Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Explain the purposes that therapeutic groups fulfill.

Question 16

Type: MCSA

The nurse is planning a psychoeducation group for substance abusers and is conducting selection interviews. Which of the following individuals with substance abuse issues would not be an appropriate member?

1. A client who has attended AA meetings in the past

2. A client who has been court ordered to attend group therapy

3. A client who has recently been promoted to district manager

4. A client who is also being treated for a psychiatric illness

Correct Answer: 3

Rationale 1: Major life changes may prevent the clients full and continued participation in the group. The client who has been court ordered to attend group may be in denial but has an external motivation to attend group. Clients being treated for a psychiatric illness and who have attended AA meetings in the past have a history of group involvement and know what to expect from group therapy.

Rationale 2: Major life changes may prevent the clients full and continued participation in the group. The client who has been court ordered to attend group may be in denial but has an external motivation to attend group. Clients being treated for a psychiatric illness and who have attended AA meetings in the past have a history of group involvement and know what to expect from group therapy.

Rationale 3: Major life changes may prevent the clients full and continued participation in the group. The client who has been court ordered to attend group may be in denial but has an external motivation to attend group. Clients being treated for a psychiatric illness and who have attended AA meetings in the past have a history of group involvement and know what to expect from group therapy.

Rationale 4: Major life changes may prevent the clients full and continued participation in the group. The client who has been court ordered to attend group may be in denial but has an external motivation to attend group. Clients being treated for a psychiatric illness and who have attended AA meetings in the past have a history of group involvement and know what to expect from group therapy.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Design a therapeutic group based on the needs and personality characteristics of potential members.

Question 17

Type: MCSA

The nurse is planning a group to rehabilitate sex offenders in a forensic psychiatric hospital. Which of the following factors would most likely decrease the degree of trust and cohesion among the members?

1. One hour weekly sessions

2. Addition of new members

3. Confidentiality rights of victims

4. Member interaction outside the group

Correct Answer: 2

Rationale 1: Closed groups with a stable membership experience a higher degree of trust and cohesion. If new members or outsiders are allowed to attend, a new dynamic occurs and time is needed to rebuild trust. One hour weekly sessions would encourage trust and cohesion. There are no confidentiality rights of victims to consider. Member interaction outside the group cannot be avoided in a locked environment such as a prison or forensic psychiatric hospital and would most likely not be an issue in the development of trust and cohesion.

Rationale 2: Closed groups with a stable membership experience a higher degree of trust and cohesion. If new members or outsiders are allowed to attend, a new dynamic occurs and time is needed to rebuild trust. One hour weekly sessions would encourage trust and cohesion. There are no confidentiality rights of victims to consider. Member interaction outside the group cannot be avoided in a locked environment such as a prison or forensic psychiatric hospital and would most likely not be an issue in the development of trust and cohesion.

Rationale 3: Closed groups with a stable membership experience a higher degree of trust and cohesion. If new members or outsiders are allowed to attend, a new dynamic occurs and time is needed to rebuild trust. One hour weekly sessions would encourage trust and cohesion. There are no confidentiality rights of victims to consider. Member interaction outside the group cannot be avoided in a locked environment such as a prison or forensic psychiatric hospital and would most likely not be an issue in the development of trust and cohesion.

Rationale 4: Closed groups with a stable membership experience a higher degree of trust and cohesion. If new members or outsiders are allowed to attend, a new dynamic occurs and time is needed to rebuild trust. One hour weekly sessions would encourage trust and cohesion. There are no confidentiality rights of victims to consider. Member interaction outside the group cannot be avoided in a locked environment such as a prison or forensic psychiatric hospital and would most likely not be an issue in the development of trust and cohesion.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Design a therapeutic group based on the needs and personality characteristics of potential members.

Question 18

Type: MCSA

A few members of an outpatient group have begun meeting socially in a local restaurant for coffee and donuts before going to work each day. What should the group therapist leader do in this situation?

1. Discourage social meetings outside regular group sessions

2. Encourage all members to meet for coffee and donuts each morning

3. Join the members a few mornings a week

4. Suggest meeting for dinner once a week instead

Correct Answer: 1

Rationale 1: Members in outpatient groups are discouraged from having relationships with other members outside the meetings. Relationships outside of the group are likely to interfere with the group dynamics because of the formation of social coalitions or dyads.

Rationale 2: Members in outpatient groups are discouraged from having relationships with other members outside the meetings. Relationships outside of the group are likely to interfere with the group dynamics because of the formation of social coalitions or dyads.

Rationale 3: Members in outpatient groups are discouraged from having relationships with other members outside the meetings. Relationships outside of the group are likely to interfere with the group dynamics because of the formation of social coalitions or dyads.

Rationale 4: Members in outpatient groups are discouraged from having relationships with other members outside the meetings. Relationships outside of the group are likely to interfere with the group dynamics because of the formation of social coalitions or dyads.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Design a therapeutic group based on the needs and personality characteristics of potential members.

Question 19

Type: MCSA

The nursing student knows that group interaction requires the therapist to focus attention on each members feelings toward other group members, the therapists, and the group to illuminate relationship implications of interpersonal transactions. This process is known as:

1. Interactional group therapy.

2. The here-and-now.

3. Process illumination.

4. Objective family burden.

Correct Answer: 2

Rationale 1: The core of interactional group therapy is the here-and-now. According to Yalom (2005), the here-and-now work of the interactional group therapist occurs on two levels: focusing attention on each members feelings toward other group members, the therapists, and the group and illuminating the process (the relationship implications of interpersonal transactions).

