Chapter 06: Family Influences My Nursing Test Banks

Chapter 06: Family Influences

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. While children voice concern about their father living alone after having a mild stroke that resulted in only minimal disability, the patient angrily disagrees, stating that hes always managed on his own and can do so now. The nurse can be most helpful to this family by:

a.

assuring them that their fathers physical limitations should not cause a safety issue.

b.

assisting them in identifying how they can help their father to live independently.

c.

offering to arrange a social service consult to arbitrate the conflict.

d.

suggesting that the patient accept the services of a home care aide on a short-term trial basis.

ANS: B

Preserving a patients autonomy through independent living is vital to a patients sense of well-being and can often be preserved through cooperation between family members to provide the required support. If the nurse can help the family find internal or external resources to support the patients desire to live independently, that is a win-win for all involved. Assuring the family that safety is not an issue does not help resolve their anxiety. The nurse can arrange a referral but can do more to help with this situation. A short-term trial of home health services is often accepted, but it does not address the entirety of the situation.

DIF: Applying (Application) REF: N/A OBJ: 6-6

TOP: Communication and Documentation

MSC: Safe Effective Care Environment

2. The physical changes that occur naturally as a result of the aging process often create an autonomy versus safety issue and is most problematic when:

a.

protracted reaction time increases the risk for driving accidents.

b.

arthritic knee and hip joints make falls more prevalent.

c.

eyesight diminishes, making following written instruction more difficult.

d.

responding to warning alarms is affected because of impaired hearing acuity.

ANS: A

Research has proven that normal aging affects a variety of factors that contribute to the increased incidence of automobile accidents caused by older adult drivers. Although the other options also relate to safety, older adults are more likely to be in multiple vehicle crashes, impacting the safety of others as well as their own.

DIF: Remembering (Knowledge) REF: Page 103 OBJ: 6-2

TOP: Teaching-Learning MSC: Safe Effective Care Environment

3. When discussing stressors with the primary caregiver of an 83-year-old patient, the nurse explores the issue of dissolving familiar social boundaries when asking:

a.

Has it been a problem taking over the role of head of the family?

b.

What do you do to help relax and revitalize yourself?

c.

Do you find it difficult to ask for help when you need it?

d.

Are there any physical care tasks that you find difficult to complete?

ANS: D

Dissolving familiar social boundaries involves caregivers and older adults sharing intimacies such as toileting, changing briefs, or catheter care, which would otherwise not be shared.

DIF: Applying (Application) REF: N/A OBJ: 6-5

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

4. The family of an 80-year-old patient shares with the nurse that they are concerned that the patient is too frail to be living alone. The nurses initial intervention is to:

a.

help the patient express the importance of living independently to the family members.

b.

assess the patients functional abilities related to being able to safely live independently.

c.

have the family provide specific examples of behaviors that cause them concern.

d.

identify ways the family can help assure the patients safety while living independently.

ANS: B

The first nursing intervention is to determine through a health assessment and history the patients ability to perform activities of daily living (ADLs) safely while living independently. All actions are appropriate, but assessment is the first step of the nursing process.

DIF: Applying (Application) REF: N/A OBJ: 6-6

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

5. An older patient with cognitive impairment is being cared for by family members. They have expressed concerns about providing appropriate care as his functional level declines. The nurse responds:

a.

Im glad that you are interested enough in his care that youve expressed this concern.

b.

His abilities will certainly decline. This is the time to discuss other care options.

c.

You are right to be concerned. Lets talk about issues that may come up in the future.

d.

The condition will get worse, so think about what will happen if you cant meet his needs.

ANS: C

Caregivers need realistic information regarding the possible progression of the disease process and how that will affect patient needs/care. The nurse provides anticipatory guidance and helps the family identify issues that may occur in the future. Stating you are glad the family voiced concerns is caring but does not address the issue. Telling the family it is time to address other care options or what they should think about is presumptuous.

DIF: Applying (Application) REF: N/A OBJ: 6-6

TOP: Caring MSC: Safe Effective Care Environment

6. An older patient who lives with family has a history of chronic alcohol abuse and poor compliance with the medical plan. The patient has begun to experience a marked decline. His family tells the nurse that these problems are a result of their inability to care for the patient properly. The nurse best responds by:

a.

evaluating the care the family has been providing.

b.

suggesting that care should be assumed by a professional caregiver.

c.

helping the family recognize that the decline is a result of the patients condition and personal choices.

d.

assuring them they are providing the patient with care motivated by love.

