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Chapter 1: Family Health Care Nursing: An Introduction
Multiple Choice:
1. The nurse is transferring to a care area that focuses on family nursing practice. What should the nurse realize about this approach to care? 1. Interventions in family care address the future plans for the family. 2. Family members must be present before the implementation of family care. 3. Resources are placed to support an ill family member with the greatest chance for recovery. 4. The nurse and family together define the family and where therapeutic energy should be placed.
2. The nurse notes that a client has been previously married and participates in raising the current spouse’s children from a previous marriage. How should the nurse document this family type? 1. Extended 2. Cohabitation 3. Nuclear dyad 4. Reconstituted
3. The nurse prepares an in-service program on family nursing for new graduate employees. Which definition of family is the best one for the nurse to use? 1. Members of a family are self-defined 2. People who share strong emotional ties 3. A family is defined by blood ties, adoption, and marriage 4. A group of people who live together with or without legal or biological ties
4. The nurse prepares to assess a client whose family is being used as a resource. Which approach to family nursing care is the nurse implementing? 1. Family as client
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2. Family as system 3. Family as context 4. Family as component of society
5. During a home visit the nurse teaches the client and family about actions to reduce the spread of infection between the family members. Which role is the nurse implementing? 1. Counselor 2. Care deliverer 3. Health teacher 4. Family advocate
6. The nurse stays with a client who is having chemotherapy for the first time until the family arrives. Which role is the nurse implementing with the client? 1. Surrogate 2. Researcher 3. Role model 4. Case manager
7. The spouse of a client with complex care needs is unavailable to attend a care conference at 2 p.m. What should the nurse do to support family nursing care? 1. Have the client attend in place of the spouse 2. Schedule the conference when the spouse is available 3. Ask the spouse to telephone in during the time of the conference 4. Provide the spouse with outcomes determined during the meeting
8. The nurse observes parents discussing an adolescent’s plans for the weekend and setting boundaries to which the adolescent agrees. Which function did this family unit demonstrate? 1. Affective 2. Economic 3. Health care
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9. The adult daughter of an older client is expected to be at the client’s bedside yet personal family responsibilities are not being completed. Which family interactional process is the daughter experiencing? 1. Role strain 2. Role conflict 3. Role ambiguity 4. Role expectations
Multiple Response:
10. The nurse prepares to assess a family during a home visit. Which traits should the nurse expect that demonstrate a healthy family? Select all that apply. 1. Develops suspicion among members 2. Exhibits a sense of shared responsibility 3. Admits to and seeks help with problems 4. Enforces participation in rituals and tradition 5. Shares leisure time
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Answers:
1. The nurse is transferring to a care area that focuses on family nursing practice. What should the nurse realize about this approach to care? Ans: 4 Page: 9 1. 2. 3. 4.
Feedback Family care is concerned with the experience of the family over time. It considers both the history and the future of the family group. The physical absence of family members does not preclude the nurse from offering family care. Family nursing is directed at families whose members are both healthy and ill regardless of the severity of the illness in the family member. The intervention that “family nurses must define with the family which persons constitute the family and where they will place their therapeutic energies” is an intervention used by family nurses to provide structure to working with families regardless of the theoretical underpinning of the nursing approach. This is an enduring idea that supports the practice of family nursing.
2. The nurse notes that a client has been previously married and participates in raising the current spouse’s children from a previous marriage. How should the nurse document this family type? Ans: 4 Page: 16
1. 2. 3. 4.
Feedback An extended family is defined as two or more adult generations and one that includes grandparents and grandchildren living in the same household. A cohabitation family type is defined as an unmarried couple sharing a household who are involved in an emotional and/or sexually intimate relationship. A nuclear dyad is defined as a married couple with no children. A reconstituted or blended family type is defined as an arrangement in which one or more of the parents was previously married and brings children from the previous marriage into the current marriage.
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3. The nurse prepares an in-service program on family nursing for new graduate employees. Which definition of family is the best one for the nurse to use? Ans: 1 Page: 5
1. 2. 3. 4.
Feedback The definition of family that is most inclusive and takes the individual family members into consideration is that the members of a family are self-defined. The definition that a family is made up of people who share strong emotional ties is a psychological definition of a family. The definition that a family is defined by blood ties, adoption, and marriage is a legal definition of a family. The definition that a family is a group of people who live together with or without legal or biological ties is a sociological definition of a family.
4. The nurse prepares to assess a client whose family is being used as a resource. Which approach to family nursing care is the nurse implementing? Ans: 3 Page: 9
1.
2.