Objective family burden refers to the impact on the family of a person with mental illness. The here-and-now is an aspect of interactional group therapy.

Rationale 2: The core of interactional group therapy is the here-and-now. According to Yalom (2005), the here-and-now work of the interactional group therapist occurs on two levels: focusing attention on each members feelings toward other group members, the therapists, and the group and illuminating the process (the relationship implications of interpersonal transactions).

Objective family burden refers to the impact on the family of a person with mental illness. The here-and-now is an aspect of interactional group therapy.

Rationale 3: The core of interactional group therapy is the here-and-now. According to Yalom (2005), the here-and-now work of the interactional group therapist occurs on two levels: focusing attention on each members feelings toward other group members, the therapists, and the group and illuminating the process (the relationship implications of interpersonal transactions).

Objective family burden refers to the impact on the family of a person with mental illness. The here-and-now is an aspect of interactional group therapy.

Rationale 4: The core of interactional group therapy is the here-and-now. According to Yalom (2005), the here-and-now work of the interactional group therapist occurs on two levels: focusing attention on each members feelings toward other group members, the therapists, and the group and illuminating the process (the relationship implications of interpersonal transactions).

Objective family burden refers to the impact on the family of a person with mental illness. The here-and-now is an aspect of interactional group therapy.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Apply the process of here-and-now activation to a therapeutic group.

Question 20

Type: MCSA

During a group session, a client becomes very angry at a comment by another member of the group. The therapist asks why the client became so angry. The group is using:

1. Events for emotional awareness.

2. Interpersonal conflict issues to resolve personal issues.

3. The self-reflective loop.

4. Fear.

Correct Answer: 3

Rationale 1: The self-reflective loop considers what happened and reflects back on why it happened. The self-reflective loop process may result in emotional awareness and resolution of personal issues. Fear is not a factor in the self-reflective loop.

Rationale 2: The self-reflective loop considers what happened and reflects back on why it happened. The self-reflective loop process may result in emotional awareness and resolution of personal issues. Fear is not a factor in the self-reflective loop.

Rationale 3: The self-reflective loop considers what happened and reflects back on why it happened. The self-reflective loop process may result in emotional awareness and resolution of personal issues. Fear is not a factor in the self-reflective loop.

Rationale 4: The self-reflective loop considers what happened and reflects back on why it happened. The self-reflective loop process may result in emotional awareness and resolution of personal issues. Fear is not a factor in the self-reflective loop.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Apply the process of here-and-now activation to a therapeutic group.

Question 21

Type: MCSA

The nurse knows that the primary task of the interactional group therapist is to make sure events in the session take precedence over:

1. Outside events.

2. Illness prevention.

3. Family matters.

4. Individual therapy.

Correct Answer: 1

Rationale 1: A primary task of the therapist is to actively steer the group discourse toward events in the session (the here-and-now) over those that occur outside or have occurred outside (the there-and-then).The work of the interactional group is not intended to displace individual therapy, prevent illness, or place priority on outside family matters.

Rationale 2: A primary task of the therapist is to actively steer the group discourse toward events in the session (the here-and-now) over those that occur outside or have occurred outside (the there-and-then).The work of the interactional group is not intended to displace individual therapy, prevent illness, or place priority on outside family matters.

Rationale 3: A primary task of the therapist is to actively steer the group discourse toward events in the session (the here-and-now) over those that occur outside or have occurred outside (the there-and-then).The work of the interactional group is not intended to displace individual therapy, prevent illness, or place priority on outside family matters.

Rationale 4: A primary task of the therapist is to actively steer the group discourse toward events in the session (the here-and-now) over those that occur outside or have occurred outside (the there-and-then).The work of the interactional group is not intended to displace individual therapy, prevent illness, or place priority on outside family matters.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Apply the process of here-and-now activation to a therapeutic group.

Question 22

Type: MCSA

The therapist for an interactive therapy group has noticed some behaviors among the members that need to be made overt. The therapist would be concerned about:

1. Expressing affection and sorrow.

2. Suggesting alternatives and denigrating each other.

3. Power struggles and attention-seeking.

4. Seeking social support and increasing conflict.

Correct Answer: 3

Rationale 1: Power struggles between members in therapy groups should be made overt. Seeking social support, suggesting alternatives, and expressing affection are usually appropriate activities in therapy groups. Increasing conflict and denigrating other group members is inappropriate behavior. Expressing sorrow may or may not be appropriate behavior.

Rationale 2: Power struggles between members in therapy groups should be made overt. Seeking social support, suggesting alternatives, and expressing affection are usually appropriate activities in therapy groups. Increasing conflict and denigrating other group members is inappropriate behavior. Expressing sorrow may or may not be appropriate behavior.

Rationale 3: Power struggles between members in therapy groups should be made overt. Seeking social support, suggesting alternatives, and expressing affection are usually appropriate activities in therapy groups. Increasing conflict and denigrating other group members is inappropriate behavior. Expressing sorrow may or may not be appropriate behavior.

