Maternity Review

Chapter 1: Traditional and Community Nursing
Care for Women, Families, and Children(FREE)

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Chapter 1: Traditional and Community Nursing Care for Women, Families,
and Children
MULTIPLE CHOICE
1. The clinic nurse understands the new description of nursing art/
aesthetics as the way that nurses and patients help each other through a
circular process. What is the event that begins this process?
A. A health threat
B. Experiencing new possibilities for health
C. Hope and understanding for the future
D. Relationship building
ANS: A
Nursing aesthetics consists of the low-tech, high-touch caring in a nurse
patient encounter. This transformative process begins with a health threat.
The event that begins the process is not experiencing new possibilities for
health, hope and understanding for the future, or relationship building.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Caring
Difficulty: Moderate
PTS: 1
2. A nurse manager in a community clinic is concerned because the local
refugee population does not seek health care routinely. What action by the
nurse would be most helpful?
A. Assess clinic staff and procedures for evidence of ethnocentrism.
B. Put up flyers advertising the clinics services in local retailers.
C. Reward preventative health patients with coupons for needed items.
D. Try to meet with community leaders to work on the problem.
ANS: A
Ethnocentrism is the view that the beliefs, values, and behaviors of one
culture are superior to those of other cultures. Ethnocentrism is dangerous
in health care because it is blind to the possibilities of other solutions and
viewpoints and alienates people in need of health care. The nurse manager
would be wise to assess the clinics staff and procedures for ethnocentrism.
Meeting with a community leader is always a good idea to learn the

viewpoints of the community, but unless ethnocentric behaviors change, it
is unlikely that the refugee community will increase its use of the clinic.
Flyers and incentives may also be helpful in some cases, but not as helpful
as reducing the barriers imposed by ethnocentrism.
Cognitive Level: Application/Applying
Patient Needs: Health Promotion and Maintenance
PTS: 1
3. The nursing faculty explains to students that ethnopluralism is an
important force shaping health care today. What concept is most important
in understanding this trend?
A. The decreased need for cultural competency
B. The growth in one ethnic group in a single area
C. The increased impact of diverse cultures on health care
D. The percentage increase of the non-Caucasian population
ANS: C
Ethnopluralism means diverse cultures. As the population of different ethnic
(non-Euro-Caucasian) groups grows, their impact on health care will
increase exponentially. Ethnopluralism is not just the growth of one ethnic
group in one location. It is also more than just the percentage change in the
non-Euro-Caucasian population, although that is part of the phenomenon.
As ethnopluralism continues to impact health care, providers will need to be
more, not less, culturally competent.
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
PTS: 1
4. A nursing faculty member is explaining recent shifts in nursing practice.
What change has been important in applying the nursing process?
A. A change to a spiral or circular process
B. A focus on more independent nursing actions
C. A return to the nurse-as-expert model of care
D. An emphasis on attaining a disease-free state
ANS: A
The nursing process has recently changed from a linear one to a spiral or
circular process in which the patient/family is motivated toward promotion,
maintenance, and restoration of health. The focus has not changed to
include more independent actions, a return to the nurse-as-expert model,
or an emphasis on attaining a disease-free state of being.
Cognitive Level: Comprehension/Understanding
Difficulty: Easy
PTS: 1
5. A nurse is working in an urban clinic with a diverse population. What
action by the nurse is most important?
A. Determine patients definitions of health and desired outcomes of health
care.
B. Explain policies such as appointment cancellations to ensure
compliance.
C. Learn to speak one or two common languages of the patients in the
clinic.
D. Read about different folk remedies common among the populations
seen.
ANS: A
Divergent populations enter the health-care system with differing beliefs
about health care and wellness and differing expectations for the outcomes
of such experiences. Understanding these expectations will help the nurse
plan care that has a better chance of meeting these expectations. Learning
languages and becoming familiar with folk remedies is helpful as well, but
these two solutions are very limited in scope and a nurse cannot hope to
become proficient in all the languages/behaviors of every population seen,
leaving some patients with a lessened experience. Explaining policies is
important too, but simply telling someone the rules does not take his or her
cultural norms into account and may not be successful.
Integrated Process: Nursing Process: Assessment
PTS: 1
6. A nurse is working with a minority group that has a high incidence of
cardiovascular disease, including hypertension and stroke. When
participating in a community health fair with this group, what action by the
nurse will be most effective?
A. Educate the participants about weight loss and a low-sodium, low-fat
diet.
B. Explain the genetic basis for the high incidence of cardiovascular
disease in the group.
C. Help participants make lifestyle changes that are culturally congruent.
D. Present statistics on the mortality and morbidity of cardiovascular
disease.
ANS: C
The ever-increasing culturally diverse population interacting with the healthcare system brings its own beliefs, values, and health-related practices that
impact health and well-being. In order to help people make healthy lifestyle
changes, the changes must be culturally congruent and acceptable.
Forcing an incongruent practice makes it highly unlikely to succeed.
Education is important, but it must be done in a culturally congruent way.
Pathophysiology and statistical knowledge, by itself, is not likely to be
beneficial.
Difficulty: Difficult
PTS: 1
7. What does the practicing nurse understand to be the most important
influence on interdependent, assertive nursing practice today?
A. Higher education of registered nurses
B. Improved working conditions and salaries
C. Increased numbers of female physicians
D. Use of the nursing process for patient care
ANS: D
Nurses were passive, deferential, and compliant to the knowledge and
orders of mostly male physicians until the late 20th century. The nursing
process changed that. The nursing process is a framework for systematic
problem solving and implementation of both independent and dependent
nursing actions. The nursing process allows nurses to make decisions

regarding patient care based on critical thinking and clinical judgment. The
other options listed were not vital in creating a nursing practice that is
interdependent and assertive.
Cognitive Level: Analysis/Analyzing
Integrated Process: Nursing Process
PTS: 1
8. A child who has been hospitalized for a long time is preparing to go
home, where care will be continued. Which action by the nurse is most
beneficial to assist the family in this transition?
A. Advise the family to call the local visiting nurses association for home
visits.
B. Call the childs school to inquire about requirements for returning to
school.
C. Consult a social worker to help evaluate insurance coverage and
transportation.
D. Give the family brochures for the local support group for chronically ill
children.
ANS: C
Preparing a family for home-based care, or other community-based care,
involves ensuring that the family is able to provide the care needed by the
child at home or in another setting. This can include discussing specialized
equipment in the home, health insurance coverage, transportation, and/or
returning to school. If the family needs or desires visiting nurses, the
nursing staff or social worker at the hospital should arrange this for the
family. Calling the school to get information about the childs return to
school yields helpful information, but may not be needed yet, and is too
limited in scope to be the best answer. Simply giving parents brochures for
support groups may or may not be helpful; the parents may not be literate
or may not understand the benefit without discussion.
Integrated Process: Communication and Documentation
PTS: 1
9. A nurse manager wants to make the pediatric clinic a more familycentered health-care setting. Which of the following actions by the nursing
staff would best meet this goal?
A. Encourage family members to be present in the exam room and to ask
questions.
B. Incorporate the use of a community health map for all new patients in
the clinic.
C. Recognize family members as experts on their child and incorporate
them in decision making.
D. Use evidence-based practice to develop policies and procedures used in
the clinic.
ANS: C
The role of the family-centered nurse is to facilitate and assist the family in
making informed choices that lead to the outcome the patient and family
desire. This requires the nurse to give up the paternalistic role of authority
on health care. The family knows the child best and should be assumed to
make decisions that are in the best interests of both child and family. The
other options are all good interventions, but are too limited in scope to be
the best way to create a family-centered environment.
PTS: 1
10. A clinic nurse is explaining to a student nurse the function of the
community health map in assessing families. Which description of this
assessment tool is most accurate?
A. It assesses how the family interacts with outside social systems.
B. It locates health-care settings in, or close to, their neighborhood.
C. It outlines family problems and social resources to help with them.
D. It shows how the health of the community impacts each family.
ANS: A
A community health map is an assessment tool for family structure,
function, and support networks. It displays significant related data and
helps the nurse focus on the family as it interacts with the social systems
within and around the family. Its purpose is not to locate local health-care
settings. The focus is on family health and past successes and current
strengths, not on family problems. Correlations can be made between the
health of the community and the health of those living in that community,
but this is not the purpose of the community health map.
PTS: 1
11. A nurse wishes to improve his or her cultural sensitivity while working
with patients. Which action by the nurse would best indicate progress
toward this goal?
A. Demonstrate good knowledge of different cultural health beliefs
B. Effectively respond to the needs of people of different cultures
C. Interact respectfully with patients who have differing health beliefs
D. Recognizes that he or she will never be the expert in other cultures
ANS: C
Cultural sensitivity is a way of approaching people who hold health beliefs
different from ones own. A nurse with this characteristic is respectful of and
open to others. Cultural competence is the ability to interact effectively with
people of different cultures and requires a certain level of knowledge about
those cultures. Cultural humility is the recognition that one will never master
all information about another culture.
PTS: 1
12. A nurse manager is evaluating staff members on their cultural
competence. Which action best demonstrates this characteristic?
A. Attends workshops on cultural diversity and health practices
B. Participates in community health events with minority populations
C. Plans care with the family members within their cultural beliefs
D. Uses family members as interpreters to make them feel important
ANS: C
The culturally sensitive nurse is able to understand and respond to the