ANS: C

Family members often feel they have failed. They may need help to recognize when failures are the result of a challenging situation and not their performance. Giving objective information about the patients medical condition and the consequences of not following the medical regime can help alleviate guilt. The nurse may need to evaluate the care the patient gets, but that puts the entire responsibility back on the family, which is counterproductive. Care may need to be assumed by a professional, but the nurse should first help the family with their feelings. Suggesting this prematurely can lead to increased guilt. Telling the family their care is motivated by love dismisses their concerns.

DIF: Understanding (Comprehension) REF: Page 107 OBJ: 6-2

TOP: Communication and Documentation MSC: Psychosocial Integrity

7. An adult child is finalizing arrangements to provide in-home care for a dependent parent. In order to best foster the long-term wellness for both the patient and the caregiver, the nurse:

a.

explains the patients plan of care in detail with both the patient and the caregiver.

b.

discusses the importance and availability of respite care.

c.

encourages the patient and caregiver to seek assistance with problems as they arise.

d.

provides written information regarding available in-home services.

ANS: B

The nurse should help caregivers recognize that caregiving is a job. Just as employees benefit from regular breaks and vacations, caregivers benefit from a break in the job. The nurse should emphasize that the need for respite care begins with the onset of caregiving. Explaining the plan of care, encouraging the family to seek assistance, and providing written information are all appropriate, but home caregivers face multiple stressors and need to care for themselves too.

DIF: Applying (Application) REF: N/A OBJ: 6-7

TOP: Communication and Documentation MSC: Psychosocial Integrity

8. An 80-year-old patient with diminishing cognitive function is being discharged into the care of his 72-year-old spouse. The nurse recognizes that besides the spouses physical ability to provide appropriate care, there is a need to evaluate the:

a.

couples financial resources.

b.

couples social support system.

c.

spouses cognitive level of function.

d.

patients long-term health prognosis.

ANS: C

The ability of the caregivers to provide health care to the dementia patient may be compromised if the caregivers themselves are cognitively challenged. The nurse should evaluate the spouses physical and cognitive abilities and the safety of the home. The other factors are important too, but safety is the key issue.

DIF: Applying (Application) REF: N/A OBJ: 6-6

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

9. The family member caring for a dependent older patient tells the nurse that she feels his care is so out of my control. To best assist the caregiver in achieving a sense of confidence, the nurse:

a.

encourages the caregiver to regularly attend the meeting of a local support group.

b.

identifies the skills and resources that the caregiver needs to provide for the patient.

c.

arranges for in-home support services to assist with care as needed.

d.

explores reasons why the caregiver feels such a lack of control.

ANS: B

Being able to do the tasks that need to be done, get needed support, or access community resources enhances feelings of being in control.

DIF: Application (Apply) REF: N/A

TOP: Nursing Process: Assessment| Emotional Needs Related to Health Problems

MSC: Safe and Effective Care Environment

10. The adult child of a patient diagnosed with Alzheimer disease has shared that he feels so sad that he is not able to carry on a social conversation with the patient anymore because of her loss of memory. The nurse suggests:

a.

keeping conversations short while focusing on things that happened in the past.

b.

concentrating on doing things his mother enjoys rather than focusing on talking.

c.

participating in support groups that offer suggestions for communication.

d.

allowing his mother to pick the topic and then simply being with her in her world.

ANS: D

Family members must have a realistic understanding of the cognitive limitations of their loved ones and learn to communicate within those limits in order to remain emotionally connected with their family member. The patient may be better able to relate to past memories for a time. Concentrating on activities does not help communication. Support groups may be able to give suggestions but not all patients react the same way.

DIF: Understanding (Comprehension) REF: Page 107 OBJ: 6-4

TOP: Communication and Documentation MSC: Psychosocial Integrity

11. Adult children of a patient beginning to show early signs of cognitive decline share with the nurse that they are reluctant to discuss financial issues because the patient was always private about money matters. The nurse responds most therapeutically when suggesting:

a.

