model is used when the family-in-community is the setting for care.

..

5-10

13. 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.

Ans: 2, 3, 4 Page: 123

Feedback 1.

2.

3.

4.

5.

Process is not a category of questions within the CFAM. The assessment questions that accompany the model are organized into three major categories that include function.

The assessment questions that accompany the model are organized into three major categories that include structure.

The assessment questions that accompany the model are organized into three major categories that include development.

Evolution of change is not a category of questions within the CFAM.

. .

6-1

Chapter 6: Family Health Promotion

Multiple Choice:

1. 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

2. 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

3. 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

4. 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

. .

6-2

4. Elimination of the need for face-to-face interactions with care providers

Multiple Response:

5. 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

6. 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

7. 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

8. 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.

. .

6-3

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

9. 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

10. 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

11. 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

Prioritization:

. .

6-4

12. 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

. .

6-5

Answers:

1. 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?

Ans: 4 Page: 149 1.

2.

3.

4.

Feedback Having resources to pay for medical bills is not a definition of family health promotion.

Living in a location where health resources are readily available is not a definition of family health promotion.

Planning for retirement and achieving a quality and dignified death is not a definition of family health promotion.

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.

2. The nurse is assessing the rituals that a family follows. Which definition of a family ritual should the nurse use when identifying these activities?

Ans: 2 Page: 170

1.

2.

3.

4.

Feedback The process of family members learning to do things together indicates a routine.

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.

A family ritual is not a process of family members resolving after a conflict.

A family ritual is not an action that the family takes to keep the family heritage and history.

3. The nurse prepares information about internal and external influencers of family health.

Which should the nurse use as an example of an external influencer?

Ans: 1

. .

6-6

Page: 156

1.

2.

3.

4.

Feedback 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.

The marital dyad would be the structure of the family unit and an internal influencer of family health.

Chronic illness is an overall internal influencer of family health.

Sibling subsystems are internal influencers of family health.

4. 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?

Ans: 2 Page: 162

1.

2.

3.

4.

Feedback A variety of factors are needed to reduce the incidence of developing a chronic disease.

However, telehealth is not one of those factors.

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

Telehealth is not a total replacement for health care. There is no evidence to support that telehealth will decrease the amount of time needed to diagnose a health problem.

Telehealth provides a forum for consultation with clients/families and health care providers when face-to-face involvement is not possible owing to barriers such as time and/or distance. It is not a total replacement for face-to-face interactions.

5. Which factor(s) should the nurse identify as influencing the promotion of a family’s health?

Select all that apply.

Ans: 1, 2, 3, 5 Page: 149-150

1.

2.

Feedback Families are primarily responsible for being a role model for health teaching and care.

Families are primarily responsible for teaching self-care and wellness behavior.

. .

6-7 3.

4.

5.

Families are primarily responsible for supporting each other during illness.

A major task of families is to make efforts toward health maintenance and health promotion, regardless of age.

Families are primarily responsible for providing care for members across their life course.

6. 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.

Ans: 2, 5 Page: 159 Feedback 1.

2.

3.

4.

5.

One goal of Healthy People 2020 is to reduce substance abuse to protect the health, safety, and quality of life for all, especially children.

One goal of Healthy People 2020 is to eliminate health disparities.

One objective of Healthy People 2020 is to reduce diseases and disorders.

The provision of medical insurance for all is neither a Healthy People 2020 goal or objective.

One goal of Healthy People 2020 is to increase the quality and years of life.

7. 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.

Ans: 1, 3, 4, 5 Page: 151

1.

2.

3.

4.

Feedback Exhibiting a sense of humor indicates appreciation and affection between the family members.

Although sharing faith and religious core values indicates attention to the family’s spiritual well-being, the family does not need to attend religious services weekly to demonstrate this characteristic of a healthy family.

Sharing family rituals and traditions is a characteristic of the family spending time together.

Demonstrating adaptability to change is a characteristic of the family’s ability to deal

. .

6-8

5.

with stress.

Communicating and listening to all family members indicates positive family communication.

8. 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.

Ans: 3, 4, 5 Page: 155

1.

2.

3.

4.

5.

Feedback According to the Family Health Promotion model, the family systems pattern is a general influencer.

According to the Family Health Promotion model, family size and structure are general influencers.

According to the Family Health Promotion model, health-related influences include the family’s definition of “health.”

According to the Family Health Promotion model, health-related influences include perceived family health status.

According to the Family Health Promotion model, health-related influences include family health socialization patterns.

9. 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.

Ans: 1, 3, 4, 5 Page: 168

1.

2.

3.

Feedback When empowering a family, the nurse collaborates with the family and provides information.

The underlying assumption of empowerment is one of partnership between the professional and the client as opposed to one in which the professional is dominant.

Problem-solving for the family would not help them become more empowered.

The primary emphasis in family empowerment is the involvement of the family in goal

. .

6-9

4.

5.

setting.

When empowering a family, the nurse collaborates with the family and provides encouragement and support.

When empowering a family, the nurse collaborates with the family and uses strategies to help the family make lifestyle changes to increase family strength.

10. 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.

Ans: 1, 2, 3, 4 Page: 163

1.

2.

3.

4.

5.

Feedback Children residing in cohabitating stepfather families experience higher rates of delinquency than teenagers living with two married biological parents.

Children residing in cohabitating stepfather families experience lower grades than teenagers living with two married biological parents.

Children residing in cohabitating stepfather families experience more behavioral problems than teenagers living with two married biological parents.

Children residing in cohabitating stepfather families experience greater lack of college expectations than teenagers living with two married biological parents.

In single-mother homes, having a working mother is positively associated with irregular breakfast consumption.

11. 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.

Ans: 1, 2, 4, 5 Page: 165

1.

2.

3.

Feedback A specific action that the nurse can use to promote spirituality and increase family resiliency is to clarify ambiguity.

A specific action that the nurse can use to promote spirituality and increase family resiliency is to create and hold a sacred space.

Encouraging the routine expression of spirituality is not identified as an action to

. .

6-10

4.

5.

promote spirituality and increase family resiliency.

A specific action that the nurse can use to promote spirituality and increase family resiliency is to help make meaning of an adverse experience.

A specific action that the nurse can use to promote spirituality and increase family resiliency is to provide compassionate witnessing by being fully present.

12. 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.

Ans: 7, 6, 1, 3, 4, 2, 5 Page: 168 Feedback: The nurse begins by completing a family assessment of wellness including the identification of areas to improve. Next, the family sets goals for the contract. Third, the plan is written identifying actions to achieve the goal. Assigning responsibilities identifies the individuals responsible for and included in the actions. Determination of time frame means the frequency for the actions to be performed. Evaluate the outcomes means the plan is reviewed, on a scheduled basis, for adherence and achievement of the identified goal. 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.

. .

Chapter 7: Nursing Care of LGBTQ Families

Multiple Choice:

1. The nurse desires to improve competency when caring for families within the LGBTQ community. Which first step should the nurse take to improve this competency?

1. Learn the relevant language 2. Evaluate personal background, beliefs, and biases 3. Build cultural and personal knowledge 4. Understand the unique disparities of the population

2. During a family assessment the nurse learns that one parent is heterosexual and the other family member is bisexual of the opposite sex. How should the nurse document this family structure?

1. Blended family 2. Family of choice 3. Mixed-orientation 4. Live Apart Together

3. A school nurse working at a middle school recognizes that several students identify as LGBTQ. Which of the following should the school nurse keep in mind when assessing these students?

1. Later onset of puberty 2. Greater popularity among student peers 3. Earlier sexual activity 4. Greater risk of teen pregnancy

4. The nurse notes that a transgender male has elevated liver enzymes and poor bone density.

What should the nurse consider as a reason for these findings?

1. Poor calcium intake 2. High intake of alcohol 3. Masculinizing hormone therapy

7-1

. .

7-2

4. Chronic use of tobacco and substances

5. During a health assessment a middle-aged homosexual male asks the nurse not to document his sexual preference because his primary health care provider is not aware. What should this request indicate to the nurse?

1. Fear of not receiving required care 2. Fear of having to pay more for care 4. Fear of not having anyone to help as aging occurs 3. Fear that family members will be discriminated against

Multiple Response:

6. The nurse learns that a homosexual male has waited more than 2 months before seeking treatment for a sexually transmitted infection. What should the nurse consider as a reason for this client to delay seeking treatment? Select all that apply.

1. Lack of access to care 2. Lack of insurance coverage 3. Confusion regarding the symptoms 4. History of overt discrimination 5. Negative experience with the health care system

7. The nurse manager suggests that the nursing staff include an assessment of mental health for all clients who are of the LGBTQ community. Why is the manager most likely making this suggestion? Select all that apply.

1. The higher risk of substance abuse within this community 2. The greater risk for depression within this community 3. The high level of social stigma and discrimination that this community often experiences 4. A preexisting bias against this community 5. The fact that suicide is a leading cause of death within this community

8. The nurse is aware of several children adopted into same-sex families that are scheduled to participate in the community preschool program. What can the nurse do to facilitate the

..

7-3

acceptance of these children’s family structure into the preschool learning environment? Select all that apply.

1. Ensure teaching materials demonstrate diverse family structures 2. Provide toys, books, and games that emphasize traditional gender roles 3. Select materials that show both genders performing a variety of roles 4. Instruct the preschool staff members on ways to reduce the stigma of these children 5. Encourage these children to play with toys that are opposite from their parents’ gender

9. The nurse prepares to assess an adolescent’s sexual history. On which questions should the nurse focus when completing this assessment? Select all that apply.

1. Priority 2. Partners 3. Practices 4. Protection 5. Pregnancy prevention

10. The nurse is assessing a middle-aged homosexual male. The nurse knows that when assessing this patient which of the following should be taken into consideration? Select all that apply.

1. Earlier onset of physical disability 2. Greater risk of cardiovascular disease 3. Lower rate of migraines 4. Higher rate of chronic gastrointestinal problems 5. Less risk for some cancers

. .

7-4

Answers:

1. The nurse desires to improve competency when caring for families within the LGBTQ community. Which first step should the nurse take to improve this competency?

Ans: 2 Page: 182 1.

2.

3.

4.

Feedback Learning the relevant language is a part of the second step in developing practice competence with LGBTQ families.

The first step in developing practice competence with LGBTQ families is to reflectively evaluate one’s own background, beliefs, and biases.

The second step is to build cultural and personal knowledge by learning the language, the history of the population, and the unique and common health needs.

The third step is to understand the unique disparities of the population and seek to develop a practice focused upon mitigating these health disparities at various socioecological levels.

2. During a family assessment the nurse learns that one parent is heterosexual and the other family member is bisexual of the opposite sex. How should the nurse document this family structure?

Ans: 3 Page: 188

1.

2.

3.

4.

Feedback A blended family is where both parents have children from previous marriages.

A self-defined family or family of choice reflects the identification of significant persons who are not linked by blood, kinship, or legal ties, but who function as family members.

A mixed-orientation marriage (MOM) is typically one in which one partner identifies as heterosexual of one sex and the other partner is a homosexual or bisexual of the opposite sex.

Live Apart Together is where one party does not live in the household but is clearly “family” and is involved to various degrees in parenting and different roles in that family.

..

7-5

3. A school nurse working at a middle school recognizes that several students identify as LGBTQ. Which of the following should the school nurse keep in mind when assessing these students?

Ans: 4 Page: 198

1.

2.

3.

4.

Feedback The research does not suggest that young people within the LGBTQ community experience a later onset of puberty than their non-LGBTQ peers.

The research does not suggest that young people within the LGBTQ community experience greater popularity than their non-LGBTQ peers.

Research indicates that young people within the LGBTQ community become sexually active at about the same rate as their heterosexual peers.

Research indicates that teen pregnancy rates may be somewhat higher among lesbian and bisexual girls.

4. The nurse notes that a transgender male has elevated liver enzymes and poor bone density.

What should the nurse consider as a reason for these findings?

Ans: 3 Page: 200

1.

2.

3.

4.

Feedback These findings are not caused by poor calcium intake.

These findings are not caused by alcohol intake.

Transgender men may experience elevations in liver enzymes and loss of bone mineral density associated with masculinizing hormone therapy.

These findings are not caused by chronic use of tobacco and other substances.

5. During a health assessment a middle-aged homosexual male asks the nurse not to document his sexual preference because his primary health care provider is not aware. What should this request indicate to the nurse?

Ans: 1 Page: 202

. .

7-6

1.

2.

3.

4.

Feedback Studies have shown that a large percentage of people within the LGBTQ community report that they have not disclosed their sexual orientation to their primary care provider for fear that they will not be treated fairly or will be denied care.

Members of the LGBTQ community are not afraid of having to pay more for care if the primary health care provider is aware of sexual preference.

Members of the LGBTQ community are not afraid of not having anyone to help as aging occurs if the primary health care provider is aware of sexual preference.

Members of the LGBTQ community are not afraid of family member discrimination if the primary health care provider is aware of sexual preference.

6. The nurse learns that a homosexual male has waited more than 2 months before seeking treatment for a sexually transmitted infection. What should the nurse consider as a reason for this client to delay seeking treatment? Select all that apply.

Ans: 1, 2, 4, 5 Page: 190

1.

2.

3.

4.

5.

Feedback Lack of access to care is a challenge routinely faced by sexual and gender minorities.

Lack of insurance coverage is a challenge routinely faced by sexual and gender minorities.

A confusion regarding the symptoms of the infection is not identified as a reason for this client to delay seeking medical treatment.

History of overt discrimination is a challenge routinely faced by sexual and gender minorities.

Negative experiences with the health care system is a challenge routinely faced by sexual and gender minorities.

7. The nurse manager suggests that the nursing staff include an assessment of mental health for all clients who are of the LGBTQ community. Why is the manager most likely making this suggestion? Select all that apply.

Ans: 1, 2, 3, 5 Page: 190

. .

7-7

1.

2.

3.

4.

5.

Feedback Members of the LGBTQ community have a 2 ½ times greater risk of substance abuse.

Members of the LGBTQ community have a 2 ½ times greater risk of depression.

Social stigma and discrimination give rise to chronic stress that lends to the higher rates of mental illness in sexual and gender minorities.

The manager suggesting that mental health assessment be completed for clients within the LGBTQ community does not demonstrate bias against the community. It is a suggestion to identify a potential mental health issue early before disease or suicide occurs.

Suicide rates have been noted to be higher within the LGBTQ community and suicide has been reported as a leading cause of death among LGBTQ youth.

8. The nurse is aware of several children adopted into same-sex families that are scheduled to participate in the community preschool program. What can the nurse do to facilitate the acceptance of these children’s family structure into the preschool learning environment? Select all that apply.

Ans: 1, 3, 4 Page: 195-196

1.

2.

3.

4.

5.

Feedback Nurses can enhance gender-positive and inclusive environments by ensuring teaching materials demonstrate diverse family structures.

Most toys continue to emphasize traditional gender roles and do not take diversity in family roles into consideration.

Nurses can enhance gender-positive and inclusive environments by selecting materials that illustrate differences related to gender, race, ability, and structure.

Enhancing preschool teachers’ and caregivers’ understanding and skills in fostering inclusive environments is important and can reduce stigma at times faced by LGBTQ families.

Children should not be encouraged to play with toys that are opposite from their parents’ gender. This is a form of bias and could lead to embarrassment for the child in a LGBTQ family.

..

7-8

9. The nurse prepares to assess an adolescent’s sexual history. On which questions should the nurse focus when completing this assessment? Select all that apply.

