Rigid boundaries are those that do not change or flex with changing circumstances, as indicated here by parents who are reluctant to revise their roles and expectations about their children as the children mature. Enmeshed boundaries are those that have failed to differentiate or develop individually; the family shares roles and thoughts to an excessive degree, without a healthy degree of individuality. Clear boundaries are not enmeshed; they are appropriate and well maintained.
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PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 35-7, 8, 33 (Box 35-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE
1. A wife believes her husband is having an affair. Lately, he has been disinterested in romance
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and working late. The husband has an important, demanding project at work. The mother asks her teen, “What have you noticed about your father?” The teen later mentions this to the father, who says, “Tell your mother that I can’t deal with her insecurities right now.” Family therapy should focus on (Select all that apply.) a. identifying and reducing the cognitive distortion in each parent’s perceptions. b. confronting the family with the need for honest, direct, assertive communication. c. helping the parents find ways to cope more effectively with their stress and fears. d. supporting the teen to redirect the parents when they try to communicate through her. e. convincing the mother that her fear of an affair is due to her own insecurities and unfounded. f. helping the husband understand how others might misinterpret the changes in his behavior. ANS: A, C, D, F
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Each parent is seeing the other’s behavior in a possibly distorted manner, which the nurse would explore and help the parents correct. The nurse would guide the parents to communicate more effectively, but confrontation would likely be non-therapeutic because it would increase the tension and triangulation. Since fear and anxiety contribute to triangulation, increasing the parent’s coping abilities as well as reducing anxiety and fear would be areas for intervention. Teaching the adolescent how to protect herself from triangulation, when done in conjunction with interventions to help the parents reduce this behavior, would be protective of the adolescent and would assist the parents in their efforts to change this pattern of communication. The nurse has no facts about whether or not the husband is having an affair; therefore, the nurse should not convince the wife that her fear is only due to her insecurities. Her fears may be well-founded. Helping the husband understand how his wife might see the changes in behavior differently can help him to respond helpfully instead of accusing her of being insecure.
PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 35-21, 22, 32 (Box 35-1) | Page 35-36 (Table 35-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
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