Chapter 10: Families as Resources, Caregivers, and Collaborators My Nursing Test Banks

Chapter 10: Families as Resources, Caregivers, and Collaborators

Test Bank

MULTIPLE CHOICE

1. During a mental health assessment, a patient reports living with two children from a previous relationship, a sibling, and a siblings three children. To use the most precise documentation, the nurse documents that the patient is part of a(n):

a.

household.

b.

nuclear family.

c.

extended family.

d.

traditional family.

ANS: C

The term extended family is used to describe a family in which the patient lives with others who are related by blood or marriage. A nuclear family consists of parents and their children. The terms traditional andnontraditional may be used to describe a family according to gender roles and employment status. Household is a less precise term referring to a residence consisting of an individual living alone or a group of people sharing a common dwelling and cooking facilities.

DIF: Cognitive Level: Comprehension REF: Text Page: 139

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. Which finding is a positive indicator of family functioning?

a.

A patients child occasionally has an asthma attack when the patient and the patients spouse argue.

b.

A patients spouse leaves for a few days and gambles after a serious fight with the patient.

c.

A patients 12-year-old child has one daily and one weekly household chore to complete.

d.

A patient calls a parent daily concerning decisions such as what to prepare for dinner.

ANS: C

Characteristics of a functional family include children assuming age-appropriate responsibility and enjoying age-appropriate responsibility. The remaining options reflect examples of dysfunctional family characteristics.

DIF: Cognitive Level: Application REF: Text Page: 139

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. Which interview information could indicate the need for further assessment of a potential problem with a patients family functioning?

a.

The patient spends time away from the family, taking both a weekly art and dance class.

b.

Every other week, the patient visits aging parents who live 1 hour away.

c.

The patient and spouse resolve problems on their own, although it often takes several hours.

d.

The patient often grounds the children for misbehavior in an attempt to raise them the right way.

ANS: D

In a healthy family the preservation of a positive emotional climate is more highly valued than doing what is right. If the children are often grounded for infractions of rules, this may be an indicator of less-than-optimal family functioning, and this warrants further assessment by the nurse. The remaining options represent indicators of a functional family, including effective problem resolution, maintenance of emotional contact across generations, and the promotion of personal growth and creativity, respectively.

DIF: Cognitive Level: Application REF: Text Page: 139

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4. A psychiatric nurse working within a competence paradigm would emphasize which of the following when working with a patient with an anxiety disorder?

a.

Use of natural family support networks

b.

Prevention of negative patient outcomes

c.

The view of anxiety disorder as a disease

d.

Treatment of dysfunctional characteristics

ANS: A

A competence paradigm promotes the use of natural support networks, focuses on growth-producing behaviors rather than treatment of problems or negative outcomes, and uses a health-based developmental model rather than a disease-based medical model.

DIF: Cognitive Level: Application REF: Text Page: 141

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5. Which statement confirms that a nurse approaches working with mentally ill patients from a pathology paradigm?

a.

The patient made some important gains during the group session today. The patient was able to identify two strategies for coping with stressors to use after discharge.

b.

Its understandable that the patient keeps getting readmitted. The family dysfunction that the patient has to cope with must be such a burden after each discharge.

c.

During our session today, I hope to be able to get the patient to share more about the familys cultural background.

d.

The patient has not yet fully grasped the concept of being a full partner in the process of care and in setting goals for functioning after discharge.

ANS: B

A pathology paradigm focuses on a disease-based medical model and a view of families as being pathological, pathogenic, or dysfunctional. The competence paradigm focuses on adaptive behaviors, care that is congruent with culture, and a cooperative partnership between patient and health care providers.

DIF: Cognitive Level: Application REF: Text Page: 141

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

6. A psychiatric nurse is sharing information with a patient and family about psychoeducational programs offered by the National Alliance on Mental Illness (NAMI). The nurse explains that which objective is the primary purpose of such programs?

a.

Enhancing compliance with medication therapy

b.

Reducing hospital readmission rates

c.

Evaluating effectiveness of therapy

d.

Providing education and support

ANS: D

Psychoeducational programs for families are designed primarily for education and support. Their aim is to improve the course of the family members illness, reduce relapse rates, and improve patient and family functioning. The remaining options represent more specific goals that are part of the overall purpose.

DIF: Cognitive Level: Application REF: Text Page: 141

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

7. A psychiatric nurse is helping to plan an educational program for families of mentally ill patients. The title of the program is Enhancing Personal and Family Effectiveness. Which topic should the nurse include in developing this program?

a.

Legal issues

b.

Conflict resolution

c.

Hygiene and appearance

d.

Prescribed medications

ANS: B

Programs designed to enhance personal and family effectiveness would most likely focus on topics such as behavior management, conflict resolution, communication skills, problem solving, stress management, assertiveness training, achieving a family balance, and meeting personal needs.