Ans: 2, 3, 4, 5 Page: 198

1.

2.

3.

4.

5.

Feedback Priority is not a category of questions when conducting a sexual history.

Use of the guidelines published by the Centers for Disease Control and Prevention, the 5 Ps for taking a sexual history, will ensure an accurate and nonjudgmental approach.

These include questions about partners.

Use of the guidelines published by the Centers for Disease Control and Prevention, the 5 Ps for taking a sexual history, will ensure an accurate and nonjudgmental approach.

These include questions about practices.

Use of the guidelines published by the Centers for Disease Control and Prevention, the 5 Ps for taking a sexual history, will ensure an accurate and nonjudgmental approach.

These include questions about protection.

Use of the guidelines published by the Centers for Disease Control and Prevention, the 5 Ps for taking a sexual history, will ensure an accurate and nonjudgmental approach.

These include questions about pregnancy prevention.

10. The nurse is assessing a middle-aged homosexual male. The nurse knows that when assessing this patient which of the following should be taken into consideration? Select all that apply.

Ans: 1, 2, 4 Page: 200

1.

2.

3.

4.

5.

Feedback Individuals who identify as lesbian, gay, or bisexual exhibit a higher prevalence and earlier onset of disabilities requiring the use of assistive devices.

Individuals who identify as lesbian, gay, or bisexual exhibit a higher prevalence and a greater risk of cardiovascular disease such as hypertension.

Individuals who identify as lesbian, gay, or bisexual exhibit higher rates of migraines.

Individuals who identify as lesbian, gay, or bisexual exhibit higher rates of chronic gastrointestinal problems.

Members of the LGBTQ community have a higher risk for and diagnosis of some cancers.

. .

7-9

. .

8-9

Chapter 8: Genomics and Family Nursing Across the Life Span

Multiple Choice:

1. A married couple arrives for an appointment for genetic testing after discovery of genetic diseases in their family histories. What should the nurse explain about genetic conditions to this couple?

1. They always become worse as a person ages.

2. They can be attributed to a mutation in a gene.

3. They are commonly presented in newborn infants.

4. They are diagnosed after recognizing a genetic condition in a family.

2. A family in the community has an inherited genetic disorder. What should the nurse realize about this family and their associated family members?

1. All family members should learn about the genetic disorder.

2. All family members should receive testing for the condition.

3. The diagnosed family member(s) may not want to discuss the genetic information with the rest of the family.

4. Family members will have the same response when learning about the genetic aspects of the condition.

3. The nurse plans to attend a continuing education program for genetics. In which situations will the nurse use this knowledge?

1. In all health care settings 2. When caring for childbearing families 3. Only after being credentialed as a genetics nurse 4. After a genetic condition is diagnosed in a family

4. The nurse receives information about the Human Genome Project. Which phrase does the nurse identify as accurately defining the human genome?

1. Alterations in genetic material 2. A chromosome that is not a sex chromosome

. .

8-2

3. The complete set of genetic material that makes an organism 4. The predictor of the pattern of inherited genes and chromosomes

5. The nurse notes that a family has a high need for certainty about a possible genetic condition.

What should the nurse expect this family to do?

1. Follow a set of family norms and values 2. Learn about the genetic condition 3. Negotiate changes in family roles with key family members 4. Avoid discussing genetic information with biological relatives

6. The nurse cares for a family who has a member with Huntington’s disease. What should the nurse realize about the other family members?

1. They are not at risk for the disease.

2. They are likely to avoid predictive testing.

3. They are likely to have various opinions about predictive testing.

4. They are likely to request predictive testing.

7. A participant in a community health program asks how genetic diseases occur. What should the nurse include about genetic diseases in the response?

1. They are X-linked disorders.

2. They are diseases caused by environmental factors that family members share.

3. They are diseases caused by biological conditions inherited from family members.

4. They are diseases caused by biological and environmental factors that family members share.

8. The nurse is preparing a unit-based in-service on genetic diseases. Which key ethical concept should the nurse emphasize during this in-service?

1. Grieving 2. Caring 3. Caregiving 4. Confidentiality

..

8-3

9. A family learns that their newborn has a genetic anomaly. Which statement best describes what genes control?

1. Major organs of the body 2. Personality characteristics of a person 3. Ability to learn across the life span 4. Functions of the human body at the cellular level

10. The nurse learns that a disease is present in more than one generation of a family. What does this suggest to the nurse?

1. A genetic disease is present.

2. The family may have either a biologically or environmentally based genetic disease or a combination of both.

3. The family should be assessed for environmental risk factors.

4. The family does not have a genetic disease.

11. The nurse notes that through genetic testing, a female carrier of an X-linked condition has one normal copy of the gene on the X chromosome and one mutated copy of the gene on the other X chromosome. What should this indicate to the nurse?

1. All children will be affected.

2. No children will be affected.

3. Sons will have a 50% chance of having the condition.

4. Daughters will have a 50% chance of having the condition.

12. A female learns of a genetic predisposition to breast cancer. What should the nurse identify as being the first line of defense for this person to be?

1. More frequent mammograms to detect early cell changes 2. Radical mastectomy to prevent the development of cancer 3. Counseling to consider adoption to decrease the spread of breast cancer 4. Grief and end-of-life counseling for family members experiencing breast cancer

Multiple Response:

. .

13. After giving birth to a newborn with a genetic disorder, the new mother asks when identification of genetic disorders can occur. How should the nurse respond? Select all that apply.

1. After birth 2. Before conception 3. Before receiving medication 4. During an acute or chronic illness 5. After experiencing a medication reaction

8-4

. .

8-5

Answers:

1. A married couple arrives for an appointment for genetic testing after discovery of genetic diseases in their family histories. What should the nurse explain about genetic conditions to this couple?

Ans: 2 Page:\213 1.

2.

3.

4.

Feedback There is no evidence that supports the worsening of genetic conditions as a person ages.

Individuals inherit genetic material from their parents and pass it on to their children. Some conditions result from a change or mutation in a DNA sequence of a gene.

There is no evidence to support that genetic conditions are commonly presented in newborn infants.

There is no evidence to support that genetic conditions are diagnosed after recognizing a genetic condition in a family.

2. A family in the community has an inherited genetic disorder. What should the nurse realize about this family and their associated family members?

Ans: 3 Page: 220

1.

2.

3.

4.

Feedback Some family members may seek predictive testing, whereas others may not want to know anything about the condition.

Although some family members may want to be tested for the condition, others may not.

Families are unique and respond to genetic discoveries differently. Some members react to genetic discoveries with grief, loss, and denial.

Responses to genetic aspects of a condition can include grief, loss, and denial.

3. The nurse plans to attend a continuing education program for genetics. In which situations will the nurse use this knowledge?

Ans: 1

. .

8-6

Page: 212

1.

2.

3.

4.

Feedback Nurses are likely to be one of the first health care providers that individuals and families go to with questions about genomics and health because nurses are typically viewed as trusted health care providers with a long history of providing holistic family-focused care. The ability to apply an understanding of genetics and genomics in the clinical setting needs to be a priority for all nurses.

Although a genetic issue might be more prevalent within a childbearing family after the birth of a child with a genetic anomaly, the nurse will use information about genetics beyond caring for childbearing families.

The nurse does not need to be credentialed as a genetics nurse to use genetic information when caring for families.

Although the nurse might be asked specific questions about a genetic condition after it is diagnosed in a family, the nurse will use this information in all health care settings.

4. The nurse receives information about the Human Genome Project. Which phrase does the nurse identify as accurately defining the human genome?

Ans: 3 Page: 213

1.

2.

3.

4.

Feedback A mutation is an alteration in genetic material.

An autosome is a chromosome that is not a sex chromosome.

The human genome is the complete set of genetic material that makes an organism and consists of approximately 3 billion bases of DNA sequence. More than 99% of these bases are the same in all individuals.

Genetic testing is used to predict the pattern of inherited genes and chromosomes.

5. The nurse notes that a family has a high need for certainty about a possible genetic condition.

What should the nurse expect this family to do?

Ans: 2 Page: 217

. .

8-7

1.

2.

3.

4.

Feedback The family is likely to seek information about the genetic condition, which could go outside of the family norms and values.

In those who prefer certainty, learning about the likelihood of developing an inherited disease can help resolve feelings of discomfort, even if the result shows the person has inherited the condition.

Having a high need for certainty about a genetic condition does not mean that the family will negotiate changes in roles with key family members.

The family with a high need for certainty about a genetic condition would want to discuss genetic information with biological relatives.

6. The nurse cares for a family who has a member with Huntington’s disease. What should the nurse realize about the other family members?

Ans: 3 Page: 219

1.

2.

3.

4.

Feedback In Huntington’s disease, if an individual carries the autosomal dominant condition, he or she will develop the disease.

Although some may want predictive testing, others may not.

Some choose not to be tested for fear that they would lose hope. Some want testing in order to know what to expect or if the disease will affect their children.

Although some may want predictive testing, others may not.

7. A participant in a community health program asks how genetic diseases occur. What should the nurse include about genetic diseases in the response?

Ans: 4 Page: 213

1.

2.

Feedback An X-linked disorder is one that appears only on the female sex chromosome.

Genetic diseases are partially influenced by environmental factors.

. .

8-8 3.

4.

Genetic diseases may begin with a biological condition; however, they may also be influenced by environmental factors.

Persons who are biologically related may have inherited many of the same DNA sequences in addition to having shared common environments with other family members. This combination ultimately increases the risk for having similar illnesses.

8. The nurse is preparing a unit-based in-service on genetic diseases. Which key ethical concept should the nurse emphasize during this in-service?

Ans: 4 Page: 219

1.

2.

3.

4.

Feedback Grieving is not an ethical concept.

Caring is not an ethical concept.

Caregiving is not an ethical concept.

Nurses must maintain the confidentiality of each family member’s genetic testing information. It is completely up to the individual to determine whether or not to reveal information about genetic risks, testing, disease, or management. Results of genetic tests are private, so they should not be disclosed to other family members without the tested person’s consent.

9. A family learns that their newborn has a genetic anomaly. Which statement best describes what genes control?

Ans: 4 Page: 213

1.

2.

3.

4.

Feedback Genes control more than the major body organs.

Genes control more than personality characteristics.

Genes may influence learning ability but they control much more than learning.

A gene is defined as the basic physical and functional unit of heredity. Because of this, the gene will control all functions of the human body at the cellular level.

. .

8-9

10. The nurse learns that a disease is present in more than one generation of a family. What does this suggest to the nurse?

Ans: 2 Page: 213

1.

2.

3.

4.

Feedback A disease can be present because of environmental factors.

Persons who are biologically related may have inherited many of the same DNA sequences in addition to having shared common environments with other family members. This combination ultimately increases risks for having similar specific illnesses. When a condition affects both male and female members, and is present in more than one generation, a dominant condition is suspected.

The family should be assessed for both biological and environmental risk factors, if they so desire.

It is likely that the family has either a biological or environmentally based genetic disease.

11. The nurse notes that through genetic testing, a female carrier of an X-linked condition has one normal copy of the gene on the X chromosome and one mutated copy of the gene on the other X chromosome. What should this indicate to the nurse?

Ans: 3 Page: 215

1.

2.

3.

4.

Feedback All children will not be affected.

Some children will be affected.

If a female carrier of an X-linked condition has one normal copy of the gene on the X chromosome and one mutated copy of the gene on the other X chromosome, the sons have a 50% chance of having the condition, and the daughters have a 50% chance of being carriers.

The daughters will have a 50% chance of being carriers.

..

8-10

12. A female learns of a genetic predisposition to breast cancer. What should the nurse identify as being the first line of defense for this person to be?

Ans: 1 Page: 222

1.

2.

3.

4.

Feedback For the person with a genetic predisposition to breast cancer, these individuals may elect to undergo regular check-ups and screenings, such as more frequent mammograms.

A radical mastectomy would not be the first line of defense. This decision would come after discussing other non-invasive options.

Adoption is not considered the first line of defense for the person with a genetic predisposition to breast cancer. Some might consider voluntary sterilization or a bilateral mastectomy to stop the spread of the cancer; however, again, this is not the first line of defense.

Grief and end-of-life counseling would not be a first line of defense for family members experiencing breast cancer. This type of counseling would occur after the disease is diagnosed and unsuccessfully treated.

13. After giving birth to a newborn with a genetic disorder, the new mother asks when identification of genetic disorders can occur. How should the nurse respond? Select all that apply.

Ans: 1, 2, 4 Page: 214

1.

2.

3.

4.

5.

Feedback Genetic testing can be performed for several purposes, including the diagnosis of a genetic condition in a newborn.

Carrier testing can tell people if they have or carry a gene alteration for a particular kind of inherited disorder called an autosomal recessive genetic disorder.

Genetic testing is not routinely done before receiving medication.

Pre-symptomatic genetic testing can indicate which family members are at risk for a certain genetic condition that is already known to be present in their family.

Genetic testing is not routinely done if a person experiences a medication reaction.

. .

9-1

Chapter 9: Families Living With Chronic Illness

Multiple Choice:

1. During a family conference, the nurse practitioner is leading a discussion with a family, which includes a 15-year-old adolescent who often “forgets” to check his morning blood glucose levels.

Which questions would be the most appropriate for the nurse to ask?

1. Why would a person neglect his body?

2. Can I tell you about the dangers of high blood glucose levels?

3. Do you think forgetting to check the blood glucose is a way of acting out?

4. I understand that you are all concerned with checking blood sugars. Is that right?

2. When planning interventions for a family with rheumatoid arthritis, it is essential that the nurse include which family member in the discussions regarding treatment options?

1. The child with the illness 2. The father as the breadwinner 3. The mother as the primary caregiver 4. All family members who are available

3. According to Knafl and colleagues’ theory of normalization, families including a child with a chronic illness must perform which action to adopt a “normalcy lens”?

1. Actively deny aspects of the illness that are unpleasant or burdensome 2. Focus attention equally on “normal” siblings and the child with the chronic illness 3. Recognize the ongoing processes of actively adapting to the child’s evolving physical, emotional, and social needs and establishing new family routines 4. Advocate for the child to ensure that he or she is mainstreamed because it provides the best hope for the child’s development

4. The nurse notes that a family with a child newly diagnosed with a chronic illness has no experience with the disease. Therefore, required routines and family life are disorganized. Which need is this family experiencing?

1. Reeducation

. .

9-2

2. Redefinition 3. Remediation 4. Realignment

5. The parents of a child with muscular dystrophy have a negative view of the child’s future and feel hopeless about future care needs. Which view of the child is the family demonstrating?

1. Thriving 2. Enduring 3. Floundering 4. Accommodating

Multiple Response:

6. The nurse prepares to assess a family with a member who has a chronic illness. On what should the nurse focus during this assessment? Select all that apply.

1. Sibling needs 2. Core processes 3. Nutritional needs 4. Economic restraints 5. Developmental milestones

7. While providing care for a family, the nurse reviews the common reactions of siblings to a diabetes diagnosis. Which statement is true regarding siblings of individuals with diabetes?

Select all that apply.

1. Some siblings of children with a chronic illness feel pressure to be the good child.

2. Most siblings of children with a chronic illness develop behavior problems.

3. Most siblings of children with a chronic illness feel shame-related embarrassment about their sibling.

4. Some siblings of children with a chronic illness experience an increased level of compassion.

5. Some siblings resent their sibling with a chronic illness because of increased responsibilities and less attention from parents.

..