3.
4.
Feedback The second approach to family nursing care centers on the assessment of all family members. The family nurse is interested in the way all the family members are individually affected by the health event of one family member. In this approach, all members of the family are in the foreground. The third approach to care views the family as a system. The focus in this approach is on the family as a whole as the client; here, the family is viewed as an interactional system in which the whole is more than the sum of its parts. In other words, the interactions between family members become the target for the nursing interventions. The first approach to family nursing care focuses on the assessment and care of an individual client in which the family is the context. This is the traditional nursing focus, in which the individual is foreground and the family is background. The family serves as context for the individual as either a resource or a stressor to the individual’s health and illness. The fourth approach to care looks at the family as a component of society, in which the family is viewed as one of many institutions in society, similar to health, educational,
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religious, or economic institutions. The family is a basic or primary unit of society, and it is a part of the larger system of society.
5. During a home visit the nurse teaches the client and family about actions to reduce the spread of infection between the family members. Which role is the nurse implementing? Ans: 3 Page: 13
1. 2.
3. 4.
Feedback As a counselor, the family nurse has a therapeutic role in helping individuals and families solve problems or change behavior. As a care deliverer, the family nurse either delivers or supervises the care that families receive in various settings. To do this, the nurse must be a technical expert both in terms of knowledge and skill. The family nurse teaches about family wellness, illness, relations, and parenting. As an advocate the family nurse advocates for families and empowers family members to speak with their own voices, or the nurse speaks out for the family.
6. The nurse stays with a client who is having chemotherapy for the first time until the family arrives. Which role is the nurse implementing with the client? Ans: 1 Page: 14
1. 2. 3. 4.
Feedback The family nurse serves as a surrogate by substituting for another person, such as when he or she stays with the client until family arrives. As a researcher, the family nurse identifies practice problems and finds the best solution for dealing with these problems through the process of scientific investigation. The family nurse is continually serving as a role model to other people, demonstrating positive health actions and strategies. As a case manager the nurse coordinates and collaborates between a family and the health care system.
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7. The spouse of a client with complex care needs is unavailable to attend a care conference at 2 p.m. What should the nurse do to support family nursing care? Ans: 2 Page: 14
1. 2.
3. 4.
Feedback It is inappropriate to expect an ill client to attend a care conference. One obstacle to family nursing practice is the hours for care. Because the spouse is not available during the scheduled meeting, the approach to overcome this obstacle is to schedule the meeting when the spouse can attend. The spouse is not available. Telephoning in for the conference is not appropriate. Providing the spouse with the outcomes of the meeting does not take the family’s needs into consideration and violates the purpose of the meeting.
8. The nurse observes parents discussing an adolescent’s plans for the weekend and setting boundaries to which the adolescent agrees. Which function did this family unit demonstrate? Ans: 1 Page: 19
1.
2. 3. 4.
Feedback The affective function, one of the basic functions of family, is essential for creating a harmonic and stable environment, and optimal for healthy child development and for the satisfaction of all family members. Affective function has to do with the ways family members relate to one another and those outside the immediate family boundaries. Well-functioning families are able to maintain a consistent level of involvement with one another, yet at the same time not become too involved in each other’s lives. The economic function of the family is focused on providing the necessities of food, clothing, and shelter for the family members. The health care function of the family is when the family learns how to maintain, protect, and restore health. The family is the first and one of the most influential settings for socialization. Families are the primary source of individual development and the primary setting in which children begin to acquire the beliefs, attitudes, values, and behaviors considered
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appropriate to society. This situation does not demonstrate family socialization.
9. The adult daughter of an older client is expected to be at the client’s bedside yet personal family responsibilities are not being completed. Which family interactional process is the daughter experiencing? Ans: 2 Page: 23-24
1. 2.
3. 4.
Feedback Role strain occurs when the person lacks knowledge about performance of a role. Role conflict occurs when expectations about familial roles are incompatible. The adult daughter needs to help an aging parent; however, she is also expected to maintain personal role functions. Role ambiguity occurs when the person does not know what to do in a situation. Role expectations occur when a person who is performing a role is expected to pick up additional responsibilities and incorporate them into the current role.
10. The nurse prepares to assess a family during a home visit. Which traits should the nurse expect that demonstrate a healthy family? Select all that apply. Ans: 2, 3, 5 Page: 6
1. 2. 3. 4. 5.
Feedback A healthy family fosters trust and respect instead of fostering suspicion. A trait common to healthy families is exhibiting a sense of shared responsibility. A trait common to healthy families is admitting to and seeking help with problems. A healthy family welcomes rituals and traditions but does not enforce participation in such family practices. A trait common to healthy families is sharing leisure time.