Maybe it would less threatening to your father if a lawyer spoke to him about the matter.

b.

Assure your dad you are only interested in making the financial arrangements he wants.

c.

A social worker can discuss the financial aspects of long-term care with your dad.

d.

This is a conversation that has to occur in order for your father to receive appropriate care.

ANS: B

Finances may be the last subject that parents want to talk about with their children, but it is also the most important. Children should convey that they do not want to know how much their parents have or might leave in their will; rather, they want to make sure there is a current and complete plan. A lawyer or social worker can assist in this process, but unless the patient believes the children are acting in his or her best interests, the other professionals will likely encounter resistance as well. Telling the family the conversation has to occur is paternalistic.

DIF: Understanding (Comprehension) REF: Page 101 OBJ: 6-7

TOP: Communication and Documentation MSC: Psychosocial Integrity

12. The nurse works with older adults to help plan for possible in-home care needs knowing that what percentage of older adults will need this type of care during their lifetimes?

a.

50%

b.

60%

c.

75%

d.

85%

ANS: D

About 85% of older adults will need some type of in-home assistance during their lifetimes.

DIF: Remembering (Knowledge) REF: Page 97 OBJ: 6-1

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

13. The nurse working with older adults wonders why fewer of the aging patients seen in the clinic live with their adult children than in the past. What trend most likely explains this?

a.

declining birth rate

b.

mobility of families

c.

rise of assisted living

d.

healthier older adults

ANS: A

The birth rate has declined from 30.1 in 1910 to 13.8 in 2009. This trend explains why so few adult children are available to help support their aging parents. Mobility is another factor, but it is not as important as the birth rate.

DIF: Remembering (Knowledge) REF: Page 98 OBJ: 6-1

TOP: Teaching-Learning MSC: Psychosocial Integrity

14. A nurse has worked with an older adult who has mild dementia and the patients family to ensure the financial status of the older person is sound and well managed on a day-to-day basis. The nurse knows planning was successful by assessing that:

a.

the parent and children are happy with the arrangements.

b.

the children have the older persons checkbook themselves.

c.

one adult child pays all the bills and sends reports each month.

d.

the children were granted conservatorship and manage the money.

ANS: A

Financial discussions and decisions are often difficult. The best plans result in the finances being handled satisfactorily and all parties are happy with the arrangement. The children may or may not need to keep the checkbook, pay the bills, or have conservatorship.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 6-4

TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity

15. The nurse is helping an adult child transition into the role of full-time caregiver for an older parent with dementia. What action by the nurse is best?

a.

Ensure the child has information on long-term care.

b.

Help the child negotiate care issues with siblings.

c.

Teach the child about the parents illness.

d.

Offer the child information on support groups.

ANS: B

All actions are appropriate and helpful; however, family issues often arise among siblings when there are differences in expectations of assistance. The nurse can best help out in this situation by assisting the caregiver to negotiate roles among the siblings.

DIF: Applying (Application) REF: N/A OBJ: 6-7

TOP: Communication and Documentation MSC: Psychosocial Integrity

16. A nurse is mediating a family meeting with an older adult and four grown children. One daughter, who has three small children of her own, keeps volunteering to do tasks until she has agreed to do about 90% of what is needed for the older adult. What action by the nurse is best?

a.

Praise the daughter for being so willing to do so much for her father.

b.

Ask the other children why they are so unwilling to help out.

c.

Ask the daughter if she can realistically accomplish all these items.

d.

Tell the daughter that she is unable to do all these things and to delegate.

ANS: C

Caregivers often overestimate their abilities. All caregivers should be asked to honestly reveal their limitations. This daughter may well be overcommitted. Praise is helpful, but it is not the best option. The nurse is mediating and is not there to criticize. Telling the daughter what to do is likely to lead to resentment.

DIF: Applying (Application) REF: N/A OBJ: 6-7

TOP: Communication and Documentation MSC: Psychosocial Integrity

17. A nurse is working with a family that is conflicted about care arrangements for an older parent who continues to live at home in less than safe conditions. What action by the nurse is best?

a.

Identify and enlist the help of the prime mover

b.

Tell the family you are calling social services

c.

