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Foundations for Population Health in Community/Public Health Nursing Test Bank

Chapter 18: Family Development and Family Nursing Assessment
Stanhope: Foundations of Population Health for Community/Public Health
Nursing,
5th Edition
MULTIPLE CHOICE
1. The following people enter the health clinic together: an unmarried man and his year-old
son, an unmarried woman with a year-old daughter, and the man’s married brother, who is
separated from his wife. During the assessment it is determined that both men work and
contribute to the household, where all of them live. Which of the following best describes
the “family”?
a. The group consists of three families: the man and his son, the woman and her
daughter, and the brother, who is married even though he and his wife are
separated.
b. There are two families involved: first, the unmarried man and woman and their
two children, and second, the brother, who is married even though he and his wife
are separated.
c. There is no family here, only three adults sharing resources between themselves
and two biologically related children.
d. The family includes whoever the adults state are family members.
ANS: D
Nurses working with families should ask an adult member to identify all those considered
to be family members and then include those members in health care planning. A “family”
may range from the traditional nuclear model with extended family to such “postmodern”
family structures as single-parent families, stepfamilies, same-gender families, and
families consisting of friends. The incorrect answers have the nurse determining who is
and who is not part of a family. This is not an appropriate action for the nurse to take,
rather the nurse should let the client describe and define his/her family.
2. The nurse in community health needs to conduct a family assessment within a commune
but is uncertain how to proceed because family lines appear blurred. The best way to
determine the family of a mother and her child is to ask the woman which of the following
questions?
a. “How many children do you have, and who is the father of each?”
b. “Is there a register of families who are members of this commune?”
c. “Tell me about your significant other.”
d. “Who are the members of your and your child’s family?”
ANS: D
The members of a family are self-defined. The family includes whoever the woman says
are family members. The nurse should include all those members in health care planning.
Asking who the father of each child is does not help define the family; the client needs to
define the family. Knowing if there is or is not a register of families on the commune does
not help the client define her own family. The client may or may not include the
significant other in her definition of a family, so this may not assist in making this
determination.
3. In taking a family history, the nurse in community health finds that this is the second
marriage for the previously divorced parents and that the male partner is the stepparent to
the oldest child. For which of the following aspects of the family assessment is data being
gathered?
a. Dynamics
b. Function
c. Structure
d. System
ANS: C
Family structure refers to the organization of the family. This defines the roles and
positions of the family members. The family functions refers to the activities and purposes
of the family. The family as a system accomplishes activities that serve the individual and
society. Family dynamics refers to the interactions and relationships within the family.
4. Which of the following statements best explains why family functions and structures
create unique challenges in family nursing?
a. Function and structure change over time.
b. Function and structure do not apply to all family units.
c. Some clients do not have families.
d. Traditional families are rare in society.
ANS: A
The functions that families serve evolve and change over time. Some become more
important and others less so. Family structures also change over time. The great speed
with which changes in family structure, values, and relationships are occurring makes
working with families at the beginning of the 21st century exciting and challenging. All
familiy units have functions (activities and purposes) and structure (organization). These
functions and structures many be very different among family members, but they do exist.
All clients are part of a family, even if they define their family as only themselves. Nurses
should be open-minded and recognize that all families are different and a “traditional”
family structure may mean something different to different individuals.
5. A nurse is working with a family who is confronting major challenges to their health.
Which of the following approaches would be most helpful for the nurse to use?
a. Allowing the family to be noncompliant
b. Building on the family’s strengths and resilience
c. Labeling the family as resistant
d. Recognizing that the family is dysfunctional
ANS: B
Families are neither all good nor all bad; families have both strengths and difficulties and
have seeds of resilience. Recognizing the family’s strengths gives the nurse assets on
which to draw in planning care. The labels of dysfunctional, noncompliant, resistant, or
unmotivated all denote families who are not functioning well; however, such labels do not
create an environment conducive for positive family change and intervention and should
not be used.
6. The nurse is told that a healthy, functional family consisting of a 25-year-old man and a
24-year-old woman, who are expecting their first child, would appreciate a nurse coming
to their apartment for anticipatory guidance in preparing themselves and their apartment
for the baby. Based on that statement, which of the following assumptions can the nurse
safely make about the family?
a. The family is lacking a strong support system.
b. The family’s basic needs are being met.
c. The couple’s in-laws are unavailable to share their expertise about child care.
d. The married couple is excited about their first baby.