needs of individuals and families from different cultures. This nurse plans
interventions with a solid knowledge of the values and practices of the
members of the culture. Being open, listening to the family, and involving
them in care demonstrates respect, unifies the nursepatient relationship,
and will motivate the patient (and family) to make positive health changes.
Attending workshops is a good way to learn about diverse cultures and
attending community events with diverse populations can increase cultural
knowledge, but these actions are too limited in scope to demonstrate
cultural competence. Nurses should use professional interpreters when
needed.
Cognitive Level: Evaluation/Evaluating
PTS: 1
13. A nurse is incorporating a cultural assessment into nursing care. Which
assessment question by the nurse leads the supervisor to conclude that
this nurse needs further education on cultural assessment?
A. What customs and traditions are important to you?
B. What kind of insurance coverage do you have?
C. When you are stressed or worried, what comforts you?
D. Who in your family is important for support?
ANS: B
Cultural influences include family support systems, religious and spiritual
beliefs, customs and traditions, communication patterns, coping strategies,
and problem-solving techniques. Asking about insurance coverage is not
directly related to culture, although this can give information about the
patient/familys living environment and ability to access resources.
PTS: 1
14. A nurse is working with a cultural group that has many proscriptions
against women seeking health care. What action by women in this
community would indicate that they have successfully negotiated a new

role in seeking care?
A. Are able to make and keep medical appointments
B. Can afford to pay for desired health-care services
C. Follow their traditional roles and responsibilities
D. Seek health-care advice from family members
ANS: A
Cultural proscriptions are beliefs, practices, and values of a group that tell
women and children what they should not do. In many traditional cultures,
women do not have permission, decision-making power, or means to
access the health-care system. If the women from such a culture
successfully negotiate their roles regarding health care, they can access
the health-care system on their own. The ability to afford services is not
related, although cultural proscriptions might forbid women from making
such a transaction. If they follow their traditional roles or seek health care
from family members, they have not demonstrated a successful negotiation
of a new role.
PTS: 1
15. A patient wishes to use complementary therapy when managing a
chronic health condition. Which action by the nurse is most appropriate?
A. Advise the patient that stopping medical treatment may cause it to
worsen.
B. Inform the patient that there are no complementary therapies for this
condition.
C. Investigate herbs that can be substituted for prescription drugs.
D. Suggest the patient add massage therapy to the medical regimen.
ANS: D
Complementary therapy is nontraditional treatment that is used in addition
to traditional medical care. Alternative therapies are used in place of
traditional therapies. Adding massage to the medical regimen is an
example of using complementary therapy. Substituting herbs for
prescription medication is an example of alternative therapy. Because the
patient is asking about complementary therapy, there is no need to warn
him or her of the effects of stopping treatment. There are always

complementary therapies that can be added to a medical regimen.
PTS: 1
16. A nurse is working with a family that uses multiple complementary and
alternative medicine (CAM) modalities. What action by the nurse is best?
A. Allow the family to continue these practices as desired.
B. Assess how these practices reflect religious beliefs.
C. Inform the family that most of these practices do not work.
D. Provide evidence-based information about the therapies.
ANS: D
The nurse working with individuals or families who use CAM practices
should respect the beliefs, values, and desires of the patient. The nurse
should encourage families to make decisions regarding CAM practices
based on evidence and research into their effects. The nurse can best
assist in this by providing and discussing information. Although the nurse
cannot stop the family from using CAM, he or she should not pass up the
teaching opportunity. Many CAM practices have demonstrated benefit, so
telling the family they dont work is false information. A culturally competent
nurse will assess how religious and spiritual beliefs affect health-care
practices, but the nurse needs to advocate for the patient/family by
providing solid information.
PTS: 1
17. A nurse acting in the role of teacher is determining learning outcomes.
Which action will produce the best outcomes for teaching?
A. Collaborate with the discharge planner on outcomes.
B. Determine the teaching priority, then establish the outcome.
C. Develop outcomes mutually agreed on with the patient.
D. Enlist other staff members to help prioritize outcomes.
ANS: C
The best nursing care (including teaching) is a collaborative effort between
nurse and patient. Each participant has knowledge and shares the power of
determining what is to be learned. The best outcomes result in patient
cooperation, because the patient was instrumental in developing them. The
other actions might be helpful in specific situations, but involving the patient
(or family) is always appropriate and vital.
PTS: 1
18. A nurse uses Nightingales theory of nursing to pattern care for patients.
Which action by the nurse is most consistent with this theory?
A. Does for the patient what he or she is unable to do for self
B. Focuses patient interactions on caring, healing, and wholeness
C. Keeps patients room clean and ensures good nutrition
D. Incorporates culturally relevant actions in a caring encounter
ANS: C
Nightingale focused on the spiritual, physical/environmental, emotional,
mental, and social needs of the patient. A major area of emphasis was on
improving the patients environment (internal and external). For this
theorist, the base of nursing practice centered around observation,
knowledge of sanitation, nutrition, caring, and compassion. The action most
closely associated with Nightingale would be keeping the patients room
clean and ensuring the patient gets good nutrition. A focus on caring,
healing, and wholeness-centered interactions is reflective of Jean Watsons
theory. Incorporation of culture into nursing care reflects the theory of
Leininger. Although not mentioned in the text, doing for others what they
would do for themselves, if able, is the basis of Dorothea Orems self-care
theory.
Integrated Process: Nursing Process: Implementation
PTS: 1
19. An inpatient nursing unit uses Madeleine Leiningers theory to organize

nursing care. The manager would conclude that a new nurse has
successfully integrated this theory into practice when the nurse does which
of the following actions?
A. Emphasizes caring over curing in nursing actions
B. Establishes trusting relationships with patients
C. Knows the cultural practices of many different groups
D. Organizes environmental factors for the patients benefit
ANS: B
Establishing a trusting nursepatient relationship is at the core of
Leiningers theory. In order to understand another persons cultural beliefs,
values, methods of providing or showing caring, causes of illness, and how
wellness is achieved, the nurse must first establish a trusting relationship
with the patient so the patient feels free to share. This is an ongoing
process. The emphasis on caring over curing is part of Watsons theory.
Knowing the practices of several different cultural groups would be a
valuable asset, but is not required for Leiningers theory. Organizing the
environment to benefit the patient is part of Nightingales theory.
PTS: 1
20. A nurse uses Watsons theory as a framework for nursing practice.
Which nursing action best demonstrates the use of this theory?
A. Actively clarifies the patients health beliefs and practices
B. Allows children to visit an ill parent despite visitation restrictions
C. Assesses both the physical and spiritual dimensions of the patient
D. Ensures the patient is neither too warm nor too hot for comfort
ANS: C
Jean Watson contends that caring as a nurse requires the nurse to pay
attention to both the physical and spiritual dimensions of the patient.
Clarifying health beliefs and practices is more related to Leiningers theory.
Allowing children to visit despite restrictions is a caring action, but is not
tied to a specific theory. Manipulating the environment for patient comfort
and well-being is a core component of Nightingales theory.

PTS: 1
21. A nursing manager wants to increase the staffs attention to patients
spirituality. Which action by a nurse would best demonstrate this concept?
A. Asked about the patients religion
B. Assessed the patients meaning of life
C. Consulted a chaplain for a patient case
D. Inquired about religious rituals in health
ANS: B
Spirituality does not necessarily equate with religion; it is more a concept
related to a persons beliefs about the meaning of life. Although all actions
might be incorporated in a comprehensive discussion of spirituality, the
best demonstration of attention to this characteristic is inquiring about the
meaning the patient ascribes to life.
PTS: 1
22. A nurse is demonstrating the professional role of provider of care to a
nursing student. Which action by the nurse is most relevant to this
professional role?
A. Assesses the patients priority physical needs
B. Gives the patient a bath instead of delegating it
C. Supervises unlicensed assistive personnel
D. Uses monitoring and IV equipment correctly
ANS: D
One of the major responsibilities of the nurse as provider of care is to
maintain competency in using monitoring and therapeutic equipment. This
is a vital safety measure for the patient. The nurse as provider of care
should assess all of the patients physical, psychosocial, and spiritual
needs, not just the priority physical needs. Supervising other personnel
may or may not be part of a nurses job description. Choosing to delegate
an activity is not a core role of the provider of care.