Rationale 4: Power struggles between members in therapy groups should be made overt. Seeking social support, suggesting alternatives, and expressing affection are usually appropriate activities in therapy groups. Increasing conflict and denigrating other group members is inappropriate behavior. Expressing sorrow may or may not be appropriate behavior.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Develop process commentary appropriate to the level and purposes of the group.

Question 23

Type: MCSA

During group therapy, a male client laughs inappropriately and rolls his eyes when another male client discusses his feelings about coming out as a homosexual. The group therapist asks the first client to explain his reaction to the rest of the group. This process is an example of:

1. Taboo behavior.

2. Clearing the air.

3. Hidden homosexuality.

4. Attention-seeking and power struggles.

Correct Answer: 2

Rationale 1: Clearing the air (making covert interpersonal difficulties overt) is an integral part of illuminating the process. The group must move beyond a focus on content toward a focus on processthe how and the why of an interaction. The members must recognize, examine, and understand the process and be willing to self-disclose to avoid future conflicts and detrimental behaviors.

Rationale 2: Clearing the air (making covert interpersonal difficulties overt) is an integral part of illuminating the process. The group must move beyond a focus on content toward a focus on processthe how and the why of an interaction. The members must recognize, examine, and understand the process and be willing to self-disclose to avoid future conflicts and detrimental behaviors.

Rationale 3: Clearing the air (making covert interpersonal difficulties overt) is an integral part of illuminating the process. The group must move beyond a focus on content toward a focus on processthe how and the why of an interaction. The members must recognize, examine, and understand the process and be willing to self-disclose to avoid future conflicts and detrimental behaviors.

Rationale 4: Clearing the air (making covert interpersonal difficulties overt) is an integral part of illuminating the process. The group must move beyond a focus on content toward a focus on processthe how and the why of an interaction. The members must recognize, examine, and understand the process and be willing to self-disclose to avoid future conflicts and detrimental behaviors.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Develop process commentary appropriate to the level and purposes of the group.

Question 24

Type: MCSA

Which of the following group therapies would be most helpful for clients diagnosed with severe and persistent schizophrenia who are living in a nursing home?

1. Bible-study groups

2. Dialectical behavior groups

3. Mutual-help groups

4. Social skills training groups

Correct Answer: 4

Rationale 1: Older people with severe and persistent schizophrenia can learn and maintain new skills and report improved functioning after cognitive behavioral social skills training. Mutual help groups do not provide enough structure for schizophrenic clients. Bible study groups may increase religious delusions. Dialectical behavior groups require understanding of abstract concepts that may be too difficult for severe and persistent schizophrenic clients to grasp.

Rationale 2: Older people with severe and persistent schizophrenia can learn and maintain new skills and report improved functioning after cognitive behavioral social skills training. Mutual help groups do not provide enough structure for schizophrenic clients. Bible study groups may increase religious delusions. Dialectical behavior groups require understanding of abstract concepts that may be too difficult for severe and persistent schizophrenic clients to grasp.

Rationale 3: Older people with severe and persistent schizophrenia can learn and maintain new skills and report improved functioning after cognitive behavioral social skills training. Mutual help groups do not provide enough structure for schizophrenic clients. Bible study groups may increase religious delusions. Dialectical behavior groups require understanding of abstract concepts that may be too difficult for severe and persistent schizophrenic clients to grasp.

Rationale 4: Older people with severe and persistent schizophrenia can learn and maintain new skills and report improved functioning after cognitive behavioral social skills training. Mutual help groups do not provide enough structure for schizophrenic clients. Bible study groups may increase religious delusions. Dialectical behavior groups require understanding of abstract concepts that may be too difficult for severe and persistent schizophrenic clients to grasp.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Maintain a therapeutic group based on the needs of a specific population in inpatient or community settings.

Question 25

Type: MCSA

Clients with chronic persistent mental illness have been attending a creative activities group which focuses on expression of feelings through poetry, music, and art. What client behaviors would be expected?

1. Increased paranoid delusions

2. Increased physical activity

3. Increased auditory hallucinations

4. Increased social interaction and self-esteem

Correct Answer: 4

Rationale 1: Activity therapies are manual, recreational, and creative techniques to facilitate personal experiences and increase social responses and self-esteem.

Rationale 2: Activity therapies are manual, recreational, and creative techniques to facilitate personal experiences and increase social responses and self-esteem.

Rationale 3: Activity therapies are manual, recreational, and creative techniques to facilitate personal experiences and increase social responses and self-esteem.

Rationale 4: Activity therapies are manual, recreational, and creative techniques to facilitate personal experiences and increase social responses and self-esteem.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Maintain a therapeutic group based on the needs of a specific population in inpatient or community settings.

Question 26

Type: MCSA

You are a nurse manager of an ICU in a local hospital and have lost two nurses on your staff. One nurse quit and the other nurse is receiving treatment in a center for alcohol abuse. What type of group would you recommend to your staff before considering a transfer or quitting?

1. Nurse-to-nurse support group

2. Nurse storytelling group

3. Nurse bibliotherapy group

4. Nurse Alcoholics Anonymous group

Correct Answer: 1

Rationale 1: Nurses who work together may form discussion and counseling groups to help reduce their job-related stress and to help them deal with problems of interpersonal relationships in more satisfying ways. Nurses in various intensive care and other high-pressure settings identify with increasing frequency the need for group work services that the psychiatricmental health nurse can provide.

