Chapter 35: Family Interventions

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. A married couple has two biologic children who live with them as well as a child from the wife’s first marriage. What type of family is evident?

a. Homogeneous b. Extended c. Blended d. Nuclear

ANS: C

A blended family is made up of members from two or more unrelated families. It is not a nuclear family because a stepchild is present. It is not an extended family, because there are only two generations present. Homogeneous is not a family type.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 35-5 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

2. A married couple has two children living in the home. Recently, the wife’s mother moved in. This family should be assessed as a. nuclear. b. blended. c. extended. d. alternative.

ANS: C

An extended family has members from three or more generations living together. Nuclear family refers to a couple and their children. A blended family is one made up of members from two or more unrelated families. An alternative family can consist of a same-sex couple or an unmarried couple and children.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 35-5 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Allocation of family resources b. Physical maintenance and safety c. Maintenance of order and authority d. Reproduction of new family members

3. When a nurse assesses a family, which family task has the highest priority for healthy family functioning?

ANS: B

Physical and safety needs have greater importance in Maslow’s hierarchy than other needs.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 35-3 TOP: Nursing Process: Assessment eBay: testbanks_and_xanax

MSC: Client Needs: Health Promotion and Maintenance a. Members provide mutual support. b. Power is distributed equally among all members. c. Members believe there are specific causes for events. d. Under stress, members turn inward and become enmeshed.

4. Which documentation of family assessment indicates a healthy and functional family?

ANS: A

Healthy families nurture and support their members, buffer against stress, and provide stability and cohesion. The distracters are unrelated or incorrect.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 35-3, 4, 9 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

5. A 15-year-old is hospitalized after a suicide attempt. This adolescent lives with the mother, stepfather, and several siblings. When performing a family assessment, the nurse must first determine a. how the family expresses and manages emotion. b. names and relationships of the family’s members. c. the communication patterns between the patient and parents. d. the meaning that the patient’s suicide attempt has for family members.

ANS: B

The identity of the members of the family is the most fundamental information and should be obtained first. Without this, the nurse cannot fully process the other responses.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 35-17 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. The family exhibits many characteristics of dysfunctional families. b. Several family members have serious problems with their physical health. c. Power in the family is maintained in the parental dyad and rarely delegated. d. Stress from living with a mentally ill member has challenged the family’s function.

6. Which information is the nurse most likely to find when assessing the family of a patient with a serious mental illness?

ANS: D

The information almost universally obtained is that the family is under stress associated with having a mentally ill member. This stress lowers the family’s level of functioning in at least one significant way. Stress does not necessarily mean the family has become dysfunctional.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-3, 12, 13 (Vignette) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. “Family dysfunction might have caused the mental illness.” b. “Family members provide more accurate information than the patient.” c. “Family assessment is part of the protocol for care of all patients with mental illness.” d. “Every family member’s perception of events is different and adds to the total picture.”

7. The parent of an adolescent diagnosed with mental illness asks the nurse, “Why do you want to do a family assessment? My teenager is the patient, not the rest of us.” Select the nurse’s best response.

ANS: D

The identified patient usually bears most of the family system’s anxiety and may have come to the attention of parents, teachers, or law enforcement because of poor coping skills. The correct response helps the family understand that the opinions of each will be valued. It allows the nurse to assess individual coping and prepares the family for the experience of working together to set goals and solve problems. The other responses are either incorrect or evasive.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-14 to 16 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Ineffective family coping related to parental role conflict b. Caregiver role strain related to the stress of chronic illness c. Impaired parenting related to patient’s repeated hospitalizations d. Interrupted family processes related to relapse of acute psychosis

8. An adult diagnosed with schizophrenia lives with elderly parents. The patient was recently hospitalized with acute psychosis. One parent is very anxious, and the other is ill because of the stress. Which nursing diagnosis is most applicable to this scenario?

ANS: B

Caregiver role strain refers to a caregiver’s felt or exhibited difficulty in performing a family caregiver role. In this case, one parent exhibits stress-related illness and the other exhibits increased anxiety. The other nursing diagnoses are not substantiated by the information given and are incorrectly formatted (one nursing diagnosis should not be the etiology for another).

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-21, 35 (Box 35-3)

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Diagnosis/Analysis a. Describe the stages of the anticipatory grieving process. b. Identify and describe effective methods for coping with anxiety. c. Recognize ways dysfunctional communication is expressed in the family. d. Examine previously unexpressed feelings related to the patient’s sexuality.

9. An adult, recently diagnosed with AIDS, is hospitalized with pneumonia. The patient and family are very anxious. Select the best outcome to add to the plan of care for this family.

ANS: B

Desired outcomes might be set for the family as a whole or for individuals within the family. The outcome most closely associated with the anxiety that each member is experiencing is to focus on identifying and describing ways of coping with the anxiety. The other options are not appropriate at this time.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-21, 22

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Outcomes Identification eBay: testbanks_and_xanax a. Spouse’s codependent behaviors b. Interactions among family members c. Patient’s reaction to the family’s anger d. Children’s responses to the family sessions

10. A parent is admitted to a unit for treatment of addictions. The patient’s spouse and adolescent children participate in a family session. What is the most important aspect of this family’s assessment?

