Question 1

A fatherless,11-year-old African American girl lives with her grandmother after the death of her mother.Her older stepbrother is very involved in her life.How should the community health nurse view this family constellation,and why?

Accepted Answer

The nurse should be aware that cultural differences and specific events may lead to variety in family constellations.This is normal.

Question 2

A nurse enters an inpatient room and finds the family disagreeing about the client's living arrangements after discharge.Which information should the nurse provide when teaching techniques to resolve family conflicts?

Accepted Answer

Functional families allow and respect differences among members.They learn to handle differences and conflict through negotiation and compromise.

Question 3

During family counseling a child states,"I just want to surf like other kids.Mom says it's okay,but Dad says I'm too young." The mother allows surfing when the father is absent.In the structural model of family therapy,what family interactional pattern should the nurse recognize?

Accepted Answer

In this situation the mother and child have formed a subsystem in which they have aligned themselves against the father.

Question 4

During family counseling,a husband tells his wife to spend more time with the family,and she responds by stating,"Okay,I'll turn in my resignation tomorrow." The husband replies,"I knew it! You've always been a quitter!" How should the nurse interpret the husband's statement?

Accepted Answer

Double-bind communication sets up no-win situations.The husband has created a situation in which no matter what the wife does,she is wrong.

Question 5

A nursing instructor is teaching about the importance of healthy family-member expectations for newly blended families.Which student statement indicates a need for further instruction?

Accepted Answer

Conforming is a behavior that interferes with adaptive functioning in terms of family member expectations.This student statement indicates a need for further instruction.Realism,flexibility,and individuality are all characteristics of healthy family-member expectations.

Question 6

A client is angry because her husband has forgotten their anniversary.The following week,the client is still unwilling to discuss this with her husband because she is afraid she will lose control.How should the nurse interpret this client's means of coping with anger?

Accepted Answer

When coping by avoidance,differences are never acknowledged openly.The individual who disagrees avoids discussing it for fear that the other person will withdraw love or approval or become angry in response to the disagreement.Avoidance also occurs when an individual fears loss of control of his or her temper.

Question 7

A clinic nurse is caring for a 40-year-old client who lives with his parents.The client's mother continues to do the client's laundry and provides spending money.Based on this situation,which family dynamic does the nurse recognize?

Accepted Answer

Taking over occurs when a family member fails to allow another member to develop a sense of responsibility and self-worth.By doing the client's laundry and managing finances,the mother is fostering the client's dependence.

Question 8

An adolescent,his mother,and his soon-to-be stepfather have been in counseling with the nurse.Which statement by the nurse fosters positive relationships within this new family structure?

Accepted Answer

Open lines of communication are needed for newly forming families to begin their relationship together and establish a new family structure.

Question 9

A couple has been married for 20 years.They argue constantly,belittle feelings,and continuously contradict each other.During a therapy session,the nurse documents "Marital schism." What does the nurse mean by this documentation?

Accepted Answer

A marital schism is a state of chronic disequilibrium and discord.This describes this couple's marriage.

Question 10

A couple is in counseling related to their dysfunctional relationship.Their daughter has recently made a suicide gesture.The nurse should recognize that this might be an example of which family system concept?

Accepted Answer

Triangulation occurs when a relationship between two people is dysfunctional.A third person is brought into the relationship to help stabilize it.The couple is triangulating with their daughter.The threatened daughter draws attention from her parent's interpersonal conflicts by her own dysfunctional behavior.

Question 11

In a family that is in the life cycle stage called "The Family with Adolescents," which changes must occur for the family to proceed developmentally?

Accepted Answer

Stage IV of the family life cycle is described as "The Family with Adolescents." The task of this stage is to redefine the level of dependence so that adolescents are provided with greater autonomy while parents remain responsive to teenagers' dependency needs.

Question 12

A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago.After the client received a college acceptance,the mother repeatedly states,"That's wonderful.I'll be fine all alone." How would the nurse interpret the mother's statements?

Accepted Answer

The client's mother says she is fine with him going away to college but then tries to make him feel guilty about her being left alone.The client is in a no-win situation because his mother has given a mixed message-a double-bind communication.

Question 13

During family counseling a husband states,"Every time my wife and I discuss child discipline,we get into shouting matches." The nurse instructs the couple to shout at each other for 2 weeks on Tuesdays and Thursdays for 30 minutes.What intervention is the nurse using?

Accepted Answer

In a paradoxical intervention,the therapist requests the family to continue the maladaptive behavior.This removes control over the behavior from the family to the therapist.Clients are made more aware of the defeating behavior and this can lead to behavioral change.

Question 14

In defiance of parental wishes,a Japanese teenager succumbs to peer pressure and gets a tattoo.According to Bowen's family systems theory,how should the community health nurse interpret the teenager's action?

Accepted Answer

The teenager is taking on some of the cultural values of peers and is beginning to develop a unique identity.This process is called differentiation and is a normal task of adolescence.

Question 15

An instructor is teaching about differentiated parent and adult child relationships.Students are instructed to give an example of a well-differentiated parent and adult child relationship.Which student example meets the instructor requirement?

Accepted Answer

The correct student example of a well-differentiated parent and adult child relationship is when an adult child considers,but is not governed by,the advice of his or her parent.The adult child should be differentiated enough not to be threatened by parental advice and should be able to consider the parental advice without feeling the advice must be followed.

Question 16

A 30-year-old client seeking therapy states,"My mom cries when she is not included in all my social activities and thinks of my friends as her own." How would the nurse describe the boundaries between this family's parent and child subsystems?

Accepted Answer

With enmeshed boundaries,family members lack individuation and experience exaggerated connectedness.The client's mother is trying to prevent independence by generating feelings of guilt.

Question 17

A home health nurse is visiting an Asian family.A married couple,their three children,and the maternal grandparents all live in the home.How should the nurse interpret the presence of the grandparents in the home?

Accepted Answer

The Asian culture highly respects the elderly.Having the grandparents living in the home is not uncommon in this culture.

Question 18

After hearing parents discuss divorce,a 5-year-old develops behavioral problems.Upon dealing with the child's behavioral issues,the marital relationship conflict decreases.The pediatric clinic nurse should recognize that this is an example of which family system concept?

Accepted Answer

Triangulation occurs when a relationship between two people is dysfunctional so a third person is brought into the relationship to help stabilize it.The son and his behavioral problems redirect the focus from the couple's marital problems.

Quiz 11: Intervention With Families