Patient Needs: Safe and Effective Care Environment: Safety and Infection
Control
PTS: 1
23. A nurse is caring for a patient from a culture with which the nurse is
totally unfamiliar. What action by the nurse will best promote effective
communication?
A. Call for a professional interpreter to translate information.
B. Pattern voice tone and eye contact after the patients behaviors.
C. Talk slowly and deliberately using simple language and cues.
D. Use nonverbal communication as much as possible with the patient.
ANS: B
In the situation where the nurse is unfamiliar with the patients culture, the
nurse should pattern verbal and nonverbal communication after the
patients own style. There is no indication that this patient does not speak
English, so using an interpreter, talking slowly using simple language, and
using mostly nonverbal communication is inappropriate.
PTS: 1
24. A nurse has been teaching a patient who seems impatient and does not
retain much of what is taught. What action by the nurse would be best to
facilitate the patients learning?
A. Assess for unmet personal needs such as pain or hunger.
B. Determine why the patient is being uncooperative.
C. Give information in writing and let the patient read it.
D. Stop the teaching session and return at a later time.
ANS: A
Learning is not likely to be effective if the patient has unmet basic human
needs such as hunger, pain, a full bladder, or fear. The nurse should
assess for those needs and meet them before continuing. Labeling a
patient as uncooperative is counterproductive and judgmental and does
nothing to enlist the patients cooperation. Written information (if the patient
is literate) is always a good idea, but doing nothing more than that will not
improve the patients learning when basic needs are unmet. Returning at a
later time also does not meet the patients needs.
Cognitive Level: Applying/Application
Patient Needs: Physiological Integrity: Basic Care and Comfort
PTS: 1
25. A nurse manager expects all employees to be patient advocates. Which
nursing action best demonstrates this nursing role?
A. Arranging a familyphysician conference to clarify treatment plans
B. Encouraging treatment options based on personal beliefs and values
C. Giving contact information for governmental assistance agencies
D. Working on a political campaign to reduce poverty in the state
ANS: A
In the advocate role, the nurse should promote patient-/family-centered
care and work to provide the patient with more control, power, and selfdetermination in the health-care setting. The nurse who arranges a family
physician conference to clarify treatment plans is advocating for the patient.
Giving contact information for assistance agencies and working on political
campaigns are also ways of demonstrating advocacy, but are too limited in
scope to be the best answer. The nurse advocate must ensure he or she is
speaking for the patient and the patients desires, not inserting personal
values and beliefs into the process.
PTS: 1
26. A nurse is describing the use of evidence-based practice (EBP)
guidelines to a nursing student. Which explanation of EBP is most
accurate?
A. Includes clinical experience and patient preferences
B. MEDLINE used as the primary source for EBP information
C. Requires the staff to be active participants in research
D. Uses research findings to plan interventions for care

ANS: A
EBP combines investigational guidelines and scientifically sound
interventions with clinical expertise and the patients values and
preferences. MEDLINE is one of three primary sources for EBP
information; the other two are the Cochrane Database of Systematic
Reviews Library and the Agency for Healthcare Research and Quality. The
staff members do not have to be actively involved in research to use EBP.
Using research findings to plan interventions is part, but not all, of the EBP
process.
PTS: 1
27. A nurse uses evidence-based practice (EBP) to plan and implement
nursing care. What action by the nurse best demonstrates this process?
A. Assesses, plans, implements, and evaluates nursing interventions
B. Incorporates specific research findings into the nursing care plan
C. Predicts and assesses for potential problems based on research
D. Uses a concept map for nursing care instead of a nursing care plan
ANS: C
The nurse who has incorporated EBP into nursing care is able to predict,
and assess for, potential problems and complications because of
knowledge of relevant research. Assessment, planning, implementation,
and evaluating are steps in the traditional nursing process. Specific
research findings do not need to be specifically incorporated into a nursing
care plan and, in fact, without including clinical expertise and patient
preferences, scientific findings are incomplete. A concept map is an
alternative to the traditional nursing care plan.
PTS: 1
28. A patient and family have the nursing diagnosis of impaired verbal
communication secondary to a language barrier. What action by the
patient/family would best indicate that short-term goals for this diagnosis
have been met?
A. Able to communicate long-term desires for health of the patient
B. Demonstrates comprehension by head nodding and saying yes
C. States understanding of condition and treatment via an interpreter
D. Understands how nonverbal communication varies between cultures
ANS: C
For a language barrier, using a professional interpreter is not only the best
way to manage communication, it is also legally required. The best shortterm goal for the patient and family is to obtain understanding of the
patients illness and treatment and state, through the interpreter, that this is
the case. Communicating long-term desires is a better long-term outcome
for this diagnosis. Nodding the head and saying yes do not always
indicate agreement, understanding, or approval. In some cultures this
behavior signifies respect. Understanding the differences in nonverbal
communication between cultures is not an appropriate short-term goal.
PTS: 1
MULTIPLE RESPONSE
1. The perinatal nurse is aware of changes in womens and childrens
health-care settings that affect family care. What factors do these changes
include? (Select all that apply.)
A. A decreased pediatric patient population
B. A redesign of policies to include families
C. Development of alternative care sites
D. Increased liberalization of visiting policies
E. Increased patient acuity across all settings
ANS: B, C, D, E
Many changes have occurred across health-care settings that have
affected family care. Hospitals have redesigned their policies to be familyfriendly and have liberalized visiting policies to decrease stress on the
family. Alternative care settings have been developed in part to combat
escalating medical costs, and patients have high-acuity illnesses and

needs across all of these settings. There has been no decrease in the
population of pediatric patients.
Difficulty: Easy
PTS: 1
2. A nurse wishes to improve critical thinking skills. Which of the following
actions would be helpful for this nurse? (Select all that apply.)
A. Developing checklists for care activities
B. Listening intently for true understanding
C. Practicing new skills
D. Remaining nonobjective in patient encounters
E. Searching the literature for new information
ANS: B, C, D, E
Critical thinking evolves from experience, seeking knowledge, practicing
skills, self-reflection, open-mindedness, calculated risk-taking, and devotion
to listening with a goal of true comprehension and understanding. Making
checklists is not part of critical thinking.
PTS: 1
3. To be effective when providing information to a patient, the nurse should
assess the patient for which of the following? (Select all that apply.)
A. Cultural beliefs and values
B. Information desired
C. Preferred learning style
D. Level of understanding
E. Past medical history
ANS: A, B, C, D
An effective teacher should assess the patients cultural beliefs and values,
information desired, preferred learning style, and level of current
understanding before planning and implementing teaching. The patients

past medical history is not essential information for teaching.
PTS: 1
4. The nurse listens to a mother and her 4-year-old child as they
communicate with each other primarily to determine which of the following?
(Select all that apply.)
A. Communication styles that need improvement
B. The childs level of language development
C. The familys culture and its influences
D. The familys personal and group values
E. The familys understanding of health care
ANS: B, C, D
Listening to the cultural voices and experiences of family and patients
affirms their value and is critically important to unifying the nursepatient
relationship. This method of interaction allows the nurse to understand
family values, family developmental aspects, and the familys cultural
aspects. It also motivates patient movement toward positive healthpromoting activities. It is not primarily to determine areas for improvement,
although the nurse may be able to role model better communication for a
patient/family. Listening to communication is also not primarily to determine
the familys understanding of health care.
PTS: 1
5. The nurse mentor explains to the new nurse that multiple societal
changes have given families greater power in health care. What changes
have contributed to this shift? (Select all that apply.)
A. Alternative community-based care sites
B. Costs of obtaining health care
C. Decreased health-care regulations
D. Multimedia information
E. Science and technology
ANS: A, B, D, E
The infusion of multiple cultures and beliefs about health-care systems,
along with exponential growth in scientific and technologic capabilities, has
been a major force in shaping the structure and delivery of nursing care. In
addition, increased consumer access to health-related information through
the Internet, mass media, and other sources that may or may not be
accurate; the unprecedented rise in health-care costs; and the increasing
imposition of cumbersome regulations have also contributed to change.
Changes in care settings to include new community-based sites have also
led to increased power for families/consumers and family-centered decision
making.
PTS: 1
6. The nurse understands that changes in family characteristics are related
to which of the following influences? (Select all that apply.)
A. Birth control accessibility and knowledge
B. Decreased mobility of people
C. Increased feminist thinking
D. Increased number of women in the workforce
E. Mass media influences
ANS: A, C, D, E
Social and technological advances of the past half century have changed
family structure, function, and definition. With the increasing acceptance
and technological methods of birth control options made available to
families since the 1970s, family size has also changed. The feminist
movement of the 1970s sent large numbers of mothers outside the home
and into the work environment. With increased population mobility and twoincome families there are fewer support persons available than before,
when living near a large extended family was the norm. Mass media is an
important determinant of social behavior.