ANS: B

Interactions among all family members are the raw material for family problem solving. By observing interactions, the nurse can help the family make its own assessments of strengths and deficits. The other options are narrower in scope when compared with the correct option.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 35-3, 4, 9, 10 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. “What changes are most important to you?” b. “How are feelings expressed in your family?” c. “What types of family education would benefit your family?” d. “Can you identify a long-term goal for improved functioning?”

11. A parent is admitted to a unit for treatment of addictions. The patient’s spouse and adolescent children attend a family session. Which initial assessment question should the nurse ask of family members?

ANS: B

It is important to understand family characteristics, particularly in a family under stress. Expression of feelings is an important aspect of assessment of the family’s function (or dysfunction). The distracters relate more to outcome identification and planning interventions, both of which should be delayed until the assessment is complete.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-8, 9

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment

12. A nurse interviews a homeless parent with two teenage children. To best assess the family’s use of resources, the nurse should ask a. “Can you describe a problem your family has successfully resolved?” b. “What community agencies have you found helpful in the past?” c. “What aspect of being homeless is most frightening for you?” d. “Do you feel you have adequate resources to survive?”

ANS: B

The correct option asks about use of resources in an open, direct fashion. It will give information about choices the family has made regarding use of resources in the community. The other questions do not address prior use of resources or focus on other aspects of coping.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-3, 22, 23

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment

13. Two divorced people plan to marry. The man has a teenager, and the woman has a toddler. This family will benefit most from a. role-playing opportunities for conflict resolution regarding discipline. b. guidance about parenting children at two developmental levels. c. formal teaching about problem-solving skills. d. referral to a family therapist.

ANS: B

The newly formed family will be coping with tasks associated with the stage of rearing preschool children and teenagers. These stages require different knowledge and skills. There is no evidence of a problem, so the distracters are not indicated.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-4, 6, 10 TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

14. Parents of a teenager recently diagnosed with serious mental illness express dismay. One parent says, “Our hopes for our child’s future are ruined. We probably won’t ever have grandchildren.” The nurse will use interventions to assist with a. denial. b. acceptance. c. acting out. d. manipulation.

ANS: B

The parents comment suggests they are experiencing grief, a common reaction to having a family member diagnosed with mental illness. The grief stems from actual or potential losses, such as the family’s ability to function, financial well-being, and altered future. Supporting the parents’ acceptance of the patient’s illness will enhance coping. Data do not support choosing any of the other options.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 35-21, 22

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning a. Impaired parenting b. Parental role conflict c. Impaired social interaction d. Interrupted family processes

15. Parents of a teenager recently diagnosed with serious mental illness express dismay. One parent says, “Our child acts so strangely that we don’t invite friends to our home. We quit taking vacations. Sometimes we don’t get any sleep.” Which nursing diagnosis best applies?

ANS: D

Interrupted family processes are evident in the face of disruptions in family functioning as a result of having a mentally ill member. Assessment data best support this diagnosis. Data are insufficient to support the other diagnoses.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-21, 22, 35 (Box 35-3) TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity

16. A family expresses helplessness related to dealing with a mentally ill member’s odd behaviors, mood swings, and argumentativeness. An effective nursing intervention for this family would be to a. express sympathy for their situation. b. involve local social service agencies. c. explain symptoms of relapse. d. role-play difficult situations.

ANS: D

Helping a family learn to set limits and deal with difficult behaviors can often be accomplished by using role-playing situations, which give family members the opportunity to try new, more effective approaches. The other options would not provide learning opportunities.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 35-19 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Refer the parents to a support group. b. Build the parents’ self-concept as coping parents. c. Teach the parents techniques of therapeutic communication. d. Facilitate achievement of normal developmental tasks of the family.

17. Parents of a mentally ill teenager say, “We have never known anyone who was mentally ill. We have no one to talk to because none of our friends understand the problems we are facing.” Select the nurse’s most helpful intervention.

ANS: A

The need for support is evident. Referrals are made when working with families whose needs are unmet. A support group will provide the parents with support of others with similar experiences and with whom they can share feelings and experiences. The distracters are less relevant to providing a network of support.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 35-23 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. “What strengths does your family have?” b. “Do you think your family copes effectively?” c. “Describe how you successfully handled one family problem.” d. “How do you think the current family problem should be resolved?”

18. Select the best question for the nurse to ask to assess a family’s ability to cope.

ANS: C

The correct option is the only statement addressing coping strategies used by the family. The distracters seek opinions or use closed-ended communication techniques.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-16, 17 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. The identified patient sends messages of aggression to selected family members. b. Family members project problems of the family onto one particular family member. c. The identified patient threatens separation from the family to induce feelings of isolation and despair. d. Family members give the identified patient nonverbal messages that conflict with verbal messages.