9-3

8. The nurse plans to use an empowerment model to plan care for a family who has a member with a chronic illness. Which type of care will the nurse use to support this family? Select all that apply.

1. Problem-based 2. Strength-based 3. Evidence-based 4. Patient-centered 5. Spiritually relevant

9. The nurse plans to assess routines that the family performs together. Which information should the nurse collect from the family during this assessment? Select all that apply.

1. Vacations 2. Traditions 3. Celebrations 4. Work and play 5. Disease prevention

10. The nurse notes that a family including a member with end-stage renal disease is feeling emotionally drained. On what should the nurse focus when assessing this core process? Select all that apply.

1. Culture 2. Control 3. Language 4. Attachment 5. Commitment

11. The mother of a child with a chronic illness is exhausted and does not feel supported by other family members when providing the child with care. Which instrumental support should the nurse recommend for this mother and family? Select all that apply.

1. Suggest attending a support group 2. Create a schedule for meal preparation 3. Assign chores for laundry and groceries 4. Listen to the mother talk about the care needs 5. Take turns providing the child with physical care

. .

12. The nurse is preparing a presentation about the needs of family caregivers for a senate hearing on caring for people with chronic health problems. What should the nurse suggest as positive actions to improve the economic status of these caregivers? Select all that apply.

1. Implement flextime 2. Provide a tax credit for caregiving 3. Expand funding for the National Family Caregiver Program 4. Reduce the fees for placing chronically ill family members into skilled facilities 5. Include the care of extended family members through the Family and Medical Leave Act

9-4

. .

9-5

Answers:

1. During a family conference, the nurse practitioner is leading a discussion with a family, which includes a 15-year-old adolescent who often “forgets” to check his morning blood glucose levels.

Which questions would be the most appropriate for the nurse to ask?

Ans: 4 Page: 265-266 1.

2.

3.

4.

Feedback Asking why a person would neglect the body is being judgmental.

Discussing the dangers of high blood glucose levels does not address the issue of the adolescent who forgets to check morning blood glucose levels.

Adolescents’ increasing need for autonomy may conflict with ongoing parental involvement when monitoring blood glucose levels. This would be helpful to explain to the parents; however, it would not be beneficial to discuss with the adolescent because this behavior may escalate.

The nurse should validate the observation, which is concern regarding the adolescent not being consistent with checking blood glucose levels. This is a good first starting point for assessment and discussion.

2. When planning interventions for a family with rheumatoid arthritis, it is essential that the nurse include which family member in the discussions regarding treatment options?

Ans: 4 Page: 264

1.

2.

3.

4.

Feedback The discussion of treatment options will affect more than the child. The options might affect the family’s finances and care needs after a treatment.

The discussion of treatment options will affect more than the finances generated by the father.

The discussion of treatment options will affect more than the care that the mother will need to provide.

The discussion about treatment options has to include all parties who are affected. All need to be present to have a successful discussion and generate a plan.

..

9-6

3. According to Knafl and colleagues’ theory of normalization, families including a child with a chronic illness must perform which action to adopt a “normalcy lens”?

Ans: 3 Page: 258-259

1.

2.

3.

4.

Feedback Actively denying aspects of the illness that are unpleasant or burdensome does not help the family achieve a sense of normalcy.

A normalcy lens does not mean that the parents should focus attention equally on all children.

Normalization is a lens through which families of children with chronic conditions focus on normal aspects of their lives and deemphasize those parts of life made more difficult by chronic conditions. When developmental delays compound the effects of a child’s physical chronic conditions, a family’s ability to organize and manage its daily life is affected significantly. In this case, parents often recognize normal and positive life aspects, acknowledge the profound challenges faced by their family, and accept a “new normal.”

Mainstreaming the child may not be the best for the child’s development and health problem. This is not an action to promote normalcy.

4. The nurse notes that a family with a child newly diagnosed with a chronic illness has no experience with the disease. Therefore, required routines and family life are disorganized. Which need is this family experiencing?

Ans: 1 Page: 263 Feedback 1.

Reeducation arises when the family has little history or experience with routines and family life is substantially disorganized.

2.

Redefinition refers to a strategy whereby the emotional connections made during routine gatherings need to be redefined.

Remediation refers to a need to make slight alterations in daily routines to fit illness care into preexisting routines.

Realignment occurs when individuals within the family disagree about the importance of different medical routines, and routines need to be realigned in the service of the child’s health.

3.

4.

. .

9-7

5. The parents of a child with muscular dystrophy have a negative view of the child’s future and feel hopeless about future care needs. Which view of the child is the family demonstrating?

Ans: 3 Page: 242

1.

2.

3.

4.

Feedback A thriving view means the parents view the child from the lens of normalcy. They see the child as just as capable as other children. Their child has a chronic health condition that is incorporated into everyday life of the child and the family as a whole.

An enduring view means the parents fluctuate in their view of the child between that of normalcy and tragedy. Sometimes parents see them as capable and other times focus on vulnerabilities.

A floundering view means the parents primarily have a negative view of their child and see the situation as tragic. They see the child as not capable and as vulnerable.

An accommodating view means the parents usually see their child from the lens of normalcy and being capable of living everyday life.

6. The nurse prepares to assess a family with a member who has a chronic illness. On what should the nurse focus during this assessment? Select all that apply.

Ans: 1, 2, 4, 5 Page: 263

1.

2.

3.

4.

5.

Feedback Nurses assist families by discussing things such as sibling needs.

The Family Health Model suggests that families have core processes or ways the family interacts with each other.

Nutritional needs are not identified as a specific area for the nurse to focus on when conducting a family assessment.

Economic restraints can cause stress to the family and should be a focus of assessment.

Developmental milestones are important for the nurse to discuss when conducting a ---family assessment.

. .

9-8

7. While providing care for a family, the nurse reviews the common reactions of siblings to a diabetes diagnosis. Which statement is true regarding siblings of individuals with diabetes?

Select all that apply.

Ans: 1, 3, 4, 5 Page: 258

1.

2.

3.

4.

5.

Feedback Siblings of children with chronic health conditions often feel pressure to be the “good” child and attempt to protect parents from further distress.

There is no evidence to support that most siblings of children with a chronic illness develop behavior problems.

Siblings of children with chronic health conditions often feel shame related to embarrassment about their sibling’s appearance or behavior.

Studies have shown that the siblings of children with chronic health problems can experience positive outcomes and develop more empathy.

Siblings of children with chronic health conditions often feel resentment when the sibling with the health problem receives special attention.

8. The nurse plans to use an empowerment model to plan care for a family who has a member with a chronic illness. Which type of care will the nurse use to support this family? Select all that apply.

Ans: 1, 2, 3, 4 Page: 263

1.

2.

3.

4.

5.

Feedback An empowerment model of chronic disease management for families is problem-based.

An empowerment model of chronic disease management for families is strength-based.

An empowerment model of chronic disease management for families is evidencebased.

An empowerment model of chronic disease management for families is patientcentered.

An empowerment model of chronic disease management for families is culturally relevant and not spiritually relevant.

. .

9-9

9. The nurse plans to assess routines that the family performs together. Which information should the nurse collect from the family during this assessment? Select all that apply.

Ans: 1, 2, 3 Page: 264

1.

2.

3.

4.

5.

Feedback Family-care routines are related to vacations and tied to making meaning and sharing enjoyable times.

Family-care routines are related to valued traditions that are tied to making meaning and sharing enjoyable times.

Family-care routines are related to celebrations that are tied to making meaning and sharing enjoyable times.

Work and play are a part of a family’s mental health routine.

Disease prevention is a part of a family’s safety and prevention routine.

10. The nurse notes that a family including a member with end-stage renal disease is feeling emotionally drained. On what should the nurse focus when assessing this core process? Select all that apply.

Ans: 4, 5 Page: 263

1.

2.

3.

4.

5.

Feedback When assessing the core process of celebration, the nurse should include culture.

When assessing the core process of change, the nurse should include control.

When assessing the core process of communication, the nurse should include language.

When assessing the core process of cathexis, the nurse should include attachment.

When assessing the core process of cathexis, the nurse should include commitment.

11. The mother of a child with a chronic illness is exhausted and does not feel supported by other family members when providing the child with care. Which instrumental support should the nurse recommend for this mother and family? Select all that apply.

. .

9-10

Ans: 2, 3, 5 Page: 255

1.

2.

3.

4.

5.

Feedback A support group addresses an informational need.

Creating a schedule for meal preparation is a type of instrumental support that addresses a household need.

Assigning chores for laundry and groceries is a type of instrumental support that addresses a household need.

Listening to the mother talk addresses an emotional need.

Taking turns providing the child with physical care is a type of instrumental support that gives the mother a type of respite from ongoing care of the child.

12. The nurse is preparing a presentation about the needs of family caregivers for a senate hearing on caring for people with chronic health problems. What should the nurse suggest as positive actions to improve the economic status of these caregivers? Select all that apply.

Ans: 1, 2, 3, 5 Page: 238-239

1.

2.

3.

4.

5.

Feedback A policy recommendation that can make an unpaid caregiver less burdensome to families is to implement flextime in work places.

A policy recommendation that can make an unpaid caregiver less burdensome to families is to provide a tax credit for caregiving.

A policy recommendation that can make an unpaid caregiver less burdensome to families is to expand funding for the National Family Caregiver Program.

Reducing the fees for placing chronically ill family members into skilled facilities is not a policy recommendation that can make an unpaid caregiver less burdensome to families.

A policy recommendation that can make an unpaid caregiver less burdensome to families is to include the care of extended family members through the Family and Medical Leave Act.

. .

10-1

Chapter 10: Families in Palliative and End-of-Life Care

Multiple Choice:

1. The family of a client with a terminal illness hesitates to agree to palliative care because of not wanting to give up on a possible cure. How should the nurse respond while also including a principle of palliative care?

1. “Most people don’t realize that palliative care means there is no cure.”

2. “There will not be another opportunity if palliative care is refused now.”

3. “The client can continue to receive treatment intended to cure the disease.”

4. “Palliative care and curative treatments cannot be provided at the same time.”

2. The family of a client receiving palliative care for a terminal illness hesitate to call for the nurse since all staff seem to be too busy to address the client’s needs. Which action should the nurse take to improve the connection with the family?

1. Vary the number and type of caregivers who respond to the client’s needs 2. Enter the room and stand or sit at the bedside to talk with the client and family 3. Provide the family with reading material that explains the role of palliative care 4. Attend to infusions and environmental issues while talking with the client and family

3. The spouse of a client nearing death is concerned because the client’s breathing is “so noisy.”

How should the nurse refer to the client’s respiratory status when talking with the spouse?

1. Pneumonia 2. Congestion 3. Death rattle 4. Fluid in the lungs

4. The family of a client nearing end-of-life asks if they can leave to get dinner. Which client observation causes the nurse to suggest that the family wait a while longer before leaving the client?

1. Cheyne-Stokes respiration pattern 2. Apneic periods of 15 to 30 seconds

. .

10-2

3. Shallow respirations at 30 per minute 4. Use of neck and shoulder muscles to breathe

5. A client assigned to a student nurse for care dies shortly after the student completes morning care. What should the nurse do to support the student at this time?

1. Suggest the student leave the clinical area 2. Encourage the student to participate in postmortem care 3. Talk with the student about the experience and answer any questions 4. Assign the student to another client for the remainder of the clinical day

Multiple Response:

6. The nurse helps the family decide whether a 13-year-old sibling should be present during the death of a younger brother. Which aspect should the nurse keep in mind when the family is making this decision?

1. Hospital visiting hours’ policy 2. Reason for the child to be dying 3. Developmental age of the sibling 4. Quality of the relationship between the children 5. Cultural practices within the family regarding death and dying

7. The hospice nurse learns that the spouse of a client with end-stage Alzheimer’s disease has been the primary caregiver without assistance for the past 3 years. What are the risks to this spouse? Select all that apply.

1. Guilt 2. Depression 3. Ambivalence 4. Lack of personal care 5. Feelings of helplessness

..

10-3

8. An interprofessional team meeting is scheduled to discuss the care needs for a client with a terminal illness. What should the nurse expect when participating in this meeting? Select all that apply.

1. Control is centralized.

2. Client goals direct care.

3. Focus is on problem solving.

4. Client’s family can be in attendance.

5. Decisions are made by the team leader.

9. The nurse suspects that a client receiving palliative care is nearing end-of-life. What did the nurse assess to make this clinical determination? Select all that apply.

1. Sleeping more often 2. Refusing to eat 3. Inability to swallow 4. Asking to talk with a pastor 5. Talking with a deceased spouse

10. The nurse providing palliative care to a client with a terminal illness is experiencing moral distress. Which situation most likely caused the nurse to experience this emotional response?

Select all that apply.

1. The nurse continues to provide chemotherapy to the client upon the family’s request.

2. The nurse is unable to relieve dyspnea because of a fear of overmedicating the client.

3. The team members decide to withhold routine fluids unless the client is thirsty.

4. Another health care provider suggested that another course of treatment might “do the trick.”

5. The adult children want everything possible done yet the client is exhausted and wants it to end.

11. The staff development trainer is preparing an educational program for nurses who provide palliative care. Which suggestion should the trainer make to encourage a trusting relationship between the nurse and family? Select all that apply.

1. Maintain a nonjudgmental approach when providing care 2. Listen to the family’s experience with illness and suffering 3. Acknowledge the strengths of the individual family members 4. Encourage the family to take a break and permit the nurse to provide care 5. Demonstrate compassion by showing an understanding of the family’s suffering

. .

10-4

Answers:

1. The family of a client with a terminal illness hesitates to agree to palliative care because of not wanting to give up on a possible cure. How should the nurse respond while also including a principle of palliative care?

Ans: 3 Page: 281 1.

2.

3.

4.

Feedback Palliative care does not mean that there is no cure for the disease.

Palliative care can be offered at any time to a client with an illness that has a high probability of leading to death.

One principle of palliative care is that it can occur concurrently with care that is curative in intent.

Palliative care and curative treatments can and do occur concurrently.

2. The family of a client receiving palliative care for a terminal illness hesitate to call for the nurse because all staff seem to be too busy to address the client’s needs. Which action should the nurse take to improve the connection with the family?

Ans: 2 Page: 293

1.

2.

3.

4.

Feedback Varying the number and type of caregivers responding to the client’s needs does not ensure continuity of care for the client or family.

The “best” nurses are those who give the impression of “having all the time in the world,” even when they are really busy. One way of doing this is to come into the room and sit or stand by the bedside, even if only briefly.

The family and client do not need reading material. They need to know by actions that the client is receiving the best possible care.

Attending to infusions and environmental issues while talking with the client and family gives the impression of not having time to address the client’s needs.

..

10-5

3. The spouse of a client nearing death is concerned because the client’s breathing is “so noisy.”

How should the nurse refer to the client’s respiratory status when talking with the spouse?

Ans: 2 Page: 305

1.

2.

3.

4.

Feedback The client does not have pneumonia and the noisy respirations should not be characterized as such.

Because the term death rattle may cause strong emotional reactions, the term respiratory congestion is now recommended.

The amount of mucus or secretions that build up because the person is unable to cough can be noisy and sometimes upsets people at the bedside even though it is unlikely to be distressing to the dying person, who is usually unconscious. Some people call it the “death rattle,” but because the term death rattle may cause strong emotional reactions, the term respiratory congestion is now recommended.

The family might think the client is drowning if the phrase “fluid in the lungs” is used. This phrase should not be used when discussing the client’s respirations with the family.