Rationale 2: Nurses who work together may form discussion and counseling groups to help reduce their job-related stress and to help them deal with problems of interpersonal relationships in more satisfying ways. Nurses in various intensive care and other high-pressure settings identify with increasing frequency the need for group work services that the psychiatricmental health nurse can provide.

Rationale 3: Nurses who work together may form discussion and counseling groups to help reduce their job-related stress and to help them deal with problems of interpersonal relationships in more satisfying ways. Nurses in various intensive care and other high-pressure settings identify with increasing frequency the need for group work services that the psychiatricmental health nurse can provide.

Rationale 4: Nurses who work together may form discussion and counseling groups to help reduce their job-related stress and to help them deal with problems of interpersonal relationships in more satisfying ways. Nurses in various intensive care and other high-pressure settings identify with increasing frequency the need for group work services that the psychiatricmental health nurse can provide.

Chapter 12. Family Therapy

Question 1

Type: MCSA

A client with a diagnosis of bipolar disorder lives with his family and discontinues taking medication when he begins feeling his symptoms are under control. Family members express their concern to the clients therapist whenever they realize the client is off his meds. The therapist understands that within the clients family, each persons behavior is contingent on and:

1. Reflects the characteristics of the clients family.

2. Affects the behavior of others.

3. Is affected by the functionality of the group.

4. Is reflective of the clients mental illness.

Correct Answer: 2

Rationale 1: Whether they are functional or dysfunctional, families have certain characteristics and dynamics. In a family, each persons behavior is contingent on and affects the behavior of the others. Family members behavior is not necessarily reflective of the clients mental illness. Each family members behavior affects the behavior of others, which may, in turn, reflect the characteristics of the family as a whole. The functionality of the group does not address family relationships.

Rationale 2: Whether they are functional or dysfunctional, families have certain characteristics and dynamics. In a family, each persons behavior is contingent on and affects the behavior of the others. Family members behavior is not necessarily reflective of the clients mental illness. Each family members behavior affects the behavior of others, which may, in turn, reflect the characteristics of the family as a whole. The functionality of the group does not address family relationships.

Rationale 3: Whether they are functional or dysfunctional, families have certain characteristics and dynamics. In a family, each persons behavior is contingent on and affects the behavior of the others. Family members behavior is not necessarily reflective of the clients mental illness. Each family members behavior affects the behavior of others, which may, in turn, reflect the characteristics of the family as a whole. The functionality of the group does not address family relationships.

Rationale 4: Whether they are functional or dysfunctional, families have certain characteristics and dynamics. In a family, each persons behavior is contingent on and affects the behavior of the others. Family members behavior is not necessarily reflective of the clients mental illness. Each family members behavior affects the behavior of others, which may, in turn, reflect the characteristics of the family as a whole. The functionality of the group does not address family relationships.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe families and their dynamics in terms of relationships, associations, and connections.

Question 2

Type: MCSA

The nurse knows that when clients are unable or unwilling to perform assigned family roles, the family experiences:

1. Stress and disequilibrium.

2. Recognition and communication.

3. Personal and political advocacy.

4. Acceptance.

Correct Answer: 1

Rationale 1: When members are unable or unwilling to perform assigned roles, the family experiences stress. For the health of the family systemnot only family members but also their relationships, their communication with one another, and their interactions with the environmentroles often must be negotiated in other than stereotyped ways. When the roles are not negotiated satisfactorily, family disequilibrium results. Not following assigned family roles does not result in recognition, communication, advocacy, or acceptance.

Rationale 2: When members are unable or unwilling to perform assigned roles, the family experiences stress. For the health of the family systemnot only family members but also their relationships, their communication with one another, and their interactions with the environmentroles often must be negotiated in other than stereotyped ways. When the roles are not negotiated satisfactorily, family disequilibrium results. Not following assigned family roles does not result in recognition, communication, advocacy, or acceptance.

Rationale 3: When members are unable or unwilling to perform assigned roles, the family experiences stress. For the health of the family systemnot only family members but also their relationships, their communication with one another, and their interactions with the environmentroles often must be negotiated in other than stereotyped ways. When the roles are not negotiated satisfactorily, family disequilibrium results. Not following assigned family roles does not result in recognition, communication, advocacy, or acceptance.

Rationale 4: When members are unable or unwilling to perform assigned roles, the family experiences stress. For the health of the family systemnot only family members but also their relationships, their communication with one another, and their interactions with the environmentroles often must be negotiated in other than stereotyped ways. When the roles are not negotiated satisfactorily, family disequilibrium results. Not following assigned family roles does not result in recognition, communication, advocacy, or acceptance.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Describe families and their dynamics in terms of relationships, associations, and connections.

Question 3

Type: MCSA

For the last three generations, the men of the family have worked in logging. The younger son wants to go to college and become a marine biologist. His parents tell him that logging is what our family does and refuse to discuss the issue. The son chooses to pursue employment in logging rather than upset his parents desires for their son. This family is experiencing:

1. Enmeshment.

2. Pseudohostility.

3. Pseudomutuality.

4. Schism.

Correct Answer: 3

Rationale 1: A family in which pseudomutuality occurs experiences persistent sameness in the structuring of roles, insistence on the desirability and appropriateness of family role structures, and intense concern over deviations from the role structure or emerging autonomy, and requires its members to give up their sense of personal identity. The family is not exhibiting pseudohostility in which there is chronic conflict, remoteness, or denial to negate hostility. Enmeshed families have diffuse boundaries. In schismatic families, adult partners devalue and undercut each other.