Difficulty: Easy
PTS: 1
7. The nurse recognizes that caring for patients and families is challenging
due to which of the following factors? (Select all that apply.)
A. Advances in medical care
B. Decreased cultural diversity
C. Decreased patient expectations
D. Increased technology development
E. Potential legal considerations
ANS: A, D, E
Advances in medical care, increased technology, and the potential for legal
ramifications should nurses not use EBP and best-practice guidelines all
increase the complexity and challenges in providing nursing care. Neither
cultural diversity nor patient expectations are decreasing.
Difficulty: Easy
PTS: 1
8. The perinatal nurse caring for a 24-year-old mother of an infant born at
26 weeks gestation is providing discharge teaching. The patient is going to
travel to the specialty center approximately 200 miles away, where her
daughter is receiving care. The nurse tells the patient that it is normal for
her to feel which emotions? (Select all that apply.)
A. Afraid
B. Anxious
C. Guilty
D. In control
E. Overwhelmed
ANS: A, B, C, E
Separation of family members needing care in specialty or tertiary care
settings often leads to feelings of anxiety, abandonment, fear, and guilt, all
of which can be overwhelming in the setting of a serious physical illness in
a family member. It would not be common for a family member to feel in
control.

PTS: 1
9. The nurse working with patients understands that health promotion can
include which of the following? (Select all that apply.)
A. Belief in the power base of the patient
B. Changed attitude to one of meaningfulness
C. Nurse-defined state of unity and holism
D. Shared understanding of the health threat
E. Shared vision about hope for the future
ANS: A, B, D, E
Health promotion can and should include a belief in the power base of the
patient to make meaningful changes in his or her life, an attitude that finds
meaning in the shared experience of illness, a shared understanding of the
nature of the health threat, and a shared vision about hopes for the future.
The nurse needs to recognize and honor the patient-defined state of unity
and holism in order to engage nursing aesthetics in practice.
Difficulty: Easy
PTS: 1
10. A clinic nurse is evaluating a child who has been treated for a cough
and fever for several weeks, without resolution of the symptoms. The child
and family are recent immigrants to America. What actions by the nurse are
most appropriate? (Select all that apply.)
A. Ask the parents about culturally relevant health-care practices.
B. Assess the familys understanding of the illness and treatment.
C. Investigate illnesses endemic to the familys native country.
D. Tell the family members they must stop using herbal or folk treatments.
E. Utilize a professional interpreter to communicate with the family.
ANS: A, B, C, E
Increased international travel and immigration require the nurse to be
culturally sensitive and also aware of the possibility of a patient having a
disease not commonly seen in the United States. In this scenario, the nurse
should assess for culturally relevant health-care practices to ensure that
the prescribed treatment is acceptable to the family members, investigate
their understanding using a professional interpreter if needed, and research
illnesses endemic to the familys country of origin. The nurse should not
simply tell the family members that they cannot use herbal or folk remedies.
The nurse should attempt to include these traditional methods of healing
when possible.
Integrated Process: Nursing Process: Assessment and Implementation
PTS: 1
11. The nursing faculty member explains to the nursing student that using
nursing aesthetics includes which of the following activities? (Select all that
apply.)
A. Care planning
B. Imagery
C. Medication administration
D. Music therapy
E. Touch
ANS: B, D, E
Nursing aesthetics is the low-tech, high-touch art of nursing. Components
can include imagery, music therapy, and touch. Care planning and
administering medications do not fall under this category of nursing action.
Difficulty: Easy
PTS: 1
12. A new nurse manager wants to initiate changes on the inpatient
pediatric unit at a regional referral center. Which actions by the manager
would be most helpful? (Select all that apply.)
A. Create a system of nurse-driven care to allow families to rest and destress.
B. Discuss proposed changes with families, soliciting feedback on potential

impact.
C. Ensure around-the-clock resources to help families with emotional
needs.
D. Make changes based on knowledge of growth and development
theories.
E. Use evidence-based practice to formulate new policies and procedures.
ANS: B, C, D, E
Caring for children at regional referral centers creates problems for families
who are impacted by the separation and the high-acuity illness of their
child. Changes should consider the emotional needs of the families, both
child and family growth and development theories, and evidence-based
practice. Family partnering is a way to involve families in the care of their
children and is more beneficial to families than nurse-driven care.
PTS: 1
OTHER
1. Place the steps of creating a concept map in the correct order.
_____ Determine beneficial goals and outcomes.
_____ Categorize assessment data under patient problem areas.
_____ Assess the patient and draw a skeleton diagram.
_____ Evaluate the patients response to the interventions.
_____ Analyze the relationships among factors and prioritize diagnoses.
ANS:
4, 2, 1, 5, 3
A concept map is similar to the nursing process and uses five steps. Begin
with assessing the patient and draw a skeleton diagram using the medical
diagnosis as the center. Next, categorize all the assessment data under
patient problem areas. Step 3 is to analyze relationships among the factors
and to prioritize patient responses. The fourth step is to determine
beneficial goals and outcomes with the patient/family. The final step is
evaluation.

Integrated Process: Nursing Process
Difficulty: Easy
Chapter 3: The Evolving Family(FREE)

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Chapter 3: The Evolving Family
MULTIPLE CHOICE
1. The clinic nurse is taking a history from a woman who came to the clinic
to get test results. The patient brought a coworker with her because she is
worried. The patient asks to have her coworker remain in the exam room
when the doctor describes the test findings. The patient states that the
friend is like a sister. The nurse would most correctly identify the two
women as which of the following?
A. Extended family
B. Family
C. Family of choice
D. Family of origin
ANS: A
A family consists of two or more members who self-identify as a family
and interact and depend on one another socially, emotionally, and
financially. Because the patient self-identifies the friend as like a sister,
the patient and friend consider themselves a family.
Difficulty: Easy
PTS: 1
2. The clinic nurse understands that children who come for well-child visits
at age 10 are in the process of developing which of the following attributes?
A. Attachment
B. Coordination
C. Personal values
D. Self-identity
ANS: D
During the school-aged and adolescent/teenage developmental stage,

personal values are shaped and clarified and ethical development occurs.
This stage provides the optimal opportunity for teaching about drugs, sex,
and health promotion.
PTS: 1
3. A new mother with a 2-month-old daughter tells the family clinic nurse
that she is experiencing a lack of sleep because of infant night feedings
and her husbands shift work and excessive overtime. Which of the
following is the best description of this family concern?
A. Caregiver strain
B. Coping stress
C. Lack of support
D. Parental maladaptation
ANS: A
Caregiver strain occurs when the main caregiver becomes overwhelmed
and feels underhelped regarding the tasks concerned with the care of the
family member. In this situation, mounting bitterness and withdrawal from
other family members may cause caregivers to push away any potential
helpers.
Difficulty: Easy
PTS: 1
4. A patient describes her spouses dependence on oxycodone
terephthalate (Percocet), which began following knee surgery last year.
Although the prescription was finished some time ago, the spouse
continues to obtain and take Percocet. Because of the spouses need for
the medication, the patient has to do all the yard work, child care, and
meal preparation. How would the nurse describe the patients behavior?
A. Enabler
B. Impaired caregiver
C. Inadequate dyad partner

