Psychiatric Nursing 7th Edition by Norman L. Keltner Debbie Steele test bank

Psychiatric Nursing  7th Edition by Norman L. Keltner Debbie Steele  test bank
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Chapter 11: Working with the Family

MULTIPLE CHOICE

1. When a nurse assesses a family, which family task has the highest priority to healthy family functioning?
a. Allocation of family resources
b. Physical maintenance and safety
c. Maintenance of order and authority
d. Reproduction of new family members

ANS: B
Physical and safety needs are given greater importance in Maslows hierarchy of needs than other needs.

DIF: Cognitive level: Applying REF: p. 107
TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

2. Which documentation of family assessment indicates a healthy and functional family?
a. Members provide mutual support.
b. Power is distributed equally among all members.
c. Members believe that there are specific causes for events.
d. Under stress, members turn inward and become enmeshed.

ANS: A
Healthy families nurture and support their members, buffer against stress, and provide stability and cohesion. The distracters are unrelated or incorrect.

DIF: Cognitive level: Understanding REF: p. 107
TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

3. A 15-year-old patient is hospitalized after a suicide attempt. The adolescent lives with his mother, stepfather, and several siblings. When performing a family assessment, the nurse must first determine:
a. how the family expresses and manages emotion.
b. the names and relationships of the patients family members.
c. the communication patterns between the patient and parents.
d. the meaning the patients suicide attempt has for family members.

ANS: B
The names and relationships of the patients family members constitute the most fundamental information and should be obtained first. Without this, the nurse cannot fully process the other responses.

DIF: Cognitive level: Analyzing REF: p. 108
TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

4. Which information is the nurse most likely to find when assessing the family of a patient with a serious and persistent mental illness?
a. The family exhibits many characteristics of dysfunctional families.
b. Several family members have serious problems with their physical health.
c. Power in the family is maintained in the parental dyad and rarely delegated.
d. The stress of living with a mentally ill individual has negatively affected family function.

ANS: D
The information almost universally obtained is that the family is under stress associated with having a mentally ill member. This stress lowers the familys level of functioning in at least one significant way. Stress does not necessarily mean the family has become dysfunctional.

DIF: Cognitive level: Understanding REF: p. 108
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity

5. The patients parent asks the nurse, Why do you want to do a family assessment? My child is the patient, not the rest of us. Select the nurses best response.
a. Family dysfunction might have caused the mental illness.
b. Family members provide more accurate information than the patient.
c. Family assessment is part of the protocol for care of all patients with mental illness.
d. Every family members perception of events is different and adds to the total picture.

ANS: D
This response helps the family understand that the opinions of each will be valued. It allows the nurse to assess individual coping and prepares the family for the experience of working together to set goals and solve problems. The other responses are either incorrect or evasive.

DIF: Cognitive level: Applying REF: p. 108
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity

6. An adult diagnosed with paranoid schizophrenia lives with older adult parents. The patient was recently hospitalized with acute psychosis. One parent is very anxious, and the other is ill from all the stress. Select the most applicable nursing diagnosis.
a. Ineffective family coping related to parental role conflict
b. Caregiver role strain, related to the stress of chronic illness
c. Impaired parenting, related to patients repeated hospitalizations
d. Interrupted family processes, related to relapse of acute psychosis

ANS: B
Caregiver role strain refers to a caregivers felt or exhibited difficulty in performing a family caregiver role. In this case one parent exhibits stress-related illness, and the other exhibits increased anxiety. The other nursing diagnoses are not substantiated by the information given and are incorrectly formatted (one nursing diagnosis should not be the etiology for another).

DIF: Cognitive level: Analyzing REF: pp. 108-109
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity

7. An adult recently diagnosed with AIDS is hospitalized with pneumonia. The patient and family are very anxious. Select the best outcome to add to the plan of care for this family.
a. Identify and describe effective coping methods.
b. Describe the stages of the anticipatory grieving process.
c. Recognize the ways dysfunctional communication is expressed in the family.
d. Examine previously unexpressed feelings related to the patients sexuality.

ANS: A
Desired outcomes might be set for the family as a whole or for individuals within the family. The outcome most closely associated with the anxiety that each is experiencing is to focus on identifying and describing ways of coping with the anxiety. The other options are not appropriate at this time.