4. The family of a client nearing end-of-life asks if they can leave to get dinner. Which client observation causes the nurse to suggest that the family wait a while longer before leaving theclient?

Ans: 2 Page: 305

1.

2.

3.

4.

Feedback Cheyne-Stokes respirations are considered a sign of imminent death; however, they can also occur with some disease processes and occur in some normal healthy adults.

Apneic periods that last 15 to 30 seconds indicate a slowing of breathing and that death is imminent.

Shallow respirations can continue for a while. The family could take turns going for dinner with this pattern if they all do not want to leave the client’s bedside.

The use of the neck and shoulder muscles to breathe indicates that breathing is on “automatic pilot.” The family could take turns leaving but death is not going to occur within a short period of time.

. .

10-6

5. A client assigned to a student nurse for care dies shortly after the student completes morning care. What should the nurse do to support the student at this time?

Ans: 3 Page: 283

1.

2.

3.

4.

Feedback The student should be debriefed before leaving the clinical area. The nurse has no way of knowing how the client’s death has affected the student.

The student may not be prepared emotionally to provide physical care to a client who has just died.

Novice nurses, or in this case a student with limited experience, may not be able to prepare for a death in advance. The nurse should debrief the student about the experience and help the student reflect on the experience to facilitate personal and professional growth, reduce anxiety, and develop positive attitudes to care of the dying.

Assigning another client ignores the student’s feelings about the death of the client.

6. The nurse helps the family decide whether a 13-year-old sibling should be present during the death of a younger brother. Which aspect should the nurse keep in mind when the family is making this decision?

Ans: 3, 4, 5 Page: 308

1.

2.

3.

4.

5.

Feedback The hospital visiting hours’ policy is not important to keep in mind when determining if a sibling should be present at the time of death of a younger family member.

The reason for the child dying is not important to keep in mind when determining if a sibling should be present at the time of death of a younger family member.

Although the sibling is 13, developmentally the adolescent may be younger and not prepared developmentally for the death of a younger brother or sister. This has to be taken into consideration.

The relationship between the siblings needs to be taken into consideration. The adolescent’s reaction may be positive or negative and may have a lasting impact on this child’s future psychological development.

The family’s approach to and acceptance of death must be taken into consideration. If

. .

10-7 death is to be feared, the family may choose to have the adolescent absent. If death is viewed as a part of life, the family may choose to have the adolescent participate.

7. The hospice nurse learns that the spouse of a client with end-stage Alzheimer’s disease has been the primary caregiver without assistance for the past 3 years. What are the risks to this spouse? Select all that apply.

Ans: 2, 3, 4, 5 Page: 285

1.

2.

3.

4.

5.

Feedback It is unlikely that the spouse will feel guilt over being the primary caregiver for 3 years.

Guilt is associated more with the family that places the dying family member in a facility for care instead of caring for him or her at home.

Family members carry a variety of burdens when a family member is dying including compromises in their own health, which can cause depression.

Family members may experience an ambivalent sense of waiting for the person to die but not wanting the person to die.

Family members caring for a dying family member are likely to forego their own needs and delay receiving personal care.

Feelings of helplessness can be caused by the constant care needed by the dying family member. The family caregiver has no time for personal needs, leading to physical and mental exhaustion. The caregiver sees no way out of the situation, leading to a feeling of helplessness.

8. An interprofessional team meeting is scheduled to discuss the care needs for a client with a terminal illness. What should the nurse expect when participating in this meeting? Select all that apply.

Ans: 2, 3, 4 Page: 286-287

1.

2.

3.

Feedback Centralized control is a characteristic of a multi-professional team.

In an interprofessional team, the client’s goals are used to direct care.

In an interprofessional team, the focus is on problem solving.

. .

10-8 4.

5.

In an interprofessional team, the client’s family may be in attendance.

Decision making completed by the team leader is a characteristic of a multiprofessional team.

9. The nurse suspects that a client receiving palliative care is nearing end-of-life. What did the nurse assess to make this clinical determination? Select all that apply.

Ans: 1, 2, 3, 5 Page: 305

1.

2.

3.

4.

5.

Feedback Sleeping more often could indicate a decrease in mental alertness and withdrawing from social interaction.

Decreased intake of food and fluids is a common sign of imminent death.

Having difficulty swallowing is a common sign of imminent death.

Asking to talk with a pastor does not indicate that death is near.

Hallucinating, such as talking with a deceased spouse, is a sign of imminent death.

10. The nurse providing palliative care to a client with a terminal illness is experiencing moral distress. Which situation most likely caused the nurse to experience this emotional response?

Select all that apply.

Ans: 1, 2, 4, 5 Page: 288

1.

2.

3.

Feedback Providing chemotherapy to a client with a terminal illness as requested by the family is not taking the client’s needs and desires into consideration. This can lead to moral distress because the nurse might not believe it is ethically appropriate to make the client suffer.

Inadequate management of symptoms can lead to moral distress. Dyspnea is often relieved with morphine; however, morphine can depress respirations, which might lead to early death.

Withholding fluids unless the client asks for something is ethically appropriate. The client’s needs should come first, regardless of the desire to maintain fluid and nutritional status.

. .

10-9 4.

5.

Suggesting another therapy because it might “do the trick” gives the family false hope.

This can lead to moral distress.

Conflict within the family regarding the best course of treatment for the client can lead to moral distress. The adult children do not see the exhaustion of the spouse. The spouse just wants everything to end. The nurse is caught between two sets of family members, yet neither are considering the needs of the client.

11. The staff development trainer is preparing an educational program for nurses who provide palliative care. Which suggestion should the trainer make to encourage a trusting relationship between the nurse and family? Select all that apply.

Ans: 1, 2, 3, 5 Page: 290

1.

2.

3.

4.

5.

Feedback Nursing interventions that promote trusting relationships include maintaining a nonjudgmental approach when providing care. If a new perspective or information needs to be shared, do so with open and honest communication.

Nursing interventions that promote trusting relationships include careful listening to the family’s experience with illness and suffering, valuing their expertise as caregivers.

Nursing interventions that promote trusting relationships include working with the family and acknowledging family strengths.

Encouraging the family to take a break so that the nurse can provide care does not promote a trusting relationship.

Nursing interventions that promote trusting relationships include demonstrating compassion by showing that you are touched by the family’s suffering.

. .

11-1

Chapter 11: Trauma and Family Nursing

Multiple Choice:

1. A level I trauma center is implementing trauma-informed care. Which principle of this type of care integrates knowledge about trauma into policies, procedures, and practices?

1. Seeking 2. Realizing 3. Responding 4. Recognizing

2. The nurse notes that a client who returned from war is having difficulty remembering recent events and is unable to perform simple self-care tasks. Which part of the client’s physiology is responsible for these behaviors?

1. Amygdala 2. Hippocampus 3. Adrenal glands 4. Prefrontal cortex

3. The nurse is reassigned to assist with triaging victims of a train derailment in the emergency department. The next day the nurse returns to providing care in the intensive care unit and is assigned the victims. If this pattern continues, which health problem is the nurse prone to developing?

1. Apathy 2. Depression 3. Poor self-esteem 4. Secondary traumatization

Multiple Response:

. .

11-2

4. A client seeks treatment for post-traumatic stress disorder (PTSD). Which category of symptoms should the nurse assess? Select all that apply.

1. Negative mood 2. Increased sensory sensitivity 3. Manifestations of high anxiety 4. Avoiding talking about the trauma 5. Intrusive thoughts about the trauma

5. The nurse plans care for a client recovering from a gunshot wound received during a robbery of a convenience store. Which intervention will the nurse select to promote trauma-informed care for this client? Select all that apply.

1. Coach in calming skills 2. Build positive social support 3. Suggest returning to the scene of the event 4. Remind the client that the injuries were not life-threatening 5. Encourage connectiveness between family members

6. The nurse cares for a toddler recovering from injuries received by an abusive parent. Which findings indicate that this client is experiencing failure to develop healthy attachments? Select all that apply.

1. Poor appetite 2. Ignoring toys 3. No eye contact 4. Watching television 5. Withdrawing from touch

7. An adolescent attends group therapy to help with unresolved feelings after being abused by an older relative. Which manifestations of this unresolved trauma should the nurse expect the adolescent to demonstrate? Select all that apply.

1. Rage 2. Depression 3. Eating disorders 4. Fatigue from a sleep disorder 5. Extreme attachment to the abuser

. .

11-3

8. During a home visit the nurse believes that a client receiving treatment for post-traumatic stress disorder (PTSD) is improving. Which signs of resiliency did the nurse assess to make this clinical determination? Select all that apply.

1. Maintaining a positive attitude 2. Asking for help when needed 3. Expressing gratitude for help 4. Sitting quietly with minimal conversation 5. Waiting for a family member to prepare food

9. The spouse of a client with post-traumatic stress disorder (PSTD) seeks medical attention for new symptoms. Which findings suggest to the nurse that the client’s health problem is affecting a family member? Select all that apply.

1. Anger 2. Flat affect 3. Weight loss 4. Poor muscle tone 5. Heart rate of 72 bpm

10. The nurse suspects that an adult client experienced domestic violence as a child. Which observations caused the nurse to come to this conclusion? Select all that apply.

1. Several arrests for armed robbery 2. Meets with friends once a week to play poker 3. Red-flagged for suicide precautions when incarcerated 4. Repeatedly admitted to a rehabilitation facility for heroin use 5. Worked for a company for 2 years and then sought new employment

11. The nurse attends an educational program that identifies people in the United States as experiencing post-traumatic stress disorder (PTSD) because of ongoing security threats. Which public health issues confirm the possibility of this being true? Select all that apply.

1. High obesity rate 2. High infant mortality 3. Increase in number of divorces 4. High use of opioids and other substances 5. Decline in the general health

. .

11-4

12. A client with PTSD arrives for a follow-up clinic appointment. Which intervention should the nurse confirm that the client is continuing to follow? Select all that apply.

1. Drinks 2 to 3 liters of fluid per day 2. Measures blood pressure every week 3. Adheres to an 1800 calorie/day eating plan 4. Attends cognitive-behavioral therapy sessions 5. Takes selective serotonin reuptake inhibitor (SSRI) as prescribed

. .

11-5

Answers:

1. A level I trauma center is implementing trauma-informed care. Which principle of this type of care integrates knowledge about trauma into policies, procedures, and practices?

Ans: 3 Page: 325 1.

2.

3.

4.

Feedback The key principle of seeking focuses on activity resisting re-traumatization.

The key principle of realizing focuses on the impact of trauma and understanding potential paths for recovery.

The key principle of responding focuses on fully integrating knowledge about trauma into policies, procedures, and practices.

The key principle of recognizing focuses on the signs and symptoms of trauma in clients, families, staff, and others involved with the system.

2. The nurse notes that a client who returned from war is having difficulty remembering recent events and is unable to perform simple self-care tasks. Which part of the client’s physiology is responsible for these behaviors?

Ans: 2 Page: 330

1.

2.

3.

Feedback With prolonged trauma, the amygdala becomes hyperactive, which interferes with the ability to appropriately process trauma memories, and decreases the function of the prefrontal cortex, causing a decreased ability to think about the response to present traumas and problem-solve appropriate reactions.

Exposure to repeated trauma causes the hippocampus, which is key in neuroplasticity or the ability to generate new neurons and new neuron pathways, to be impaired. This process explains why many who experience prolonged and repeated trauma struggle with cognitive impairments, such as poor short-term memory and difficulty learning new skills.

If homeostasis is not reached, the adrenal glands secrete the stress hormones, epinephrine and norepinephrine. These hormones stimulate the sympathetic nervous system, and the result is increased heart rate, dilation of pupils, relaxation of bronchial tubes, increased tension and circulation of blood to large muscles, and initial stimulation of the prefrontal cortex through a surge of dopamine, followed by

. .

11-6 bypassing the prefrontal cortex to the amygdala.

4.

The prefrontal cortex is responsible for cognitive processing of traumatic memories. Without prefrontal cortex functioning, fear extinction cannot occur. With hyperactive activity in the amygdala, the prefrontal cortex cannot be fully functional, resulting in unresolved traumatic memories.

3. The nurse is reassigned to assist with triaging victims of a train derailment in the emergency department. The next day the nurse returns to providing care in the intensive care unit and is assigned the victims. If this pattern continues, which health problem is the nurse prone to developing?

Ans: 4 Page: 339-340

1.

2.

3.

4.

Feedback Apathy is a symptom of secondary traumatization. The nurse could develop this health problem in addition to others.

Depression is a symptom of secondary traumatization. The nurse could develop this health problem in addition to others.

The nurse is not prone to developing poor self-esteem.

There is a correlation between secondary traumatization and symptoms of PTSD. Nurses describe the difficulty of caring for those who have experienced a traumatic event. Nurses not only heard about the traumatic event repeatedly from families, but witnessed the traumatic events over and over as they cared for families across time. This witnessing of trauma led to secondary traumatization.

4. A client seeks treatment for post-traumatic stress disorder (PTSD). Which category of symptoms should the nurse assess? Select all that apply.

Ans: 1, 2, 4, 5 Page: 324 Feedback 1.

2.

According to the DSM-5, a negative mood is one of the four categories of symptoms of PTSD.

3.

Manifestations of high anxiety are not a category of symptoms of PTSD.

According to the DSM-5, increased arousal or sensory sensitivity is one of the four categories of symptoms of PTSD.

. .

11-7 4.

5.

According to the DSM-5, avoiding a discussion or other stimulus that reminds the person of the trauma is one of the four categories of symptoms of PTSD. According to the DSM-5, intrusive thoughts about the trauma is one of the four categories of symptoms of PTSD.

5. The nurse plans care for a client recovering from a gunshot wound received during a robbery of a convenience store. Which intervention will the nurse select to promote trauma-informed care for this client? Select all that apply.

Ans: 1, 2, 5 Page: 325

1.

2.

3.

4.

5.

Feedback An essential element of trauma-informed care interventions includes promoting calming skills.

An essential element of trauma-informed care interventions includes promoting a sense of safety including building positive social support.

Suggesting that the client return to the scene of the event is not a recommended intervention in trauma-informed care.

Reminding the client that the injuries were not life-threatening is not a recommended intervention in trauma-informed care.

An essential element of trauma-informed care interventions includes promoting connectiveness between family members.

6. The nurse cares for a toddler recovering from injuries received by an abusive parent. Which findings indicate that this client is experiencing failure to develop healthy attachments? Select all that apply.

Ans: 1, 2, 3, 5 Page: 329

1.

2.

3.

Feedback A poor appetite indicates the absence of self-regulation by inconsistent and unpredictable patterns of eating.

Ignoring toys indicates a lack of response to the environment.

No eye contact indicates a lack of response to caregivers.

. .

11-8 4.

5.

Watching television indicates interaction with the environment.

Withdrawing from touch indicates lack of response to caregivers.

7. An adolescent attends group therapy to help with unresolved feelings after being abused by an older relative. Which manifestations of this unresolved trauma should the nurse expect the adolescent to demonstrate? Select all that apply.

Ans: 1, 2, 3, 4 Page: 330

1.

2.

3.

4.

5.

Feedback As a child develops into adulthood, he or she may try to adapt to those feelings; however, the underlying fear remains; the threat to self and to the ability to survive is not over. Symptoms emerge over time, which include rage.

As a child develops into adulthood, he or she may try to adapt to those feelings; however, the underlying fear remains; the threat to self and to the ability to survive is not over. Symptoms emerge over time, which include depression.