ANS: B
In functional, healthy, or resilient families, the basic survival needs are met. Healthy
families exist based on attachment and affection. There is nothing in the example to
suggest that they are married, that their income is low, or that they lack other resources or
support systems.
7. A nurse focuses on the care of the individual while viewing the client’s family as a
background resource or possible stressor. Which of the following conceptualizations of
family does this nurse’s view represent?
a. Client
b. Component of society
c. Context
d. System
ANS: C
Family as the context, or structure, has a traditional focus that places the individual first
and the family second. In the “family as context” concept, the family serves as either a
resource or a stressor to individual health and illness. When family is the the client, the
family is placed first, and individuals are second. The family is seen as the sum of
individual family members. When family is the system, the focus is on the family as the
client, and the family is viewed as an interacting system in which the whole is more than
the sum of its parts. When the family is seen as a component of society, it is seen as one of
many institutions of society, along with health, education, religious, or financial
institutions.
8. A nurse asks a family member, “What has changed between you and your spouse since
your child’s head injury?” Which of the following focuses of the family is the nurse
assessing?
a. The context
b. The client
c. A system
d. A component of society
ANS: C
When the focus is on the family as a system, the family is viewed as an interactional
system in which the whole is more than the sum of its parts. The approach simultaneously
focuses on individual members and the family as a whole at the same time. The
interactions between family members are the target for nursing interventions. When family
is the the client, the family is placed first, and individuals are second. The family is seen as
the sum of individual family members. When the family is seen as a component of society,
it is seen as one of many institutions of society, along with health, education, religious, or
financial institutions. When family is the context, the individual is placed first and the
family second. In the “family as context” concept, the family serves as either a resource or
a stressor to individual health and illness.
9. Which of the following theories views the family as a whole with boundaries that are
affected by the environment?
a. Family developmental
b. Exosystems
c. Bioecological systems
d. Family systems
ANS: D
The theory that views the family as a whole with boundaries that are affected by the
environment is the family systems theory. In this theory, the emphasis is on the whole
rather than on individuals. Families are viewed from both a subsystem and suprasystem
approach. The family developmental theory focuses on common tasks of family life and
provides a longitudinal view of the family life cycle. The bioecological systems theory
describes how environments and systems outside of the family influence the development
of a child over time. The definition of exosystems is found within the bioecological
systems theory; these are the external environments that have an indirect influence on the
family.
10. A nurse organizes care for a family by focusing on the common tasks of family life and
considering a longitudinal view of the family life cycle. Which theory is being applied?
a. Family systems
b. Bioecological systems
c. Family developmental
d. Family nursing
ANS: C
The family developmental theory focuses on common tasks of family life and provides a
longitudinal view of the family life cycle. In the family systems theory, families are
considered social systems, composed of a set of organized, complex, interacting elements.
The bioecological systems theory describes how environments and systems outside of the
family influence the development of a child over time. Family nursing theory is an
evolving synthesis of the scholarship from three different traditions: family social science,
family therapy, and nursing.
11. A new mother is a full-time college student who lives with her parents, because the baby’s
father has been imprisoned related to theft and drug abuse. The infant’s grandmother,
although also employed, cares for the child while the young mother attends classes. Which
of the following theoretical frameworks would be most helpful to the nurse when
assessing this family’s needs?
a. Developmental
b. Family nursing
c. Bioecological
d. Systems
ANS: A
Developmental theory explains and predicts the changes that occur to humans or groups
over time. Achievement of family developmental tasks helps individual members
accomplish their tasks. In this case the new mother has tasks, whereas her parents have
temporarily interrupted their progress in response to their daughter’s (and grandchild’s)
needs. In the family systems theory, families are considered social systems, composed of
a set of organized, complex, interacting elements. The bioecological systems theory
describes how environments and systems outside of the family influence the development
of a child over time. Family nursing theory is an evolving synthesis of the scholarship
from three different traditions: family social science, family therapy, and nursing.
12. A nurse considers how the environment outside of the family influences the development
of a child when planning care for a family. Which of the following theories is being used
by the nurse?
a. Bioecological systems theory
b. Family systems approach
c. Family developmental theory
d. Family nursing theory
ANS: A
The bioecological systems theory describes how environments and systems outside of the
family influence the development of a child over time. In the family systems theory,
families are considered social systems, composed of a set of organized, complex,
interacting elements. The family developmental theory focuses on common tasks of family
life and provides a longitudinal view of the family life cycle. Family nursing theory is an
evolving synthesis of the scholarship from three different traditions: family social
science, family therapy, and nursing.