Rationale 2: A family in which pseudomutuality occurs experiences persistent sameness in the structuring of roles, insistence on the desirability and appropriateness of family role structures, and intense concern over deviations from the role structure or emerging autonomy, and requires its members to give up their sense of personal identity. The family is not exhibiting pseudohostility in which there is chronic conflict, remoteness, or denial to negate hostility. Enmeshed families have diffuse boundaries. In schismatic families, adult partners devalue and undercut each other.

Rationale 3: A family in which pseudomutuality occurs experiences persistent sameness in the structuring of roles, insistence on the desirability and appropriateness of family role structures, and intense concern over deviations from the role structure or emerging autonomy, and requires its members to give up their sense of personal identity. The family is not exhibiting pseudohostility in which there is chronic conflict, remoteness, or denial to negate hostility. Enmeshed families have diffuse boundaries. In schismatic families, adult partners devalue and undercut each other.

Rationale 4: A family in which pseudomutuality occurs experiences persistent sameness in the structuring of roles, insistence on the desirability and appropriateness of family role structures, and intense concern over deviations from the role structure or emerging autonomy, and requires its members to give up their sense of personal identity. The family is not exhibiting pseudohostility in which there is chronic conflict, remoteness, or denial to negate hostility. Enmeshed families have diffuse boundaries. In schismatic families, adult partners devalue and undercut each other.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Describe families and their dynamics in terms of relationships, associations, and connections.

Question 4

Type: MCSA

The nursing student taking care of a client in the mental health clinic learns through assessment that the clients wife insisted he admit himself into the clinic even though his wife is the one with a documented history of mental illness. The client states, I just want her to be happy. The nursing student suspects that the clients relationship with his wife may be:

1. Enmeshed.

2. Disengaged.

3. Hostile.

4. Skewed.

Correct Answer: 4

Rationale 1: Families in which one mate is severely dysfunctional are called skewed families. The other mate, who is usually aware of the dysfunction of the partner, assumes a passive, peacemaking, submissive stance to preserve the relationship. The couples relationship does not appear enmeshed, disengaged, or hostile.

Rationale 2: Families in which one mate is severely dysfunctional are called skewed families. The other mate, who is usually aware of the dysfunction of the partner, assumes a passive, peacemaking, submissive stance to preserve the relationship. The couples relationship does not appear enmeshed, disengaged, or hostile.

Rationale 3: Families in which one mate is severely dysfunctional are called skewed families. The other mate, who is usually aware of the dysfunction of the partner, assumes a passive, peacemaking, submissive stance to preserve the relationship. The couples relationship does not appear enmeshed, disengaged, or hostile.

Rationale 4: Families in which one mate is severely dysfunctional are called skewed families. The other mate, who is usually aware of the dysfunction of the partner, assumes a passive, peacemaking, submissive stance to preserve the relationship. The couples relationship does not appear enmeshed, disengaged, or hostile.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Differentiate among schism, skew, enmeshment, and disengagement as problems of intimacy and control in families.

Question 5

Type: MCSA

The nurse is working with a family in the process of a divorce. The parents are pressuring the children to decide which parent to live with after the divorce. The children are conflicted because they love both parents equally and want the family to stay together. This is an example of a:

1. Schismatic family.

2. Skewed family.

3. Hostile family.

4. Disengaged family.

Correct Answer: 1

Rationale 1: Families in which the children are forced to join one or the other camp of two warring spouses or adult caretakers are called schismatic families. The constant fighting in these families is most likely a defense against intimacy or closeness. The family does not appear skewed, disengaged, or hostile.

Rationale 2: Families in which the children are forced to join one or the other camp of two warring spouses or adult caretakers are called schismatic families. The constant fighting in these families is most likely a defense against intimacy or closeness. The family does not appear skewed, disengaged, or hostile.

Rationale 3: Families in which the children are forced to join one or the other camp of two warring spouses or adult caretakers are called schismatic families. The constant fighting in these families is most likely a defense against intimacy or closeness. The family does not appear skewed, disengaged, or hostile.

Rationale 4: Families in which the children are forced to join one or the other camp of two warring spouses or adult caretakers are called schismatic families. The constant fighting in these families is most likely a defense against intimacy or closeness. The family does not appear skewed, disengaged, or hostile.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate among schism, skew, enmeshment, and disengagement as problems of intimacy and control in families.

Question 6

Type: MCSA

A child with ADHD is referred to the nurse practitioner for family therapy. The father and mother are out of the country and have been out of touch for three months. The childs older sister has assumed the role of parenting her younger sibling. This is an example of a:

1. Disengaged family.

2. Enmeshed family.

3. Skewed family.

4. Schismatic family.

Correct Answer: 1

Rationale 1: In disengaged families, family members seem oblivious to the effects of their actions on one another. They are unresponsive and unconnected to each other. Structure, order, or authority in the family may be weak or nonexistent. In these families, a child often assumes the parental role. The family does not appear skewed, enmeshed or schismatic.