As a child develops into adulthood, he or she may try to adapt to those feelings; however, the underlying fear remains; the threat to self and to the ability to survive is not over. Symptoms emerge over time, which include eating disorders.

As a child develops into adulthood, he or she may try to adapt to those feelings; however, the underlying fear remains; the threat to self and to the ability to survive is not over. Symptoms emerge over time, which include fatigue from a sleep disorder.

The adolescent is not prone to developing extreme attachment to the abuser.

8. During a home visit the nurse believes that a client receiving treatment for post-traumatic stress disorder (PTSD) is improving. Which signs of resiliency did the nurse assess to make this clinical determination? Select all that apply.

Ans: 1, 2, 3 Page: 334

1.

2.

Feedback Resilience refers to positive outcomes, adaptation, or the attainment of developmental milestones or competencies in the face of significant risk, adversity, or stress. Factors considered as qualities of resiliency include a positive attitude.

Resilience refers to positive outcomes, adaptation, or the attainment of developmental

. .

11-9

3.

4.

5.

milestones or competencies in the face of significant risk, adversity, or stress. Factors considered as qualities of resiliency include trusting that help will be available if needed.

Resilience refers to positive outcomes, adaptation, or the attainment of developmental milestones or competencies in the face of significant risk, adversity, or stress. Factors considered as qualities of resiliency include demonstrating gratitude.

Sitting quietly with minimal conversation demonstrates withdrawing from the environment. This is not a quality of resiliency.

Waiting for someone else to meet needs such as preparing food is not a quality of resiliency. The individual who is resilient cares for himself or herself and is attuned to personal needs.

9. The spouse of a client with post-traumatic stress disorder (PSTD) seeks medical attention for new symptoms. Which findings suggest to the nurse that the client’s health problem is affecting a family member? Select all that apply.

Ans: 1, 2, 3, 4 Page: 335-336

1.

2.

3.

4.

5.

Feedback Key areas that affect family functioning when one or more members are diagnosed with PTSD include anger as family members struggle to cope with the changes in the person with PTSD and anger that expectations are not being met.

A flat affect could indicate depression, which is common among individuals with PTSD and their family members. The longer the symptoms of PTSD last, family members may lose hope that their family member will ever get back to normal.

Health problems increase in individuals with PTSD and their family members, including poor eating habits.

Health problems increase in individuals with PTSD and their family members, including lack of healthy exercise exemplified by poor muscle tone.

A heart rate of 72 bpm does not indicate that the spouse is experiencing the effects of a family member with PTSD.

10. The nurse suspects that an adult client experienced domestic violence as a child. Which observations caused the nurse to come to this conclusion? Select all that apply.

. .

11-10

Ans: 1, 3, 4 Page: 338

1.

2.

3.

4.

5.

Feedback Long-term childhood domestic violence increases the risk for violent crimes such as armed robbery.

Meeting with friends to play poker does not indicate exposure to long-term childhood domestic violence.

Long-term childhood domestic violence increases the risk for suicide.

Long-term childhood domestic violence increases the risk for drug abuse.

Working for a company for 2 years and then seeking new employment is not a behavior pattern associated with long-term childhood domestic violence.

11. The nurse attends an educational program that identifies people in the United States as experiencing post-traumatic stress disorder (PTSD) because of ongoing security threats. Which public health issues confirm the possibility of this being true? Select all that apply.

Ans: 1, 2, 4, 5 Page: 341

1.

2.

3.

4.

Feedback The high obesity rate in the United States is a clear example of a nation experiencing dysregulation and fear. Obesity is growing the fastest in our poor and crowded neighborhoods. The lack of healthy foods, safe neighborhoods that support outdoor activity, high levels of stress, and presence of early and repeated trauma are key factors in causing obesity and related chronic health conditions. However, the response to obesity is not centered on trauma-focused interventions, but instead on unsuccessful dieting and major surgeries.

Infant mortality is dismally high, with the United States ranking highest among the top seven industrialized countries of the world. This is another indication that the nation is experiencing the effects of PTSD. Divorce rate has not been identified as an indicator that the nation is experiencing PTSD. An indicator that the United States as a nation is struggling with high levels of trauma and related stress symptoms is the increasing rate of substance abuse. Addiction to other substances, such as alcohol and opiates, is increasing at an alarming rate.

Researchers have found that those struggling with drug addiction exhibit decreased

. .

11-11

5.

dopamine levels. Drug use temporarily raises dopamine levels. A lack of dopamine, particularly in the frontal cortex, is caused by early trauma more often than genetics.

Many argue that the United States is suffering from PTSD from repeated traumatic events. One symptom of this premise is the decline in the general health of U.S. citizens, not unlike the health of individuals suffering from PTSD. Americans possess the shortest life span of any industrialized nation, with almost half of American adults struggling with hypertension, high cholesterol, diabetes, or all three.

12. A client with PTSD arrives for a follow-up clinic appointment. Which intervention should the nurse confirm that the client is continuing to follow? Select all that apply.

Ans: 4, 5 Page: 344

1.

2.

3.

4.

5.

Feedback Fluid intake is not a specific intervention to treat PTSD. Weekly blood pressure measurement is not a specific intervention to treat PTSD. Adhering to a specific daily caloric eating plan is not a specific intervention to treat PTSD. The best evidence-based nursing treatments for the individual with PTSD include cognitive-behavioral therapy.

The best evidence-based nursing treatments for the individual with PTSD include education and monitoring of prescribed selective serotonin reuptake inhibitors (SSRIs).

. .

12-1

Chapter 12: Family Nursing With Childbearing Families

Multiple Choice:

1. The nurse suspects that a family has closed boundaries. Why will this family not be amenable to nursing interventions?

1. They are unstable.

2. They do not have children.

3. They do not interact with each other.

4. They reject influences from the outside environment.

2. The nurse assesses a family’s ability to transition to having a baby. To which concept is transition the most similar?

1. Stress 2. System 3. Change 4. Communication

3. Although the nurse desires to use Duvall’s Family Developmental Theory to guide the care of a family, the nurse decides against it. Which is the major reason for the nurse to make this decision?

1. The theory does not use the life-span approach.

2. The theory is based on individuals rather than families.

3. The theory does not include family life before having children.

4. The theory is based on traditional nuclear families and does not address diverse family structures.

4. The nurse is planning care for a family with a new baby. Which reason should the nurse identify as a risk for conflict between the nurse and the client during this time?

1. Acute illness occurring in the new mother 2. Agreement between the father, or partner, and the mother 3. Agreement between grandparents and the nurse

. .

12-2

4. Different advice from family members versus the nurse

5. The nurse plans to discuss an expectant client’s decision regarding infant feeding. What is important for the nurse to do when considering feeding management for this family?

1. Inform the client that she should breastfeed 2. Assist the parents to form a nurturing relationship surrounding the feeding of the infant 3. Encourage bottle-feeding because this will guarantee proper nutrition for the infant 4. Encourage the father, or partner, to leave the feeding decision up to the mother

6. The nurse plans care for a postpartum client arriving for a wellness visit. What should the nurse tell the client about postpartum depression?

1. Most mothers recognize the symptoms.

2. Most mothers are reluctant to ask for professional help.

3. Most fathers and mothers become depressed after the birth of a child.

4. Most health care providers confuse postpartum depression with anxiety.

7. When should the nurse consider that a new mother is developing postpartum depression?

1. Feeling blue the day after delivery 2. Crying 3 to 5 days after returning home 3. Sitting in a dark room ignoring the baby after 6 months 4. Not interested in caring for the baby a week after delivery

8. The nurse plans care to address the communication pattern within a family with a new infant.

What intervention should the nurse select for this family?

1. Encourage talking when the baby is sleeping 2. Hold the baby while talking with each other 3. Teach how to recognize and respond to the baby’s cues 4. Keep voice tone low when discussing a difficult situation

9. The parents of a new baby are both 19 years old. Which intervention should the nurse identify to help this family with realigning the intergenerational pattern?

. .

12-3

1. Remind to limit time away from the baby 2. Instruct on ways to move from dependence to independence 3. Limit exposure to extended family members 4. Ask the new mother the feeding approach that is best for her

10. The female partner of a family is upset because the spouse will not talk about the inability to conceive. Which response should the nurse make to this client?

1. “Talking about the problem can increase your spouse’s anxiety about it.”

2. “Men deny the amount of emotional distress they experience.”

3. “Most men do not share their feelings.”

4. “Men only want to talk to other men and won’t do that unless they know someone else has the same problem.”

Multiple Response:

11. The nurse asks a family about space arrangements for an expected baby. What is the nurse assessing about the family at this time? Select all that apply.

1. The ability to meet the baby’s basic needs 2. The fear about the survival of the baby 3. The acceptance of the reality of having a baby 4. The support from extended family 5. The ability to afford the financial obligations of a baby

12. The nurse learns that a family has not planned a space for an expected infant. For which reason should the nurse assess the family about this lack of planning? Select all that apply.

1. Denying that the birth is pending 2. Viewing a birth as a routine occurrence that does not need special planning 3. A cultural belief that space planning occurs after the birth of a healthy infant 4. Too busy with other responsibilities to allow time to plan for the baby’s space 5. Inability to please all members of the family regarding the location of the space

..

12-4

13. The nurse suspects that a new mother is at risk for poor attachment with the newborn. What could be a reason for poor attachment? Select all that apply.

1. Family stress 2. Poor self-image 3. Family violence 4. Low self-esteem 5. Maternal depression

. .

12-5

Answers:

1. The nurse suspects that a family has closed boundaries. Why will this family not be amenable to nursing interventions?

Ans: 4 Page: 361 1.

2.

3.

4.

Feedback A family with closed boundaries is not considered unstable.

A family with closed boundaries may or may not have children.

There is no evidence to support that the members of a family with closed boundaries do not interact with each other.

Very closed or enmeshed families may have nonpermeable or “closed” boundaries and are likely to reject outside influences, including nursing care. Families can become closed because they interpret the outside environment and systems as hostile, threatening, or difficult to cope with.

2. The nurse assesses a family’s ability to transition to having a baby. To which concept is transition the most similar?

Ans: 3 Page: 369

1.

2.

3.

4.

Feedback Transition used to be associated with stress; however, that concept has since been replaced with the concept of change.

Transition is not associated with a system.

Transition is associated with change in families.

Transition is not associated with communication.

3. Although the nurse desires to use Duvall’s Family Developmental Theory to guide the care of a family, the nurse decides against it. Which is the major reason for the nurse to make this decision?

Ans: 4 Page: 361

. .

12-6

1.

2.

3.

4.

Feedback The theory does use the life-span approach and addresses the various life cycles.

The theory is a family development theory. The focus is the family.

The theory does not need to include family life before having children.

Many present-day childbearing families in North America do not fit into the classic sequence and timing of family developmental stages and tasks originally described by the theory. Therefore, nontraditional and high-risk families require care that is different from that needed by traditional families. This is a major limitation of this theory.

4. The nurse is planning care for a family with a new baby. Which reason should the nurse identify as a risk for conflict between the nurse and the client during this time?

Ans: 3 Page: 368

1.

2.

3.

4.

Feedback The presence of an acute illness in the new mother is not a reason for conflict between the client and the nurse.

Agreement between the father, or partner, and the mother is not a reason for conflict between the client and the nurse.

Agreement between the grandparents and the nurse is a reason for conflict.

Grandparents often provide the greatest amount of support to families when a child is born. The nurse should be aware that grandparents are a strong influence on childrearing practices and are often intimately involved in daily family dynamics.

Different advice from family members is not a reason for conflict between the client and the nurse.

5. The nurse plans to discuss an expectant client’s decision regarding infant feeding. What is important for the nurse to do when considering feeding management for this family?

Ans: 2 Page: 364

. .

12-7

1.

2.

3.

4.

Feedback Breastfeeding is not an expectation for all new mothers.

Nurses must be aware that the father’s, or partner’s, role in the newborn feeding decision and his level of support and encouragement are important factors in the success of the feeding relationship.

The benefits of breastfeeding include less episodes of diarrhea, fewer ear or other infections, and a reduced rate of sudden infant death syndrome (SIDS).

Fathers, or partners, play an important role in the feeding decision of the baby.

6. The nurse plans care for a postpartum client arriving for a wellness visit. What should the nurse tell the client about postpartum depression?

Ans: 2 Page: 380

1.

2.

3.

4.

Feedback Most women do not recognize the symptoms of postpartum depression in themselves.

Usually women do not volunteer information about their depression out of shame, fear, lack of understanding about the seriousness of their illness, or lack of available access to appropriate health care services.

There is no evidence to support that most fathers and mothers become depressed after the birth of a child.

Most health care providers do not confuse postpartum depression with anxiety.

7. When should the nurse consider that a new mother is developing postpartum depression?

Ans: 3 Page: 379

1.

2.

Feedback The “postpartum” or “baby” blues are a common postpartum experience, with up to 80% of mothers experiencing this temporary emotional distress during the first 3 to 5 days after delivery.

The “postpartum” or “baby” blues are a common postpartum experience, with up to 80% of mothers experiencing this temporary emotional distress during the first 3 to 5 days after delivery.

. .

12-8 3.

4.

Depressive symptoms that persist during the first year are of concern because they can adversely affect maternal health and the ability of mothers to function in their new role.

The “postpartum” or “baby” blues are a common postpartum experience, with up to 80% of mothers experiencing this temporary emotional distress during the first 3 to 5 days after delivery.

8. The nurse plans care to address the communication pattern within a family with a new infant.

What intervention should the nurse select for this family?

Ans: 3 Page: 367

1.

2.

3.

4.

Feedback The parents should not be limited to talking only when the baby is sleeping.

The baby does not need to be held while the parents are talking with each other.

An intervention to help with the family’s communication pattern with a new baby includes teaching how to recognize and respond to the baby’s cues.

Difficult discussions can occur at any time. There are no specific recommendations regarding how to deal with these situations.

9. The parents of a new baby are both 19 years old. Which intervention should the nurse identify to help this family with realigning the intergenerational pattern?

Ans: 2 Page: 368

1.

2.

3.

4.

Feedback Limiting time away from the baby does not help the new parents maintain their couple activities, interests, and friendships.

To help the new parents who are still adolescents, the nurse should provide learning opportunities to help them move from dependence to independence and self-reliance.

Family members are a source of support for this couple and exposure to them should not be limited.

The feeding approach should be discussed and supported by both parents and not just the mother.

. .

12-9

10. The female partner of a family is upset because the spouse will not talk about the inability to conceive. Which response should the nurse make to this client?

Ans: 1 Page: 370

1.

2.

3.

4.

Feedback Men report that talking about infertility only increases their anxiety.

Men cope with infertility through avoidance and by disguising their feelings to protect themselves, their partners, or both.

Although men might not want to share their feelings, this response does not address the client’s concern.

Men cope with infertility through avoidance and by disguising their feelings to protect themselves, their partners, or both.

11. The nurse asks a family about space arrangements for an expected baby. What is the nurse assessing about the family at this time? Select all that apply.

Ans: 1, 2, 3, 5 Page: 362

1.

2.

3.

4.

5.

Feedback Asking the family about space arrangements for an expected baby helps the nurse assess the family’s ability to meet the baby’s basic needs.

Asking the family about space arrangements for an expected baby helps the nurse assess if the family has any fears about the survival of the baby.

Asking the family about space arrangements for an expected baby helps the nurse assess if the family has accepted the reality of having a baby.

Asking the family about space arrangements for an expected baby is not done to assess if the family has extended family support for the baby.