13. A nurse is in the termination phase of the nurse-family relationship. Which of the
following strategies would the nurse most likely implement?
a. Increasing sessions with the nurse
b. Making referrals when appropriate
c. Providing a formative evaluation of the relationship
d. Refusing additional communication with the family
ANS: B
Making referrals when appropriate is part of the termination phase as the nurse ends the
relationship with the family. It also includes decreasing contact with the nurse, extending
invitations to the family for follow-up, and a summative evaluation meeting for formal
closure. If sessions were the nurse were to increase, it would be unlikely that the
relationship was going to be soon terminated or ended. Formative evaluation occurs
throughout the relationship and is ongoing; an evaluation that would be done at the closure
of the relationship would be summative. It would be appropriate for the nurse to extend an
invitation for follow-up, not refuse additional communication.
14. A nurse is making an appointment with a family for a nursing visit. Which of the
following describes a potential barrier the nurse may encounter?
a. The assessment cannot be done unless the extended family is present.
b. It may be difficult to find a convenient time for all family members to be present.
c. Nurses have limited time to do home visits.
d. Families are often scattered over a large area, making access difficult.
ANS: B
It is important to encourage all family members to attend the meeting. However, it can be
difficult to find a convenient time for all family members to attend. Many times late
afternoon or evening appointments are necessary to accommodate the needs of the family.
It is probably most important that the immediate, not necessarily the extended, family is
present. If the nurse is making an appointment with a family this would be part of the role
of the nurse, and it would be within the scope of the nurse’s practice to make time to
complete home visits. The nurse may need to be creative in how to best meet the needs of
the family to arrange a meeting. The larger barrier is finding a common time, not distance
of the family member.
15. Which of the following factors must be considered before deciding on an appropriate plan
of action?
a. Family agrees to the nurse’s plan.
b. Family is capable of the required actions.
c. Family will learn better coping skills from the nurse’s plan.
d. Nurse has informed family how to complete the required actions.
ANS: B
Family theorists stress that any intervention plan must be developed in collaboration with
the family, using and enhancing family strengths and increasing independence of family
members. The family must have the skills and commitment necessary and to complete the
developed plan. The plan cannot be the nurse’s choice alone. Further, the plan must be
within the information and skill level of the family, and the family must be committed to
the plan and have adequate resources available to implement the plan.
16. Which of the following terms refers to government actions that have a direct or indirect
effect on families?
a. Family funding
b. Family legislation
c. Family planning
d. Family policy
ANS: D
Government actions that have a direct or indirect effect on families are called family
policy. The range of social policy decisions that affect families is vast, such as health care
access and coverage, low-income housing, Social Security, welfare, food stamps, pension
plans, affirmative action, and education. Family planning is only one example of family
policy that can have a direct or indirect effect on families. Family funding may occur
through programs administered by the government, but these programs are developed from
family policy. Family policy is broader than only addressing legislative action.
17. A nurse is using the provisions of the Family Medical Leave legislation. Which of the
following actions is the nurse most likely to take?
a. Resigning from employment, but retaining health insurance
b. Sharing family information with colleagues
c. Providing Medicaid to a family who cannot afford health insurance
d. Taking a defined time off of work for family events without fear of job loss
ANS: D
The Family Medical Leave legislation allows for a family member to take a defined
amount of leave for family events, such as births and deaths, without fear of losing his or
her job. The Health Insurance Portability and Accountabilty Act (HIPAA) allows for
familys to retain health insurance after resigning from employment. HIPAA prevents
family information from being shared with colleagues unless they have a need to know
based on the care they are providing for the family. The provision of Medicaid is not part
of the Family Medical Leave legislation.
18. A nurse is conducting a family assessment. Which of the following behaviors would the
nurse recognize as suggestive of a family with problems?
a. Before eating, the family prayed, expressing gratitude for their blessings.
b. During family play, jokes and laughter were heard.
c. Each person had a private room with a door for alone time.
d. Most of the conversation was between the father and the eldest daughter.
ANS: D
Limited communication or certain families members dominating the conversation can be
suggestive of problems within the family. Evidence of healthy families can be seen in a
variety of observations, including open communication among all members, mutual play
with humor, balanced interactions among all members, expressions of a religious core or
other value system, and each member being allowed some privacy.