DIF: Cognitive Level: Application REF: Text Page: 142

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

8. A nurse is educating a patients family about becoming involved in the patients treatment plan. Which belief held by the nurse would be a barrier to such education?

a.

The family system perpetuates the patients illness.

b.

Alliance with the family will not interfere with patient confidentiality.

c.

Services provided to families are as important as those provided to patients.

d.

An alliance with the family supports the nurses relationship with the patient.

ANS: A

Barriers to educating families for involvement in their loved ones treatment include professional bias against families based on exposure to family-system theories that suggest families cause or perpetuate the illness. The remaining options are true and do not represent a barrier to family education.

DIF: Cognitive Level: Application REF: Text Page: 142

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

9. The symbolic interactionism theoretical model helps explain the:

a.

hypotheses explaining why patients with schizophrenia hear voices.

b.

basis for social difficulties experienced by patients with bipolar disorder.

c.

impact that living with a mentally ill person has on their family structure.

d.

relative lack of support for mentally ill patients of certain U.S. subcultures.

ANS: C

Family literature is available to help nurses understand family burden. The symbolic interactionism model explains family attitudes, beliefs, and behaviors toward the ill person in terms of the symbolic meaning that the experience of living with the ill person has for each family member.

DIF: Cognitive Level: Comprehension REF: Text Pages: 142-143

TOP: Nursing Process: N/A MSC: NCLEX: Psychosocial Integrity

10. When providing education for families of mentally ill patients, the nurse realizes that which of the following organizations places the most importance on this intervention?

a.

The Managed Care Association

b.

National Alliance on Mental Illness

c.

American Psychiatric Nurses Association

d.

New Freedom Commission on Mental Health

ANS: D

The New Freedom Commission on Mental Healths report Achieving the Promise: Transforming Mental Health Care in America sites family involvement in the care of the mentally ill as a goal of treatment. While the other options are related to the care of the mentally ill, they are not as focused on family education as is the correct option.

DIF: Cognitive Level: Comprehension REF: Text Page: 142

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

11. When using symbolic interactionism, which question should a nurse use to best gain an understanding of the experiences of the family of a patient with schizophrenia?

a.

What situations create stress in your family at this time?

b.

What are the transportation costs of traveling to and from therapy sessions?

c.

Is there always enough money to pay the family bills and pay for therapy?

d.

Have things become better at home since your family member was discharged last time?

ANS: A

Symbolic interactionism suggests that the nurse learn to walk in the shoes of family members by asking questions that elicit a description of their situation. The correct option is such a question. While inquiring about the situation at home since the patients discharge is partially correct because it seeks to elicit the familys view, it is a closed-ended question and is narrower in scope. The remaining options are inappropriate because they are factual and do not increase understanding of the lived experience of family members.

DIF: Cognitive Level: Analysis REF: Text Pages: 142-143

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

12. A patient experiences frequent recurring bouts of bipolar illness. Which member of the patients family is likely to be most profoundly and negatively affected by the patients illness?

a.

Her mother

b.

Her child

c.

Her husband

d.

Her adult sister

ANS: B

Children of mentally ill parents face great difficulty. They are at high risk for problems with trust and intimacy, identity, self-esteem, and dependence on the approval of others.

DIF: Cognitive Level: Application REF: Text Page: 143

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

13. When dealing with the family of a patient being admitted to a psychiatric unit, the nurse should give priority to the possibility that family members may:

a.

also be in need of support.

b.

view the staff in a negative light.

c.

be relieved that someone else is responsible for the patient care.

d.

want more information sharing than confidentiality rules allow.

ANS: A

The family members needs and concerns have priority since their status often has a direct impact on the patient.

DIF: Cognitive Level: Application REF: Text Page: 144

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

14. A parent accompanies an adult patient to an outpatient clinic. During an interview the nurse is primarily focused on the possibility that the parent:

a.

may be contributing to the patients problem.

b.

is a potential source of valid patient-focused information.

c.

will be vital in supporting prescribed medication compliance.

d.

may minimize the patients symptoms in order to reduce a sense of guilt.

ANS: B

A family member is often a valuable source of information. Viewing the family as a part of the problem is an older, outdated approach to mental illness. Medication compliance is impacted by many factors, and there is no evidence to support that the parent will distort any information.

DIF: Cognitive Level: Application REF: Text Page: 144

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

15. To plan and budget for preventive services, a nurse in charge of a community mental health center has reviewed the records to discern how many families received services in the current year. To estimate the need for the coming year, the nurse should:

a.

increase the allocation, because most eligible families are underserved.

b.

decrease the allocation, because most eligible families are overserved.

c.

interview the families currently being supported to determine valid needs.

d.

ask for a consultant to ascertain community interest in preventive services.

ANS: A

Many families who are eligible for preventive services do not avail themselves of these services. As families become more aware of services, budgets will need to be increased.

