Chapter 12: A Family Perspective in Community/Public Health Nursing Nursing School Test Banks

Chapter 12: A Family Perspective in Community/Public Health Nursing
Test Bank

MULTIPLE CHOICE

1. When a home health nurse visits a family for the first time, what is the nurses primary goal?
a. Complete physical examinations on as many family members as time allows.
b. Have the family complete as many assessment tools as time allows.
c. Make sure all records, including third-party payer information, are accurate.
d. Observe and interview the family to identify family strengths and needs.
ANS: D
Although all these activities may be performed and may be of importance, the most important first task is to gather information and plan care with the family, on basis of the familys resources and strengths.

DIF: Cognitive Level: Application REF: pp. 323-324

2. After completing an assessment, the nurse discusses with the family some actions that needed to be taken and refers to the wife in the family as an incredible organizer. Which of the following goals is the nurse trying to achieve by making this statement?
a. Making the husband proud that he had married his wife
b. Making the wife feel very complimented and positive
c. Encouraging the wife to volunteer to follow through on all the needed actions
d. Reinforcing for the family some of the strengths of one of their family members
ANS: D
Although such positive comments may have made everyone feel better, the nurse was also validating the presence of a strength, which made the strength more evident and thereby helped the family perceive one of their strengths.

DIF: Cognitive Level: Application REF: p. 326

3. Upon what variable are Duvalls developmental stages based?
a. Age of the oldest child
b. Age of the parent or parents
c. Family function
d. Family structure
ANS: A
Duvall defined developmental tasks and stages of the family life cycle according to the age of the oldest child in an ideal family structure of father, mother, and children.

DIF: Cognitive Level: Knowledge REF: p. 326

4. Why would a family strenuously resist the nurses efforts to be helpful?
a. People have the tendency to want to stay the same.
b. The family as a system operates on the principle of equifinality.
c. The nurse crossed the familys coping boundary.
d. The family system is trying to achieve entropy.
ANS: A
As a system, the family will want to stay the same (morphostasis) and will therefore resist change, even when a suggested change would be helpful.

DIF: Cognitive Level: Comprehension REF: p. 327

5. After completing an assessment and discussing the plan of care with the family, upon which member would the nurse focus effort?
a. The adult patient with the acute flare-up of chronic illness
b. The child who, being young, was energetic and enthusiastic
c. The extended family, who had to learn to become a resource
d. The spouse, who was flexible and able to cope
ANS: D
Change occurs most often when the member of the system who is most flexible and has some power in the family makes a change. Hence, the nurse will target intervention with the members in the system who have the strength and adaptability to carry out the intervention.

DIF: Cognitive Level: Application REF: p. 328

6. In the midst of anxiety and concern over the new diagnosis, it seems that every family member was distancing himself or herself from the rest of the family. What mechanism would the nurse recognize that the family members are using?
a. Anger reduction strategies
b. Double-bind communication
c. Circumplex modeling
d. Triangling
ANS: D
People often try to maneuver into a distant position in a triangle to escape tension. Triangles are usually dynamic and changing as various family members engage in stressful situations. Although this strategy may be used to reduce anger, it is an example of triangling. Double-bind communication sends two conflicting messages. The Circumplex Model of family systems demonstrates how adaptability and cohesion interact within families.

DIF: Cognitive Level: Application REF: p. 329

7. The nurse is caring for a family who is very anxious and tense. Which of the following would be the most appropriate nursing intervention?
a. Being supportive as the family debates what should be done about the problems
b. Calmly discussing the familys perception of their problems and coping mechanisms
c. Sharing with the family the interventions to be made and the goal of the interventions
d. Telling the family what should be done to reduce their anxiety and fearfulness
ANS: B
When families are very anxious and tense, the nurse should remain very calm in order to thoughtfully relate to the family. Such an approach is more effective than trying to find a way to fix the family problems.