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Chapter 2: Theoretical Foundations for the Nursing of Families
Multiple Choice:
1. The nurse reviews potential theories to use as a guide for providing care to a family in the community. What should the nurse keep in mind as a major function of theory in family nursing? 1. Identifies a specific hypothesis 2. Answers “How?” or “Why?” questions 3. Examines how the concepts create a meaningful pattern 4. Improves nursing services provided to families
2. The nurse reviews a theory for applicability to a family health situation. On which part of the theory should the nurse focus in order to understand the expected relationship between the theory’s concepts? 1. System 2. Hypothesis 3. Propositions 4. Conceptual model
3. The nurse prepares to assess a family according to a family development theory. Which action will the nurse complete first during this assessment? 1. Health of individual members 2. Employment status of the parents 3. Family structure and life cycle stages 4. Education status of the children
4. The nurse is struggling with using a developmental model when assessing a family new to a community. Which data could explain the difficulty the nurse is having using this model? 1. The parental units are same-sexed. 2. The youngest son is beginning college. 3. The middle child is attending high school. 4. The oldest daughter has just gotten married.
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5. The nurse uses the bioecological system theory to assess a family. On which system should the nurse focus to determine the impact of the mother’s change in employment? 1. Mesosystem 2. Exosystem 3. Microsystem 4. Macrosystem
6. The nurse reviews the bioecological system theory before discussing this approach with a group of new graduate nurses. What should the nurse explain as the blueprint for the ecology of human and family development? 1. There is no one system that can serve as a blueprint. 2. Macrosystems contain mesosystems and exosystems. 3. The microsystem sets the stage for all future development. 4. Sociohistorical conditions determine developmental progress.
7. The nurse works in an environment in which a family therapy theory serves as the model for assessing and planning care. Which data should the nurse expect when assessing the family? 1. Pathology 2. Health problem 3. Illness treatment 4. Normal trajectory
Multiple Response:
8. The nurse selects the family systems theory as a guide for providing care to a family. Which concept of this theory should the nurse use to maintain the stability of this family? Select all that apply. 1. The whole is more than the sum of its parts. 2. All parts of the system are interconnected. 3. Families develop and change over time. 4. Systems can be organized into subsystems.
Rowe Family Health Care Nursing, 6e 5. There is a boundary between the system and the environment.
9. The nurse learns that the father of a family passed away at age 41. How should the nurse classify this family event in relation to family development theory? Select all that apply. 1. On time 2. Off time 3. Normative 4. Conflicting 5. Nonnormative
10. The nurse prepares to employ the family systems theory to assess a family. Which actions will the nurse complete during this assessment? Select all that apply. 1. Complete a family ecomap 2. Determine normative and nonnormative events 3. Complete a family genogram 4. Conduct family member care-planning sessions 5. Collect data on the family and individual members
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Answers:
1. The nurse reviews potential theories to use as a guide for providing care to a family in the community. What should the nurse keep in mind as a major function of theory in family nursing? Ans: 4 Page: 29 1. 2. 3. 4.
Feedback Theories construct hypotheses, or the question, “What is expected to happen?” Theories in general explain what is happening; they provide answers to “How?” and “Why?” questions, help to interpret and make sense of complex phenomena, and predict what could happen in the future based on careful thought and study about what has happened in the past. Theories are designed to make sense of the world by showing how one concept is related to another and how together they make a meaningful pattern that can predict the consequences of certain clusters of characteristics or events. The major function of theory in family nursing is to provide knowledge and understanding that improves nursing services to families.
2. The nurse reviews a theory for applicability to a family health situation. On which part of the theory should the nurse focus in order to understand the expected relationship between the theory’s concepts? Ans: 2 Page: 29
1. 2. 3. 4.
Feedback System is not part of a theory. A hypothesis is a way of stating an expected relationship between concepts or an expected proposition. Propositions are statements about the proposed relationship between two or more concepts. A conceptual model is a set of general propositions that integrate concepts into meaningful configurations or patterns.
3. The nurse prepares to assess a family according to a family development theory. Which action will the nurse complete first during this assessment?
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Ans: 3 Page: 45-46
1. 2. 3.
4.
Feedback The health of individual members is analyzed according to the impact on the entire family unit. The employment status of the parents is not a specific feature of family development theory. When conducting family assessments using the developmental model, nurses begin by determining the family structure and where this family falls in the family life cycle stages. The children’s education is addressed after the family structure and life cycle stage is identified.