D. Overstressed parent
ANS: A
An enabler is a common role in families with addictions. The enabler makes
excuses for the addicted persons behavior. The patients behavior allows
the spouse to continue with the addiction without being held accountable.
Difficulty: Easy
PTS: 1
5. A mother brings her 8-year-old daughter to the clinic for the third time in
2 months. The mother states that her daughter is very active and often falls
down. The mother states that her daughter eats well, but the childs weight
falls below the 10th percentile. The clinic record shows the child had
multiple bruises on her arms at the time of the last two visits. Today the
nurse notes that the child has areas of ecchymosis on her left leg and
ankle. Which action by the nurse is best?
A. Ask the child and her mother again about the childs bruises.
B. Question the child about her accident-prone behaviors.
C. Speak with the child alone, asking if she feels safe at home.
D. Teach the mother to keep a diary of what her child is eating.
ANS: C
This childs presentation is suspicious. If child abuse is suspected, the
nurse should question the child privately. In all situations the nurse is
legally obligated to report the abuse to the proper investigating agency.
Difficulty: Easy
PTS: 1
6. The clinic nurse notices that each time a child with leukemia is brought in
to see the doctor, her mother and aunt accompany her. The mother states
that she finds her daughters illness to be very traumatic and is having
difficulty coping. The childs aunt encourages the childs mother and
distracts the child while her blood work is being drawn. The childs aunt
could be described as taking on which of the following roles?
A. Child-caregiver role
B. Kinship role
C. Socializer role
D. Therapist role
ANS: D
Structural-functional theory focuses on the functioning of the family and the
roles assumed by each family member to promote family function.
Necessary roles include provider, housekeeper, child caregiver, socializer,
sexual partner, therapist, recreational organizer, and kinship member. The
therapist role is assumed when one family member expresses concern for
anothers health or emotional well-being. The aunt does not appear to be
the primary caregiver (child-caregiver role). There is no indication that the
aunt fills the socializer role by organizing family social activities. The
kinship role includes maintaining family and social ties by things like
remembering important dates, and the aunt does not appear to function in
that role either.
PTS: 1
7. The nurse observes a woman and her sister who live together. They are
trying to support one another and provide extended care to their mother
who has recently been diagnosed with Alzheimers disease. The two sisters
describe their experience with a homemaker who visits their home to help
bathe their mother. They say she is humorous and cheerful and absorbs
their mothers attention for the whole time she is present. This is a positive
description of which component of Bowens family systems theory?
A. Communication
B. Family relationship building
C. Family rituals
D. Triangulation
ANS: D
According to Bowen, triangulation occurs when a dyad (the sisters) focuses
on a third person who draws attention away from their conflicts. The
homemaker is serving this function in this family. Bowens theory looks at

family problems that are rooted in family processes, such as
communication. Relationship building and rituals are not part of this theory.
PTS: 1
8. A nurse is assessing a single person at a clinic visit. How would the
nurse classify this patients family?
A. Family of choice
B. Family of origin
C. Not in a family
D. Nuclear family
ANS: C
Most definitions of family require at least two people who self-define as
being part of that family. Thus, a single individual cannot be a family. A
family of choice is the family adopted through marriage or cohabitation. A
family of origin includes the individuals who reared the person of interest. A
nuclear family consists of a male partner, a female partner, and their
children.
Difficulty: Easy
PTS: 1
9. A patient tells the nurse about living in a commune. What does the nurse
understand about this family structure?
A. Family with distant relatives included
B. Group of men, women, and children
C. Kinship care provided to children
D. Unmarried man and woman living together
ANS: B
A commune is a group of men, women, and children all living together.
Families with relatives beyond the nuclear family are called extended
families. Kinship care provided to children constitutes a no-parent family.

An unmarried man and woman living together is called cohabitation.
Difficulty: Easy
PTS: 1
10. A nurse is assessing a child with very poor social skills. What
conclusion can the nurse make about the childs family?
A. Emotional or mental illness
B. Not filling socialization needs
C. Poorly educated, poor job skills
D. Probably lower-income status
ANS: B
Families should fulfill five functions: physical needs, economic needs,
reproductive needs, affective and coping needs, and socialization needs. A
child with poor social skills probably (but not necessarily) comes from a
family that is not fulfilling the childs socialization needs. Assuming that the
child has an emotional or mental illness without further assessment is
unhelpful. Assuming that the family is lower income, is poorly educated,
and has poor job skills is stereotypical.
PTS: 1
11. A nurse is working with family members who have been striving to
improve their functioning as a family unit. What behavior would suggest to
the nurse that the family is meeting its goals?
A. The children are in multiple activities to develop talents.
B. The desire to be understood guides most communication.
C. Family members gave up some activities in order to eat dinner together
on most nights.
D. The parents have a strong desire for the children to succeed.
ANS: C
Effective tools for families include ways to enhance family performance.

One very effective tool is to put the family first in this very chaotic world.
Giving up some activities in order to eat dinner together shows the family is
putting the unit as a whole first over individual desires. This is the opposite
of children being in multiple activities, which often cuts into family time and
can be disruptive. Communication should be guided by the desire to
understand the other first, then to be understood. A strong desire for the
childrens success does not guarantee successful family functioning.
Integrated Process: Nursing Process: Evaluation
PTS: 1
12. A nurse works a great deal with refugees and is frustrated because, as
a group, they dont seem to want to implement desired health behaviors.
What action by the nurse would be most helpful?
A. Conduct a health screening and educational event each month.
B. Provide written information in the groups native language.
C. Teach selected group representatives to be lay health educators.
D. Try to establish relationships within the refugee community.
ANS: C
According to family systems theory, each family system contains
boundaries that affect how the outside world interacts with the family.
Families that have recently immigrated to the United States might have
closed boundaries and may only be receptive to health information
provided by extended family members or members of their community.
Establishing a lay health educator program in which community members
can be taught health information with the intent of delivering it to their
communities would be a good way to work with these families while
respecting their boundaries. Regularly occurring health events might
improve the nurses standing in the community. Written information may or
may not be helpful; many refugees are illiterate in their native languages
and some languages do not have a written form. Establishing relationships
within the community is advisable, but does not go far enough to solve the
problem.

PTS: 1
13. A patient is dismissed from the hospital and is receiving nursing care at
home to help in the recovery from a serious illness and operation. The
visiting nurse notes that the family is in a state of disarray and members
are disorganized and not communicating. The patient is trying to direct
everyones actions. The nurse calls a family meeting. What action by the
nurse is best?
A. Encourage family members to make to do lists and assign chores.
B. Explain that changes in one person require changes in the others.
C. Make a referral to a counselor or mental health nurse practitioner.
D. Tell the family members that for the patient to recover, they have to
assume his or her role.
ANS: B
Family systems theory recognizes that changes in one member of a family
affect every other member of the family. In order for the family to function
effectively, all members need to adapt to the major changes in one of the
members. Making lists and assigning chores are simple tasks that might
help with organization, but this does not go far enough in solving the
problem. The family may or may not need a referral for counseling. Simply
telling the family members a fact does not give them enough information to
adapt.
PTS: 1
14. A nurse who works with families uses Duvalls family developmental
theory as the core of nursing practice. What action by this nurse takes
priority?
A. Assessing the developmental stage of the family
B. Determining how the family interacts with society
C. Observing what roles each family member assumes
D. Tailoring teaching to the specific needs of the family
ANS: A
Developmental theory has as its core the idea that every person moves
through developmental stages with tasks that must be mastered before
they can move on to the next stage. Family developmental theory assumes
the same progression for families as a unit. Duvalls theory identifies eight
family stages. The nurse using Duvalls family developmental theory must
first assess the stage the family is in, because teaching and all other
interventions must be tailored to that stage. Only tailoring the teaching to
specific needs does not necessarily require assessment of the family using
a developmental approach. Determining how the family interacts with
society is more in line with systems theory. Observing roles is part of
structural-functional theory.
PTS: 1
15. A nurse is working with a blended family of 1 year with five children
aged 3, 7, 13 (twins), and 19. The parents seem overly stressed and
anxious and do not seem to work well as a unit. What can the nurse
conclude about this family?
A. Communication problems are the core of the parents stress.
B. Economic stressors are impacting the parental dyad.
C. The family is in too many developmental stages to master any of them.
D. There are too many children to give each one adequate attention.
ANS: C
In family developmental theory, the age of the child determines the stage
the family is in. If there is more than one child, the family is probably in
multiple developmental stages at the same time. The family is probably in a
combination of beginning families, preschool, school-aged and adolescent,
and launching stages. The competing priorities of all of these stages pave
the way for chaos. Without further information, the nurse cannot conclude
that economic stressors or communication problems are the root cause of
the issue. Simply concluding that the family has too many children is
judgmental and does not leave any room for interventions.