19. The hospital-based nurse has worked with a client at some length regarding appropriate
diet. Based on the family systems theory, which of the following will most likely occur
when the client returns home?
a. The family member who prepares food will probably suggest the newly discharged
member eat the meals everyone in the family enjoys.
b. The family member who prepares food will probably try to modify family meals
without obvious change for the family as a whole.
c. The family member who prepares food will probably prepare meals based on the
diet plan for all the family.
d. The family member who prepares food will probably prepare special meals for the
newly discharged member.
ANS: B
Family systems typically maintain stable patterns, although families do change constantly
in response to stresses. Change in one part of the family affects the total system. However,
if family members are supportive, they will want to try to help the ill member. Therefore,
the member who prepares the meals will probably compromise by trying to meet the ill
member’s needs without making drastic changes in the overall eating patterns of the
family. It is not realistic to expect the whole family to change eating patterns immediately
based on the needs of one family member. Because of the rapid change and stress in
American society, preparing different sets of meals is not very realistic. If the family
member who prepares the meals does not attempt to make some changes, this would not
be therapeutic for the family member who is ill.
20. A nurse has just met a family and is completing their family assessment. Which of the
following actions should the nurse take before engaging in self-disclosure?
a. Confirm the reason for the appointment.
b. Demonstrate cultural awareness.
c. Take time to build trust.
d. Understand the family dynamics.
ANS: C
The family assessment process is interactive. As the nurse is evaluating the family, the
family is evaluating the nurse. Too much disclosure during the early contacts between the
family and nurse may scare the family away. The nurse should slow the process down, and
take time to build trust. Components of building trust with the family would include
confirming the reason for the appointment so that the family knows the nature of the visit
and demonstrating cultural awareness during interactions. As the nurse completes the
family assessment, the nurse will note the dynamics of the family; understanding the
family dynamics is not important before engaging in self-disclosure.
21. A nurse is completing a tertiary prevention activity in a predominantly poor community,
where eating clay (pica) is a common practice. Which of the following actions would the
nurse most likely take?
a. Assist those who eat large amounts of clay to obtain food stamps after explaining
that clay, although filling, does not provide necessary nutrients.
b. Initiate early intervention in the school system through education programs
designed to focus on healthy food choices.
c. Provide laboratory testing and physical assessments to assess for nutritional
deficits resulting from clay intake.
d. Survey families in the community to determine whether they eat clay and how
much clay they eat.
ANS: A
Tertiary prevention is undertaken to prevent additional health problems when a problem
has occurred. If the family members are eating clay, this demonstrates that a problem
already exists. Early intervention in the school system is an example of primary
prevention. Lab testing and surveying families are screening activities to determine
whether a problem is present and to catch it in the early phases; such screening activities
are representative of secondary prevention.
MULTIPLE RESPONSE
1. A nurse requests to meet a newly referred family in their home. Which of the following
best explains the rationale for this request? (Select all that apply.)
a. The nurse can assess the family environment.
b. The family will feel more comfortable.
c. Families typically welcome others into their home.
d. More family members can typically be involved.
ANS: A, B, D
Advantages to meeting in the family home include the fact that it allows the nurse to see
the everyday family environment and observe typical family interactions. Also, more
family members can be present, and families are often more comfortable in their own
environment. However, a disadvantage to meeting in the family s home is that family
members may view this as an intrusion into the only place they feel safe from outside
observation; thus, the nurse must be highly skilled in guiding the interactions and setting
limits.
2. In comparison with traditional norms, which family functions have become increasingly
important in modern American society? (Select all that apply.)
a. Conferring appropriate social status
b. Educating the younger members
c. Ensuring physical and mental health
d. Fostering interpersonal relationships and support
ANS: C, D
Today, the more important functions are fostering relationships (emphasizing how people
get along and their level of satisfaction) and promoting physical and mental health.
Historically, families have had several functions including financial survival, reproduction,
protection from hostile forces, and enculturation, including religious faith, education,
conferring social status.