Asking the family about space arrangements for an expected baby helps the nurse assess if the family can afford the financial obligations of having a baby.

..

12-10

12. The nurse learns that a family has not planned a space for an expected infant. For which reason should the nurse assess the family about this lack of planning? Select all that apply.

Ans: 1, 3, 4 Page: 362

1.

2.

3.

4.

5.

Feedback Not identifying space for an expected infant could indicate that the family is denying the pregnancy and pending birth. This might occur with an adolescent who does not want to tell her parents about the pregnancy.

There is no evidence to support the lack of planning for space for a baby is because the family views the birth as routine and does not need special planning.

A family that does not plan space for a baby may have a cultural belief that the planning of space should not occur until after the baby is born healthy.

A family may not plan for the space of a baby because of being too busy with other responsibilities. The family just does not have the time to plan.

Not being able to please all family members regarding the location of the space is not a reason for the family to not plan space for the baby.

13. The nurse suspects that a new mother is at risk for poor attachment with the newborn. What could be a reason for poor attachment? Select all that apply.

Ans: 3, 5 Page: 379

1.

2.

3.

4.

5.

Feedback A lack of attachment to a new baby could cause family stress, but is not necessarily a reason for poor attachment.

Poor self-image is not associated with a lack of attachment to a new infant.

Family violence could be a reason for poor attachment.

Low self-esteem is not associated with a lack of attachment to a new infant.

Maternal depression and apathy could be a reason for poor attachment to a new infant.

. .

13-1

Chapter 13: Family Child Health Nursing

Multiple Choice:

1. What does the family health nurse use to determine the most appropriate health promotion activities in a family with young children?

1. The children’s health practices 2. The parents’ and grandparents’ health beliefs 3. The patterns of daily routines and family rituals 4. The patterns of disease and illness reorganization task management

2. Which phrase most accurately characterizes the purpose for family child health nurses to practice family-centered health care?

1. Form partnerships between families and nurses 2. Provide consistently high-quality care for all families 3. View the nurse as the constant in family and child health 4. Foster partnerships between members of different families

3. The nurse prepares material for a group of new staff members. How should the nurse describe family careers?

1. Normative events that occur in all families 2. Parents’ occupation across the life span from marriage to old age 3. Predictable developmental stages that occur in most families in the United States 4. Unique events that occur in families that affect family development and processes

4. Which principle should family nurses incorporate in their care to help a family with a child who has diabetes?

1. Protection is paramount in each interaction.

2. Patterns of illness and disease differ in between families.

3. Patterns of illness are usually predictable in families.

4. Reorganization of family routines is discouraged.

. .

13-2

5. During a home visit the nurse learns that a family is experiencing a situational transition.

Which event most likely occurred in this family?

1. Parents filed for divorce 2. Child diagnosed with cystic fibrosis 3. Oldest daughter accepted into college 4. Grandparent retired from a full-time job

6. The nurse learns that the parents of a family are rarely at home and are not involved in the children’s activities or interests. Which type of parenting style is represented by this family?

1. Permissive 2. Uninvolved 3. Authoritative 4. Authoritarian

7. The nurse prepares health promotion information for a family with a toddler. Which intervention will the nurse recommend to the parents?

1. Placing the child on the back to sleep 2. Providing head gear when playing outside 3. Placing medications in a locked cabinet 4. Instructing about the dangers of drinking and driving

8. A family with a child diagnosed with cystic fibrosis has newly relocated to a community.

Which health trajectory will the nurse use as a guide for this family’s care?

1. Chronicity 2. Uncertainty 3. Degenerative 4. Gradual onset

Multiple Response:

..

13-3

9. The nurse is preparing to assess a family with small children. Why should the nurse focus on the family transition points during this assessment? Select all that apply.

1. They represent a time when the family has a large amount of time to plan.

2. They represent a time when the family has to spend a great deal of money.

3. They represent a time when families are most likely to reorganize and change.

4. They represent a time when individuals within the family are at greatest risk for illness.

5. They represent a time when individuals within the family are most likely to change roles and related tasks.

10. The nurse prepares an educational seminar about families for a community health fair. What should the nurse explain as the overall major function or task of parents? Select all that apply.

1. To help children learn to read 2. To provide food, shelter, and clothing 3. To socialize children into schools and the community 4. To encourage children to leave the home after college 5. To assist children in developing spiritual beliefs to guide daily tasks

11. Which action will the nurse take to promote well-being in a family with children? Select all that apply.

1. Communicate with the family 2. Reinforce the use of discipline 3. Understand the family’s routines 4. Encourage modeling positive behavior 5. Support development of parenting skills

. .

13-4

Answers:

1. What does the family health nurse use to determine the most appropriate health promotion activities in a family with young children?

Ans: 3 Page: 403 1.

2.

3.

4.

Feedback The children’s health practices will not help the nurse determine the most appropriate health promotion activities in the family.

The parents’ and grandparents’ health beliefs contribute to identifying health promotion activities; however, the young children’s needs might not be taken into consideration.

Establishing daily routines and family rituals is an important health promotion strategy.

These predictable patterns influence the physical, mental, and social health of children, as well as the health of the family itself. Nurses help families integrate physical, socialemotional, and cognitive health promotion into family routines; and in doing so, they affirm positive patterns of health or provide alternative ones.

Patterns of disease and illness reorganization task management help identify disease management actions and not necessarily health promotion activities.

2. Which phrase most accurately characterizes the purpose for family child health nurses to practice family-centered health care?

Ans: 1 Page: 390

1.

2.

3.

4.

Feedback A general principle of family-centered health care is forming partnerships between families and health care providers to decide jointly what is important for families.

Family-centered health care is more than providing high-quality care.

Families are the “constants” in children’s lives, whereas the personnel in other systems, including the health care system, fluctuate.

Family-centered health care does not focus on fostering partnerships between members of different families.

3. The nurse prepares material for a group of new staff members. How should the nurse describe family careers?

. .

13-5

Ans: 4 Page: 392

1.

2.

3.

4.

Feedback Family career incorporates all family events and not just normative events.

Family career does not focus on the occupation of the parents across the life span.

Family career takes into consideration the predictable and unpredictable stages that occur in families.

Family career is the dynamic process of change that occurs during the life span of the unique group called the family. Family career incorporates stages, tasks, and transitions, and is similar to family development theory in that it takes into account family tasks and raising children. Family career takes into account the diverse experiences of American families and includes both the expected developmental changes of the family life cycle and the unexpected changes of situational crises, such as divorce, remarriage, and death.

4. Which principle should family nurses incorporate in their care to help a family with a child who has diabetes?

Ans: 2 Page: 412-413

1.

2.

3.

4.

Feedback Protection is not a major concern.

Families with children who have chronic illnesses vary greatly in their needs, ranging from families who are rarely affected by their children’s condition to those who are significantly affected. To varying degrees, all families of children with chronic conditions bear the consequences of their children’s conditions.

Illness is unpredictable. Although a pattern of symptoms, diagnosis, and treatment may be consistent, the overall pattern of illness cannot be predicted.

Family routines would be reorganized in a family with a child with diabetes.

5. During a home visit the nurse learns that a family is experiencing a situational transition.

Which event most likely occurred in this family?

. .

13-6

Ans: 1 Page: 397

1.

2.

3.

4.

Feedback Situational transitions include changes in personal relationships, roles, and status.

Divorce is an example of a situational transition.

Having a child diagnosed with an illness is an example of a health-illness transition.

The oldest daughter planning to attend college is an example of a developmental transition.

A grandparent retiring from work is an example of a developmental transition.

6. The nurse learns that the parents of a family are rarely at home and are not involved in the children’s activities or interests. Which type of parenting style is represented by this family?

Ans: 2 Page: 402

1.

2.

3.

4.

Feedback Permissive parenting style allows children to pursue child-determined goals with little guidance from the parents.

In the uninvolved parenting style, the parents lack clear boundaries and expectations, and lack nurturing, warmth, and responsiveness.

An authoritative parenting style is characterized by reciprocity, mutual understanding, shared decision making, and flexibility.

Authoritarian parenting style is an inflexible and unilateral style in which parents have clear expectations and demands of their children, but insist on compliance with the parental perception of what is best for their children, with limited explanation and rationale or acceptance of their children’s perceptions.

7. The nurse prepares health promotion information for a family with a toddler. Which intervention will the nurse recommend to the parents?

Ans: 3 Page: 406 Feedback

. .

13-7 1.

2.

3.

4.

Placing a child on the back to sleep is appropriate for an infant or baby.

Head gear when playing outside would be appropriate for a preschool and school-age child.

For a toddler, placing medications in a locked cabinet is a health promotion action that addresses the high-risk period in the child’s development.

Teaching the dangers of drinking and driving is appropriate teaching for an adolescent and young adult.

8. A family with a child diagnosed with cystic fibrosis has newly relocated to a community.

Which health trajectory will the nurse use as a guide for this family’s care?

Ans: 1 Page: 415

1.

2.

3.

4.

Feedback Cystic fibrosis is considered a chronic condition. The nurse should use the chronicity trajectory when planning this family’s care.

A child with cancer would be on the uncertainty trajectory.

A child with cancer or multiple sclerosis would be on the degenerative trajectory.

A child with muscular dystrophy would be on the gradual onset trajectory.

9. The nurse is preparing to assess a family with small children. Why should the nurse focus on the family transition points during this assessment? Select all that apply.

Ans: 3, 4, 5 Page: 397-398 Feedback 1.

2.

3.

4.

Transitions do not represent a time when the family has a large amount of time to plan.

Transitions do not represent a time when the family has to spend a great deal of money.

Common health promotion challenges of children and their families are experienced during transitions as individual members and their families grow and change.

Transition events are signals to nurses that families may be at risk for health problems. Although families work to create and implement strategies to keep their children safe, these safety measures often fall behind during times of transition as

. .

13-8

5.

parents find themselves coping with the stress of transition while continuing to cope with parenting stress.

Transitions occur within a family when the members may need to change roles because of illness.

10. The nurse prepares an educational seminar about families for a community health fair. What should the nurse explain as the overall major function or task of parents? Select all that apply.

Ans: 1, 2, 3, 5 Page: 396

1.

2.

3.

4.

5.

Feedback A basic family function or task that is essential to survival is helping children with learning activities.

A basic family function or task that is essential to survival is providing food, shelter, and clothing.

A basic family function or task that is essential to survival is socializing children in school, work, and community life.

Encouraging children to leave the home after college is not a basic family function or task that is essential to survival.

A basic family function or task that is essential to survival is assisting children with spiritual development.

11. Which action will the nurse take to promote well-being in a family with children? Select all that apply.

Ans: 1, 3, 4, 5 Page: 402

1.

2.

3.

Feedback In promoting child and family well-being, nurses support families in care of their children by communicating with the family.

Reinforcing the use of discipline is not an intervention to promote child and family well-being.

In promoting child and family well-being, nurses support families in care of their children by understanding the family’s routines.

. .

13-9 4.

In promoting child and family well-being, nurses support families in care of their children by encouraging parents to model positive behavior.

5.

In promoting child and family well-being, nurses support families in care of their children by supporting the development of parenting skills.

. .

14-1

Chapter 14: Family Nursing in Acute Care Adult Settings

Multiple Choice:

1. 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.

2. 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

3. 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

4. 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

..

14-2

4. Balancing the professional relationship and the more personal relationship the family seeks with the nurse

5. What type of communication from nurses do families find as being the most helpful?

1. Brief 2. Honest 3. Vague 4. Limited

6. 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

7. 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

Multiple Response:

8. 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

. .

14-3

9. 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

10. 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

11. 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

12. 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

. .

14-4

13. 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

14. 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

15. 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

. .

14-5

Answers:

1. 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?

Ans: 3 Page: 430 1.

2.

3.

4.

Feedback Flexibility of visiting hours has shown to improve client outcomes and family satisfaction with the care provider.

Care conferences are of paramount importance in family-centered care and should include family members whenever possible.

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.

Discharge planning begins on the day of admission.

2. What should the nurse consider when determining the degree of family involvement in discharge planning?

Ans: 2 Page: 441

1.

2.

3.

4.

Feedback A current advance directive for the client does not need to be considered when determining the degree of family involvement in discharge planning.

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.

A family letter is not needed when determining the degree of family involvement in discharge planning.

Legal advice is not required when determining the degree of family involvement in discharge planning.

..

14-6

3. 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?

Ans: 2 Page: 447

1.

2.

3.

4.

Feedback A struggling family is the most conflicted family type. Decisions are mostly emotional. Some members are not able to decide and the family is in disagreement.

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.

The maintaining family has varied communication, which at times is good and at other times not. The family mixes some facts with emotions. The decision will be made to discontinue care with moderate-to-extreme difficulty.

The accommodating family has fairly good communication and uses facts and some emotions to make decisions. The decision is usually made to discontinue care with little-to-moderate conflict.

4. For which reason might a nurse experience role ambiguity when caring for a critically ill client and the family?

Ans: 1 Page: 433

1.

2.

3.

4.

Feedback 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. Experiencing difficulty balancing the biomedical technical model with the holistic nursing model causes role conflict in ICU nurses.

Asking to withhold information until test results are confirmed is not a source of role ambiguity for the nurse.

Balancing professional relationships and the more personal family relationships causes role conflict in ICU nurses.

. .

14-7

5. What type of communication from nurses do families find as being the most helpful?

Ans: 2 Page: 441

1.

2.

3.

4.

Feedback Brevity is not a type of communication that is helpful to families.

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

Vague communication creates distrust.

Limited information is a combination of brief and vague. Not knowing what is occurring with a client can cause extreme stress to the family.

6. What research information should the nurse manager use as evidence to increase the amount of family involvement in the care of a hospitalized client?

Ans: 4 Page: 454

1.

2.

3.

4.

Feedback Family help reduces the length of stay, which helps to reduce the cost of care.

Family caregiving improves outcomes.

Failure to increase family help can increase family stress.

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.

7. 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?

Ans: 2 Page: 445 Feedback

. .

14-8 1.

2.

3.

4.

The client’s advance directive needs to be reviewed to determine if other measures besides CPR should be done.

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.

The situation does not address comfort measures.

Extraordinary measures need to be defined.

8. 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.

Ans: 1, 2, 3, 4 Page: 430

1.

2.

3.

4.

5.

Feedback Clients and families often feel alone when entering an acute care setting.

Families are often unsure of their role in an acute care setting.

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.

Family caregivers will focus attention on the critically ill family member and often pay little attention to their own health.

Family members will not feel comforted by staff interventions until knowing the condition of their family member.

9. 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.

Ans: 2, 3, 4, 5 Page: 438-439

1.

2.

Feedback Confusion is not identified as a reaction by the family of a client being transferred from intensive care to a regular medical–surgical care area.

Families describe experiencing vulnerability when they had to accept their new responsibility as a different kind of family caregiver within the hospital setting. Their

. .

14-9

3.

4.

5.

sense of vulnerability was found to be the most intense of these family emotions.

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. Families feel abandonment when the transfer is abrupt and not planned.

Families report having a feeling of unimportance because of the different staffing ratio on the medical–surgical unit.

10. 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.

Ans: 1, 3, 4, 5 Page: 431

1.

2.

3.

4.

5.

Feedback Comfort is the fourth dimension of family need as identified through the Critical Care Family Needs Inventory.

Teaching is not a dimension of family need as identified through the Critical Care Family Needs Inventory.

Proximity is the third dimension of family need as identified through the Critical Care Family Needs Inventory.