PTS: 1
16. A family practice nurse is working with a patient who is asking for antianxiety medications to deal with the stress and frustration of an adult child
who wont leave the home. Based on knowledge of the tasks of launching
children, which resource should the nurse suggest first?
A. Anger management counseling
B. Contact numbers for vocational training
C. Information on a parenting workshop
D. Marriage and couples counseling
ANS: B
An adult child who still lives at home is either using home base as a
temporary arrangement while continuing education or as a nonaction until
more permanent ties have been established elsewhere. With the parents
frustration and anxiety, this situation of incomplete launching needs to be
addressed. The first suggestion should be about vocational assessment
and training for the adult child. There is no indication the patient needs
anger management, a parenting workshop, or marriage counseling.
PTS: 1
17. A patient has been dismissed from the hospital after a serious illness
and needs several weeks of home care and rehabilitation. When the
visiting nurse comes to the house, it is apparent that the family is not
functioning. The house is dirty, there is little food available, and one parent
and an older child are arguing about picking up a younger sibling from
school. What action by the nurse is most appropriate?
A. Ask the parents if they need financial resources for the basic necessities.
B. Assess each family member for the roles he or she plays in the family.
C. Contact child protective services or social work to assess the home
environment.
D. Provide referrals for family and couples counseling in the community.
ANS: B
According to structural-functional theory, each person in a family unit

occupies a specific role. Sometimes roles are shared. A problem can occur
when one member of the family is unable to fill his or her role and no one
else is doing it. That appears to be the situation here. The nurse should
assess what roles each family member plays and assist them to see how
they can fulfill the role formerly held by the patient. The family may need
financial resources if the patient was the breadwinner. There is no need to
conduct an environmental assessment, as it does not appear that any
family member is in danger. The family may or may not need counseling at
this time.
PTS: 1
18. A nurse who uses the structural-functional theory would assess which
of the following when working with families?
A. Communication patterns
B. How things get done
C. If goals are being met
D. Looseness of boundaries
ANS: C
The structural-functional theory focuses on the outcomes, not the
processes, within the family. The nurse using this theory would assess if
the family goals are being met. Communication patterns are critical to
communication theory. Processes are important to family developmental
theory, and boundaries are important in family systems theory.
PTS: 1
19. A nurse is providing anticipatory guidance to a mother of a toddler.
Using communication theory, which information is the most appropriate?
A. Dont nod your head yes when you say no.
B. Explain things in several different ways.
C. There is no need to see if a toddler understands.

D. You shouldnt yell at such a young child.
ANS: A
According to communication theory, verbal and nonverbal messages
should be congruent. A verbal no accompanied by nodding the head yes
is sending inconsistent messages. Messages should be clear, so explaining
things in many different ways would not be recommended. Good
communicators determine if the listener has understood. Good
communication demonstrates love and support clearly, but the advice to not
yell is vague and seems to send the message that yelling at an older child
would be more acceptable.
PTS: 1
20. A nurse is working with a woman who is newly married and pregnant
and says she is distressed because she and her husband seem to be so
different and they argue over petty issues. What action by the nurse using
group theory would be best?
A. Ask the woman if she can remember why she and her husband fell in
love.
B. Caution her that this level of disagreement will cause stress to the
unborn baby.
C. Offer the woman a referral to a community counseling center for couples
therapy.
D. Reassure her that this is normal and help her brainstorm ways to work
cooperatively.
ANS: D
According to group theory, groups evolve through the distinct stages of
forming, storming, norming, performing, and adjourning. Storming often
occurs when a group that has recently formed notices differences in
members, leading to chaos or confusion. This couple is in this stage. At this
point, the nurses best action is to reassure the woman and help her
brainstorm ways of working together cooperatively, which might include
forming rules or procedures that both parties agree to follow. Asking about
their early relationship does not give the woman information that will help
the present situation. Warning the patient about the negative effects of
stress on her unborn baby sounds judgmental and threatening. A referral
for counseling might be needed at a future date.
PTS: 1
21. A clinic nurse is using group theory to assess a family whose youngest
child recently moved back home after graduating from college and is
unable to find a job. Which statement by a parent would indicate to the
nurse that goals for norming have been met?
A. Im glad my son stays in his room in the basement all day so he doesnt
bother us.
B. Its hard to decide how much food to buy because we dont know where
hes eating.
C. My son is gone a lot of the time, so we really dont notice that he moved
back in.
D. We have agreed not to have a curfew as long as we know when he will
be home.
ANS: D
According to group theory, a healthy family adjusts to changes in its
structure by resetting roles and norms. In this family, a launched child has
moved back in, disrupting the patterns established when he left. Agreeing
to new rules and roles is a sign of adaptation. The other responses do not
show adaptation to the new situation.
PTS: 1
22. A student observes as an adult brother and sister lash out at the nurse
caring for their hospitalized parent. The parent lives at home but is
dependent on the children for care and is obviously neglected. The nurse
has informed the children that social work will be involved in their fathers
case. How does the nurse explain this interaction?
A. Dont worry; they will calm down eventually.

B. Families often get emotional in these situations.
C. They are focusing attention on me, not the problem.
D. This family is obviously highly dysfunctional.
ANS: C
This family is dysfunctional, but that does not go far enough to explain the
situation. This behavior is known as triangulation, and occurs when a dyad
diverts attention away from their problems and chooses instead to focus on
a third party, in this case the nurse. Reassuring the student they will calm
down is neither helpful nor accurate as the family members may choose to
continue to lash out. Families often do get emotional, but again, this
information is not really helpful.
PTS: 1
23. A nurse working with a married couple notes that both parties seem to
try to be dominant in their sessions. According to Bowens family systems
theory, which question asked by the nurse would yield the most useful
information?
A. Are you each a first-born, middle child, or youngest sibling?
B. How demonstrative were each of your parents when you were growing
up?
C. How many children were in each of your families?
D. What socioeconomic classes did you both grow up in?
ANS: A
According to this family theory, birth order plays an important role in
predicting certain patterns of behavior. Spouses who occupy the same birth
order may have difficulty functioning together. In this case, both spouses
probably are first-borns with a need for control. The other questions may
yield helpful information as part of a thorough assessment, but are not
related to this theory.
PTS: 1
24. A nurse working in a pediatric clinic is attempting to assess a schoolage child who is disrespectful of the nurse and parent and tears up a
magazine when asked to sit down. What conclusion can the nurse make
about this family?
A. The child is not getting enough attention from the parents.
B. The family is from an underserved community group.
C. Financial stress has caused family strife and fighting.
D. The parental disciplinary approach is inconsistent.
ANS: D
Children whose parents have a laissez-faire disciplinary style tend to be
disrespectful, aggressive, and disobedient. A laissez-faire disciplinary style
includes inconsistent use of discipline, allowing children (rather than the
parents) control over the environment, few rules, and children making their
own decisions rather than being guided by parents. The other options may
be true, but without further assessment, the nurse cannot make those
conclusions.
PTS: 1
25. A family with a loud, disobedient child has been working with a nurse.
Which action observed by the nurse indicates that goals for the diagnosis
of impaired parenting have been met?
A. The father delivers consequence to the child calmly.
B. The father only asks the child twice not to do something.
C. The mother doesnt cry when disciplining her child.
D. The mother states that the child is still testing the limits.
ANS: A
Consistency in setting and enforcing rules is critical. Consequences should
be delivered immediately, without anger, and consistently. The fathers
disciplining the child without getting mad is demonstrating that goals have
been (or are being) met. The other options do not show consistent, calm,
immediate consequences.

Difficulty: Easy
PTS: 1
26. A female patient from a refugee community is in the emergency
department and needs urgent surgery. The patient defers making a choice
on the operation, preferring to wait for a cultural elder to arrive. What action
by the nurse is most appropriate?
A. Encourage the patients family to talk her into having the operation.
B. Explain kindly to the patient that her situation cannot wait.
C. Respect the patients choice and wait for the elder to arrive.
D. Take the patient to surgery under the principle of implied consent.
ANS: C
This is a difficult situation, but because the patients wishes are known, the
nurse has no choice other than to wait. In the emergency department,
sometimes surgery is performed under the principle of implied consent (for
instance, on an unconscious patient with no known family), but in this case,
the patient has been clear as to her wishes, so doing that would be an
ethics violation. The nurse must be careful to not be coercive. The nurse
(and physician) would ensure that the patient understands the risks of
waiting.
PTS: 1
27. A nurse wishes to assess how often members of a family consume
alcohol or use drugs during a typical week. What type of family assessment
tool would this nurse choose?
A. Ecomap
B. Genogram
C. Qualitative
D. Quantitative
ANS: D
A quantitative tool measures the frequency at which problems or behaviors
occur. An ecomap is a tool that displays the outside systems used by the
family. A genogram illustrates the family structures and compares

generations within the same family. Qualitative tools measure the
descriptions and depth of family experiences.
PTS: 1
28. A mother is worried about her three children developing an inherited
medical condition because many members of her family have died from this
disease. To start an assessment of this family, which tool should the nurse
choose?
A. Ecomap
B. Genogram
C. Problem list
D. Quantitative tool
ANS: B
A genogram is a diagram of at least three generations that illustrates the
present family structures and compares past generations with the present
ones. To determine the prevalence of this inherited disorder in the family,
the nurse would use a symbol to denote each family member with this
disease. An ecomap displays the outside systems with which the family
interacts. A problem list helps family members identify difficulties or
negative characteristics. A quantitative tool assesses the frequency of a
behavior or problem. A genogram has a quantitative influence, as it
documents how many people in the family have the characteristic being
studied, but a genogram is more specific.
Difficulty: Easy
PTS: 1
29. A nurse explains the benefits of a strengths-and-problems list to a
student. Which is the best explanation?
A. Can use their strengths to work on identified priority problems
B. Demonstrates that each family has both strengths and problems
C. Forces people to be accountable and take responsibility for problems