Rationale 2: In disengaged families, family members seem oblivious to the effects of their actions on one another. They are unresponsive and unconnected to each other. Structure, order, or authority in the family may be weak or nonexistent. In these families, a child often assumes the parental role. The family does not appear skewed, enmeshed or schismatic.

Rationale 3: In disengaged families, family members seem oblivious to the effects of their actions on one another. They are unresponsive and unconnected to each other. Structure, order, or authority in the family may be weak or nonexistent. In these families, a child often assumes the parental role. The family does not appear skewed, enmeshed or schismatic.

Rationale 4: In disengaged families, family members seem oblivious to the effects of their actions on one another. They are unresponsive and unconnected to each other. Structure, order, or authority in the family may be weak or nonexistent. In these families, a child often assumes the parental role. The family does not appear skewed, enmeshed or schismatic.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate among schism, skew, enmeshment, and disengagement as problems of intimacy and control in families.

Question 7

Type: MCSA

The nursing student knows that involving families with the clients treatment is an important aspect of family nursing. Certain biases, such as believing families are responsible for the clients mental illness, prevents:

1. Social interaction and violates family rights.

2. Hope, support, and happiness.

3. Future episodes of negative client behavior.

4. Family identity and reduces negative perceptions.

Correct Answer: 1

Rationale 1: Assessing and intervening with the families of clients is an essential nursing role. Unfortunately, some mental health care professionals still have a bias against family involvement. This bias is a remnant of now-discredited theories that poor parenting and dysfunctional family interaction patterns give rise to mental illness. A related bias is the belief that if families cause schizophrenia, then the familys contact with the client should be limited for the clients sake. Besides violating family rights, this bias prevents social interaction with family members that might serve as a normalizing force by confronting clients with reality. These biases do not reduce negative perceptions, negative client behavior, or hope, support, and happiness.

Rationale 2: Assessing and intervening with the families of clients is an essential nursing role. Unfortunately, some mental health care professionals still have a bias against family involvement. This bias is a remnant of now-discredited theories that poor parenting and dysfunctional family interaction patterns give rise to mental illness. A related bias is the belief that if families cause schizophrenia, then the familys contact with the client should be limited for the clients sake. Besides violating family rights, this bias prevents social interaction with family members that might serve as a normalizing force by confronting clients with reality. These biases do not reduce negative perceptions, negative client behavior, or hope, support, and happiness.

Rationale 3: Assessing and intervening with the families of clients is an essential nursing role. Unfortunately, some mental health care professionals still have a bias against family involvement. This bias is a remnant of now-discredited theories that poor parenting and dysfunctional family interaction patterns give rise to mental illness. A related bias is the belief that if families cause schizophrenia, then the familys contact with the client should be limited for the clients sake. Besides violating family rights, this bias prevents social interaction with family members that might serve as a normalizing force by confronting clients with reality. These biases do not reduce negative perceptions, negative client behavior, or hope, support, and happiness.

Rationale 4: Assessing and intervening with the families of clients is an essential nursing role. Unfortunately, some mental health care professionals still have a bias against family involvement. This bias is a remnant of now-discredited theories that poor parenting and dysfunctional family interaction patterns give rise to mental illness. A related bias is the belief that if families cause schizophrenia, then the familys contact with the client should be limited for the clients sake. Besides violating family rights, this bias prevents social interaction with family members that might serve as a normalizing force by confronting clients with reality. These biases do not reduce negative perceptions, negative client behavior, or hope, support, and happiness.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Carry out a family assessment.

Question 8

Type: MCSA

In order to obtain detailed information that gives insight into how a clients family may function, the nurse knows to ask:

1. What are your goals after discharge?

2. How often do you attend church?

3. What are your favorite foods?

4. Do you take your medicine at the same time every day?

Correct Answer: 2

Rationale 1: How actively the family pursues religious/spiritual activities is the sort of detailed information that will give insight into family functioning. Goals after discharge, favorite foods, and medication information are not related to family functioning.

Rationale 2: How actively the family pursues religious/spiritual activities is the sort of detailed information that will give insight into family functioning. Goals after discharge, favorite foods, and medication information are not related to family functioning.

Rationale 3: How actively the family pursues religious/spiritual activities is the sort of detailed information that will give insight into family functioning. Goals after discharge, favorite foods, and medication information are not related to family functioning.

Rationale 4: How actively the family pursues religious/spiritual activities is the sort of detailed information that will give insight into family functioning. Goals after discharge, favorite foods, and medication information are not related to family functioning.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Carry out a family assessment.

Question 9

Type: MCSA

When collecting family interactional data, the nurse knows to ask:

1. How do the actions of your family worsen your symptoms of schizophrenia?

2. Since you have been in the hospital, who is taking care of your children?

3. How often do you shop for nutritional items for your family?

4. What do you buy when you shop at the local market?

Correct Answer: 2

Rationale 1: Family interactional data is probably the most complex data to obtain. It is important to determine family alliances and family supports. Information about shopping habits is not part of the interactional data. Implying that the family causes or affects the clients mental illness reflects the nurses bias.

Rationale 2: Family interactional data is probably the most complex data to obtain. It is important to determine family alliances and family supports. Information about shopping habits is not part of the interactional data. Implying that the family causes or affects the clients mental illness reflects the nurses bias.