DIF: Cognitive Level: Application REF: pp. 329-330

8. Which of the following would be better understood by the nurse after using a family map?
a. Recognition of the communicator and leader who speaks for the family
b. Description of the genogram or family tree of the family
c. Identification of the geographic location of neighborhood resources for the family
d. Roles and relationships within the family
ANS: D
A family map is used to diagram spatial and relationship qualities of a family system and to understand hierarchies and roles, as well as subsystems, their boundaries, and their interactions.

DIF: Cognitive Level: Application REF: p. 330

9. Which of the following statements would be the most accurate description of symbolic interaction in a family?
a. Behaviors of one person are the cause of behaviors in another family member.
b. Behaviors of one person are the effect of behaviors in another family member.
c. Behaviors of one person are both the cause and the effect of behaviors in another family member.
d. Behavior within the family is consistent, patterned, and repetitious.
ANS: C
Symbolic interaction is the way in which family members interact with each other. Behaviors of one person are both the cause and the effect of behaviors in another family member.

DIF: Cognitive Level: Comprehension REF: pp. 330-331

10. A community/public health nurse is working with a family who is having difficulty with communication. Which of the following behaviors would cause the nurse to be concerned?
a. Family members communicate through behaviors and verbal statements.
b. Family members use rules to regulate behaviors in the family.
c. Family members use double-bind messages.
d. Family members communicate through metacommunication.
ANS: C
Communication should be open, honest, direct, and congruent with internal feelings. Metacommunication occurs as messages have both a literal meaning and inform about feelings. All behavior communicates, but double-bind communication, in which two conflicting messages are sent, makes it impossible to respond appropriately because the messages are contradictory.

DIF: Cognitive Level: Application REF: p. 331

11. A nurse has completed an assessment and diagnosed a familys problems. Which of the following actions should the nurse take next?
a. Determining which problem should be addressed first
b. Emphasizing the familys adaptability, strengths, and resources
c. Sharing conclusions with the nurses employing agency
d. Writing the diagnoses in the order of their priority
ANS: B
Family theories have changed from concentrating on the pathologic process within families to focusing on family strengths, resources, and adaptability. The primary resource the nurse has to use in assisting the family is the familys adaptability, strengths, and resources.

DIF: Cognitive Level: Application REF: p. 331

12. According to the ABCX model, with which of the following feelings or behaviors will a typical family react after a crisis occurs?
a. Disorganization, recovery, and then reorganization
b. Grief, anger, denial, and then frustration
c. Loss, confusion, and then seeking answers
d. Shock, denial, and then acceptance
ANS: A
The family is thought to experience a rollercoaster course of adjustment, a process that involves disorganization, recovery, and a subsequent level of reorganization. Although some crises may involve loss and hence stages of grief, crisis can also result from a positive change or event, which also requires adaptation.

DIF: Cognitive Level: Comprehension REF: p. 331

13. What are the two phases that families experience after a major life event?
a. Asking for help and accepting assistance
b. Seeking assistance and relying on the familys own resources
c. Temporary adjustment and long-term adaptation
d. Reduction of stressors and adapting to reduce tensions
ANS: C
According to the resiliency model, families respond to life events and transitions in two phases: the adjustment phase, which consists of transitory changes families make in response, and the adaptation phase.

DIF: Cognitive Level: Knowledge REF: p. 332

14. Which of the following variables makes some families more vulnerable to dysfunction than others in facing a particular crisis?
a. A family members moving away
b. Addition of a new family member
c. Additional stressful events
d. Previous experience with stressful events
ANS: C
The more events being experienced by the family, the more vulnerable the family will be.

DIF: Cognitive Level: Knowledge REF: p. 332

15. Which of the following actions should a community/public health nurse perform when providing care with the use of a family perspective?
a. Assessing all individuals for necessary services and interventions
b. Engaging in therapy on the basis of theories of communication and symbolic interaction
c. Maximizing the health and well-being of all individuals within a family
d. Suggesting appropriate roles for various family members during a crisis
ANS: C
All baccalaureate nursing graduates can conduct basic family assessments and interventions. Family nursing maximizes the health and well-being of all individuals within a family. This approach includes seeing the family as the unit of care and as the context of care.