D. Lets families see which members have problems affecting them
ANS: A
A strengths-and-problems list requires the family members to list their
strengths as well as what each member brings to the group that is positive.
The problems list helps the family prioritize problems to work on. By seeing
this information in writing, the family members can capitalize on their
strengths to work on the problems. It does demonstrate that each family
has both strengths and problems, but that is not the main purpose. It does
not force families to take responsibility, although it does encourage this. Its
purpose is not to point out who has which problems.
PTS: 1
30. A nurse working with a pregnant woman who is a recent immigrant to
the United States notes that her husband rarely accompanies her to
prenatal visits, and when he does, he sits in the waiting room. What action
by the nurse is best?
A. Ask the patient what role men in her culture play in pregnancy.
B. Ask the woman why her husband doesnt seem involved.
C. Encourage the man to participate in order to support his wife.
D. Research the couples cultural background and health beliefs.
ANS: A
Culture affects the roles family members assume during times of illness,
pregnancy and childbirth, and death. The best option is to ask the woman
what role men in her culture play during pregnancy and childbirth. This can
open a discussion of how the woman is coping and if she is getting enough
support, either from her mate or friends and family. Asking why the man
doesnt seem involved is judgmental. Encouraging the man to participate
may not be desired by the woman and may be seen as an intrusion by the
man. The nurse could research the culture but this would not lead to a
discussion until the next visit. It is also important to be aware that there are
variations in how people of the same culture behave and believe.

PTS: 1
31. A family has weekly game nights and monthly family together days. The
nurse documents these events as examples of which of the following?
A. Family beliefs
B. Family bonding
C. Family building
D. Family rituals
ANS: C
Family-building activities are an extension of family rituals and center on
recreation and leisure. They do contribute to family bonding, but the most
specific answer is family building. Family activities are influenced by family
beliefs.
Difficulty: Easy
PTS: 1
32. A nurse is working with a family that has the nursing diagnosis of
altered family processes. When formulating goals, whom does the nurse
include?
A. Entire family
B. No one else
C. Parents
D. Physician
ANS: A
The most effective goals are those that include the entire family. The entire
family agrees upon the goals and commits to working on them.
Integrated Process: Nursing Process: Planning
Difficulty: Easy
PTS: 1
33. A 17-year-old high school senior is resentful about caring for younger
siblings so the parents can have a date night once every 2 weeks. The
teen often forgets and schedules work or social activities that override the
parents plans. The parents are angry that the teen is so indifferent to their
needs. What action by the family indicates that goals for the diagnosis of
impaired family processes have been met?
A. Parents and teen mutually plan date nights in advance.
B. Parents consistently discipline teen for forgetting.
C. Teen acknowledges forgetting date night on purpose.
D. Teen expresses feelings about being made to babysit.
ANS: A
All the outcomes show some positive resolution, but the most optimal
response is the parents and teen jointly planning the parents nights out.
This shows collaboration, communication, and mutual respect. In the end,
everyones needs are taken into consideration, and the teen will be more
willing to adapt the current role to include watching the siblings. Consistent
consequences delivered without anger is a hallmark of healthy discipline.
The teen is taking responsibility when he or she acknowledges that the
forgetting occurs on purpose. The lines of communication are open when
the teen is allowed to verbalize feelings.
PTS: 1
34. A nurse is working with a family with the diagnosis of impaired family
processes. Although both parties worked, one person worked part time and
had the main responsibility for the household. The other spouse retired
recently and has not taken on more of this role. Both people are angry and
resentful. What goal would be best for this couple?
A. Adapt to role changes positively within 2 months.
B. Divide up household duties between spouses more evenly.
C. Express feelings using I statements within 1 month.
D. Learn to discuss anger and other negative emotions.
ANS: C
A good goal or outcome is specific, measurable, and has a time element.
The goal that best meets that description is expressing feelings using I
statements within 1 month. Adapting to role changes is vague and not

measurable. Dividing duties more evenly is not measurable and has no
time element. Learning to discuss negative emotions does not mean using
what is learned, so it is not as specific as the correct answer.
Integrated Process: Nursing Process: Planning
PTS: 1
35. A patient is being discharged from a psychiatric facility after a suicide
attempt. The family consists of the patient, two parents, and two other
teenage children. What action should the nurse teach the entire family as a
priority?
A. Assess for drugs or alcohol in the patients room.
B. Encourage the patient to take medications.
C. Monitor the patient for signs of suicidal thoughts.
D. Plan menus that contain nutritious food items.
ANS: C
Safety is a priority concern in every family and all members should be
made aware that the patient could have continued suicidal thoughts. If the
siblings notice this, they should be taught to tell the parents immediately
and could also be taught some effective communication to use. Looking for
drugs or alcohol in the patients room, encouraging medication use, and
planning menus are all actions more appropriate for the parents.
PTS: 1
36. A nurse is working with a family in which one member has
schizophrenia. Using systems theory, for which concern should the nurse
specifically assess this family?
A. Balance
B. Boundaries
C. Childrens ages
D. Subsystems
ANS: B
Systems theory looks at boundaries, balance and homeostasis, and
subsystems. An important concern in the family whose member is
diagnosed with a mental illness is social isolation, which is related to
boundaries. Some families view mental illness as shameful and try to keep
the information secret. The nurse should work to ensure the family
understands the importance of healthy interaction with outside systems.
Childrens ages would be assessed using developmental theories.
PTS: 1
37. A grade school nurse is conducting vision screening before school and
notes the student is accompanied by an older sister who has also brought a
middle school child. The older child states that time is a problem because
middle school starts in a few minutes and tells the younger child to go right
to the classroom after the screening, then leaves. What question by the
nurse would be most appropriate to ask the youngest child during the
screening?
A. Do you feel safe at home or is someone hurting you there?
B. Does your sister always bring you and your sibling to school?
C. Have you ever seen your parents drinking a lot or using drugs?
D. Why arent your parents available to bring you to school?
ANS: B
In substance-abusing families, one child often takes the role as the
responsible person, allowing the family to continue functioning. The fact
that a sibling was bringing the children to school is a little unusual, and the
nurse should assess the reason behind it. However, substance-abusing
families often keep secrets for both social and legal reasons. The nurse
should not ask directly about substance abuse, but rather open a line of
discussion by introducing a nonthreatening question. There is no indication
of abuse, so asking if the child is safe is not appropriate at this time. In a
secret-keeping family, asking directly about drinking or drug use would
most likely elicit a negative response. Asking why questions is
confrontational.

PTS: 1
38. A patient has just been admitted to the hospital in critical condition. In
caring for the entire family, what action by the nurse is most important?
A. Assessing who in the family will make decisions
B. Determining if the family needs financial resources
C. Ensuring each member understands the situation
D. Orienting the family to visiting hours on the unit
ANS: A
All options are important activities to keep the family engaged fully with the
patient. However, for a patient who is critically ill, determining who makes
medical decisions (and if there are advance directives) is crucial. The other
actions can occur later.
PTS: 1
39. A hospice nurse is making the initial home visit to a patient who just
returned home after a lengthy hospitalization. What action by the nurse is
most appropriate to help the family continue to function?
A. Assess the degree of comfort in family caregiving.
B. Ensure the family understands the hospice concept.
C. Provide information about available hospice services.
D. Refer the family to a community counseling center.
ANS: A
In the at-home hospice setting, family members must find a balance
between direct caregiving activities and their own needs for personal time.
The nurse must assess this to help the family avoid caregiver strain and
resentment and to maintain roles necessary for family functioning. Ensuring
the family understands the hospice concept and providing information are
also important, but are not directly related to family functioning. The family
may or may not need counseling.