19. Which scenario best illustrates scapegoating within a family?

ANS: B

Scapegoating projects blame for family problems onto a member who is less powerful. The purpose of this projection is to distract from issues or dysfunctional behaviors in the members of the family.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 35-32 (Box 35-1) | Page 35-33 (Box 35-2)

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Impaired parenting related to verbal abuse of oldest child b. Impaired social interaction related to disruption of family bonds c. Ineffective community coping related to fears about economic stability d. Disabled family coping related to insecurity secondary to loss of family income

20. A parent became unemployed 6 months ago. The parent has subsequently been verbally abusive toward the spouse and oldest child. The child ran away twice, and the spouse has become depressed. What is the most appropriate nursing diagnosis for this family?

ANS: D

Disabled family coping refers to the behavior of a significant family member that disables his or her own capacity as well as another’s capacity to perform tasks essential to adaptation. The distracters are inaccurate because the stressors influence more than one individual.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-21, 35 (Box 35-3)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Health Promotion and Maintenance a. Educate the parent about stages of family development. b. Report the son to law enforcement authorities. c. Refer the son for substance abuse treatment. d. Make a referral for family therapy.

21. A parent says, “My son and I argue constantly since he started using drugs. When I talk to him about not using drugs, he tells me to stay out of his business.” What is the nurse’s first most appropriate action?

ANS: D

Family therapy is indicated, and the nurse should provide a referral. Reporting the child to law enforcement would undermine trust and violate confidentiality. The other distracters may occur later.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 35-10, 11, 25

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation a. One parent takes care of children. The other parent earns income and maintains the eBay: home. b. A family has strict boundaries that require members to address problems within the family. c. A couple requires their adolescent children to attend church services three times a week. d. A couple renews their marital relationship after their children become adults.

22. Which scenario best demonstrates a healthy family?

ANS: D

Revamping the marital relationship after children move out of the family of origin indicates the family is moving through its stages of development. Strict family boundaries or roles interfere with flexibility and use of outside resources. Adolescents should have some input into deciding their activities.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-3, 5, 6, 8 to 10 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. “Our youngest child always starts arguments and upsets everyone else.” b. “We all express our feelings openly except when we think it might upset my husband.” c. “Our oldest child knows that my husband and I are doing all we can for the others.” d. “After my husband has been drinking, I have to get everyone up and ready for school.”

23. Which comment by a mother during a family therapy session shows evidence of scapegoating?

ANS: A

Scapegoating is blaming family problems on a member of the family who is not very powerful. The purpose of the blaming is to keep the focus off painful issues and off the blamers themselves. A double-bind message, such as “We all express our feelings openly except when,” involves giving instructions that are inherently contradictory or that place the person in a no-win situation. “Our oldest child knows that …” is an example of triangulation, wherein a third party is engaged to help stabilize an unstable pair within the family. A child assuming parental responsibilities (e.g., caring for siblings) because a parent fails to do so is an example of enabling.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 35-32 (Box 35-1) | Page 35-33 (Box 35-2)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. A mother tells her daughter, “You make me so mad that sometimes I wish I had never had you.” b. A teenager tells her father, “You are treating me like a baby when you tell me I must be home by 10 PM on a school night.” c. A son tells his mother, “You worry too much about what might happen. Nothing has happened yet, so why worry?” d. A wife tells her husband, “You go ahead with your bowling trip. Try not to worry about me falling on my crutches while I’m alone at home.”

24. Which example of behavior in a family system demonstrates double bind communication?

ANS: D

A double bind communication is one that is inherently contradictory, that is, a comment that gives conflicting directions. In this case, the wife on crutches suggests that her husband should go bowling but then indicates that she will be at greater risk if he does, which in effect tells him “go ahead” and “don’t do it” at the same time. This remark places the husband in a double bind, a situation in which no acceptable response exists. The distracters are clear, direct communications.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 35-32 (Box 35-1) | Page 35-33 (Box 35-2)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. Multigenerational dysfunction b. Triangulation c. Enmeshment d. Blaming

25. A wife believes her husband is having an affair. Lately, he has been disinterested in romance 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.” Which family dynamic is evident?

ANS: B

Triangulation is a family dynamic wherein a pair relationship (usually the parents) is under stress and copes by drawing in a third person (usually a child) to align with one or the other members of the pair relationship. Multigenerational dysfunction is any dysfunction that exists within or across multiple generations of a family, such as child abuse or alcoholism. Blaming is distracting attention from one’s own dysfunction or reducing one’s own anxiety by blaming another person. Enmeshment refers to blurred family boundaries or blending together of the thoughts, feelings, or family roles of the individuals so that clear distinctions among members fail to emerge.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 35-15, 32 (Box 35-1) | Page 35-33 (Box 35-2)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. Rigid b. Clear c. Enmeshed d. Differentiated

26. A 16-year-old wants to drive, but the parents will not allow it. A 14-year-old sibling was invited to several sleepovers, but the parents found reasons to deny permission. Both teens are annoyed because the parents buy clothes for them that are more suitable for younger children. The parents say, “We don’t want our kids to grow up too fast.” Which term best describes this family’s boundaries?

ANS: A

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.

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 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