Give the family a deadline for making decisions

d.

Offer to give the family tours of different facilities

ANS: A

Families often have a prime mover, the person who gets things done. The nurse can enlist this person to move on the decisions needing to be made. Threatening to call social services or giving deadlines will most likely result in entrenchment by the family. Offering to give tours will not help this family make decisions.

DIF: Applying (Application) REF: N/A OBJ: 6-7

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

18. The nurse working in a diverse community would most expect the eldest son from which community to care for aging parents?

a.

African Americans

b.

East Asian

c.

Native American

d.

Hispanic

ANS: B

Many cultures consider daughters, or oldest daughter, to be responsible for the care of aging parents, but in East Asian cultures, the oldest son assumes this role.

DIF: Remembering (Knowledge) REF: Page 99 OBJ: 6-1

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

19. The nurse working with older patients understands what fact about a health care proxy?

a.

It states that no resuscitation should occur if breathing or heartbeat cease.

b.

It can specify what treatment measures are or are not acceptable to the patient.

c.

It explains patients wishes regarding treatment if the patient cannot communicate.

d.

It designates a surrogate health care decision maker if the patient is incapacitated.

ANS: D

The health care proxy designates a surrogate health care decision maker if the patient is incapacitated. A do not resuscitate order prohibits cardiopulmonary resuscitation (CPR) if breathing or heartbeat stops. Specifying what treatment the patient finds unacceptable is part of the living will. Explaining wishes is in the advanced health directive.

DIF: Remembering (Knowledge) REF: Page 101 OBJ: 6-7

TOP: Communication and Documentation

MSC: Safe Effective Care Environment

20. An adult child of a parent with mild dementia is worried about the parent driving. Where does the nurse refer the adult child to find out about safe driving courses?

a.

Senior Driving from AAA

b.

AARP Driver Safety

c.

Older Drivers Education

d.

State Department of Transportation

ANS: B

AARP offers safe driving classes for people over 50. Senior driving incorporates videos, pictures, and text presentation. Older Drivers Education offers resources for families of older drivers. Each states department of transportation may or may not offer driving classes or resources.

DIF: Understanding (Comprehension) REF: Page 104 OBJ: 6-7

TOP: Communication and Documentation

MSC: Safe Effective Care Environment

MULTIPLE RESPONSE

1. The nurse is about to discuss the possible ways to meet the physical needs of an older adult patient with the patients adult children. The nurse guides the discussion based on which of the following American societal realities?(Select all that apply.)

a.

Most dependent older adults prefer to live with family members whenever possible.

b.

Family members are generally the care providers for dependent older adult family members.

c.

Nursing facilities are generally a familys last resort for the care of an older dependent adult.

d.

A family is generally willing to pay for services for the care of their older family member.

e.

Older dependent adults expect their adult family members to provide for care.

ANS: B, C, D

The reality of American attitudes regarding the aging adult and their needs is that family members provide most of the required care and are willing to pay for services as needed within their ability to pay. Americans view nursing homes as the last option for assuring care for their dependent older family member.

DIF: Remembering (Knowledge) REF: Page 99 OBJ: 6-7

TOP: Communication and Documentation MSC: Psychosocial Integrity

2. The nurse working with older patients knows that which of the following items are important to most older adults as they approach the end of life? (Select all that apply.)

a.

Pain and symptom control

b.

Having funeral arrangements

c.

Leaving money to children

d.

Personal cleanliness

e.

Being at peace with God

ANS: A, B, D, E

The main interests of patients nearing the end of life are pain and symptom control, financial and health decision planning, funeral arrangements, being at peace with God, maintaining dignity and cleanliness, and saying goodbye.

DIF: Remembering (Knowledge) REF: Page 103 OBJ: 6-3

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

3. The nurse is assessing a family caregiver for signs of role stress. Which assessment findings are consistent with this condition? (Select all that apply.)

a.

Denial

b.

Anger

c.

Social withdrawal

d.

Irritability

e.

Restfulness

ANS: A, B, C, D

Denial, anger, social withdrawal, and irritability are signs of potential caregiver stress. Restfulness is not a sign.

DIF: Remembering (Knowledge) REF: Page 106 OBJ: 6-3

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

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