Assurance is the first dimension of family need as identified through the Critical Care Family Needs Inventory.

Information is the second dimension of family need as identified through the Critical Care Family Needs Inventory.

11. What factor should be considered when determining hospital visiting policies? Select all that apply.

Ans: 1, 2, 3, 4 Page: 434-435

1.

2.

Feedback The client’s request or need to see family should be taken into consideration.

The family’s request or need to see the ill family member should be taken into consideration.

. .

14-10 3.

4.

5.

The treatments or routine care activities that should be performed confidentially and privately should be taken into consideration.

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.

The location of the waiting room does not need to be considered when determining hospital visiting policies.

12. Which of the following are considered advantages to the family being present during resuscitative efforts? Select all that apply.

Ans: 1, 2, 4, 5 Page: 450

1.

2.

3.

4.

5.

Feedback 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.

During resuscitative efforts, families have an opportunity to talk with the client and say good-bye.

Family presence is not encouraged to ensure that the client receives appropriate care.

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.

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.

13. 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.

Ans: 1, 2, 3, 4 Page: 439 Feedback

. .

14-11 1.

2.

3.

4.

5.

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.

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.

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.

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.

Families in acute care settings reported numerous stressors and changes in their family environment, and are often desperately in need of support. Limiting information to one family member is not an action to reduce family stress.

14. Which emotion might a family experience when a family member is in the intensive care unit (ICU)? Select all that apply.

Ans; 1, 4, 5 Page: 436

1.

2.

3.

4.

5.

Feedback 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.

Peace is not an emotion that family will experience when a family member is in the ICU. Relief is not an emotion that family will experience when a family member is in the ICU. 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.

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.

15. 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.

Ans: 2, 3, 4, 5 Page: 433 Feedback

. .

1.

2.

3.

4.

5.

14-12 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 do not include providing visiting hours.

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.

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.

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.

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.

. .

15-1

Chapter 15: Family Health in Mid- and Later Life

Multiple Choice:

1. What age group should the nurse identify as the fastest growing group of older adults in the United States?

1. 55 to 65 years 2. 65 to 75 years 3. 75 to 85 years 4. Older than 85 years

2. The nurse notes that a large number of older clients are living longer. What could be the reason for this?

1. Decreased birth rates 2. Increased family care of older adults by family members 3. Improved social and community support systems 4. Overhospitalization and prescription drug use

3. Changes result in stress. Which type of change is found to be the most stressful for an older adult?

1. Normative 2. Nonnormative 3. Normative and nonnormative 4. Neither normative nor nonnormative

4. The nurse suspects that a family is experiencing ambivalence. To what does this term refer in the family?

1. The ability to avoid stress over time 2. Conflicting emotions regarding relationships with older adults 3. The level of harmony with extended family members over time 4. Maintaining a stable level of balance in the midst of changes

. .

15-2

5. The nurse learns that a grandparent will be the guardian of a grandchild. Which relationship is the strongest predictor of the grandparent–grandchild relationship?

1. Father and child 2. Mother and father 3. Father and grandparent 4. Mother and grandparent

6. A frail older client does not have children. What should the nurse consider when planning this client’s care?

1. Depend on formal services for assistance 2. Rely on friends and extended family for care 3. Consider admission to a long-term care facility 4. Identify an agency that provides care 24/7 in the home

7. The nurse completes an instrumental activities of daily living (IADL) with an older client.

Which activity will this assessment include?

1. Bathing 2. Hygiene 3. Shopping 4. Toileting

Multiple Response:

8. The nurse plans to use the SPICES tool during an assessment. Which of the following are assessed with this tool? Select all that apply.

1. Confusion 2. Compliance 3. Poor nutrition 4. Sleep disorders 5. Skin breakdown

. .

15-3

9. The nurse prepares to use the FAMILY tool to assess a client and family. Which of the following will the nurse assess with this tool? Select all that apply.

1. Years of age 2. Members’ needs 3. Assistance needed 4. Family involvement 5. Integration into care plan

10. Why is it important for acute care nurses to have gerontological nursing experience? Select all that apply.

1. Older clients are less likely to have health insurance.

2. Older clients make up 25% of trauma cases.

3. Older clients are at risk for geriatric syndromes.

4. Older clients experience typical symptoms for diseases.

5. Older clients make up a high percentage of acute and critical care cases.

11. An older client seeks medical attention after being injured during a home invasion. Which of the following should the nurse consider as reasons for this client’s physical abuse? Select all that apply.

1. Frailty 2. Disability 3. Confusion 4. Low income 5. Lack of social support

12. The family is discussing a continuing care retirement community for an aging family member. Which of the following topics should be explained to the client about this type of community? Select all that apply.

1. Home care 2. Assisted living 3. Independent living 4. Private duty nurses 5. Skilled nursing care

. .

15-4

Answers:

1. What age group should the nurse identify as the fastest growing group of older adults in the United States?

Ans: 4 Page: 460 1.

2.

3.

4.

Feedback Adults aged 55 to 65 years are not the fastest growing group of older adults in the United States.

Adults aged 65 to 75 years are not the fastest growing group of older adults in the United States.

Adults aged 75 to 85 years are not the fastest growing group of older adults in the United States.

The fastest growing segment of the population in all developed nations is those in the oldest age groups. The United States will see the number of those older than 85 triple between 2015 and 2040, from 6.3 to 14.6 million.

2. The nurse notes that a large number of older clients are living longer. What could be the reason for this?

Ans: 4 Page: 462

1.

2.

3.

4.

Feedback Life-span changes are not caused by a decrease in birth rates.

Life-span changes may not be directly influenced by the increase in care of older adults by family members.

Life-span changes may not be directly influenced by improved social and community support systems.

Older adults are overrepresented in all health care utilization, including hospitalization and prescription drug use, which is one reason for the overall increase in life span.

3. Changes result in stress. Which type of change is found to be the most stressful for an older adult?

. .

15-5

Ans: 2 Page: 459

1.

2.

3.

4.

Feedback Normative changes are expected changes and would therefore cause less stress.

Nonnormative changes are not expected and would cause the most stress. These changes include divorce and widowhood.

Because normative changes are expected and nonnormative changes are not, these types of changes would not cause the same level of stress in an older adult.

Nonnormative changes would result in stress, whereas normative changes would not.

4. The nurse suspects that a family is experiencing ambivalence. To what does this term refer in the family?

Ans: 2 Page: 469-470

1.

2.

3.

4.

Feedback There is no particular term that is used to describe the ability to avoid stress over time.

The concept of ambivalence recognizes that family members simultaneously hold positive and negative feelings about one another, often because of contradictory roles. This can include a sense of care and nurturing, accomplishment, and love mixed with feelings of anger, role overload, and guilt.

There is no particular term to describe the level of harmony with extended family members over time.

Resiliency refers to maintaining a stable level of balance in the midst of changes.

5. The nurse learns that a grandparent will be the guardian of a grandchild. Which relationship is the strongest predictor of the grandparent–grandchild relationship?

Ans: 4 Page: 468

. .

15-6

1.

2.

3.

4.

Feedback The strongest predictor of grandparent–grandchild relationships is not the quality of relationship between the father and child.

The strongest predictor of grandparent–grandchild relationships is not the quality of relationship between the mother and father.

The strongest predictor of grandparent–grandchild relationships is not the quality of relationship between the father and grandparent.

The strongest predictor of grandparent–grandchild relationships is the quality of relationships between parents and grandparents, especially between mothers and grandparents.

6. A frail older client does not have children. What should the nurse consider when planning this client’s care?

Ans: 1 Page: 467

1.

2.

3.

4.

Feedback With widowhood, poor health, and frailty, a childless person has fewer social resources and must depend more on the formal service systems.

The client may not have friends and extended family to help with care.

There is not enough information to determine if the client should be admitted to a long-term care facility.

The client may not have the financial resources to pay for 24/7 care in the home.

7. The nurse completes an instrumental activities of daily living (IADL) with an older client.

Which activity will this assessment include?

Ans: 3 Page: 462

1.

2.

3.

Feedback Bathing is an activity of daily living.

Hygiene is an activity of daily living.

Shopping is an instrumental activity of daily living and helps determine if an

. .

15-7

4.

individual can live independently in the community.

Toileting is an activity of daily living.

8. The nurse plans to use the SPICES tool during an assessment. Which of the following are assessed with this tool? Select all that apply.

Ans: 1, 3, 4, 5 Page: 491

1.

2.

3.

4.

5.

Feedback Confusion is assessed when using the SPICES tool.

Compliance is not assessed when using the SPICES tool.

Poor nutrition is assessed when using the SPICES tool.

Sleep disorders are assessed when using the SPICES tool.

Skin breakdown is assessed when using the SPICES tool.

9. The nurse prepares to use the FAMILY tool to assess a client and family. Which of the following will the nurse assess with this tool? Select all that apply.

Ans: 2, 3, 4, 5 Page: 491

1.

2.

3.

4.

5.

Feedback Years of age is not assessed with the FAMILY tool.

Members’ needs are assessed with the FAMILY tool.

The level of assistance needed is assessed with the FAMILY tool.

Family involvement is assessed with the FAMILY tool.

Integration into care plan is assessed with the FAMILY tool.

10. Why is it important for acute care nurses to have gerontological nursing experience? Select all that apply.

Ans: 2, 3, 5

. .

15-8

Page: 477

1.

2.

3.

4.

5.

Feedback Older clients have Medicare or Medicaid as health insurance.

Older clients are also commonly seen in emergency departments, where they account for up to 25% of trauma admissions.

Older clients are at particular risk for age-specific conditions or geriatric syndromes such as falls, pressure injuries, delirium, incontinence, and deconditioning.

Older clients may present atypically, making it difficult to recognize early signs of infection or heart failure.

Although most nurses who work in acute care do not consider themselves gerontological nurses, a high proportion of acute and critical care patients are older than age 65.

11. An older client seeks medical attention after being injured during a home invasion. Which of the following should the nurse consider as reasons for this client’s physical abuse? Select all thatapply.

Ans: 1, 2, 4, 5 Page: 470

1.

2.

3.

4.

5.

Feedback Causes of mistreatment remain poorly understood, but risk factors include frailty.

Causes of mistreatment remain poorly understood, but risk factors include disability.

People with dementia are especially vulnerable to psychological abuse and neglect.

Causes of mistreatment remain poorly understood, but risk factors include low income.

Causes of mistreatment remain poorly understood, but risk factors include lack of social support.

12. The family is discussing a continuing care retirement community for an aging family member. Which of the following topics should be explained to the client about this type of community? Select all that apply.

Ans: 1, 2, 3, 5

. .

15-9

Page: 477

1.

2.

3.

4.

5.

Feedback Continuing care retirement communities include various elements of supportive care including home care.

Continuing care retirement communities include various elements of supportive care including assisted living.

Continuing care retirement communities include various elements of both independent living and supportive care.

Continuing care retirement communities do not provide private duty nurses.

Continuing care retirement communities include various elements of supportive care including skilled nursing services.

. .

16-1

Chapter 16: Family Mental Health Nursing

Multiple Choice:

1. Which approach describes a growing trend in the care of individuals with a mental health condition?

1. Use of family members as caregivers 2. Implementation of wraparound services in all communities 3. Practice of multigenerational assessments in all settings 4. Decreased use of psychotropic medications in the treatment

2. A client is diagnosed with depression. For which comorbid condition should the nurse assess this client?

1. Social phobia 2. Panic disorder 3. Bulimia nervosa 4. Post-traumatic stress disorder

3. The nurse learns that a client with a mental health condition has an 8-year-old child. What action should the nurse take?

1. Arrange for another family member to care for the child.

2. Complete a family-centered assessment of the child’s needs.

3. Discuss placing the client in a treatment center to protect the child.

4. Identify medication that might help the child to be more helpful to the client.

4. A client with a major depressive disorder is prescribed a serotonin reuptake inhibitor. What should the nurse instruct the family to do in order to prevent this client from developing serotonin syndrome?

1. Do not provide any herbal supplements.

2. Ignore mild fevers as they commonly occur with this medication.

3. Stop the medication if excessive sleeping occurs.

4. Double the dosage of the medication if diarrhea occurs.

. .

16-2

5. The nurse provides care to a client with dementia. How should the nurse communicate with this client when assisting with mealtime?

1. “Let me help you, honey.”

2. “How can I help you, Mrs. Smith?”

3. “Oh my! You made a messy!”

4. “Let me feed you so you don’t dirty your clothes.”

Multiple Response:

6. A child with attention deficit-hyperactivity disorder is prescribed a stimulant. What about this medication should the nurse instruct the family? Select all that apply.

1. It can lead to slow bone growth.

2. A long-acting form is available.

3. Regular health checkups are required.

4. This medication will cure the disorder.

5. Impulsive behaviors will be eliminated.

7. The health care provider suggests that a family participate in psychoeducation. What should the nurse instruct the family to expect when participating in this type of instruction? Select all that apply.

1. Social support 2. Family education 3. Home care support 4. Training in coping skills 5. Behavioral therapy techniques

8. The family is concerned because a member with schizophrenia frequently has violent outbursts. What should the nurse suggest that this family include in their crisis plan? Select all that apply.

1. Safe location

. .

16-3

2. Dose of a sedative 3. Insurance information 4. Suicide hotline telephone numbers 5. List of providers and telephone numbers

9. A client is recovering from major depression. On which areas should the nurse focus when helping this client maintain a life in recovery? Select all that apply.

1. Home 2. Health 3. Purpose 4. Community 5. Employment

10. A spouse plans to provide care at home to a client with a mental health condition. Which common tasks should the nurse instruct the spouse to expect to perform when providing care?

Select all that apply.

1. Providing companionship 2. Offering emotional support 3. Performing behavioral therapy 4. Monitoring symptoms 5. Attending group therapy

11. A client taking olanzapine for schizophrenia is diagnosed with metabolic syndrome. In order to reduce the hazards of this health problem, what should the nurse instruct the family? Select all that apply.

1. Encourage exercise 2. Provide healthy foods 3. Monitor blood pressure 4. Wean off the olanzapine 5. Take anticholesterol medication as prescribed

12. The nurse learns that a family is providing care to a client with bipolar disorder. What should the nurse do to support this family? Select all that apply.

1. Offer support

. .

2. Be noncritical 3. Remain nonjudgmental 4. Assure that cures are available 5. Provide honest information

16-4

. .

16-5

Answers:

1. Which approach describes a growing trend in the care of individuals with a mental health condition?

Ans: 1 Page: 501 1.

2.

3.

4.

Feedback There has been a trend to provide care to persons with a mental health condition in the community rather than in an institutional setting. This change has resulted in the transfer of care to the family level.

Wraparound services are not identified as a growing trend in the care of individuals with a mental health condition.

A multigenerational assessment is not a growing trend in the care of individuals with a mental health condition.

Decreased use of psychotropic medication is not a growing trend in the care of individuals with a mental health condition.

2. A client is diagnosed with depression. For which comorbid condition should the nurse assess this client?

Ans: 3 Page: 513

1.

2.

3.

4.

Feedback Anxiety disorders often coexist with social phobia.

Anxiety disorders often coexist with a panic disorder.

Depression often coexists with eating disorders, such as bulimia nervosa.

Anxiety disorders often coexist with post-traumatic stress disorder.

3. The nurse learns that a client with a mental health condition has an 8-year-old child. What action should the nurse take?

Ans: 2 Page: 505

. .

16-6

1.

2.

3.