DIF: Cognitive Level: Application REF: Text Page: 145

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

16. A patient accompanied by a sibling has returned to the hospital because of a recurrence of bipolar disorder. The admitting nurse notes that the sibling seems disinterested in the admitting process. The nurse should act on the thought that the sibling:

a.

may be quiet by nature.

b.

is probably thankful for the admission.

c.

may be feeling hurt, anger, or resentment.

d.

may not fully understand the admission process.

ANS: C

Hurt, anger, and resentment are common emotions among families with mentally ill members. The nurse should assess for this and give support as necessary.

DIF: Cognitive Level: Application REF: Text Page: 143

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

17. Which observation best demonstrates that a patient is a member of a well functioning family?

a.

Family members openly discuss the patients needs and how to meet them effectively.

b.

The patient looks forward to family members visits and is less stressed after they spend time together.

c.

The patient asks for his family members input when making a decision and generally seeks their approval.

d.

Family members are likely to provide the patient with suggestions on what should be done and when it should be done.

ANS: A

One characteristic of a well-functioning family is open, effective communication among its members. The remaining options reflect a controlling and dependent relationship.

DIF: Cognitive Level: Application REF: Text Page: 139

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

18. A nurse has established a helping relationship with the family of a mentally ill patient. This relationship should focus on:

a.

the patient and the patients needs.

b.

family attending educational sessions.

c.

family concerns with burden and grief.

d.

helping the family members meet their own needs.

ANS: D

Foci for collaboration with family are as follows: offering information on mental illness, improving family communication and problem solving, helping with service-system use, helping family members meet their own needs, and addressing special issues concerning the patient and concerning the family.

DIF: Cognitive Level: Application REF: Text Page: 146

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

19. When a family is having difficulty adjusting to the burden of having a mentally ill family member, which is the most therapeutic resource of ongoing support a nurse can suggest to the family?

a.

American Medical Association (AMA)

b.

National Alliance on Mental Illness (NAMI)

c.

American Psychiatric Nurses Association (APNA)

d.

National League for Nursing (NLN)

ANS: B

With chapters across the United States, the National Alliance on Mental Illness (NAMI) offers support and education for mentally ill patients and their families. AMA is the American Medical Association. APNA is the American Psychiatric Nurses Association. The National League for Nursing (NLN) is a professional nursing organization.

DIF: Cognitive Level: Application REF: Text Page: 146

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

MULTIPLE RESPONSE

1. Which aspect of a family is likely to be determined or influenced by cultural or ethnic differences? (Select all that apply.)

a.

Beliefs governing family relationships

b.

Family norms regarding what is right and wrong

c.

How outside events are perceived and interpreted

d.

Educational level family members are allowed to achieve

e.

Career family members are encouraged to pursue as adults

ANS: A, B, C

Culture within a family often determines the definition of family, the beliefs governing family relationships, the conflict and tensions present in the family and the responses (adaptive or maladaptive) to them, the norms of the family, how outside events are perceived and interpreted, and the type and frequency of family interventions that will be most effective. The educational level and careers that family members achieve or select are less closely linked to culture than the other options presented.

DIF: Cognitive Level: Comprehension REF: Text Pages: 139-140

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. A nurse constructing a family genogram for an adult patient would necessarily include which family member mentioned by the patient? (Select all that apply.)

a.

Brother

b.

Stepson

c.

Aunt

d.

Adopted brother

e.

Great-grandmother

ANS: A, B, C, D

A genogram typically includes three generations and includes the patient. Thus a great-grandparent may not necessarily be included in a genogram for an adult patient. The genogram includes first-degree relatives, such as parents, siblings, and children, as well as second-degree relatives, such as aunts and uncles, nieces and nephews, grandparents, and grandchildren. All family members by marriage, partnership, or adoption and step-family members also are included.

DIF: Cognitive Level: Comprehension REF: Text Page: 140

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

3. Which item would not be included by a nurse when using the family APGAR tool as an assessment measure of family roles and relationships? (Select all that apply.)

a.

Nurturing

b.

Decision making

c.

Recreational activities

d.

Emotional experiences

e.

Allocation of earned income

ANS: A, B, D, E

The family APGAR tool can be used to explore family roles and relationships. It includes an assessment of how resources, decisions, nurturing, emotional experiences, time, space, and money are shared within the family.

DIF: Cognitive Level: Comprehension REF: Text Page: 140

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

4. Which component would be part of a comprehensive program for working with families of mentally ill patients? (Select all that apply.)

a.

Skill

b.

Social

c.

Debate

d.

Emotional

e.

Family process

ANS: A, B, D, E

Comprehensive programs for working with families should include a didactic component, a skill component, an emotional component, a family process component, and a social component. Debate is not part of the structure of these programs.

DIF: Cognitive Level: Knowledge REF: Text Page: 141

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

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