PTS: 1
40. An immigrant family is working with a nurse on improving family
dynamics. The nurse notes that the teenage children do not subscribe to
their parents social and cultural mores and identify more with their nativeborn American friends. What description of the children is most accurate to
record in the familys chart?
A. Acculturated
B. Assimilated
C. Disconnected
D. Lost children
ANS: B
Assimilation is the process whereby a family or individual loses its unique
cultural identity and identifies more with the dominant culture. The teens
appear to be assimilated. Acculturation is the changes in cultural patterns
within a group to match those of the host society. Connectedness relates to
with whom the family identifies and relates as a family unit. Lost children
are often seen in substance-abusing families.
PTS: 1
MULTIPLE RESPONSE
1. A nurse is explaining to a student why it is so important to consider the
entire family as the patient. What explanation for this is best? (Select all
that apply.)
A. Families are a rich source of information and support.
B. Families will have to take over the caregiving role at home.
C. If they are not included, families tend to interfere in care.
D. The patient has to reintegrate into the family upon discharge.
E. The patients background context includes the family.
ANS: A, D, E
The patients family should be welcomed into nursing experiences. The

family is a rich source of support and information about the patient. The
patient will have to reintegrate into the family upon discharge. The patients
family represents the context from which he or she comes. Families may or
may not have to assume the caregiving role. It is stereotypical to assume
that families will interfere in patient care.
Difficulty: Easy
PTS: 1
2. The nurse explains to the student that television and movies have often
portrayed families in certain ways, depending on the decade. Which of the
following statements about this trend are correct? (Select all that apply.)
A. 1950s1960s: nuclear family, simple issues, father dominated
B. 1960s1970s: extended families, lower income, divorced parents
C. 1980s1990s: exploring social issues, stressed family closeness
D. 1990s: single parents, social issues including poverty and abuse
E. New millennium: alternative family structures, extended family
ANS: A, C, D, E
In the 1950s and 1960s, families were father-dominated and nuclear in
structure and shows focused on problems that were simple and easily
solved. In the 1960s and 1970s, the trend was toward blended families
(with widowhood being the reason for remarriage) that were mostly in an
upper-income bracket. In the 1980s and 1990s, social issues such as class
and politics became popular. The shows may not have shown resolution of
the problem at hand, but emphasized the closeness of the family unit. In
the 1990s, shows brought increased awareness of the challenges facing
families dealing with a host of problems such as alcoholism, poverty, and
abuse. In the new millennium, shows present alternative and extended
family formats.
Difficulty: Easy
PTS: 1
3. A nurse working in the community understands that health is often

affected by social stressors. Which of the following are examples of societal
pressures having a negative impact on the health of todays families?
A. Economic trends affecting access to health care
B. Increased HIV/AIDS in women and children
C. Loss of resources in public schools
D. Restricted health-care access for adult males
E. Violence and increased teen suicides
ANS: A, B, C, E
Many social pressures have negative effects on the health of our families.
Some of these trends include the economic situation, HIV and AIDS in
women and children who are vulnerable due to barriers to health care, a
loss of resources in schools, and an increase in all types of violence. As a
group, adult males do not have restricted access to health care.
Difficulty: Easy
PTS: 1
4. A nurse using family systems theory to work with patients and their
families would do which of the following?
A. Assess how school, work, and church impact the family.
B. Describe the developmental stage the family is in.
C. Determine if there are any family secrets or taboos.
D. Listen to how information is shared with providers.
E. Observe how family members interact with each other.
ANS: A, C, D, E
Family systems theory considers family boundaries (how the family
interacts with the outside world) and looks at interaction among all the
members, as the family unit itself is considered more important than the
individuals within it. Boundaries can also be assessed in part by
determining if there are family secrets or taboos (closed boundaries) or if
information is shared too freely (open boundaries). Developmental stages
of the family are not considered in family systems theory, but are part of
Duvalls family developmental stages and theory.

PTS: 1
5. The nurse using developmental theory offers anticipatory guidance on
preventing injuries to the family of a preschooler. What concepts guide this
information?
A. Coordination lagging behind activity
B. Development of personal values and ethics
C. Impact of friends and peer group
D. Poor judgment about safety risks
E. Toddlers increasing physical abilities
ANS: A, D, E
The toddler is in a stage where rapid physical development occurs but
coordination and judgment are lagging behind. Thus the toddler is prone to
accidents and injury. The nurse should offer anticipatory guidance so the
parents can keep their child safe. Development of personal values and
ethics occurs in the school-age and adolescent stage. Impact of peer group
increases in this stage as well.
PTS: 1
6. The family nurse completes a genogram map when conducting a family
assessment. Appropriate information the nurse should include in the
genogram map includes which of the following? (Select all that apply.)
A. Congenital diseases in the family
B. Country of origin for family members
C. Dates of birth for all family members
D. Dates of divorce and deaths for family members
E. Three or more generations
ANS: A, C, D, E
The genogram may be used to highlight generational influences of
behaviors, illnesses, vocational information, or any other pertinent
information that provides a larger picture of patterns that exert influence on
the familys current situation. The genogram should include at least three
family generations and should list dates of births, divorces, deaths,
stillbirths, and other pertinent elements of family information.
Difficulty: Easy
PTS: 1
7. The nurse assesses the communication in a family that includes a single
mother, a teenage son and daughter, and a grandmother. During the family
interview, the daughter answers many questions while the son and mother
are quiet and the grandmother is absent. What conclusions can the nurse
make about this family? (Select all that apply.)
A. The communication patterns are healthy.
B. The daughter may have a lot of power.
C. The grandmother does not want to be involved.
D. The grandmother may have little power.
E. The mother and son may have a coalition.
ANS: B, D, E
Communication theory asserts that patterns of communication within a
family reveal much about the way the family functions, the structure of the
family, the power base, decision making, affection, trust, and affiliation.
Preliminary conclusions the nurse can make about this family are that the
daughter may have a lot of power because she answers many questions
without input from anyone else, the grandmother may not have much
power because she is not even present, and the mother and son may have
a coalition opposed to the daughter. The nurse will need to confirm these
conclusions with further assessment. These communication patterns are
not healthy. The nurse should not assume that the grandmother does not
want to be involved but should assess the reason for her absence.
PTS: 1
8. The clinic nurse keeps resource numbers and contacts for assistance
with situations in which family members may potentially require assistance
to restore balance and function to the family. These developmental crises
may include which of the following situations? (Select all that apply.)
A. Home fire requiring a lengthy hotel stay
B. Hospitalization of a family member
C. Identification of domestic violence
D. Postpartum depression in a young family
E. The anticipated birth of a new baby
ANS: A, B, C, D
Sometimes families are in special need of nursing intervention due to
situational or developmental crises that go beyond the familys internal
resources. Developmental crises occur as part of expected growth events
that can take place during any developmental stage of the family or its
individual members and include such situations as being displaced,
hospitalization of a family member, domestic violence, and serious
depression. Childbirth is a normal event that does not generally require
special nursing intervention unless complications occur.
PTS: 1
9. A nurse assessing a family includes which components in the
assessment? (Select all that apply.)
A. Dietary habits
B. Family size and structure
C. Parenting style
D. Religious affiliation
E. Socioeconomic status
ANS: B, C, D, E
A family assessment includes family size and structure; parenting style; and
religious, cultural, and socioeconomic orientation. Dietary habits are not
specifically assessed, although this information may be part of a cultural
assessment.

Difficulty: Easy
PTS: 1
10. A nurse is assessing a family whose patriarch died recently. Using
Kbler-Rosss stages of grieving, what stages should the nurse assess for?
A. Bargaining
B. Dealing
C. Denial
D. Remorse
E. Shock
ANS: A, C
Kbler-Rosss stages of grieving include denial, anger, bargaining, and
acceptance. Dealing is one of Rodebaughs stages. Remorse is one of
Eppersons stages. Shock is one of Harveys phases.
Difficulty: Easy
PTS: 1

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Chapter 1: Traditional and Community Nursing

Care for Women, Families, and Children(FREE)

Meeting with a community leader is always a good idea to learn the

nursing actions. The nursing process allows nurses to make decisions

The culturally sensitive nurse is able to understand and respond to the

community would indicate that they have successfully negotiated a new

him or her of the effects of stopping treatment. There are always

19. An inpatient nursing unit uses Madeleine Leiningers theory to organize

Content Area: Pediatrics/Maternity

Cognitive Level: Application/Applying

D. Uses research findings to plan interventions for care

escalating medical costs, and patients have high-acuity illnesses and

understanding before planning and implementing teaching. The patients

Patient Needs: Health Promotion and Maintenance

Cognitive Level: Comprehension/Understanding

B. Discuss proposed changes with families, soliciting feedback on potential

Patient Needs: Safe and Effective Care Environment: Management of Care

Chapter 3: The Evolving Family(FREE)

During the school-aged and adolescent/teenage developmental stage,

C. Inadequate dyad partner

homemaker is serving this function in this family. Bowens theory looks at

families. Kinship care provided to children constitutes a no-parent family.

Effective tools for families include ways to enhance family performance.

Patient Needs: Health Promotion and Maintenance

Integrated Process: Nursing Process: Assessment

According to structural-functional theory, each person in a family unit

C. There is no need to see if a toddler understands.

A. Dont worry; they will calm down eventually.

Content Area: Pediatrics/Maternity

family. A genogram illustrates the family structures and compares

C. Forces people to be accountable and take responsibility for problems

Patient Needs: Psychosocial Integrity

statements within 1 month. Adapting to role changes is vague and not

Content Area: Pediatrics/Maternity

Content Area: Pediatrics/Maternity

The patients family should be welcomed into nursing experiences. The

3. A nurse working in the community understands that health is often

Content Area: Pediatrics/Maternity

Patient Needs: Psychosocial Integrity

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