4.

Feedback There is no immediate need to take the child out of the home environment.

Whereas a primary role for a nurse who is providing care to an adult with a mental health condition (MHC) is to identify the presence of children living in the family and to offer support and education to those children, the nurse also needs to perform a family-centered assessment of the child’s needs.

The client does not need to be removed from the home environment.

There is no reason to medicate the child.

4. A client with a major depressive disorder is prescribed a serotonin reuptake inhibitor. What should the nurse instruct the family to do in order to prevent this client from developing serotonin syndrome?

Ans: 1 Page: 513

1.

2.

3.

4.

Feedback Herbs such as St. John’s wort can interact with a serotonin reuptake inhibitor to produce serotonin syndrome.

A fever is a manifestation of serotonin syndrome and should be reported.

Abruptly stopping medication is not recommended. Excessive sleepiness does not indicate serotonin syndrome.

Diarrhea is a mild symptom of too much serotonin. The dosage should never be adjusted without the health care provider’s prescription.

5. The nurse provides care to a client with dementia. How should the nurse communicate with this client when assisting with mealtime?

Ans: 2 Page: 517

1.

2.

Feedback Using pet names can be disrespectful and demeaning to the client and family.

It is important to treat the person with respect and to use normal conversational words that are commonly used with adults.

. .

16-7 3.

4.

The nurse should not communicate with the client as if he or she were a child.

The nurse should not communicate with the client as if he or she were a child.

6. A child with attention deficit-hyperactivity disorder is prescribed a stimulant. What about this medication should the nurse instruct the family? Select all that apply.

Ans: 1, 2, 3 Page: 518

1.

2.

3.

4.

5.

Feedback There is a link between children taking amphetamines and slower bone growth.

The medication can be provided as individual doses or a long-acting dose.

The child taking the stimulant requires regular checkups.

Amphetamines do not cure attention deficit-hyperactivity disorder.

Impulsive behaviors will not be eliminated.

7. The health care provider suggests that a family participate in psychoeducation. What should the nurse instruct the family to expect when participating in this type of instruction? Select all that apply.

Ans: 1, 2, 4 Page: 520-521 Feedback 1.

2.

Family psychoeducation is a term used to describe various family programs that incorporate social support.

Family psychoeducation is a term used to describe various family programs that incorporate family education.

3.

4.

Home care support is not a part of family psychoeducation.

5.

Behavioral therapy techniques are not a part of family psychoeducation.

Family psychoeducation is a term used to describe various family programs that incorporate training in coping skills.

..

16-8

8. The family is concerned because a member with schizophrenia frequently has violent outbursts. What should the nurse suggest that this family include in their crisis plan? Select all that apply.

Ans: 1, 3, 4, 5 Page: 522

1.

2.

3.

4.

5.

Feedback Nurses should suggest that families have a binder/notebook that identifies a safe location for family members to go during periods of escalation.

Sedative administration is not a part of a crisis plan.

Nurses should suggest that families have a binder/notebook that identifies insurance information.

Nurses should suggest that families have a binder/notebook that identifies suicide hotline telephone numbers.

Nurses should suggest that families have a binder/notebook that identifies a list of health care providers, emergency professional contact names, and telephone numbers.

9. A client is recovering from major depression. On which areas should the nurse focus when helping this client maintain a life in recovery? Select all that apply.

Ans: 1, 2, 3, 4 Page: 500

1.

2.

3.

4.

Feedback Recovery from a mental health disorder is the major goal for mental health care.

Home has been identified as a major area that contributes to maintaining a life in recovery.

Recovery from a mental health disorder is the major goal for mental health care.

Health has been identified as a major area that contributes to maintaining a life in recovery.

Recovery from a mental health disorder is the major goal for mental health care.

Purpose has been identified as a major area that contributes to maintaining a life in recovery.

Recovery from a mental health disorder is the major goal for mental health care.

Community has been identified as a major area that contributes to maintaining a life in recovery.

. .

16-9 5.

Recovery from a mental health disorder is the major goal for mental health care.

Employment has not been identified as a major area that contributes to maintaining a life in recovery.

10. A spouse plans to provide care at home to a client with a mental health condition. Which common tasks should the nurse instruct the spouse to expect to perform when providing care?

Select all that apply.

Ans: 1, 2, 4 Page: 503

1.

2.

3.

4.

5.

Feedback Care is typically provided in the family home and providing companionship is one of the most common tasks performed on a daily basis.

Care is typically provided in the family home and offering emotional support is one of the most common tasks performed on a daily basis.

The spouse is not expected to provide behavioral therapy.

Care is typically provided in the family home and monitoring symptoms is one of the most common tasks performed on a daily basis.

The type of condition will determine if group therapy attendance is expected or would be helpful.

11. A client taking olanzapine for schizophrenia is diagnosed with metabolic syndrome. In order to reduce the hazards of this health problem, what should the nurse instruct the family? Select all that apply.

Ans: 1, 2, 3, 5 Page: 512

1.

2.

3.

4.

5.

Feedback Exercise is an intervention to maintain a healthy body weight and reduce the risks associated with this syndrome.

Consuming healthy foods help the client attain a healthy weight and reduce the risks associated with this syndrome.

Monitoring blood pressure identifies the need for antihypertensive medication.

Weaning off the medication is not an option.

Taking anticholesterol medication reduces the risk of adverse cardiovascular effects

. .

16-10 caused by the syndrome.

12. The nurse learns that a family is providing care to a client with bipolar disorder. What should the nurse do to support this family? Select all that apply.

Ans: 1, 2, 3, 5 Page: 516

1.

2.

3.

4.

5.

Feedback Caregivers of persons with bipolar disorder often have felt overlooked by health care providers and report that if health care providers offered support, then it would decrease their burden of care.

Caregivers feel more supported if the mental health nurse is noncritical.

Caregivers feel more supported if the mental health nurse is nonjudgmental.

Mental health care providers need to be honest about the fact that bipolar disorder is not curable.

Caregivers feel more supported if honest information is provided about the disorder.

. .

17-1

Chapter 17: Families and Community and Public Health Nursing

Multiple Choice:

1. The nurse prepares material to share during a community health fair. Which definition of community should the nurse keep in mind while preparing this material?

1. A group of vulnerable people 2. A group of people with the same illness 3. A group of people with similar characteristics 4. A group of people living in the same environment

2. The nurse prepares health promotion activities for a family. Which statement best describes the nurse’s purpose for planning activities for this family?

1. To teach the family to resolve conflicts 2. To improve or maintain the well-being of family members 3. To help the family identify strengths and trust personal decisions 4. To protect family members from diseases and the outcomes of these illnesses

3. The nurse compares the Ottawa Charter for Health Promotion with the Population Health Promotion Model. Which is a major difference between these two approaches to population care?

1. The Ottawa Charter focuses on social issues.

2. The Ottawa Charter uses determinants of health as a key assumption.

3. The Population Health Promotion Model focuses on issues that place a population at risk.

4. The Population Health Promotion Model uses strategies for families to improve their health.

4. The nurse provides care to people within an urban community. What needs to be established in order for interventions to be successful?

1. The nurse–client relationship 2. Payment for services provided 3. Times when the nurse is available 4. Frequency of visits to the families

. .

17-2

Multiple Response:

5. A family is having difficulty with health promotion activities. Which barrier should the nurse realize is hindering this family’s success with behavior modification? Select all that apply.

1. Stress 2. Conflict 3. Disinterest 4. Lack of time 5. Lack of money

6. Which action should the nurse take to reduce health inequities within a community? Select all that apply.

1. Develop families’ skills 2. Improve access to resources 3. Increase the use of home care services 4. Reduce the cost for health care services 5. Increase participation in family care processes

7. The nurse reviews the Alma Ata Declaration on Primary Health before meeting a family new to the community. On what are the foundational principles for this health promotion framework based? Select all that apply.

1. Equity 2. Technology 3. Empowerment 4. Access to health 5. Access to health care

8. The nurse provides care to a culturally diverse community. Which outcome indicates that this care is culturally safe? Select all that apply.

1. Trust

. .

17-3

2. Confusion 3. Humiliation 4. Empowerment 5. Open communication

9. The nurse plans to visit families within a community. On what should the nurse focus when meeting with these families to reduce the risk for health disparities? Select all that apply.

1. Ways to avoid injuries 2. Actions to maintain health 3. Strategies to manage chronic disease 4. Reasons to receive required immunizations 5. Approaches to adhere to prescribed eating plans

10. The public health nurse reviews the latest reports on the health issues for a particular community. Which areas should the nurse provide the most attention? Select all that apply.

1. Elder abuse 2. Homelessness 3. Environmental toxins 4. Chronic pain management 5. Opioid addiction and overdose

11. The nurse prepares to assess a community in order to identify population health needs.

Which approach should the nurse use during this assessment? Select all that apply.

1. Identify populations at risk 2. Meet key community leaders 3. Observe the target population 4. Evaluate the living environment 5. Collect data on the target population

. .

17-4

Answers:

1. The nurse prepares material to share during a community health fair. Which definition of community should the nurse keep in mind while preparing this material?

Ans: 3 Page: 534 1.

2.

3.

4.

Feedback A community may contain a group of vulnerable people; however, this is not the definition of a community.

A community may contain a group of people with the same illness; however, this is not the definition of a community.

A community is a group of people who share similar interests, needs, and outcomes.

A community may contain people who live in the same environment; however, this is not the definition of a community.

2. The nurse prepares health promotion activities for a family. Which statement best describes the nurse’s purpose for planning activities for this family?

Ans: 2 Page: 536

1.

2.

3.

4.

Feedback Health promotion does not include conflict resolution activities.

Interventions for families are planned, implemented, and evaluated from a health promotion perspective. From this perspective, nurses help to reduce health inequities by engaging families in processes that promote their control over their own health.

Health promotion does not focus on identifying strengths and personal decisions.

Disease prevention actions protect families from actual or potential diseases and the outcomes of these illnesses.

3. The nurse compares the Ottawa Charter for Health Promotion with the Population Health Promotion Model. Which is a major difference between these two approaches to populationcare?

Ans: 3

. .

17-5

Page: 538

1.

2.

3.

4.

Feedback The Population Health Promotion Model focuses on social issues.

The Population Health Promotion Model uses determinants of health as a key assumption.

The Population Health Model focuses on the specific issues that put populations at risk.

The Ottawa Charter uses strategies for families to improve their health.

4. The nurse provides care to people within an urban community. What needs to be established in order for interventions to be successful?

Ans: 1 Page: 544

1.

2.

3.

4.

Feedback The nurse–client relationship is key to the success of intervention programs. This is what needs to be established first.

The nurse does not need to establish how payment for services will be provided for interventions to be successful.

The nurse does not need to establish the times when available for interventions to be successful.

The nurse does not need to establish a schedule of family visits for interventions to be successful.

5. A family is having difficulty with health promotion activities. Which barrier should the nurse realize is hindering this family’s success with behavior modification? Select all that apply.

Ans: 1, 4, 5 Page: 536

1.

2.

Feedback Nurses know that for families to modify their behaviors, they must address specific barriers beyond their control, such as stress.

Conflict is not identified as a barrier to modifying behaviors.

. .

17-6 3.

4.

5.

Disinterest is not identified as a barrier to modifying behaviors.

Nurses know that for families to modify their behaviors, they must address specific barriers beyond their control, such as lack of time.

Nurses know that for families to modify their behaviors, they must address specific barriers beyond their control, such as lack of money.

6. Which action should the nurse take to reduce health inequities within a community? Select all that apply.

Ans: 1, 2, 5 Page: 536

1.

2.

3.

4.

5.

Feedback Nurses help to reduce health inequities by engaging families in processes that promote their control over their own health. This includes developing families’ skills.

Nurses help to reduce health inequities by engaging families in processes that promote their control over their own health. This includes improving access to resources.

Increasing the use of home care services is not an action to reduce health inequities within a community.

The nurse has no control regarding the cost of health care services.

Nurses help to reduce health inequities by engaging families in processes that promote their control over their own health. This includes increasing participation in their care process.

7. The nurse reviews the Alma Ata Declaration on Primary Health before meeting a family new to the community. On what are the foundational principles for this health promotion framework based? Select all that apply.

Ans: 1, 3, 4, 5 Page: 537

1.

Feedback The Alma Ata Declaration on Primary Health Care (WHO, 1978) laid the foundation for subsequent health promotion frameworks. The principles for this framework are based upon equity.

. .

17-7 2.

3.

4.

5.

Technology is not a principle of this framework.

The Alma Ata Declaration on Primary Health Care (WHO, 1978) laid the foundation for subsequent health promotion frameworks. The principles for this framework are based upon empowerment.

The Alma Ata Declaration on Primary Health Care (WHO, 1978) laid the foundation for subsequent health promotion frameworks. The principles for this framework are based upon access to health.

The Alma Ata Declaration on Primary Health Care (WHO, 1978) laid the foundation for subsequent health promotion frameworks. The principles for this framework are based upon access to health care.

8. The nurse provides care to a culturally diverse community. Which outcome indicates that this care is culturally safe? Select all that apply.

Ans: 1, 4, 5 Page: 542

1.

2.

3.

4.

5.

Feedback Culturally safe care creates trust.

Confusion indicates that attempts at culturally safe care have failed.

Humiliation indicates that attempts at culturally safe care have failed.

Culturally safe care encourages empowerment.

Culturally safe care creates open communication.

9. The nurse plans to visit families within a community. On what should the nurse focus when meeting with these families to reduce the risk for health disparities? Select all that apply.

Ans: 1, 2, 3 Page: 545

1.

2.

3.

Feedback Nursing home and visitation intervention programs by nurses provided an effective route to empower people at risk for health disparities to avoid injuries.

Nursing home and visitation intervention programs by nurses provided an effective route to empower people at risk for health disparities to maintain health.

Nursing home and visitation intervention programs by nurses provided an effective route to empower people at risk for health disparities to manage chronic disease.

. .

17-8 4.

5.

Immunizations would be a strategy to maintain health or manage a chronic disease, but not to reduce the risk for health disparities.

Adhering to prescribed eating plans would be a strategy to maintain health or manage a chronic disease, but not to reduce the risk for health disparities.

10. The public health nurse reviews the latest reports on the health issues for a particular community. Which areas should the nurse provide the most attention? Select all that apply.

Ans: 1, 2, 4, 5 Page: 547

1.

2.

3.

4.

5.

Feedback Public health nurses are often on the front lines in detecting elder abuse in a variety of settings.

Understanding how public health nurses can assist with the process of rehousing while supporting family agency and self-efficacy can lead to a rich new role for public health nurses.

Environmental toxins are not an identified area of concern for public health nurses.

Chronic pain management in older adults living in the community is a pervasive public health problem that can be amenable to public health nursing interventions aimed at individuals and families.

Often community, public health community, and public health nurses and nursing students have been involved in injury prevention programs to reduce the effects of opioid addiction and overdose.

11. The nurse prepares to assess a community in order to identify population health needs.

Which approach should the nurse use during this assessment? Select all that apply.

Ans: 1, 2, 3, 5 Page: 549-550

1.

2.

3.

4.

Feedback When assessing the community, the nurse should identify the populations at risk.

When assessing the community, the nurse should meet with key community leaders.

When assessing the community, the nurse should observe the target population to gain a better understanding of needs.

Evaluating the living environment is an approach that the nurse should take when

. .

17-9

5.

assessing a family.

When assessing the community, the nurse should collect data that helps explain the issues that the target population is facing.