DIF: Cognitive level: Applying REF: pp. 108-109
TOP: Nursing process: Outcome Identification/Planning
MSC: NCLEX: Psychosocial Integrity

8. A parent is admitted to a chemical dependency treatment unit. The patients spouse and adolescent children participate in a family session. What is the most important aspect of family assessment?
a. Spouses co-dependent behaviors
b. Interactions among family members
c. Patients reaction to the familys anger
d. Childrens responses to the family sessions

ANS: B
Interactions among all family members are the raw material for family problem solving. By observing interactions, the nurse can help the family make its own assessments of strengths and deficits. The other options are too narrow in scope when compared with the correct option.

DIF: Cognitive level: Analyzing REF: pp. 108-109
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity

9. A parent is admitted to a chemical dependency treatment unit. The patients spouse and adolescent children attend a family session. What is the priority assessment question to ask family members?
a. What changes are most important to you?
b. How are feelings expressed in your family?
c. What types of family education would benefit your family?
d. Can you identify a long-term goal for improved functioning?

ANS: B
It is important to understand family characteristics in both the family of origin and the present family. The other questions are related more to outcome identification and planning intervention, neither of which should be attempted until assessment is complete.

DIF: Cognitive level: Analyzing REF: p. 109
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity

10. A nurse interviews a homeless parent with two teenage children. To best assess the familys use of resources, the nurse should ask:
a. Can you describe a problem your family has successfully resolved?
b. What community agencies have you found helpful in the past?
c. Do you feel you have adequate resources to survive?
d. What is one thing you dislike about this family?

ANS: B
The correct option asks about resource use in an open, direct fashion. It will give information about choices that the family has made to use other family members or resources in the community. The other questions do not address prior use of resources.

DIF: Cognitive level: Applying REF: p. 108
TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity

11. Two divorced people plan to marry. The man has a teenager, and the woman has a toddler. This family will benefit most from:
a. guidance about parenting at two developmental levels.
b. role-playing opportunities for conflict resolution.
c. formal teaching about problem-solving skills.
d. referral to a family therapist.

ANS: A
The newly formed family will be coping with tasks associated with the stages of rearing preschool children and dealing with teenagers. These stages require different knowledge and skills. There is no evidence of a problem, so the distracters are not indicated.

DIF: Cognitive level: Applying REF: pp. 107-108 TOP: Nursing process: Planning
MSC: NCLEX: Health Promotion and Maintenance

12. Parents of a teenager recently diagnosed with serious mental illness express dismay. One parent says, Our hopes for our childs future are ruined. We probably wont ever have grandchildren. The nurse should use interventions to assist with the parents:
a. denial.
b. grieving.
c. acting out.
d. manipulation.

ANS: B
Grief is a common reaction to having a family member diagnosed with mental illness. The grief stems from actual or potential losses such as ability to function, altered family functioning, income, and altered future prospects. Data do not support choosing any of the other options.

DIF: Cognitive level: Understanding REF: pp. 107-108
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity

13. Parents of a teenager recently diagnosed with serious mental illness express dismay. One parent says, Our child sometimes acts so strangely that we dont invite friends to the house. Sometimes we dont get any sleep. We quit taking vacations. Which nursing diagnosis applies?
a. Impaired parenting
b. Dysfunctional grieving
c. Impaired social interaction
d. Interrupted family processes

ANS: D
Interrupted family processes are evident in the face of disruptions in family functioning as a result of having a mentally ill member. Data support the possibility of this diagnosis. Data are insufficient to consider the other diagnoses.

DIF: Cognitive level: Understanding REF: pp. 108-109
TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

14. A family expresses helplessness related to dealing with a mentally ill members odd behaviors, mood swings, and argumentativeness. An appropriate nursing intervention for the family would be to:
a. express sympathy.
b. involve local social services.
c. explain symptoms of relapse.
d. role-play problem situations.

ANS: D
Helping a family learn to set limits and deal with difficult behaviors can often be accomplished by using role-playing situations, which give family members the opportunity to try new, more effective approaches. The other options would not provide learning opportunities.

DIF: Cognitive level: Applying REF: p. 109
TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

15. Parents of a mentally ill teenager say, Weve never known anyone who was mentally ill. We have no one to talk to because none of our friends understand the problems. The nurses most helpful intervention would be to:
a. refer the parents to a support group.
b. build their self-esteem as coping parents.
c. teach techniques of therapeutic communication.
d. facilitate achievement of normal developmental tasks.