Rationale 3: Family interactional data is probably the most complex data to obtain. It is important to determine family alliances and family supports. Information about shopping habits is not part of the interactional data. Implying that the family causes or affects the clients mental illness reflects the nurses bias.

Rationale 4: Family interactional data is probably the most complex data to obtain. It is important to determine family alliances and family supports. Information about shopping habits is not part of the interactional data. Implying that the family causes or affects the clients mental illness reflects the nurses bias.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Carry out a family assessment.

Question 10

Type: MCSA

The nurse knows that because people with mental illness continue to be ostracized by mainstream society, families must cope with the burden of:

1. Dementia.

2. Shame.

3. Isolation.

4. Stigma.

Correct Answer: 4

Rationale 1: Family burden refers to the difficulties and responsibilities of family members who assume a caretaking function for relatives with psychiatric disability. Stigma is one example of family burden. Other family burdens reported most often are financial strain, violence in the household, reductions in the physical and mental health of family caregivers, disruption of family routines, worry about the future, the mental health system itself as a stressor, and feeling overwhelmed or unable to cope. Isolation is more of an issue for the person with mental illness than for the family. Dementia and shame are not considered family burdens.

Rationale 2: Family burden refers to the difficulties and responsibilities of family members who assume a caretaking function for relatives with psychiatric disability. Stigma is one example of family burden. Other family burdens reported most often are financial strain, violence in the household, reductions in the physical and mental health of family caregivers, disruption of family routines, worry about the future, the mental health system itself as a stressor, and feeling overwhelmed or unable to cope. Isolation is more of an issue for the person with mental illness than for the family. Dementia and shame are not considered family burdens.

Rationale 3: Family burden refers to the difficulties and responsibilities of family members who assume a caretaking function for relatives with psychiatric disability. Stigma is one example of family burden. Other family burdens reported most often are financial strain, violence in the household, reductions in the physical and mental health of family caregivers, disruption of family routines, worry about the future, the mental health system itself as a stressor, and feeling overwhelmed or unable to cope. Isolation is more of an issue for the person with mental illness than for the family. Dementia and shame are not considered family burdens.

Rationale 4: Family burden refers to the difficulties and responsibilities of family members who assume a caretaking function for relatives with psychiatric disability. Stigma is one example of family burden. Other family burdens reported most often are financial strain, violence in the household, reductions in the physical and mental health of family caregivers, disruption of family routines, worry about the future, the mental health system itself as a stressor, and feeling overwhelmed or unable to cope. Isolation is more of an issue for the person with mental illness than for the family. Dementia and shame are not considered family burdens.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Carry out a family assessment.

Question 11

Type: MCSA

The family nurse therapist, in an effort to learn more details about family patterns and interactions over time, may use:

1. The psychiatrists progress notes.

2. Anecdotes from family and friends.

3. Police reports.

4. A genogram.

Correct Answer: 4

Rationale 1: From the study of families in detail, it becomes apparent that patterns are spread over generations. The timeline, or genogram, is highly effective as a visual representation of family patterns from one generation to the next. The other choices have not been proven effective in soliciting information about multigenerational patterns.

Rationale 2: From the study of families in detail, it becomes apparent that patterns are spread over generations. The timeline, or genogram, is highly effective as a visual representation of family patterns from one generation to the next. The other choices have not been proven effective in soliciting information about multigenerational patterns.

Rationale 3: From the study of families in detail, it becomes apparent that patterns are spread over generations. The timeline, or genogram, is highly effective as a visual representation of family patterns from one generation to the next. The other choices have not been proven effective in soliciting information about multigenerational patterns.

Rationale 4: From the study of families in detail, it becomes apparent that patterns are spread over generations. The timeline, or genogram, is highly effective as a visual representation of family patterns from one generation to the next. The other choices have not been proven effective in soliciting information about multigenerational patterns.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate the data obtained in a family assessment into the care plan for the client.

Question 12

Type: MCSA

When developing a care plan for a client in family therapy, which of the following questions will provide the best information for planning appropriate interventions?

1. What kinds of activities does your family enjoy together?

2. Who is the primary caregiver in your family?

3. What is the most important problem that you want help with?

4. How often do you attend church together as a family?

Correct Answer: 3

Rationale 1: The best way to find out what families need from mental health professionals is to ask them directly. The other questions provide information during a family assessment, but do not solicit the familys opinion of what they think they need help with.

Rationale 2: The best way to find out what families need from mental health professionals is to ask them directly. The other questions provide information during a family assessment, but do not solicit the familys opinion of what they think they need help with.

Rationale 3: The best way to find out what families need from mental health professionals is to ask them directly. The other questions provide information during a family assessment, but do not solicit the familys opinion of what they think they need help with.

Rationale 4: The best way to find out what families need from mental health professionals is to ask them directly. The other questions provide information during a family assessment, but do not solicit the familys opinion of what they think they need help with.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate the data obtained in a family assessment into the care plan for the client.

Question 13

Type: MCSA

Which of the following interventions is not an appropriate strategy for the family therapist?

1. Openly disagree with one another when appropriate

2. Showing that anger and pain are not safe emotions to examine

3. Delineating family roles and functions

4. Openly discuss problems with one another

Correct Answer: 2

Rationale 1: The family therapist should encourage examination of all emotions in a safe environment. There are no forbidden areas that cannot be examined during family therapy. The other interventions are all appropriate strategies for the family therapist to engage in during therapy.