4. The nurse is struggling with using a developmental model when assessing a family new to a community. Which data could explain the difficulty the nurse is having using this model? Ans: 1 Page: 47
1.
2. 3. 4.
Feedback A primary criticism of family development theory is that it best describes the trajectory of intact, two-parent, heterosexual nuclear families. It does not consider same-sex couples and normalizes one type of family while ignoring others. Children leaving home to go to college would be an expected trajectory within the developmental model. Children progressing through basic education would be an expected trajectory within the developmental model. Children leaving home or “launching” is an expected trajectory within the developmental model.
5. The nurse uses the bioecological system theory to assess a family. On which system should the nurse focus to determine the impact of the mother’s change in employment? Ans: 2
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Page: 49
1.
2. 3.
4.
Feedback Mesosystems are the relationships among major microsystems in which persons or families actively participate, such as families and schools, families and religion, and families with peers. An exosystem is an external environment that influences an individual and family indirectly such as the effect of job experience on family life. Microsystems are the settings in which individuals/families experience and create dayto-day reality. They are the places people inhabit, the people with whom they live, and the things they do together. Macrosystems are the broad cultural attitudes, ideologies, or belief systems that influence institutional environments within a particular culture/subculture in which individuals/families live.
6. The nurse reviews the bioecological system theory before discussing this approach with a group of new graduate nurses. What should the nurse explain as the blueprint for the ecology of human and family development? Ans: 2 Page: 49
1. 2. 3. 4.
Feedback Mesosystems and exosystems, within macrosystems, serve as blueprints. Mesosystems and exosystems are set within macrosystems, and together they are the “blueprints” for the ecology of human and family development. The microsystem is the setting for day-to-day reality. It does not serve as a blueprint for the family’s development. Chronosystems are time-related contexts that effect the other systems and are influenced by sociohistorical conditions.
7. The nurse works in an environment in which a family therapy theory serves as the model for assessing and planning care. Which data should the nurse expect when assessing the family? Ans: 1
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Page: 34
1. 2. 3. 4.
Feedback The target population for family therapy theories is families with pathology or troubled families. The target population for any nursing theory is families with health problems. The target population for any nursing theory is families with illness treatment. The target population for a family social science theory is a “normal” family with an expected trajectory.
8. The nurse selects the family systems theory as a guide for providing care to a family. Which concept of this theory should the nurse use to maintain the stability of this family? Select all that apply. Ans: 1, 2, 4, 5 Page: 39-40
1.
2.
3. 4.
5.
Feedback The second concept of the family systems theory is that the whole is more than the sum of its parts. This means that the family as a whole is composed of more than the individual lives of family members. It goes beyond parents and children as separate entities. Families are not just relationships between the parent-child but are all relationships seen together. The first concept of the family systems theory is that all parts of the system are interconnected. This means that whatever influences one part of the system influences all parts of the system. The concept that families develop and change over time is a concept associated with family development theories. The fourth concept in the family systems theory is that systems can be further organized into subsystems. These subsystems identify relationships between family members and are used to create interventions specific to the needs of those members. The third concept is that all systems have some form of boundary between the system and the environment. Boundaries are physical or abstract imaginary lines that families use as barriers or filters to control the impact of stressors on the family system.
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9. The nurse learns that the father of a family passed away at age 41. How should the nurse classify this family event in relation to family development theory? Select all that apply. Ans: 2, 5 Page: 43
1.
2.
3. 4. 5.
Feedback On time refers to a family transition within family development theory. It is considered to be “on time” when a family unit experiences something that is considered a societal norm such as being married before having children. Off time refers to a family transition within family development theory. It is considered to be “off time” when a family unit experiences something that is against a societal norm such as having children before being married. Normative refers to a predictable change that occurs within a family based on expected developmental steps. Conflicting is not a term or concept related to family development theory. Nonnormative refers to a change in a family that occurs out of sequence or is caused by an illness or other family event.
10. The nurse prepares to employ the family systems theory to assess a family. Which actions will the nurse complete during this assessment? Select all that apply. Ans: 1, 3, 4, 5 Page: 34-35
1. 2. 3. 4. 5.
Feedback A family ecomap is completed to see how individuals and the family relate to the community around them. Determining normative and nonnormative events is an action completed when following a family development and life cycle theory. A family genogram is completed to understand patterns and relationships over several generations over time. Care-planning sessions are held to address the needs of individual members and the family as a whole. Assessment questions relate to the interaction between the individual and the family, and the interaction between the family and the community in which the family lives.