DIF: Cognitive Level: Application REF: p. 332

MULTIPLE RESPONSE

1. What are some reasons why community/public health nurses may choose to focus on the family as a unit of care? (Select all that apply.)
a. A family perspective allows for a broader view than an individual perspective.
b. A family perspective results in a better understanding of an individual who needs care.
c. An individuals health depends on his or her family.
d. An individuals ill health will affect the family.
e. The family has always been the unit of focus of nursing care.
f. The family perspective allows for higher reimbursement of nursing care.
ANS: A, B, C, D
A nurse may choose a family perspective because family thinking gives a broader picture than an individual perspective, the family is a unit of care, the family assumes a crucial role in maintaining health, and dysfunction in one member may lead to added stress and depletion of resources for the entire family. Historically and traditionally, nurses have usually focused on the individual as a unit of care. Reimbursement depends on factors other than the nurses perspective as the nurse provides care.

DIF: Cognitive Level: Comprehension REF: p. 334

2. Which of the following information will a nurse need to assist a family trying to cope with developmental changes? (Select all that apply.)
a. A list of credentialed family therapists available as resources
b. Ages of the extended family members
c. Examples of apparent success of the familys previous coping strategies
d. Current family strategies to meet demands
e. The familys knowledge of current developmental demands
f. The familys pattern of using professional health care
ANS: C, D, E
To determine the familys stage in the life cycle in preparation for assisting the family, the nurse should include assessing the familys knowledge of current developmental demands, the strategies they are using to meet these demands, and their success at accomplishing them.

DIF: Cognitive Level: Application REF: p. 334

3. Which of the following actions would be the most appropriate method for the nurse to influence family communication? (Select all that apply.)
a. Emphasizing the importance of listening to professional suggestions
b. Pointing out when a family member communicates inappropriately
c. Role-modeling appropriate communication patterns
d. Stating very clearly and directly what should be done by family members
e. Sharing what the nurse observes about family communication
f. Telling the family members how best to communicate
ANS: C, E
The nurse can influence the family situation by being careful about personal communication. The nurses outside position allows for observation of family communication patterns that can be described to the family. The nurse can also demonstrate open, honest, direct communication, thereby role-modeling appropriate communication patterns. Emphasizing the importance of listening to professional suggestions, pointing out when communication is inappropriate, stating what family members should do, and telling the family how to best communicate are examples of a dominant role of the nurse with the family. The nurses role should be collaborative to encourage improvement in communication patterns.

DIF: Cognitive Level: Application REF: p. 334

4. Which of the following factors help families make the most healthful adjustment possible to a family crisis? (Select all that apply.)
a. Appraising the crisis as a challenge that can be met
b. Experiencing an emotional upheaval, including fear, anger, denial, and frustration
c. Having developed effective problem-solving and coping behaviors
d. Having limited prior experience in dealing with a crisis
e. Having resources such as friends or a church available to help
f. Using distancing as a coping mechanism
ANS: A, C, E
The family type or amount of resiliency, resources (including problem-solving and coping behaviors), and appraisal of the stress lead to adjustment. If the crisis is appraised as a challenge that can be managed, then family members will probably adjust fairly well.

DIF: Cognitive Level: Comprehension REF: p. 336

5. Which of the following nursing interventions can be implemented to assist families? (Select all that apply.)
a. Providing anticipatory guidance for growth and development needs
b. Assisting families with coping with illness or loss
c. Explaining the familys situation so that other people may offer assistance
d. Helping families cope with stressors or a crisis
e. Referring families to sources of assistance or support
f. Obtaining funds or supplies for the family in need
ANS: A, B, D, E
Nurses assist families dealing with growth and development or coping with illness, loss, or external stressors and often give referrals to families with inadequate resources or support. However, nurses do not share information about a family or directly give funds and supplies to a family.

DIF: Cognitive Level: Application REF: p. 336

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