3. Which of the following must be firmly established before beginning a family assessment?
(Select all that apply.)
a. Why the data are needed
b. How best to interview each individual in the family
c. The most convenient time for you to visit the family
d. The rationale or purpose of the visit
ANS: A, C, D
Assessment of families requires an organized plan, including the purpose of seeing the
family, which family members can be present, what you are assessing and why, and how
will you obtain the necessary data. The preferred time to visit is when most family
members will be available. It is more informative to interview the family as a whole so
that you can observe family interaction (rather than focusing on interviewing each
individual
Chapter 31: The Nurse in the Schools
Stanhope: Foundations of Population Health for Community/Public Health
Nursing,
5th Edition
MULTIPLE CHOICE
1. Which of the following activities are expectations for a school health nurse?
a. Ensuring that children with health problems are accepted by their peers
b. Driving children home if parents can’t pick them up
c. Giving emergency care in the school or during school events
d. Giving medications as needed if children are ill
ANS: C
School nursing responsibilities include making sure that children get the health care they
need, including emergency care in the school; keeping track of the state-required
vaccinations that children have received; carrying out the required screening of the
children based on state law; and ensuring that children with health problems are able to
learn in the classroom. The nurse cannot convince children to accept other children as
peers, although certainly efforts should be made. HIPAA would not allow individual
examples of health problems to be shared, other than providing group statistics. It would
not be appropriate for the school nurse to provide transportation services to the students
attending the school.
2. Which of the following statements best explains why many school nurses are not able to
ensure that all children receive needed health care in the schools?
a. There is a shortage of baccalaureate-prepared nurses with national school health
nurse certification.
b. Most nurses prefer to be employed in hospitals giving direct care.
c. Most school districts are unable to afford a nurse in every school.
d. School districts and taxpayers see no need for nurses in schools.
ANS: C
In Healthy People 2020, objective ECBP-5 states that there should be one nurse for every
750 children in each school (U.S. Department of Health and Human Services, 2010). Most
schools have not achieved this objective. In 2006, approximately 40% of the nation’s
schools met that standard. The new objective is that 44.7% of the country’s elementary,
middle, junior high, and senior high schools have this many nurses by 2020 (U.S.
Department of Health and Human Services, 2010). Having fewer nurses in the schools
means that the nurses are expected to perform many different functions. It is therefore
possible that they are unable to provide the amount of comprehensive care that the
students need. There is not a national requirement that school nurses must have
baccalaureate preparation or school nurse certification. Preference of employers by nurses
does not impact why school nurses are unable to ensure that adequate care if provided.
School districts may see that the need for nurses is important, but may have insufficent
funds to be able to afford to pay for their services.
3. A school health nurse is requested by the board of education to assist in choosing new
playground equipment for an elementary school that meets safety standards. Which of the
following best describes the nurse’s role in this scenario?
a. Case manager
b. Consultant
c. Counselor
d. Health educator
ANS: B
The school nurse is the person best able to provide health information to school
administrators, teachers, and parent–teacher groups. As a consultant, the school nurse can
provide professional information about proposed changes in the school environment and
their effect on the health of the children. The nurse also can recommend changes in the
school’s policies or ask community organizations to help make the children’s schools
healthier places. As a case manager, the school nurse helps to coordinate the health care
for children with complex health problems. As a counselor, the school nurse is considered
a trustworthy person to whom the children can go if they are in trouble or when they need
to talk. In the health educator role, the school nurse may be asked to teach children both
individually and in the classroom.
4. At the annual community health fair, the school health nurse displays a science booth that
examines the hazards of ineffective hand washing. Which of the following best describes
the nurse’s role in this scenario?
a. Consultant
b. Community outreach
c. Counselor
d. Researcher
ANS: B
When participating in community outreach, nurses reach out to residents in the
community. One common way this occurs is when nurses are involved in activities such as
community health fairs or festivals in the schools. As a consultant, the school nurse can
provide professional information about proposed changes in the school environment and
their effect on the health of the children. As a counselor, the school nurse is considered a
trustworthy person to whom the children can go if they are in trouble or when they need to
talk. As a researcher, the nurse can study outcomes related to school nursing services
which may advance the practice of school nursing.
5. Which of the following best explains why school nurses are involved in helping teachers
with the task of teaching children how to practice problem solving, communication, and
other life skills?
a. Teacher shortages have required nurses to be increasingly involved in teaching life
skills.
b. Because so many nurses want to be employed in schools, this responsibility was
assumed to increase employment opportunities.
c. States are requiring nurses to screen and to teach life skills.
d. Nurses have been enlisted in this role to help reduce risk factors for future health
problems in school children.
ANS: D
Nurses fulfilling the health educator role assist in teaching children both individually and
in the classroom. This teaching should assist in helping reduce the risk factors among
children in the future. Potential teacher shortages have not impacted the role of the school
nurse as a health educator. Use of the role of health educator has not changed the need for