ANS: A
The need for support can be clearly identified. Referrals are made when working with families whose needs are unmet. A support group such as the National Alliance for the Mentally Ill (NAMI) will provide these parents with the support of others who have had similar experiences and with whom they can share feelings and experiences. The distracters are less relevant.

DIF: Cognitive level: Applying REF: p. 109
TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

16. Select the best question to assess a familys ability to cope.
a. What strengths does your family have?
b. Do you think your family copes effectively?
c. Describe how you successfully handled one family problem.
d. How do you think the current family problem should be resolved?

ANS: C
The correct option is the only statement addressing coping strategies used by the family. The other options seek opinions or are closed-ended.

DIF: Cognitive level: Applying REF: pp. 108-109
TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

17. Which scenario best illustrates scapegoating within a family?
a. Messages of aggression are sent by the identified patient to selected family members.
b. Family members project problems of the family onto one particular family member.
c. The identified patient threatens separation to induce feelings of isolation and despair.
d. Family members give the identified patient nonverbal messages that conflict with verbal messages.

ANS: B
Scapegoating projects blame for family problems onto a member who is less powerful. The purpose of this projection is to distract from issues or dysfunctional behaviors in the family members.

DIF: Cognitive level: Understanding REF: pp. 106-107
TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

18. A parent has become verbally abusive toward the spouse and oldest child since losing a job 6 months ago. The child ran away twice, and the spouse has become depressed. What is the most appropriate nursing diagnosis for this family?
a. Impaired parenting, related to verbal abuse of oldest child
b. Impaired social interaction, related to disruption of family bonds
c. Ineffective individual coping, related to fears about economic stability
d. Disabled family coping, related to insecurity secondary to loss of family income

ANS: D
Disabled family coping refers to the behavior of a significant family member that disables his or her own capacity as well as anothers capacity to perform tasks essential to adaptation. The distracters are inaccurate because more than one individual is affected by the stressors.

DIF: Cognitive level: Analyzing REF: p. 107
TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

19. A parent says, My son and I argue constantly since he started using drugs. When I talk to him about not using drugs, he tells me to stay out of his business. What is the nurses most appropriate action?
a. Educate the parent about the stages of family development.
b. Report the son to law enforcement authorities.
c. Refer the son for substance abuse treatment.
d. Make a referral for family therapy.

ANS: D
Family therapy is indicated, and the nurse should provide a referral. Reporting the child to law enforcement would undermine trust and violate confidentiality. The other distracters may occur later.

DIF: Cognitive level: Applying REF: pp. 108-109
TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

20. Which option describes a healthy family?
a. One parent takes care of the children. The other parent earns income and maintains the home.
b. A family has strict boundaries that require members to address problems inside the family.
c. A couple requires their adolescent children to attend church services three times a week.
d. A couple renews their marital relationship after their children become adults.

ANS: D
Revamping the marital relationship after children move out of the family of origin indicates that the family is moving through its stages of development. Strict family boundaries or roles interfere with flexibility and the use of outside resources. Adolescents should have some input into deciding their activities.

DIF: Cognitive level: Understanding REF: p. 107
TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. A parent was recently hospitalized with severe depression. Family members say, Were falling apart. Nobody knows what to expect, who should make decisions, or what to do to keep the family together. Which interventions should the nurse use when working with this family? Select all that apply.
a. Help the family set realistic expectations.
b. Provide empathy, acceptance, and support.
c. Empower the family by teaching problem solving.
d. Negotiate role flexibility among family members.
e. Focus on the family rather than on the patient in planning.

ANS: A, B, C, D
The correct answers address expressed needs of the family. The other option is inappropriate.

DIF: Cognitive level: Applying REF: p. 109
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity

2. Which situations are most likely to place severe, disabling stress on a family? Select all that apply.
a. A parent needs long-term care after sustaining a severe brain injury.
b. The youngest child in a family leaves for college in another state.
c. A spouse is diagnosed with liver failure and needs a transplant.
d. Parents of three children, age 9, 7, and 2 years, get a divorce.
e. A parent retires after working at the same job for 28 years.

ANS: A, C, D
Major illnesses place severe, potentially disabling stress on families. The distracters identify normal milestones in a familys development.

DIF: Cognitive level: Analyzing REF: pp. 109-110
TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

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