Rationale 2: The family therapist should encourage examination of all emotions in a safe environment. There are no forbidden areas that cannot be examined during family therapy. The other interventions are all appropriate strategies for the family therapist to engage in during therapy.

Rationale 3: The family therapist should encourage examination of all emotions in a safe environment. There are no forbidden areas that cannot be examined during family therapy. The other interventions are all appropriate strategies for the family therapist to engage in during therapy.

Rationale 4: The family therapist should encourage examination of all emotions in a safe environment. There are no forbidden areas that cannot be examined during family therapy. The other interventions are all appropriate strategies for the family therapist to engage in during therapy.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate the data obtained in a family assessment into the care plan for the client.

Question 14

Type: MCSA

Parents of adult clients with mental health disorders struggle to find a balance between emotional support and fostering independence. The nurse helps by:

1. Teaching the client and family about past mistakes.

2. Providing psychoeducation group therapy.

3. Providing interaction with family members.

4. Teaching the client to embrace the future.

Correct Answer: 2

Rationale 1: Family members can benefit from psychoeducation groups designed to help them cope with their loved ones illness. Family psychoeducation programs have emerged as a strongly supported evidence-based practice in the treatment of schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder, and borderline personality disorder. Family psychoeducation has also been found to reduce psychotic relapse and rehospitalization and to improve client recovery and family well-being. The other answers may be results of psychoeducation group therapy.

Rationale 2: Family members can benefit from psychoeducation groups designed to help them cope with their loved ones illness. Family psychoeducation programs have emerged as a strongly supported evidence-based practice in the treatment of schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder, and borderline personality disorder. Family psychoeducation has also been found to reduce psychotic relapse and rehospitalization and to improve client recovery and family well-being. The other answers may be results of psychoeducation group therapy.

Rationale 3: Family members can benefit from psychoeducation groups designed to help them cope with their loved ones illness. Family psychoeducation programs have emerged as a strongly supported evidence-based practice in the treatment of schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder, and borderline personality disorder. Family psychoeducation has also been found to reduce psychotic relapse and rehospitalization and to improve client recovery and family well-being. The other answers may be results of psychoeducation group therapy.

Rationale 4: Family members can benefit from psychoeducation groups designed to help them cope with their loved ones illness. Family psychoeducation programs have emerged as a strongly supported evidence-based practice in the treatment of schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder, and borderline personality disorder. Family psychoeducation has also been found to reduce psychotic relapse and rehospitalization and to improve client recovery and family well-being. The other answers may be results of psychoeducation group therapy.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Partner with clients and their families in recognizing when family interventions, referral to NAMI, or family therapy are appropriate.

Question 15

Type: MCSA

Which of the following is a grassroots, self-help support organization of families, friends, and clients with severe mental illness?

1. National Institute of Mental Health (NIMH)

2. American Mental Health Association (AMHA)

3. A mental health clinic

4. National Alliance on Mental Illness (NAMI)

Correct Answer: 4

Rationale 1: The National Alliance on Mental Illness (NAMI) is a grassroots, self-help, advocacy and support organization of families, consumers (a term used by NAMI to describe people diagnosed with and receiving treatment for severe mental illness), and friends of people with severe mental disorders. NAMI provides several services to families and consumers, including general information on mental disorders, psychiatric medications, and mental health policy positions; referral to state and local affiliates and support groups throughout the country; and support from trained volunteersconsumers and family memberswho know what its like to have a mental disorder or to have a family member with a mental disorder. The other agencies are not grassroots self-help organizations.

Rationale 2: The National Alliance on Mental Illness (NAMI) is a grassroots, self-help, advocacy and support organization of families, consumers (a term used by NAMI to describe people diagnosed with and receiving treatment for severe mental illness), and friends of people with severe mental disorders. NAMI provides several services to families and consumers, including general information on mental disorders, psychiatric medications, and mental health policy positions; referral to state and local affiliates and support groups throughout the country; and support from trained volunteersconsumers and family memberswho know what its like to have a mental disorder or to have a family member with a mental disorder. The other agencies are not grassroots self-help organizations.

Rationale 3: The National Alliance on Mental Illness (NAMI) is a grassroots, self-help, advocacy and support organization of families, consumers (a term used by NAMI to describe people diagnosed with and receiving treatment for severe mental illness), and friends of people with severe mental disorders. NAMI provides several services to families and consumers, including general information on mental disorders, psychiatric medications, and mental health policy positions; referral to state and local affiliates and support groups throughout the country; and support from trained volunteersconsumers and family memberswho know what its like to have a mental disorder or to have a family member with a mental disorder. The other agencies are not grassroots self-help organizations.

Rationale 4: The National Alliance on Mental Illness (NAMI) is a grassroots, self-help, advocacy and support organization of families, consumers (a term used by NAMI to describe people diagnosed with and receiving treatment for severe mental illness), and friends of people with severe mental disorders. NAMI provides several services to families and consumers, including general information on mental disorders, psychiatric medications, and mental health policy positions; referral to state and local affiliates and support groups throughout the country; and support from trained volunteersconsumers and family memberswho know what its like to have a mental disorder or to have a family member with a mental disorder. The other agencies are not grassroots self-help organizations.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity